26494 APPLIUAN 1 1 U PILL IN INYUISM/1I IUN 111111 MIN ISCU LINCD-UOC UALL YUAN 1 I-CM UPIL I
CITY OF CUPERTINO BUILDING" '•'CI RICA]. PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-NfECIIANICAI, n 6 /1 n /1
.BUILDING PROJECT IDF,N I'IFICATION L f'I J�}
❑II-ILDIINLlNG ADDRESS SANITARY N(1, APPLICA'I ION SOMME ITAl.DA IIs
[XJ' OL3 N/y (,/(�C(�(� aa+Y7 UNil'A 1.01'A �1
Ni NERS (lCONTRACIOR:9NAME: LIC NO:NL I ` N
ICHI'MCI/ENGINEER: LIC NO: ADDRESS: ❑
CONI'AM: PHONE: I •:)-• - BUILDING PERMITINFO
QTY. j , . ELECTRIC PERMIT .FEB
I11.W Ii1.1:129' I'Lllnlli Alr'.CII
PERMIT ISSUANCE El
LICENSED CONE RACTOR'S DECIARA'DOE APPLIANCES-RUSIDEN'HAL
0a'Z Ihcrebynflhrn laid l um lieentedvnderprovi.tinnanfchnpmr9 lvominencinRwilh Jlsif IJESCRII'I'111N
11
+00❑ Scoina]ggpnl Division l of the Business end Pmfeu .o
i...Cmle. d Any license ie in PANEIS
FpsUU full force and effect. \ � �
N'!_W L1ccn¢Cm,a Lic.A LEE DO 200 AMPS
Qa Ume N,immncam 201-I000 AMPS
F',z ARCIII'II:r["S IIECIARA'I'ION OVERIIMNIAMI!S SQ.I'1'.141010 AREA 4/SV FI'.
OV.—C) Inndm.annA my clam mM1All M1cvmJaapuMicmcmda.
PLC W SIGNS ELFCIRICAI.
<t2, I,;....tnl Pmlmiannl
yaa6 OWNER"IMILDERDECIARA'1'ION SPECIALCIRCUDIM
yOyU I hereby alarm Ibar I am e,erapl from the Cwnmamr's License Inst far the
W,3 E- hdlmvingreasa..ESention 90115,Rosiness AM Profesaiam Code:Any,my...caumy IIiMP.mrtl::R 1'11 'INST.
l-I_•O5 which regddrea a lemdl In cmralmn,alter,improve,derllnnvn,nr«p:nr imy nmtluR
F.�Y2 priordoiln i,suince.al.tureyuire.alhe Applicant suchpennino6le asi,AoI"memrnl POWER Dr
Iy�j pG,<O don he is liemnedpllran:Innn line pmsi.imn of the Cnmraclor's Llcens,Law lC'haper Sw INNi 1'O I '.IiCr IC
ot.K: 9(commoncin,with Sen m]INIBInrEA, on3onhe Entities,and Pmfe..kms Csale) VALE A IJON
W^y armalbeI,e,ernpuhemhom and the basis for.he alleged esemfion Any v mhnion of nUTLli1'S- CAIS-P RES
L-z_< Sectirm]0115 by any applicant for a permit subjects IM1e applicant a civil penalty of
s (mare than live hundred&I Tarr($500). N17W NET I i 'CTR 5 FI.
W $ n❑ I...o.....lac Prnpety.mmyanpinyeeswidh weReaaatheirsole cnmpenmlinq Q' SloHll!S 'I'YI'I!CONSIRUCIION
p, xllldolhexmk.; 10,......cone iaoni rendedmnNned farsalc(Sow.Wald,Portio...
And Prnlca.i.m,Cade The Cmlmleon,Licmnm Law mrs not apply In non owner al
pmpeny whulmRd,ur impmvet.her nn.,nnd,holo,such work him.ell or Enough his
empl�y¢,,pnwidnl maluahinhpanvemenkare nal intendalmolfercallmsnle.l[ (N:C'.❑INJRIV RES.ONE IN
how ete..me hnildinga,impusva.non,is sold within rine year of compleion,oheowner- TOTAL:
NAME,,will into the burden of Proving that he did am build m improve for purpose Of
,t.).
LlI.Amaxmohmdo,prrvniny,urn„ru,i,aly cmnmcling with tc,A.ed conuacmnm QTY. .• 1- RING PERMIT;- FEE IT.oOO ZONE nrN
Lmshocl the project(Sec.71144,lin.jne.as and Pnd,s.ions Cmlo:)The ComlNearrs
Tcensc Law da•s our Apphym am owner of property whn hmiWs or turnout s lhereon.and PERMIT ISSUANCE
xhncammen rm.nch pmjet'1a with n ann.mconto licensed pumuam In the Commemr.
Lwtaw Lam. I
ALTER-DRAIN A V EN'r-WA I HR THA) TEIR SUMMARY
❑ 1 Am e,ernu under See. ,B R P C fm.his ream. FLOW Villi ECT.DEVICE U TSI T.19:MIT-
RACE
SANITARY Y N
Owner Dam UItA1NS-FLOOR,ROOF.ARCACOND. RECEIVE
WnRKMANCOMI'IiNSATION[)ECI.ARATTON . , , SCHOOLI'AX Y N
I hereby nllimnhm l have a cenihcane of,oncatto.wiFinmre,m a cermi' roof1:1%'NRFS 1'IiR'I RAP RECEIVER
Wokvd Cmnlrnavimh Insurance or o cenihed copy merenflSee.3900.I,ah C.)ahlcn PARK FEE Y N
LOVCT%all employee's under this permit. GAS-EA.SYS I IN-I INC. Of''T LEI S RECEIVE'N
put icy x BUILDING DIVISION I'EIS
Company GAS-EA.SYSI'1iM"OVER 4([:At PI.ANCNECK ITE.
❑ Ce.rred,r,pr fa hcreny IAnd.ah,d,
❑ CenilieA copy is tiled with IM1e city inspenian Aivi.ion. OREASEdNOIISIRI,WAS IF IN'IERCEPIOR GRADING FFF.
CERTIFICAIECIVE.XEMPTION FROM WORKERS' GREASFTRM' SAILS ITE
COMPENSATE ION INSURANCE
(Eds section need nor hecmnphaed if.he Tacoma is for one hundrol dollars D mail SEWER-SANITARY-STORM CA.1011. ENERGY FEE
less.)
I certify but in the pemorniance of the work far which this pemnil its i..ned,i shall WAI ER TEA'IFR W/VENTTLCC1'R
Aid employ Any format in any nmtner so as In hemme subject In.he Workers PAI[)
Z Cona,montnnlnwsof Culifnmio Dam IERSYSTIi 1O'NF.ATING [):lie Recital
Applicant
Z0 N01 ICE APPLICANT:If.After making Ceaihcate of EsemMinn,you dinuld _ )EN I'IAI,Ill-MR. SQ.FF. 'IOI'AL
�-a :
r V) becmme suhjen m
to the Worker's Copensadin provisions of the Labor Cade,you must
I'^ fnnhwilh campy with such poi or this permit shallh deemed revoked. flIIILDING THE
a
z affirm
LENDING AGENCY SEISMIC FEE
1 hereby arm thatthere is a a onstruction le nding.gent,far the pedmmance of
the wad for x hirM1 mita permit is issue)(Sec.3007.Civ.C.1 VI.ECI'RIC FEE
U O lender's Name
0 E"cnder',Addre.a QTY. MECIIANICAL PERMIT FEE PLUMBING ITE
I certify that 1 have read his Application and state that the aMve jninrmntom is MECHANICAL Viii
comeat, Ingrte In vompiy widM1 all tidy and rnnmy onlinmaen and erose laws rc11111mR nit VERMI IISSUANCE
Hhnilding....Iw 0on,aod ho,byauthoriae repreremativesal This city dnenter ufmn the Cf1NSIRlICDON TAX
V ,Z nMrve-nmmim od fmpeny fa,inspection pnrfrse, AIA OR ADD 1 O MF,CII.
(Wo)agree on save,indemnify And keep harmless the City of Cmcninn against
IishiNies,judgmem,,cos.sande,pen,a which may many way accrue against anal Cit, AIR&&ANGLING I INE r I If 10.000 CI:MI
I.cn serlue ce lir the gsummations,you n,.
AIR IIANDLIN ;IINI F(OVIiR Im.0mI CIM)
Sip .fiaral Applicnm/ConNanm Done EXIIAUSI'I OODOWPAIMO
PAID
IIA]ARDsOOS MATERIALS DISCLOSE PRE: IlliA'IINOIINII'1I1111XI,INNIII'llll Dam RnciptA
Will the APidi,mntlir firm.,ouldintrreo,an.mire lir In He M1vnolmw mm,6il
..donned by l he Cupcn lou MuniclNd Cal,Chapmo 9.I2.And the l ealmnnd.Sably IIFA'1'I NO I INE I'(OVER IINIJNN)It IIB 111
fad,,Scalnn 25112011
❑Yes 11 No VIfN'I'ILA'1ION IRAN fFINGI.Ii It VSIDI
ISSUANCE UA'I'li
Will then hdinanun roan«buildin Imm�aces JeviceawhioLenrit I1011.lili"Cllntl•glll`uR I1MIaMNI II'llll
II g«capon I pnnimm
tom air mmmmlina dS n d,ftmal by the Bay Area Air Quality Managcmenl HOILER-COME(OVER 110.1X0[11 t11
Ji,lrla] �)
❑Yr,. ❑No NEW RESIDENTIAL MECII. SQ.I'I'. s �j
I huts road One huaardous numrinls reynirementa under Clmpm.6!)5 of the ' rI s
Kiln,building
Safely Crsdc.Smtlom3585.255A ny n25544. Iundersmndmat ` IAT 8 19,9 p�
Cali
meho.Ihe Jar,but tralyCode S,,t...M.5that it ismyrapnmihilorMmnl.d the A' Y
11170-FA
cupm.Of the requlrememt which oma he unit prier to issuance f a Certificate of t
Uwnur nnaaatnnim ngrnl IIDIC I0'I'AI4 IS qt R!b til':
--OFFICE