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CITY OFCUPERTINO •rrrarran�.a�rn� •' BUILDING-ELECIRICA PERMIT INO' 0195
BUILDING DIVISION APPLICATIONAaERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILDING A00RE55: S SANITARY NO. APPLICA'T'ION SIIDh1U'I'AI.UA'I li
19a
OWNI NAl ONIi: C(1N1'RAC UR:S NAht P.: LIC NU:
NIC C(IN'I R(ll,x
tCll I 'CIIENtIINr:I>i: . .NO: All )RIi.SN: ❑
CONTACT PHONE: BUILDING PERMIT INFO
EDL ❑ Cmisnitunt Fees Paid by Applicant(Initial) ULIX; Turr PLUMB MOI
7,V6 _ff6 00
LICENSED CON I RACIOR'S DECLARAI ION QTY ELECTRIC PERMIT FEE
1 bract,afro' her I um licensed mule,'nock it,of Chirac'9(,"a"„enrmg JOB DESCRIPTION
4OIYZ wi,hSaoiun]Ixx)ol Divkhm]nnbe nnsincaanan Poofr..inna Colic.and my(loco"is RESIDENTIAL:
00 I'ItltMIr ISSUANCI:
-� loll lime and eft ��`` ❑SFDWI. ❑PLUMBING
R1RE.PIPi1.
-rcR U-6 License(sat _ Li<.M..]�_ API'LIANCCS-RCSIDFNI'IAI. ❑ADDITION ❑PLII%1BING RILPIPF.
FZa Dam Cnnhnpmr
ItI-7H A RCI If IICI'S Dl!Cl A R AT ION IIAN121S ❑MULTI-UN I'' ❑STRUCTURAL
I nralerurmd m my prithrill he read m pmlie rnnN, MOUIFICATION
DZ—p UPT0200AMRS 1 ❑INFER[OR ❑CHIMNEY REPAIR
y Y„y,�ul LicenaA Prnkttinnnl
2111-1000AMPS IMPROVEMENT
C .JJ OWNER-BUILDER DECLARATION OVER IBpIAMI'S ❑BATA RFMOUEI/RF.I'AIR DEMOLITION
yy C Ity�6 1 hnchy til irna that I nm exempt final me Cnmranart Liunae Luw for the
a(aCV hdlowip ❑OTHER
g:ratna.fti..I.o mnS.nal.iar,.<mpr Pmretamnt Gv,,term ray([rutlurr SIGNS F,LIiCTRICAI.
—^O�j prior Tit,boa a penah or far,.peer.id for u.h peri tt nr teeth nny trmpwm
g prior no i.amen"..nlsn¢yuiaslhe oppliram ln,.wait penni0o fileatigned tummem SPECIAL CIRCUI I/MISC.
yIhpl he ie riaenad pu.auionto lie pmvkhe of the Cnnnacln's License l aaw lCh:yucr9
HMO It.,
ing will'Sorion]0x0of Divisi.m S of the nuninea anti Pallesainn<Cale)or 'I[IMP.Mr.rER OR PDI.':INS C COMMERCIAL;
L y' mm he it.amain ahnefmm and the heti,fm tial ollegcd exemplum.Any vinlmiun of ❑NEW BLDG/ADDT TION ❑DEMOLITION
01
Sc0ionTHUS by may ri,hinnr fern permit suhjca,tbc.,icanl teci
n vil pen ilty of IRIWFR DRVIC'ES
❑TENANT ❑FOOD SERVICE
nm nm¢than five huadeddollmt(11501).
< IMPROVEMENT
T roo,neo
rofrhep geo,ormycrloy a ith Magetprllelr.udeam.nen...rT R
on, SWIMMING find.ELECT
O w01dnrhevouCto mre mint in Wliffrnl for ure(Rce.]rWd.liminex. ❑OTHER
u $ and Profet.r s Calc a Cin c nw Law does nor apply rn nn owner of OUTLETS-SWITCIIP_S-FIX'TUN S
pnq'eny x1 huikk, i ,end who dox such wok himalf or Ihrmgh
Pit awn cn:p ca' trial vat ch Improve Ix are air i:n, Icd or oIfurrd Ina NEW RESIDIiNI'IAL VI i( SV FI'.
rule.If,I ul impmveaaem haul within one yin til r.....plohm.alie SQ.FI'.FL<R)R AREA LSV.F,L
no,Fruit, ve the hurnen of proving that he dial nut hnild or improve to pm. -Z
pave of sure(. '.
LJ I,pas-owner mI the unpeaY.am excluxi very conducting with license([cna aclor<m n
mrtnct me Inpject(Sec.7044,B.,ineaa and Ponfe,diana Cale:)'fhe CnnrocaMs Li-
wuselawdor,not apply loan owner of papery who huildao,impnerena.wrvmnod QTY. PLUMBING E
ho counter for oul'Foil with a contractual)licensed pmmaannn da Contractor',
Liana Liov. PERMIT ISSUANCE: =p
I.,it comp under Sec. ,R A P C fur thiaacnon or
Date ALTER-URAINHVENI'-WN' .ER Z' VALUAf1UN
WORKERIS COMPENSAI ION DECLARATION BACK FLOW PROTECT.Fill
I herchy xlfina node,I,enntry of perjury one of the hdluwing dah ani'o: /VW
❑Ilimemod%ill lnaimain aCeniracareuf ComwnttorelGinaura fm W.pknkcompem DRAINS-FI.(AIR,ROOT•,ARI?A,COND. STORIES TYPE CONS I RUCTION
Talion,nix provided ler by Section 1701 of rhe Lahr Cele,for the pobammaee til He
wn,k fur whidnhia permit i<iisuett FI%TURITS-PER'rRAP
CI I have Had will maintain Weaker',Con.pre nvhall h'umnce, H rtquinA by Section
17110 M theLaborLabor Code.for me fictiornmace��(nppplppptlu,wank(oorr'gwhich
Our
'prould i�.ai/tramd. GAS-EA.SYSTEM.I INC.4 OUTIXTS (WC,GROUT' APN
MI
Polic
Currier')(ISIUI1�IvtL nI/4I O)f?)IAI,/•I N Nay WORKED 1Qc'7
d GAS-E:A.SYSTEM-OVER d(IiA)
CIiRI'IIIC o OF FSAI ION(INSURANCE
WORKERS'
COMI'IiNSAI ION INSURANCE GRIiASPIINDIISTRI.WASTE INTERCEPTOR BUILDING DIVISION FEES
(This genion need out he completed Alive permit is Bio'hundred dolls IDID) GREASFTRAP
nr lep<I PLANCIIECK FEE
I crnify that ladle prifnrn,ance lithe work for which mix Tarin ix kocd,Lmall
SEWER-SANITARY-S TORM EA.20l FT.
Aar empinY nnY penin in nny rrenmr m'as m M1ecane whjmr m❑¢WSarkera Gnnpem ENERGY RiE
OZ itis.Laws of Cnlifaoin.Due WATER REST FIR WOVEN'UFI.ECTR
Q Applicam GRADING FEE.
NOI[CF'IT)APPLICAN I:IL aficrnmking lfik CeriOrne of ldempioa,yam'fir Id WAI ITR SYS I ENTI BEAT ING
hcome mhj«l Ili the Wur4cak Con'pcmarion provitinm of the lnkn Calc,You nao SOIIS FEE
G f..To,1h comply x ilhorh pmvi<inn<nr all,panni(moll lredcnned revoked. WAI'ERSURVICE
Q
CONST NIICIIUN LENDING AGItNCINEW RfSIUIiN'lIAh 19.MI1. SV.PT. PAID
V O IhcrrhYnBinn d,rc..aIle itucon.tni.inn lending nFrncy Ln dv prdnrmxnac til Unm Ra'6'IpIM
U. r-•t Li,work lar which mi.Ivrmit i.ierueA(Sri.]IMI],(ia.C.1
4[.!7 Truro',Nvnc lnlAl.:
W Lrndrr'IcrHfd 'I OIA
ertiL
:
a 1 cfyyroan I lame rear Ili,npplicnti9n rand tat¢that the nlarvc inLnnmriup is Of111.DING PT:E
V7) correct.I agree m comply with all city and amnrymditwncexaml Mao lawtaclaaing or QTY. MECIIANICALPERMIT FEE jr to;
V G
Thudding ten.m'lion.anti hereby nnmodu m,evaenalivet nfthis city toenter uD'ninne
SEISMICigili
nkrvc ed pu'pmy fm intferli po
(We,agrcm v,va ndemnify anti keep lunnka the City of 6'pcninn aga ' PERMIT ISSUANCE
O
ELECTRIC RF
liahiliriea,jndgancurx,c..."and exp:nae which may in any wary Berme apaino void City ACT FR 0R A DI)TO M ECI I. i'LGMBIN(ilTl:
Or cunaynence of the granting til this permit,
APPLICANT UNDERSTANDS ANT)WILL COMPLY WTI'It ALi.NOWPOIN'r AIR I IANDLING IINIT(TO IB,OMICFM) MECHANICAL PFF
SODItCr'.NEfR11.AT IONS, T t�1
M7/,�� � ? /� � AIR IIANDLING UNI I(OVER 10010CI'bll CONSTRUCTION TA �jl J.
Sign intlCnnmahn �r /Ua7m EXHAUST 11001)I W/DUCT')
IIAZARDOIJS MATERIALS DISCLOSURE ]RAISING MITI(IA�'ION FEE �(
Will the applicant or future building occupant rime or handle haaaNnus material I REAPING UNI I'(TO 100,001 IFI LB
m dcfincr by the Cupenino Municipal Cale.Chapter 9.12,and the ItentM1 and Snfey'
Cole.Sino..25512m1l I II?APING UNIT (OVER 100.000 BTU)
❑Yea Yln' VEN I ILAI ION I'AN IS INDIA:RUSID) PAID
[).are Rl x
W'nknot applicant m Pomra keeling bather nix ea Air mar AMani whirr ROILER-C'Ihll'011P OR 100,0X1911 B
About hpmnlnna air cnnmmiwnra pa deOneA by the Ory Area Air Quality Managenmm TOTAL:
Dia'in,
1'n FK BOILIiR-f.OMP(OVIiR 100,000111-11)
I have trail The hamdnnt materials mquimrenD miler Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
fnnia WHO,A Silly Cale.Section,25505,25515 auI255)4.1 ondcmmid Thnr if the NEW RESIDHNFIAL MUCH. SQ.Fr.
building does nor currently have a tenant,that it is my«tpxnihility to notify de nacapnnr
of rhe ar rip IM.ich mu4 tofixture'.ala Ce Hill cif a r
y.
t
O%ncr mnrima of"tit Dme '101'Al.: ISSUE _
OFFICE