S 1798 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO EdII.DIN(:-ELECT'RICA I, 1'F: HT No
BUILDING DIVISION APPLICKPION/PERMIT PLNG 1'ItkiNG-MECHANICAL 179 $
---rd",I UJF.C1 IDI{NTIFICAITON
BUILDING ADDRESS: SANITARY NO, APPLICAI ION SURMI]'1'At,DA['
20 Ba �r
a -r� - 4Z.Vb
I'11ONY_' (IUNFHAG TIE'S AMI'' 'USO SIC CON'IRol.0
s h , 8 s�
I'I ECVEN .I liltR: LINO' ADDRESS5T- ❑
CONTACT`C.644
'MUNE: ,//1 131111,UINC PIiI2M1'I'INTO
'/ i Consultant Fees Paid by Applicant(initial) — fRESI�[)ENT[Al,. HLECI' PLUME MBC!
LICIiNSED CONIRnC'IT)R'S O[CLA A(ION Q'TY ELECTRIC PERMIT Plili
1 hereby ammo had 1 an Boomed order provi..om or Chant,1)[erre eencing 1013 DES&1l'rlON
CMZ whltSmliun 9tXpl of Division?ohne Business mAPntfcssiea.note.and my license is S J PERNII F ISSUANCE in full force and effect. ) ❑KITCIIIiN REhfOUI .
ULiccmc Class Lich APPLIANCES-RES I UPSIIAh ON ❑PhUhfIHNG RE-PII'li-W Datc Contrusvtrc. ANCIII'IIiCI"S DIiChARAT JONPANIiIS -0NIT' ❑,S FRUC'I UItAh
~v= I marbOrnl my plans shall he used as public records
MODIIICATION
Z C,n- UP TO 200 AMPS ❑INFERIOR ❑CHIMNEY REPAIR
CZ-C
�'4tW Licensed Prufe,i of 201-HXXIAMPS IMPROVEMENT 0SWIMMING POROUS
Q,y,�.J OWNIIN-BUILDER DITCLARNHON OVER k)0AMPS ❑BATA RIIMODY,IJRBPAIR ❑UEMOLII[ON
C C Q I hemby aftinm thin lion cxengn frmt the Comrai License Luw sect the
X3 UI'I IIiR
=U fallowing semen.(Section IlDI 5,Business and I'n testicles CtJe:Any city or leanly SIGNS ELECTRICAL ❑
W y which reyuires a Iteral Im nmslmcl,alcor,improve.demolish,so repair any arecmrc
F�C)st prior it,itsl,4 the applicant b h Permitl File a signed stamen SPECIAL CIRCUIT/MISC.
'. y
hat tic 1" : II nto in, : l tire C t t Low((I psrY MERCIAI;
W '
ap0 Inn ult uhmclan 7k)fl) IUA"smi lamIiuxne— II session.Cloth)... TEM('MI,-FEH OR P01.17 INS'i'.
a i o C thin be is exempt therefrom=1 the basis for the alleged exemption.Any violation of NIiW BLDGIAUDITION ❑DEM(IhI'IIUN
Wim Section 0031,5 byany applicam our a permit subjects the upplicamma civil penalymf POWER DEVICES ❑TENANT ❑IrOOD SERVICE
not one than 0ve hundred dnllurs(SSgq. IMPROVEMENT
�Zd 0Ln.nwncrolthc propcny elmy mnplayccs with wale-1 their note cawysuauon, SWIMM ING POOL E ILVC'I'RIC
❑UFIII,R
xilldo,hewnr R.and lbcslmctule is not handed-onered locl,(Scc.91,14,Ifu.ine,, .
Yf o n OV-2
W 3 w and Prnlcxdnnx Ct><Ic:The Cnmmnnrs License Law Jocx nal apply m an owner nl OUT ELIT'TS-SWI'ICIIIS-PI RI-S
property who builds or improves thereon,and who due%such work himself or through
his awn employees,provided thin such improvements um net intended or offered for NEW RESIDENTIAL SQ 11'.
suit.11,however.the It filing orlmprovement"woold within eau year efeninpktlon,the SQ.171,FLOOR AREA b/SQ.ITC.
c h"IJ III' th burden fp 60 th JJ h'll P f p - L7J�
Own y
putt I. , ( I: •��� /� / or7. 35
❑1 of property. Id contracting ad licensed c t t m
constructh project f,I ,,X4 0 .: Iprofessionscal ITh C t t 'i'-
scl.nwdee. mapplro lo•toworont ops ty woeIntose Ids ear 1pmshemuu nand QTY. PIAMBINO PE FE8
Li-
"i"t,
loosens for xtcltt projects wi[no mnhuctmnx7liccn.cJ pursuanuothc Cnnuuclor's �
],let.law. PERMIT'ISSUANCB
Iamcecmptundcr Sec ,B R P C serious reason
Al TER-DRAIN&VIENT-WAIF ll IEA) VALUATION
Adc -�
WORKER MENSAL ION DITCLAHNobBACK FLOW PRfYF I!CI'.DEVICE1 -7 000
1 hereby annual under Pamalty of pe fury one of the following dedurnions:
1-1 I have and will ntaionina CcniucuteofConsent mwlf-inwre far Worker's Counter- DRAINS-FLOOR,R(X)1'.AREA.COND. )RHES TYPECONSTT RUCI'IOI
saran,as trnvlded tor by Sealien 37004 the Lothar Coo Ins Oe perbonn:mee of the
work too which n,.pernot N voomil. I FIX'11JRI
is-PER'I'RAP
I have and will nrinta.Worktr's Compctvsulion Insurance,as reyuireJ by Sw0on
311XIobthe labor Gale.fill he performance mf the work for whichlhis pemtit is issued. GAS-11A.SYSTEM-I INC.J OU'I LETS UCC GROUP AI:N
My Workers Compemmion Insurance tamer and Policy nuttd,cr um: GAS-ITA.SYSTEM-OVER)BTA(
Carrier: R.Ilcy No.'.
(Ton sttttn'I'IEICAIE Lic pXEMPfION FROM WORKERS J/ GRI?nSiJINDUS'IRh WASTE IN c RIC PION
CEIt /� /{
ITNSATION INSURANCE /[ I11111.D1 I 'SHIN I�P,1$
CO�I,
ncednot M1eamnplerd if the permit is formal,hundred dollar,(SINE
los) GRGASE'I'RAP PhANCHITCli
K BiV
I cenifY thin in the pedennanevaffhe work far which this ry:nnit i.isued.Illicit SEK'lIN- - 11,A.21X Q
cot cmpluynny PerDort inany n. a.m Ise ntnl,.ah", ,,d¢W..van,Carl'.- IiNIiHOY FRIT '�
t rte nu xn
O Z smian laws of Califomiu.Dull WATER 1 CI' WIV 'VELE CT ORAOI s,Lot
�Q Applicant
NOTICE TO APPLICANT,If,after making this Cenifcate of bovempnon.you should WAT IN S\ TREAT 11 4t IIXU SOUS FEE
ti Female subject w the Worke,I Comtensalion prnvi.innhCe
dr.al the Laey Cdr.yon must e
klconal
hall hc,1,c
Gmhwlth unntly withCONSTRUMION I1IGNDINGsAGENCY MIA I. NE'1 RSH r D
G. W RP_SIIJ IAL I'hMB, SG,P PAID Oat Reacipt p
U Q1 hereby radical hatthere is a construction lending agency fonts performance of
the work for which this pmmit ix mord(See 3097.Cie C) TOl'A L:
O U Lender's Naas
,r U Lrthr.AdJress ISUILI G lulu D
` I modify that 1 have read this application and state that the above information is
0. cncel.lagacmalmply with all city and rnunyardinrnecs and state lawsmlatingto QI'Y. MECHANICAL PERMIT PEE ��} IC 'EE
V Z building construction.mod hcroby mnhmriee reprenenmtivex fit tote city lnemcrupenthc
uhnvc utartioned poeperry too inapection'bi'n's, PERMIT'ISSUANCE iC' IC IITIT 3
(Wc)agme to save,and expecte aotl Acct in
an the Cay of Cupcnst said
City
� Iiahililies.juJBmemn,costs anJ expenses which may in anyway serve aquina nail City AITER UN ADD TU MIiCH. 1'1.1, RING PIiIi
in mnseyuene,of the gowning of this tomtit.
APPLICANT UNI117HS1'ANOS AND WILL COMPLY WI'I'If ALL NON-POEM' AIR I IANDLING UNI'1'(1010.000 CPM) .CI IANICAL FEE?
SOLRCE REG111,AI'I ONS, -
AIRHANULINGLIST(OVER 10.000 CPM) CO TRUC'HON TAX
Slgnmure of Applimmu Canlrenm Dmc EX I IAUST HOOD(W/DUCT) I IGUSL"GbI(LIGATION ITE
HAZARDOUS MATERIALS DISCLOSURE
Will the upplimnu orinunt,Isindingoccupant store ror h"'I'L huntn0nw inmred II EXI'ING INTI fl'O 11Xo0001f1'it)
as defined by the Cupenie,Municipal Code Chapter 9.12 and the Traditional Safety NEAL LING UNIT(OVER Upt art,
Code,Suction 25532(x)?
EJ Yes- INo VITN'IT LATION PAN(SINGLE RES I D) PAID
D. a
Will the applleunt or until budding ts"i'sn I use tt e"une m ran dc,kc'"It"' BOILIER-COMP y311P(1R Ind IX n arIT)
,,if hazardous air contaminants a defined by the Bay Area Air Quality Management 'I Ol'N,:
District? HOILER-COMP(OVER IOQall)11Lo
Cl You, No /
AIR CONDITIONER ISSUANCli DA793
I Iav Ieml the hnronlnus sregairenwntunda Cluntor(s95mb the Cah.
min t{ca .W:duty Cade ve'lo n,25505,2553?and 2$$34.I unJcrtanJ Win it the NEW RESIDES I'IAI.MITCl1, SQ.Irl'. 1
huilding: a Oyl ave tenor.ohm it is my rtzrymsibilitymnolify the relator b
"fiber ntx i ht t mel prionoissuanee ofa Cenilicatu nflkcupancy. �\/{-/�/ )CA�
wni
ue1 agent Data
'UYI'A L: ISSl1ED I)V: '' ` l i P
OFFICE
-7 cF p ADDITIONAL PERMIT FEES
/ BUILDING PROJECT IDENTIFICATION VALUATION
nooneu0
U —N
ANE
FEE SUMMARY
.O.,
°ONT""OiOflS BUILDING
NAME
LIC.NO PLAN CHECK A
I.PlEAC*oP s FEE
AODPESS
°NONE SEISMIC FEE
OTV. ELECTRIC PERMIT FEE
UTLETS-SWITCHES-RECEP ELECTRIC
LIGHTING FIXTURES
PLUMBING
PPLIANCES-RESIDENTIAL
PANELS MECHANICAL
SIGNS
SIGNS TRANS. TOTAL
SPECIAL CIRCUIT
EMP.METER OR POLE INS. PERMIT VALIDATION
MOTORS SEE FEE SCH.
O SERVICE CHANGE
F- o TOTAL
ISSUANCE DATE
• W OTV. PLUMBING PERMIT FEE BLDG. ELECT, PLG. NEC..
( 2 ALTER-DRAIN&VENT-WATER-(EA.) ❑ ❑ ❑ ❑ 1
LL 0 BACK FLOW PROTECT.DEVICE
O w DRAINS-FLOOR,ROOF,AREA,GOND,
} d FIXTURES TRAP
h
F 2 GAS-EA.SVST STEM-/INC.4OUTLETS
(J GAS-EA.SYSTEM OVER4(EA.)
INDUSTRIAL WASTE INTER. 1 .
LAWN SPRINKLERS 1 INC 5 V.B.
LAWN SPRINKLERS OVER 5(EA.)
SEWER-SANITARY-STORM EA.200ft/
WATER HEATER W/VENT
WATER SYSTEM
• ' WATER TREATING EQUIP. I 1,
DTV. MECHANICAL PERMIT r
ALTER OR ADD TO MECH.
_ APPLIANCE
AIR HANDLING UNIT ITO 10=C.F.M.)
AIR HANQUNG UNIT(OVER 10=C.F.M.)
�• } EXHAUST HOOD(WITH DUCT)
HEATING UNIT(TO 100,000 B.T.U.)
HEATING UNIT(OVER 100,000B.T.U.)
VENTILATION FAN (SINGLE)
BOILER CONR(0 H.P.or 100,000 B.T.U.) ,f
BOILER-COMP 10. 100,000 BTUI SEE FEE BC..
TOTAL
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