29014 `APPLICANTTO F ..
'R ILL IN-INFORMATION WITHIN RED LINESa-USE BALCFOINT-PEN'ONLY
CITY OF CUPERTINO ° .. t" .' .y d` '.BUILDING-ELECTRICAL { yr ^n PERMITNO"
BUILDING DIVISION ^ APPLICATION/PERMIT+ - +(•PLUMBING'-MLCHANICAL r•. i' i," 2901'4'
BUILDING PRO,ILrCFIDENTIFICA9ION�qall I
III
BUILDING l ADDRESS e > ;w„r-' ,r ".�, '," :• " SANITARY NO. APPLICATION SUBMITTAL DATE Creel � � vc�
---t-W�
"OWNERS NAME' + '•� "PH NG � "'• CONTRACTORS NAME:it -' " LIC NO:.•` - -
1;''I $ f. NIC CONTROL#
1RCHITELTIEN EEIL t LIC NO -ADDRRS$ •^ F '
., a ....
d�
.CONTACT:' PHONE ;i�'� - "• a^ `_' " - BUILDING PERMIT INFO
$ ` ❑ Coosullant Fees Paid bylApplicant(Imnp hI BLDG •eLEcr• PLUMB C
., 1 <' LICENSFUCONfRACIOkSOFCIARATION k QTY
r
r ELHCTRIC PHRMIT• - FEE
e 1 hereby mm,that I licensed d p f cit p1 9( g - ' _ ? " JOB DESCRIPTION
Woo iNS t 91% ) fD' aBuso s dPufessitn C d 1 rylce RESIDENTIAL'.
O In - "PERMIT ISSUANCE
F Iy� toll! d if L.LZgG� t1 ❑SFDWL ❑KITCHEN REMODEL.
UU LmeneCle:' L' .# J II -. gPPL1ANCL5=RLSIDLNTIAL'
�W Dam Compact., e.� "1-< `--'-�•N •CIADDITION ro ❑PLUMBING RE-PIPE
R' ARCHH ECT S DECLARATION ❑MULTI UNIT ° , OSTRUCTURAL
J�0�y Z )., F r I t d y plans shall be used bl neounds., PANEI S '
p r +. - I .MODIFICATION
OZ`4q r - UN TO 206 AMPS A - 'p N NTERIOR�" P A 'I FiCHIMNEY REPAIR
Lan s!Poortrial.' 2011000AMPS�y����ppp+++•�.I IMPROVEMENT'
O ER-BUILDER LA,RATION " V
I hereby affir at l am exemptfront I contractor'sL L w for the OVER WGAMPS BATH R F
REPAIR DIiM011TION
follow ng re'S R 7031,5,6 ' d P .'C de Any city ar ummy SIGNS ELMIRICAE:y,� µ OTHER
1+11+7 hmh q P I I t t It p v m_L h P Y I t A
ionI
prl, y 1h p..la, 1f h u fl g d.rl I SPECIALCIRCU111ISC
W� that I h IF an,to the P _Weas theCcut, I Luescar Law Ch'm r9
as (emnioncei vidiSection7"orrTuvisor 6filailmoi •ss and Pmft,,i,,c,CW) ?EMP.METER OR POIEINST COMMERCIAL' • �N�111 U
C trial h mpt Ne of 1 the basis f to II g d xen pl n Any I I f 'f -
iC tG 'ANEW BLDG/ADDITION ❑DF,MOf(TION
Secti 091 S by y pI 1 f peer t bj t Ih a pl c t1 I p Ry f POWER DEVICES
W m t •' .TENANT .< ❑FOODSERVICE
F i+ nlthanf h dredd II ($500)
6n flh p pen, y lh to fs J _ IMPROVEMENT
I
p t 'SWIMMING POOL ELECTRIC _
$y� 'Ifd 1h k dt ast u to a d df I (S 91064 B s ' Il ❑OTHER �
W�
Foresaw Cd he C on l: J lapplyt f LETS SWITCHES FIXTURES -
P
ply.ho ino t re ,ed d ch orkhowelf'orlhmugh •
els hid w orm. d I suchim u nems ore nm
ot ended or offered for NEW RESIDP.NTIAC ELECTR SQ Fp.
v
sale If, c it ulme em eoldwipinmxYrrrrdcampl¢Lion,the - SQ.FT.FLOOR AREA a $/SQ.FT
own M1uI ebonden ofp i gthat he did not hold prove for pur y .
To f s ) d 1.
❑I, t0 o11 ,Be I 1Y t t s thl d muua, l f_ :` "
court t the project ]044 B . ..and Proleas s C de)en C t t Li-
reas raw
'thaconwel OI edpur mt theC '
desn lapplyt nerof pmp ry h M1 'la. r npro es ghee d QTY 'PLUMBING PERMIT^ FCC I
who, I 1 f uehpmleets ommet - -
Lic law I PERMITISSUANCE t 'i '.rI I L
❑.la
uoptonamo Se< ",B&P C for this reason +�
d A
# is
Ow'ne ' Data
ALTER-DRAIN&VENT WATER(EA),
BACKLOW PROTECT.DEVICE " -,. - 5 1 V
yofmERS COMPENSATION DECLRTION
jW,Y IM1 ebd Fo Ity fpe) ry ffi following declaration,
H and will
; .
'
Cnf t fC tt If n f W k C n 'S
pe DRAINS FLOOR;ROOF ARLA'COND?%-
an STORIES TYPE.CONST RUCTION'
sal provided f by Section 9900 f Ih I bo C i f th perforator f to
work for h hth' pe t' d n d -'ELXTURBS-PER TRAP y, '`" /
E:]
I have l II maintainWorkers Compensation I e required bySection
- G.�- I V
- T100 fth L b rf C de,f Thep fth Il h hIn lrrmh stssudl y GAS EA SYSTEM-I INC 40 TLETS OCC.GROUP APN 'r
My War Cl pan 06W1 pp11q d defyQ n Q !� f
Corrielw'� 11l pICYN 1Tpr`�SHy00 / 5Tj sGAS EA SVSTEM OVPR4(AA) e•
T�JC61f��Q '%FMPTION FROM WORKERSr I ,e o. _ IJ ..
(T e%2 MPFJJSATION INSURANCL` , r 'GREASE/INDUSTRL WA TEi E F.PTOR .yU1LDING DIVISION FEES
(Th I ad tb pl t d fth pc C.[ itch J dd II ($Im) ' .
or lei ) 1 + - GRLA$ETRAP -,;. 'PIANCHFCK FEE �A
Ic rtfYt t 'Nepel fth k[ witch lhiprml: dl],hill, - f " .0 o-" LTJ
nal em •SEWER 9AN AR RM LA.21X1 PT ♦
P Y Y Y st M1' (he W k C 'p - ENERGY FEE /_O,
Z. sehon L ws of C hour Date n- (.
y� Applies I - 't _ _ WATLR HEA /ELLCTk " ,GRADINGFEE ,
F7 V] NOTICE TdliOPLICANT.If fl r maks g chi,Ceftiritim,of Evorninion,yen should Wpfhk SYSTEM PATTNG i.
forthwith
comply m the Wok s C p sat h p 1s of the LohngCode,you must _ SOILS ME
aG forthwithwM u hpmv io: Ip '1.hllbd d ked. '^ - }
'W WATPR'SERACE c } r
0' 1CONSfRUC91ON LENDING AGENCY f ' NEW RESIDENT AL PLMR SQ FT. '' PAID „
Iherebyaffrm that there iso construction letdngrl,rra for the perfommnaof 'Date pRpa,ga -
_w H the work for which this perm)is issued(See 309],'Co,C.)b I)4 _
LLemanc, - TOTAL:
s Leaders Add .y. - - k - e ' 'LOYAL "'.d '
. lecolfytbul l haveread Ill application andslamthal lh bt ve informoti m's - - BUILDINGFEE
Va`i mrtect I gre t ply with II city d aunty ordinances Lances and state I relating to'. QTY. ' MECHANICAL PERMIT:, f' PCH -
C) bu ldi gwnstrvcf n nth eby an
mhonze representatives of thiscity to ter ups the - SEISMIC ME
shove menmme rn uiy fm arx'ect nn pnrpasea I
(Wefts elo eve. ndemnfy and keep harmless the Cayef Cupertino againsl n PRRMI'I'ISSUANCE P . ELECTRIC FEE ;'! 1 n
diabilitiesjudg eat cost d pores which may inanyway same agaiumadd City - -
incansequenc rut egm fns fthis permil. #p, s ALTER ORADDTO ME. IT PLUMBING FEE 3'•
APPLICANT U ERSTANDS AND WILL COMPLY.WR ALL NON-POINT AIR HANDLING UNIT(TO 10,006CFM)
SOURCE .GU,ATIONST- I , < - MECHANICAL.FELTIC
+2_ AIR HANDLING UNIT IOVER'IO,IIW CPM) t e•
' - CONSTRUCTIO<S TAX
_ .. -
Signat App aHA 1 mq D1 EXHAUST HOOD(W/WED .
I - - - HOUSING MITIGATION PEC-�
�w HAZARDOUS MATERIALS DISCLOSURE
�. -Wil to ppfcent rfuture hu'Id'ng occupant Anne or handle hazardousural al 'f�HEATING UNIT.(TO IOO,IXMI BTU) v- /
as defined by the Cuperl Mu icipal Cade,Ch pt r 9 12;and the H lth and S;fdy - HEATING UNIT(OVER W,OOI)PTU)
Code,Section 25592(q? ' ^ d
❑Y ❑N +,.- VENTILATION PAN(SINGLE RESID) °' - PAID
c - l/- Dale Receipt If
W ll th ppf t far..b Ildutg occupant me equ p 1 device,wh h s ^`t
th dust conn t. defined by the Bay ArealQuality^Marineau , BOILER-CHMP(3HP ORIm.Om BTU)
&ort . _. TOTAL:
Drstrict .t.A. ,+••N rkg, BOILER-COMP(OVER 100,000 BTU)
❑Yes
El +
' ".' .. sew i �.V •.. . t ."
°a (have readiheha d mists AIR CONDITIONER a
requ re a and,,Chapter 6.95 of the Coli- - _ - -:ISSUANCE DATE'. q
forme Health&Sufdy C W S t s 15505 25591 1255J4 1 n ndervmnJ Ihm d th Ito
bu Win does not current) have atenant.that p' - y y p : NLW RESIDENTIAL MFCH' SQ FT, r v
g y ny res ansibltl loom t iheaccu am
ofthe y nuwtid ch mod be pnorl faCent mofOmParty. ,t,'• "^ r .
.yr _ ... .,
Owne 1h ed agent ¢Date F 4" �'f
IISSUED
B
OFRCE ` b L
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