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31106 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO, BUILDING-ELECERICAL PERMIT No. 311 O b .BUILDING DIVISION APPLICATION/PERNIIT ' PLUMBING-MECHANICAL 3 1 BUILDING PROJECT IDENTIFICATION _ BU DINGADDRESS' SANITARY NO. APPLICATION SUBMITTAL DAT --v\ OWN SIAM/E❑% /If HONE;. CpryTRAC"ICl/S NAME: �j `LIC NO, -^ hi OLN f ARC- IE{1 21IC NO: KApDRF(Jo—SS/CJ //I�GaO� /'J/KV�_� LJ/����-'xC/N'o�7� ❑ t CONTACT. / PHONE: /�-]Vw BUILDING PERMIT INFO .� S�Z*4 - ❑ Consultant Foes Paid by Applicant(Initial) LDG EL2CT - PLUMBMUCH ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY, ELECTRIC PERMIT FEE I Fertby affirm that I.nt lia,.ae und[r pr.w,.ion.of Chapsr 9(commencing - ' JOB DESCRIPTION �Qy z I the im2UW)o[ 3afthc Busimsend PrnfeaxionrCMc.end mYliccnse is FOO infml farceend clfe, /� p PERVDT ISSUANCE - 'RESIDENTIAL Ia..UU ,in LicY �V �/ �. rElSFDWL ❑KITCHEN REMODEL N Q 6 De¢ Conlmela APPLIANCES—RESIDENTIAL .[I ADDITION ❑PLUMBING RE-PIPE. ARCHITECTS DE,CIARAIWN PANELS El MULTI-UNIT [I STRUCTURAL Z�j�z 1 untknland my Piens shall be axed as public records MODIFICATION OZ _ UPTO 200 AMPS - - rr ❑INTERIOR El CHIMNEY REPAIR Liccncd Profcx,iorul 201-10WAMPS IMPROVEMENT, =1NJ rp exemptBUILDEfront OVER ILYMI AMPS ❑BATH REJNODFUREPAIR ❑DEMOLITION CC a 1 hereby e[fum IM1et 1 em exempt from the Convenor',License Law for the following«aaan.(Section 211315,Bueirccs and improve. l rroh Cork:Any city or county SIGNS ELECTRICAL OTHER which rtyuirts a permit w amxWcl,ell«,improv[.demolish,or appear any wucwrt �i4--'� prjm In h.inxaarkc,ala,rtynirtethcy,phcant Tor such pcamh in fl[asigMd stntnrrm SPECIAL CIRCUTDVUSC. met her,li¢md pursuvnt In the p r,,mr,of the Contractors License Law Chepter9 t �pQ ( mmenng wimatins S2(Mp)ofDdmkxtor ivision3ofrW Business aP , e CMor e) TPMEMETT.ER OR POLE INSCOMMERCIAL: Ococi 0,y o K dwt he ie eacmp therefrom and the basis for the ellegM excmptim.Any violation of - ❑NEW BLDCJAp� OO D�IDfrBI LITTON Section 7031.5 by any inmac pplicarm for a pemitwbj is the apphcem to a civil penally of POWER DEVICES pMF.NT ^h not dun live hundrml dollars(5500).. El DSERVICE ~�O ❑I;as nwry of the lrapcny.nr my employers wid,wngo ea lhcirmlecompcnsation. SWIMMINGPOOLELEC`UUC IS1P wJldo lhcw«k,and dcswcmmu not wcndudnroDered fatale(Scc 70,14.Business ❑OTHER �('l 63Prafo.iav Cola:Inc Cnnlmclare Liana Law doc.i not triply mrnowner of OUTLETS -SWITCHES-FDJURES 411� 1'RV prapeny whu build,a improves Ih«eon,aid who dnea such work hoped f a dvargh h,.awn employca,leciided tont...h improvements vie not In¢nded a offered for NEW RESIDENTIAL ELL SQ FT IANR We.If.Enwwa,the building or improvement issold within ane Yrvr o(mmpletiaa me SQ.FT.FL00 - - ASQ.FC" cr-Wi1J[r will have tha hoNcn of that b[did not build or int fay pmvmg prove par- _ F-1 of seta). ❑ - N ori t the p of ct See 7 ,1 am sine si veld[orasrsiong wish P Tire Ccornua«on to TOTAL' oommn the project(Ser."1094 owner ane py w1voon,each:)' Con leper e Li - uLowacesrer apply in an owner of pnopcny was buikL aimpmvw lh[rmn.and QTY. PLUMBING PERMIT FEE who emtreeu[or smhpmjecl.withemnvaanrtJ lic[nsN pursuannolhe Convenor's � ' License Lew. " PERMIT ISSUANCE - Mom exemp under .Sec _ ,B&P C for this rennin - - .Obamer - ALTER-GRAIN&VENT-WATER(EA) yA1,UA110N' - WORKER'SCOMPENSATIONDECLARATION BACK FLOW PROTECT.DEVICE - Y) Ai• I hereby affirm under woolly of perjury one of the following daluetions'. - LJ(/ ❑ thetas and will maintvnaCenifcmc ofCaurntmaelf-instrrt fa WM«'.v Canpen- DRAINS-M.CCIC ROOF AREA,COND. STORIES TYPE COr;_STRUCTION Sadao,as provided far h;Section 37M of the IsMr Coda,f«tha perfom ence of Be - - , wart for whidh Nu penom is issued FIXTURES-PER TRAP _ 1 have and will iwinuin Workers Compensation Imurenes,u rtyulred by Section ' 3200of the Labor Cade,forihe perfamormeaf the work for which this permit is issued. GAS-EA,SYSTEM-1 INC.4 OUTLETS OCC.GROUP "NMy Workers Canp ti� Imuw eanieraWKlicynumberem: _ - c Policy No.: GAS-EA.SYSTEM-OVER 4(EA) - - t CERTIFICATEOMPE SATIONII NFROM WORKERS' - ^ COMPENSATION INSURANCE GRFASE/WDUSTRL WASTE INTF.RCEI'TOR (This.uclion nail not be completed iflep«mit it forone hundred dollws(5100) BUILDING DMSION FEES odes'.) GREASE TRAP I clify(her in ihep«fnntunce oflM work forwhich lhupermil i.i.asued,I shell ENERGY ITI FTE norem In tla le Waken'Cnm SEWER-SANITARY-STORM EA�200 FT p y in my pen, ENERGY FUE OC) Adan La of Cnlifn in WATER HEATER WNENT/ElECfR. - 7 � Apphc GRADING PEE q 4 NO TO AP ,CANT:If,d¢r meting Nis Ccnifcar.of Exempinn,you eb,ud WATER SYSTEMCFBEATING m Ne Worker's Compensnttan provieionwf the Lahr Code,you mart SOILS FEH {L) fmlhwithcotnplYwitli.wehpmv,e,aaturlhirpennit OCC [de mvaked. WATER SERVICE Q � z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID', I haaby eflrm that domeiza0m,motion MMingegency frle peroxofam of Dale Receipt U 0 fiw work for which thisparmi ec.N097.t ,Saul(S ],civ.C7 OIcnd«', TOTAL: L<rndcr.Adds - TDTAL'. R1 1 artily diet I love red this applicmim ane nam shot de above mformmion ie BNIDING FEH % avaL 1 agra to comply with ell city ane aoamy,edinvrc and stmt Inws mmtin6 m QTY, MECHANICAL PERMIT -FEE U Z building am....,and hcrehy oamoric,,epic,eentaivcs ofthis thyro coronationthe SEISMIC FE2 abovem[ntiancd propmy tar itupenlon purposes. PERMIT ISSUANCE (We)agree to vv[.IMemnify end keep harmless the City of Cupertino against ELECTRIC FEE liabilme,,judgmentc,tori and expenses which may in my way aamc Urn"sand City mnugaa¢mfth[granting of Nis permit. ALTER OR ADD TO MESH. PLUMBING FEE - APPLICANT STANDS AND.WILL COMEINWITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CTM) MLCHANICALFEE SOURCE .'ULATII NS. AIR HANDLING UNIT(OV ER 10,000 CFM) CONSTRUCTION TAX' gtamrtof Appli W n—r on r Date EXHAUST HOOD(WMUCF'. HOUSING MITIGATION FEF. HA]ARcure MAIBRIAIS DISCLOSURE - i ffio C.cm,t uv Mari i en]ing Cove,Ch l storeortbandit,Health andus Safety HEATING UNIT(TO I W.g10 BTU) a.Jcfrcd by i25 Cupcnino Municipal Cove,Chep«9.12,ami d¢Hcahh aid Saftty C,d[.Section 25532(np. - HGTING UNIT(OVER If1f1,fMM1 BTU) jQY[s (]Na VENTILATION FAN(SINGLE RESID) PAID "'- Will then Iicant on future building I use t or dees vicwhich Data vrtk - Raxipt A t hav,air antuminents rte clefted by me Bay Area AirnQualily Maregement BOILER—COMP(3HP OR 100.000 B'N) Dixuid? TOTAL: ❑Ver ❑Na BOILER—COMP(OVER 100,110013M I hav[rtnithc hazvdixu meh-riaLxrt uirrn,entautd«CM1 6.95 ofihe Cali- AIR CONDITIONER y dace, ISSUANCE DATE- forma Health& comy Cordae r Section,15505.i5myp,D and!25530.1 to notify the Thalifthe NEW RESIDENTIALh1ECH. SQ.FT. ai e,og ma ml u,wirc y hen[a omit,onto¢myce,4arCerriy In e o notify lhcoampom of me mquinetn[nu which itwn be met priawiswa eMaCrnifret[of(kcuporcy. O.a,vr.mr.ri edagent Date i TOTAL: ISSUEDBY: OFFICE APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO, BUILDING-ELECERICAL PERMIT No. 311 O b .BUILDING DIVISION APPLICATION/PERNIIT ' PLUMBING-MECHANICAL 3 1 BUILDING PROJECT IDENTIFICATION _ BU DINGADDRESS' SANITARY NO. APPLICATION SUBMITTAL DAT --v\ OWN SIAM/E❑% /If HONE;. CpryTRAC"ICl/S NAME: �j `LIC NO, -^ hi OLN f ARC- IE{1 21IC NO: KApDRF(Jo—SS/CJ //I�GaO� /'J/KV�_� LJ/����-'xC/N'o�7� ❑ t CONTACT. / PHONE: /�-]Vw BUILDING PERMIT INFO .� S�Z*4 - ❑ Consultant Foes Paid by Applicant(Initial) LDG EL2CT - PLUMBMUCH ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY, ELECTRIC PERMIT FEE I Fertby affirm that I.nt lia,.ae und[r pr.w,.ion.of Chapsr 9(commencing - ' JOB DESCRIPTION �Qy z I the im2UW)o[ 3afthc Busimsend PrnfeaxionrCMc.end mYliccnse is FOO infml farceend clfe, /� p PERVDT ISSUANCE - 'RESIDENTIAL Ia..UU ,in LicY �V �/ �. rElSFDWL ❑KITCHEN REMODEL N Q 6 De¢ Conlmela APPLIANCES—RESIDENTIAL .[I ADDITION ❑PLUMBING RE-PIPE. ARCHITECTS DE,CIARAIWN PANELS El MULTI-UNIT [I STRUCTURAL Z�j�z 1 untknland my Piens shall be axed as public records MODIFICATION OZ _ UPTO 200 AMPS - - rr ❑INTERIOR El CHIMNEY REPAIR Liccncd Profcx,iorul 201-10WAMPS IMPROVEMENT, =1NJ rp exemptBUILDEfront OVER ILYMI AMPS ❑BATH REJNODFUREPAIR ❑DEMOLITION CC a 1 hereby e[fum IM1et 1 em exempt from the Convenor',License Law for the following«aaan.(Section 211315,Bueirccs and improve. l rroh Cork:Any city or county SIGNS ELECTRICAL OTHER which rtyuirts a permit w amxWcl,ell«,improv[.demolish,or appear any wucwrt �i4--'� prjm In h.inxaarkc,ala,rtynirtethcy,phcant Tor such pcamh in fl[asigMd stntnrrm SPECIAL CIRCUTDVUSC. met her,li¢md pursuvnt In the p r,,mr,of the Contractors License Law Chepter9 t �pQ ( mmenng wimatins S2(Mp)ofDdmkxtor ivision3ofrW Business aP , e CMor e) TPMEMETT.ER OR POLE INSCOMMERCIAL: Ococi 0,y o K dwt he ie eacmp therefrom and the basis for the ellegM excmptim.Any violation of - ❑NEW BLDCJAp� OO D�IDfrBI LITTON Section 7031.5 by any inmac pplicarm for a pemitwbj is the apphcem to a civil penally of POWER DEVICES pMF.NT ^h not dun live hundrml dollars(5500).. El DSERVICE ~�O ❑I;as nwry of the lrapcny.nr my employers wid,wngo ea lhcirmlecompcnsation. SWIMMINGPOOLELEC`UUC IS1P wJldo lhcw«k,and dcswcmmu not wcndudnroDered fatale(Scc 70,14.Business ❑OTHER �('l 63Prafo.iav Cola:Inc Cnnlmclare Liana Law doc.i not triply mrnowner of OUTLETS -SWITCHES-FDJURES 411� 1'RV prapeny whu build,a improves Ih«eon,aid who dnea such work hoped f a dvargh h,.awn employca,leciided tont...h improvements vie not In¢nded a offered for NEW RESIDENTIAL ELL SQ FT IANR We.If.Enwwa,the building or improvement issold within ane Yrvr o(mmpletiaa me SQ.FT.FL00 - - ASQ.FC" cr-Wi1J[r will have tha hoNcn of that b[did not build or int fay pmvmg prove par- _ F-1 of seta). ❑ - N ori t the p of ct See 7 ,1 am sine si veld[orasrsiong wish P Tire Ccornua«on to TOTAL' oommn the project(Ser."1094 owner ane py w1voon,each:)' Con leper e Li - uLowacesrer apply in an owner of pnopcny was buikL aimpmvw lh[rmn.and QTY. PLUMBING PERMIT FEE who emtreeu[or smhpmjecl.withemnvaanrtJ lic[nsN pursuannolhe Convenor's � ' License Lew. " PERMIT ISSUANCE - Mom exemp under .Sec _ ,B&P C for this rennin - - .Obamer - ALTER-GRAIN&VENT-WATER(EA) yA1,UA110N' - WORKER'SCOMPENSATIONDECLARATION BACK FLOW PROTECT.DEVICE - Y) Ai• I hereby affirm under woolly of perjury one of the following daluetions'. - LJ(/ ❑ thetas and will maintvnaCenifcmc ofCaurntmaelf-instrrt fa WM«'.v Canpen- DRAINS-M.CCIC ROOF AREA,COND. STORIES TYPE COr;_STRUCTION Sadao,as provided far h;Section 37M of the IsMr Coda,f«tha perfom ence of Be - - , wart for whidh Nu penom is issued FIXTURES-PER TRAP _ 1 have and will iwinuin Workers Compensation Imurenes,u rtyulred by Section ' 3200of the Labor Cade,forihe perfamormeaf the work for which this permit is issued. GAS-EA,SYSTEM-1 INC.4 OUTLETS OCC.GROUP "NMy Workers Canp ti� Imuw eanieraWKlicynumberem: _ - c Policy No.: GAS-EA.SYSTEM-OVER 4(EA) - - t CERTIFICATEOMPE SATIONII NFROM WORKERS' - ^ COMPENSATION INSURANCE GRFASE/WDUSTRL WASTE INTF.RCEI'TOR (This.uclion nail not be completed iflep«mit it forone hundred dollws(5100) BUILDING DMSION FEES odes'.) GREASE TRAP I clify(her in ihep«fnntunce oflM work forwhich lhupermil i.i.asued,I shell ENERGY ITI FTE norem In tla le Waken'Cnm SEWER-SANITARY-STORM EA�200 FT p y in my pen, ENERGY FUE OC) Adan La of Cnlifn in WATER HEATER WNENT/ElECfR. - 7 � Apphc GRADING PEE q 4 NO TO AP ,CANT:If,d¢r meting Nis Ccnifcar.of Exempinn,you eb,ud WATER SYSTEMCFBEATING m Ne Worker's Compensnttan provieionwf the Lahr Code,you mart SOILS FEH {L) fmlhwithcotnplYwitli.wehpmv,e,aaturlhirpennit OCC [de mvaked. WATER SERVICE Q � z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID', I haaby eflrm that domeiza0m,motion MMingegency frle peroxofam of Dale Receipt U 0 fiw work for which thisparmi ec.N097.t ,Saul(S ],civ.C7 OIcnd«', TOTAL: L<rndcr.Adds - TDTAL'. R1 1 artily diet I love red this applicmim ane nam shot de above mformmion ie BNIDING FEH % avaL 1 agra to comply with ell city ane aoamy,edinvrc and stmt Inws mmtin6 m QTY, MECHANICAL PERMIT -FEE U Z building am....,and hcrehy oamoric,,epic,eentaivcs ofthis thyro coronationthe SEISMIC FE2 abovem[ntiancd propmy tar itupenlon purposes. PERMIT ISSUANCE (We)agree to vv[.IMemnify end keep harmless the City of Cupertino against ELECTRIC FEE liabilme,,judgmentc,tori and expenses which may in my way aamc Urn"sand City mnugaa¢mfth[granting of Nis permit. ALTER OR ADD TO MESH. PLUMBING FEE - APPLICANT STANDS AND.WILL COMEINWITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CTM) MLCHANICALFEE SOURCE .'ULATII NS. AIR HANDLING UNIT(OV ER 10,000 CFM) CONSTRUCTION TAX' gtamrtof Appli W n—r on r Date EXHAUST HOOD(WMUCF'. HOUSING MITIGATION FEF. HA]ARcure MAIBRIAIS DISCLOSURE - i ffio C.cm,t uv Mari i en]ing Cove,Ch l storeortbandit,Health andus Safety HEATING UNIT(TO I W.g10 BTU) a.Jcfrcd by i25 Cupcnino Municipal Cove,Chep«9.12,ami d¢Hcahh aid Saftty C,d[.Section 25532(np. - HGTING UNIT(OVER If1f1,fMM1 BTU) jQY[s (]Na VENTILATION FAN(SINGLE RESID) PAID "'- Will then Iicant on future building I use t or dees vicwhich Data vrtk - Raxipt A t hav,air antuminents rte clefted by me Bay Area AirnQualily Maregement BOILER—COMP(3HP OR 100.000 B'N) Dixuid? TOTAL: ❑Ver ❑Na BOILER—COMP(OVER 100,110013M I hav[rtnithc hazvdixu meh-riaLxrt uirrn,entautd«CM1 6.95 ofihe Cali- AIR CONDITIONER y dace, ISSUANCE DATE- forma Health& comy Cordae r Section,15505.i5myp,D and!25530.1 to notify the Thalifthe NEW RESIDENTIALh1ECH. SQ.FT. ai e,og ma ml u,wirc y hen[a omit,onto¢myce,4arCerriy In e o notify lhcoampom of me mquinetn[nu which itwn be met priawiswa eMaCrnifret[of(kcuporcy. O.a,vr.mr.ri edagent Date i TOTAL: ISSUEDBY: OFFICE