S 2668 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Ii11ILDING.ELECI'RICAI. VERMI 1'No
DDII,DING DIVISION APPLICATION/PERD1ITPLUMING.-MECHANICAL S 2668
BUILDING PROJECT IUENTIFICA'1'[ON
BUILDING ADDRESS: SAN]IARY NO. APPLICATION SUBMlrlAI.QAIF
(� 3 is� Y.,�osc +�c �� 3 —3 -ori
O%VNERS NAME' ^I�J,N PHONE: C(INDIACfOR'S NAI,E: T LICN(1: NIC CONTROLI
�RCIII'ILCTIENGINF"ER: LIC NO: ADIM1!5S' ❑
gEJ.
sfr
CONI'ACl': PHONE: 13UILDINC PF;RMIT INFO
— ❑ Consullanl Furs Paid by Applicant(Initial) BE ELECT PLUMB MECII
JC3y �la� N3 c• ��/6'� ❑ ❑
LICENSED CONTRACT OR'S DECIARATION QTY EI,E RICPERMIT FEE J013 Df:SCRIPTION
1 hereby affirm(hal I am licenced under provisions of Chapter 9 kaemencing
��Z with Scctinn]Ilfl(11 of Sof the Braine,,- d Professors now,and mylrccnsers RESIDENTIAL:
LLOp PERMIT ISSUANCE;I;
CSF nlull lune-nd cff 'ivi'u- ` ❑SFl)WL [I KITCHEN RLh10Dli1.
<-U License Wss Lica Na APPLIANCES-RF.SI ENTIAL ❑ADDITIIIN ❑PLUMBING RI:PIPIi
i-ZEZ Uule Conandnr
snQq ❑MULI'1-UNI"1' ❑STRUCTURAL.
n R shell ECI'S DECLARATION PANELS
Z FOtiZ undcrqunA my plana shall nu nsul un pnbllc rcesnls CHIMN1CA'Of]N
OZ�C UI"fD 2(M1AMI'S INTERIOR ❑S IMMINGPO L
p.'�1-W limm.c.lP feaionnl 201-IINHIAMPS IMPHOVIiMIiN'f SWIMMING]'(l(lLS
OWNER-HIIILDIiR DECLARATION OVER 1000AMPS ELI BAT iMODIH/REPA]R ❑DEMOLTITON
C C Q I Hereby affirm,nut 1 nm cnenpl floor the Commelics I.Icense law]in the
X6 U ]idluwing reason.(Section]1111.5,Business and Professions Cede:Any city or county SIGNS ELECfRICAI, ER
LL 3 LL h which requires a permit to a,mvaet,cher,improve.demolish.or repair any saucmre LI"P
F��g prior h,its inuancc.also reyuiez We applicam for sucM1 permino flcasigncd swmmm�t SPF.CIALCIRCUIUMISC. �Vv
��}; tbo he is licensed pursuant to the provisions of the ConrraiI License Law(Chapter COMMERCIAL
1+100 (commencing with Section 7000)of Division loft he Business and Prafessis I O )1,-
q a W that he is exempt therefrom and the nags for the alleged exemption.Any ,Intron of ,5 ❑NEW BLDG/ADDITION ❑DEMOLITION
W^h Section 70315 by any applicam fou,u n of subjects the npplicant to a civ malty of �s�POWP.R
n more Ihun live hundred dollars($510y I lV1iMl?N'Q
=0 [� I,;n ovular little progeny,onny, cn...loyeuc with wages as rhea"deco ` SWIM 1N_n_ OL lil.l!I ER
will dothe wnrk,anditu,"'cmrc in nntmwnded.....acted Ea sale f5cc.]f ILtni �
F s U"1'•• -SWI'Is'IIT IIXT E
W 3 m ;old I'rnlessions Code:The C,rometor'n Liecnm law dces not apply m
owner
P' prpeny who huilds or improves Thine,and who docs such work himsct
his own employee.,p ovidrd War such hnproveniam,me not ineaded or nHvrcd for IiSI1lIiN'rl .li CfH
rale.If.however,the burlding or rmprm
vcenr r%sold within one year of n,mpletion,thc SQ.P )H li -Irl'.
Her-builder will have the burden of proving that he did not Wild or Improve for put-
'se of sic.). TOl'AI
1,as owner of the progeny,mm exclusively contracting with licensed teamsters to :RMBy
construct the project(Sea.70W.Business and Professions Cade:)The Contractor's Li-
se law Arcs not apply to an owner of progeny who hudds or improves thereon,and Q7Y. PLUMBING IT FEE
who c mens lion such projects with a contmomes)heenwd par aunt h,the Commm�nr's
License Law. PERMIT ISSUANCE
� I not eve nn a oder Sm. ,Date
N&PCfor lhis mmnn
ACIER-DkAIN 'I' (H V,URIION
�(lwncr following
WORKERS CIIMPFNSAHON DECLARATION BACK FLOW I ROI I:Cr DEV
hereby infirmai under penally of or Con enc of the inarefog drelarWorkarhnan
�Ibavc and will maimuinaCenificam nl Consent maclf-insert for Workcr'r Contain- DRAINS-I'I OUR,ROOF.AREA.COND. S'101211!S TYPIiCO ION
ration,as provided for by See inn 3700 of the IaMrt CWc,for the performance of the Q
Is far.Inch alis permir is issued. FIXTURES-PER TRA('
I�)1ylhave and will maintain Worker's Compensation Insurance,as required by Section
b].oflhe labor Code.for We pvrlomruna n(We work far x Each this Permit is iasned GAS-IiA.SYS]'EF1-I INC.J OUTLETS FICC.GROUT' A'N O6
My
�Wo. 1115 1.14unce curicrland liy No. 'r1 GAS-EA Sys'f1iM{lWRJ(F:A) 3Z
CIiRTIF]CXIIT OFFXI!MVHON FROM WORKERS' GRFAIIlYINUUSI'RI.WAS'IE INTERCEPTOR
COMPENSATION INSURANCE: I1111,IlING DIV ION IT"
frb111116"1 need nm be completed i 0he permit is for one Hundred dol lays l51(H0 GREASIi'IRAI'
1'LANCIIIi'R I Pili
Toy any
tpesn m anyamarr,al%fiewort,lbr whrch,oOlhe it.ter,cd,Ishall SEN'EN-SANI'I'ARV-STORM EA.21H11+I'.
nm cnmpiny mmY M1^•nn many mm�nlr.co un m neem¢nuhject Oahe Workcci Compeer ENERGY PIil3
,Z .anion lawsof Culifonia.Doc WATER HEAI ER WNIiNI'IELECTR
zApplicant GRADING PEIi
NOTICE 10 APPLICANT:If,afe,nmking this Curificme of Exemption,you nbould WATER SYSTEM/T BEATING SOILS Flits.
? nccome .b m the Worker's Compenurion provisions of the labor Cndr,gnu must
fnnhwirh comply with such provisions or this permit shall he deemed revoked. WATER SERVICE
PAID
7 z CONSTRUCT
Ise
ON Lion AGENCY NEW RESIDIiN'1'IA1,1'Lh19, SQ.IT. p' Receipt p
UO Glot which
that there ,nonameiem17.lending,.agency for me perd,nmlmle of
oma wmk Ter ween Wtspem,n.a maned fsw.Ban.cm.c.l
C) cra wrote
L1 In.
. T(rrAl.:
�" d 1 eerlify ram I nave rend Ihiv uppllcatinn and nemtnm Ibc nMrvc'mf rmulinn Iv ISUILDING hili /
uo—O (agree to comply with all city Tied emery oNfnancaand.ante laws rudating m QTY. MECIIANICALPERMIT FE SHE CFEE
U z building concretion,and hereby actbnrr,,cpnxntmlvcs of thin city m enter.,"I'he
a avc-n¢ntioned progeny lot insryction purfooe, PERMIT ISSUANCE. GLBCTRIC PER
(We.)agree ro save,indemnify and keep branches,the City of Caper inn agarose
Irahilkies,judgments.costs and expenses which may in any way iii against said City ALTER OR AIIU TO MECH. PLUMBING FEE;
in eomcyunal,afthe grunting ofthis pen 1.
APPI.IC T UNDERST. N $ANTI "11.1.COMPLY WITH Ah[.NON.POINT AIR HANDLING UNIT(TO IB.00 CPM) MECHANICAL FITIi
S(lUH" F,GULATION
AIR HANDLING INI'I'(OVER III.gXl CFM) CONSTRUCI'ION'fn%
,m ,IAppl; nm/Con actor D•dc EXHAUST 11001)t WIUUCI) HOUSING Mr II GM ION I'I?li
I iAZARDOUS MAI'IzR ALS DISCLOSIIRI?
Ill the up,bram or 1.1.11 burlding nacap.nLxlall or handle hamNousmwerial HEATING UNI'I'('10 IINI,(NN1 B'IlA
as d - nl by We Cti,aam o Munrclpal Calc.CM1upmr 9.12,and rhe Ilcallh and Saety
Cmx]e,Section 25512(x)1 HEATING(IN)I(OVER TWO Tu)
❑Yes 0 N VENIHAT1ONPAN(SIN .ERESID) PAID I' Rcacipt4
I Will the applicant or future building occupant a-cquip.nl nr devices which BOILER—COM('O OR 100.000 BTU)
coal hr ,indous air contaminants as defined by the Bay Area Air Quality Managcmlm TOTAL.
District? BOILER—CO (ovER HErmHH)RTD)
❑Yes
HIR Co' TIONER ISSUANCE DATE
I hu read Ise lar inntcri; rtgmenanu undor .I h 695 at the Cali
fnmin Ilia X Safoty Co c 55 ^SSl1 trod 25511 I undersand the if his N' RESIIIEN'IIAI.SUIT H. SQ.Ff.
I I'li I c nolwmnd tr ceemm.;L lbw it i. ny a,vacbifny mnmily Ace-lalum
11 cIli ry - - hf Prinrr uw¢cnl'u CuniGmnc of Ucmmcnry.
al
let r uthariettl age Dale TOTAL: ISSUEeD Ely;
OFFICE
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Ii11ILDING.ELECI'RICAI. VERMI 1'No
DDII,DING DIVISION APPLICATION/PERD1ITPLUMING.-MECHANICAL S 2668
BUILDING PROJECT IUENTIFICA'1'[ON
BUILDING ADDRESS: SAN]IARY NO. APPLICATION SUBMlrlAI.QAIF
(� 3 is� Y.,�osc +�c �� 3 —3 -ori
O%VNERS NAME' ^I�J,N PHONE: C(INDIACfOR'S NAI,E: T LICN(1: NIC CONTROLI
�RCIII'ILCTIENGINF"ER: LIC NO: ADIM1!5S' ❑
gEJ.
sfr
CONI'ACl': PHONE: 13UILDINC PF;RMIT INFO
— ❑ Consullanl Furs Paid by Applicant(Initial) BE ELECT PLUMB MECII
JC3y �la� N3 c• ��/6'� ❑ ❑
LICENSED CONTRACT OR'S DECIARATION QTY EI,E RICPERMIT FEE J013 Df:SCRIPTION
1 hereby affirm(hal I am licenced under provisions of Chapter 9 kaemencing
��Z with Scctinn]Ilfl(11 of Sof the Braine,,- d Professors now,and mylrccnsers RESIDENTIAL:
LLOp PERMIT ISSUANCE;I;
CSF nlull lune-nd cff 'ivi'u- ` ❑SFl)WL [I KITCHEN RLh10Dli1.
<-U License Wss Lica Na APPLIANCES-RF.SI ENTIAL ❑ADDITIIIN ❑PLUMBING RI:PIPIi
i-ZEZ Uule Conandnr
snQq ❑MULI'1-UNI"1' ❑STRUCTURAL.
n R shell ECI'S DECLARATION PANELS
Z FOtiZ undcrqunA my plana shall nu nsul un pnbllc rcesnls CHIMN1CA'Of]N
OZ�C UI"fD 2(M1AMI'S INTERIOR ❑S IMMINGPO L
p.'�1-W limm.c.lP feaionnl 201-IINHIAMPS IMPHOVIiMIiN'f SWIMMING]'(l(lLS
OWNER-HIIILDIiR DECLARATION OVER 1000AMPS ELI BAT iMODIH/REPA]R ❑DEMOLTITON
C C Q I Hereby affirm,nut 1 nm cnenpl floor the Commelics I.Icense law]in the
X6 U ]idluwing reason.(Section]1111.5,Business and Professions Cede:Any city or county SIGNS ELECfRICAI, ER
LL 3 LL h which requires a permit to a,mvaet,cher,improve.demolish.or repair any saucmre LI"P
F��g prior h,its inuancc.also reyuiez We applicam for sucM1 permino flcasigncd swmmm�t SPF.CIALCIRCUIUMISC. �Vv
��}; tbo he is licensed pursuant to the provisions of the ConrraiI License Law(Chapter COMMERCIAL
1+100 (commencing with Section 7000)of Division loft he Business and Prafessis I O )1,-
q a W that he is exempt therefrom and the nags for the alleged exemption.Any ,Intron of ,5 ❑NEW BLDG/ADDITION ❑DEMOLITION
W^h Section 70315 by any applicam fou,u n of subjects the npplicant to a civ malty of �s�POWP.R
n more Ihun live hundred dollars($510y I lV1iMl?N'Q
=0 [� I,;n ovular little progeny,onny, cn...loyeuc with wages as rhea"deco ` SWIM 1N_n_ OL lil.l!I ER
will dothe wnrk,anditu,"'cmrc in nntmwnded.....acted Ea sale f5cc.]f ILtni �
F s U"1'•• -SWI'Is'IIT IIXT E
W 3 m ;old I'rnlessions Code:The C,rometor'n Liecnm law dces not apply m
owner
P' prpeny who huilds or improves Thine,and who docs such work himsct
his own employee.,p ovidrd War such hnproveniam,me not ineaded or nHvrcd for IiSI1lIiN'rl .li CfH
rale.If.however,the burlding or rmprm
vcenr r%sold within one year of n,mpletion,thc SQ.P )H li -Irl'.
Her-builder will have the burden of proving that he did not Wild or Improve for put-
'se of sic.). TOl'AI
1,as owner of the progeny,mm exclusively contracting with licensed teamsters to :RMBy
construct the project(Sea.70W.Business and Professions Cade:)The Contractor's Li-
se law Arcs not apply to an owner of progeny who hudds or improves thereon,and Q7Y. PLUMBING IT FEE
who c mens lion such projects with a contmomes)heenwd par aunt h,the Commm�nr's
License Law. PERMIT ISSUANCE
� I not eve nn a oder Sm. ,Date
N&PCfor lhis mmnn
ACIER-DkAIN 'I' (H V,URIION
�(lwncr following
WORKERS CIIMPFNSAHON DECLARATION BACK FLOW I ROI I:Cr DEV
hereby infirmai under penally of or Con enc of the inarefog drelarWorkarhnan
�Ibavc and will maimuinaCenificam nl Consent maclf-insert for Workcr'r Contain- DRAINS-I'I OUR,ROOF.AREA.COND. S'101211!S TYPIiCO ION
ration,as provided for by See inn 3700 of the IaMrt CWc,for the performance of the Q
Is far.Inch alis permir is issued. FIXTURES-PER TRA('
I�)1ylhave and will maintain Worker's Compensation Insurance,as required by Section
b].oflhe labor Code.for We pvrlomruna n(We work far x Each this Permit is iasned GAS-IiA.SYS]'EF1-I INC.J OUTLETS FICC.GROUT' A'N O6
My
�Wo. 1115 1.14unce curicrland liy No. 'r1 GAS-EA Sys'f1iM{lWRJ(F:A) 3Z
CIiRTIF]CXIIT OFFXI!MVHON FROM WORKERS' GRFAIIlYINUUSI'RI.WAS'IE INTERCEPTOR
COMPENSATION INSURANCE: I1111,IlING DIV ION IT"
frb111116"1 need nm be completed i 0he permit is for one Hundred dol lays l51(H0 GREASIi'IRAI'
1'LANCIIIi'R I Pili
Toy any
tpesn m anyamarr,al%fiewort,lbr whrch,oOlhe it.ter,cd,Ishall SEN'EN-SANI'I'ARV-STORM EA.21H11+I'.
nm cnmpiny mmY M1^•nn many mm�nlr.co un m neem¢nuhject Oahe Workcci Compeer ENERGY PIil3
,Z .anion lawsof Culifonia.Doc WATER HEAI ER WNIiNI'IELECTR
zApplicant GRADING PEIi
NOTICE 10 APPLICANT:If,afe,nmking this Curificme of Exemption,you nbould WATER SYSTEM/T BEATING SOILS Flits.
? nccome .b m the Worker's Compenurion provisions of the labor Cndr,gnu must
fnnhwirh comply with such provisions or this permit shall he deemed revoked. WATER SERVICE
PAID
7 z CONSTRUCT
Ise
ON Lion AGENCY NEW RESIDIiN'1'IA1,1'Lh19, SQ.IT. p' Receipt p
UO Glot which
that there ,nonameiem17.lending,.agency for me perd,nmlmle of
oma wmk Ter ween Wtspem,n.a maned fsw.Ban.cm.c.l
C) cra wrote
L1 In.
. T(rrAl.:
�" d 1 eerlify ram I nave rend Ihiv uppllcatinn and nemtnm Ibc nMrvc'mf rmulinn Iv ISUILDING hili /
uo—O (agree to comply with all city Tied emery oNfnancaand.ante laws rudating m QTY. MECIIANICALPERMIT FE SHE CFEE
U z building concretion,and hereby actbnrr,,cpnxntmlvcs of thin city m enter.,"I'he
a avc-n¢ntioned progeny lot insryction purfooe, PERMIT ISSUANCE. GLBCTRIC PER
(We.)agree ro save,indemnify and keep branches,the City of Caper inn agarose
Irahilkies,judgments.costs and expenses which may in any way iii against said City ALTER OR AIIU TO MECH. PLUMBING FEE;
in eomcyunal,afthe grunting ofthis pen 1.
APPI.IC T UNDERST. N $ANTI "11.1.COMPLY WITH Ah[.NON.POINT AIR HANDLING UNIT(TO IB.00 CPM) MECHANICAL FITIi
S(lUH" F,GULATION
AIR HANDLING INI'I'(OVER III.gXl CFM) CONSTRUCI'ION'fn%
,m ,IAppl; nm/Con actor D•dc EXHAUST 11001)t WIUUCI) HOUSING Mr II GM ION I'I?li
I iAZARDOUS MAI'IzR ALS DISCLOSIIRI?
Ill the up,bram or 1.1.11 burlding nacap.nLxlall or handle hamNousmwerial HEATING UNI'I'('10 IINI,(NN1 B'IlA
as d - nl by We Cti,aam o Munrclpal Calc.CM1upmr 9.12,and rhe Ilcallh and Saety
Cmx]e,Section 25512(x)1 HEATING(IN)I(OVER TWO Tu)
❑Yes 0 N VENIHAT1ONPAN(SIN .ERESID) PAID I' Rcacipt4
I Will the applicant or future building occupant a-cquip.nl nr devices which BOILER—COM('O OR 100.000 BTU)
coal hr ,indous air contaminants as defined by the Bay Area Air Quality Managcmlm TOTAL.
District? BOILER—CO (ovER HErmHH)RTD)
❑Yes
HIR Co' TIONER ISSUANCE DATE
I hu read Ise lar inntcri; rtgmenanu undor .I h 695 at the Cali
fnmin Ilia X Safoty Co c 55 ^SSl1 trod 25511 I undersand the if his N' RESIIIEN'IIAI.SUIT H. SQ.Ff.
I I'li I c nolwmnd tr ceemm.;L lbw it i. ny a,vacbifny mnmily Ace-lalum
11 cIli ry - - hf Prinrr uw¢cnl'u CuniGmnc of Ucmmcnry.
al
let r uthariettl age Dale TOTAL: ISSUEeD Ely;
OFFICE