S 1493 —APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECIRICAI. reBaprr NO- 1493 ,
BUILDING DIVISION APPLICA•FION/PERMIT PLUMBING.MECHANICAL
"BUII,DINGPRO,IEC'I'IDENTIFICATION,
BUILDING ADDRESS: SANITARY NO. APPLICA'ION SUBMI'PI'AL DATE
OWNER'S NAME: tjitv 9 .7!6o pNT$nI "541�.6 ',-' 4If7� _
T \JS LL{ NIC CONTROL k
ARCHITECTIENGINt:Eki LIC NO: .1pORrcc. A ���/��� `' ❑ -
CONTACT: - PHONE. // D/� !V" Ib/ SET "'BUILDING PERMIT INFO fi-
- -2-1O E:1Coneuluna Pecs Paid by Applicant(Initial) nE❑nr ELECT 'hU❑MD MECH
LICENSED CON IRACI OR S DECLARATION 4'Py ELECT PRICPERMIT.- PEE
II by R far l licensed I -n fCbaptef 9 Bonn, g .. - JOB DESCRIPTION -"
{rO{r�04Z withS l 7000).1'D -.l t3olNeBn e u IP .sessions Code andny It ase �� RESIDENTIAL" '
FI-_ tufl l Ruse and elievl�lQ Ot(17e1 PLRMI91SSIlANCL ❑SFDWL ❑KITCHEN REMODEL
UyU Liceme Cluyli O011 Lica `f TT A� APPLIANCES-RESIDENTIAL ❑ADDITION [:1 PLUMBING REPIPE
FU til Unm Lonunnor r -
N 0. BARCHITECTS DECLAItA'I'ION PANELS MULTI-UNIT ❑STRUCTURAL.
Z O y l umdcrsmnd my plans shall be used as public rcnutts - MODIFICATION
UP TO 200 AMP.5 `^ [I INTERIOR ❑CHIMNHYREPAIR
�4t:W Licensed Probes sinnuP
nn (Section _ '
201-IOOOAMPS IMPROVEMENT E]
SWIMMING PO
OLS
tkHUIUReGLAE/T10N
I b f that I f m ❑ C I t License for the OVER ? RABATH R&MODEV REPAIR DEMOLITION
flb wng easo . E(III S,Business and Pr.scas'o v CndiA y ciytrcountt IGNSIL'CICAL
❑OTHER
w+� F
which requires it permit to construct,alter.t aprove Larassish,or ri,shary structure
�•-� Art t t 1 Ii 'pplc If Ip 'n fl .6 Ltt •nt SPECIAL CIRCIP IYMISC. 45,
-� �� ( -
IM1ch I' Ip II Ih p' t fN C t t 1 L '(CI'pl r9 _
�20 (sir nen,villi See, n9B0(b.1Division3 of the Boeiren dI desees Code)o' 'TEMP.M U ITR OR POLE INS'I'. COMMERCIAL:
0.0.o C that he Is ex rapt therefrom and the basis for the alleged exemption Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION'
iC W Section 91131,5 by any applicant fors pemlit subjects the at,dwanl to a civil penally of POWER DEVICES
❑TENANT El F006 SERVICE
not tl f I. 11 It :($500)
F Z>' IMPROVEMENT
O� I a' ftl 1 pets) p ;( SWIMMING POOL ELECTRIC
illdo
- "
w Ili k and t n
I
I ttd d ff d fie . B - _ CI and Professions Code; 11 Contractor's f L es J In an
t 1pl) owner of, Of)'ILe'PS-SWITCHES-FIXTURES
property%looboudscrinnoproveslherum,and iodressuch k hinselforthough -
his own employees,provided Not such improvemeres are not intended or offered for NEW RESIDENTIAL ELECTR SQ FT.
sale.If,awcveeNe building or intpmvemam issold within one Yivrtdnintplclinn,We S(.FE PIA RAt EA $/SQT`E
h Ide,- fth th M1 a tp gd1ll did tb Id 1 f p
pas 1. )
❑I f the p Mn4 'I . ly I f g II I' . d t-t r - - I
cant nthLittle,fs 9044 Business d P who d I )Il Contrat 'I - - . - - t -
c t I 1 t'pPIYt fp p ty ic leinfusesN I 'QT'V PLUMBING PERMIT s.FEE ,t ;
wh I I f I I ] 't. lhaumt I rlgl u.nsWp noiflau Con t
LicenseLaw, FERMI'I ISSUANCE
❑1 arn escou,suadvi-Scv. B&PC PoI'this as
Owner Date ALTER-DRAIN&VENT-WATER LEA) L,,..,O4
- WORKER'S COMPENSAI'I ON DECLA RATION BACK]:LOW PRO I'HC f DEVICE
1 hereby union under preally ofp jury one of the Iellowing her nalines
❑ I huvenel willmnintaina Cenifieere of Consent to elftinsure,for Wo,ons Cotmwro DRAINS-FLOOR,ROLE,AREA,COND. S'f0121 PS 'TYPE CONSTRUCTION
wilco,as provided for by Sorien 3900 of Nc Labor Code,forthe perfmmarne of Ibc
fwhich this perndt Is i....d.- FIXTURES-PER TRAP '
w h:orne and will maintain Worker's Comry salien Instance,err,marital by Section -
3000 Ne Labor Code,I.,the perfonnanceof lbs work for which this permit is issued. GAS-EA.SYSTEM-I INC.40U'ILE'I'S OCC,GROUP APN
My Workc(s Com mnsnt'a husuzTnee }B tu. dPalicy nether vr:
Canicc fMhe,Nn.: 'e..e���� OAS-BA.SYS'I'HM-OVP,R4(EA) -
CE I-CATE O XEM PTION PROM WORKIiRS
COMPENSATION INSURANCE - GREASE/INEPIMBIO,
'ERCCPI
(I'hls section ner4 not bewmpined ifthe permit is foronu hundrwi Jnllau:v($100) 'BUILtIING PIIVlS20 PP,0.4
no Us,) - ❑RIiASP.TRPLANCHECK FEE
Icertifyther In the performarecot thevork forwhich this permit is issued,I shall SEWER-S 'A. d
nor employ any penoh in anyaritur snavt0 beconm subjeemNu Workers'Compo.- ENERGY FEE
cation Lows of Criteria.Date WATER HEk
O Applicant 1 - GRADING LEE -
NO'IICL''1'0 APPLICANI`If,nfv,making this Cerlifieateof Hxemptien,you should Wgl'Ek SYS
F bewns subject to the Workerls Compenwuion provisions of the Wthor Cdle,you mull - SOILS Fee
Wn,.t forthwitheomplywiN such provisions or this perratshall bedecmulrevoked. WATER SER
M
CONSTRUCTION LENDING AGENCY NF.N'IiESIDSQ.Pf. PAID _
Ibachy affimiNal there isaunuavuc(ion lending agency fur the perlonnance of - Date I �eiptp
.w the work for whleh this Re 1,is issued 13097.Ci¢C.)
F' Lcndn''s Name VVTOTAL:
U Lit 1on,Address TOTAL:
0. I caciffy that I have rund1h.application andI that the aboveI .. .,, BUILDING FI? -
�. Z) correct. g to conply with all city and county ordinances and sthe laws reliningt QTY' 'MP.CHAN(CAI,PERMIT" PEE'
U Z Drilling con...actiondhereby.t thorize representimfves of this city is enter upon NeS +'t �"' SEISMICI ELECTRIC.I:
m
ti above- entioned raised,hu,h,,vOh u purposes. PERMIT'ISSUANCE f J
(We)agree m.save,makohnify and keep harmless the City of Cupertino against D
liabilities,tadgencns.ensla and expense.whichmay in any wayallucagoiea oid City ALT ER OR ADD TO MECH.
in antsnyuopee of the'tenting of His peftnil. PLUMBING P
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(T'O 10,11(IOCFM) `
SOURCE.REGULATIONS. MP.CHANIC .FEF.
1. . i AIR HANDLING UNIT(OVER 0,000CFM) CONST RUGA N LAX
Slgnuturetf AppliunUCnnwelor - Lure 6XI TAU S EOOD(W/UUCT) HOUSING MITI TION PER
HAZARDOUS MATERIALS DISCLOSURE
Willdre upph,cal or folate hankie'nmupad,uncor handle hazardous mmerial HEATING UNIT(10 W,000 B'I'U) 12— -2- 0
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health anti Snfny
Code,Section 25532bd? DEAL ING UNIT(OVER Inn'tKKl II'I'U)
Ll Yes Nu. VENTILATION I AN(SINGLE RESID) PAID
One Receipt#
Will,love,liciantor ft c building ocupan tsd ey 'p I it deovi,c,which pOII.ER-COMP(311POR 1011.0011 BTU)ern I l Arte t a s defined by the Bay Area A Quality M Inge hent - TOTAL: - -
Dlctet
❑Yea BOILER-COMP(OVER W.NX)BTU)
[��c --
AIR CONDITIONER r
1 h Safety
h d I .I. I n I Ch I t understand
ori Call- - L SUANCE DATE
tote H'bh&bflY(. I S i .255atitis 13 d355141 J t dd l'I the NEW RESIDENTIAL MECH. SQ.ItI'. .� � 'f
.1th6J 1 dyh of td It y :po 'bltyt nIfYN Punl Cell
of the ns which mull iter Ipr I LCnI dOt p, y. -
? —� �— -Sg
Owns t Ili rued agent Dale TOT ISSUED BY:. - 1
OFFICE