S 1772 I' a APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
-'ITV OF CUPERTINO BIH DING-FLECTRICA]. Pli TT NO
BUILDING DIVISION APPLICATION/PERMIPI'LuXIIIINc-] U
IKCANICAL 1772
BUILDING PROJECT IDEN1'IF'ICATION
BUILDINGADDRESS: SANITARYNO. AIWLICAGON SUBMITTAL DA'IF
D �- 600/ e -g —'? 9
OWNS 'S NAME: FHUNE: CONTR rOR'S NAM': LIC NO:
N/c CON'BOLp
'III I'IiCUENGINEER: LIC NO: ADDRESS ❑
9
CON'IACI., PHONE' BUILDING PGI2MI'I'INFO
I � ❑ Consultant Fees Pahl by Applicant(Initial) BLDG ELFCIPLUMB MHCH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PfiRMIT hili
o z 1 hereby alum Thal 1 am licensed under provisions of Chats v(commencing JOB DESCRIPTION
wish Semon 7000)of nivrsmn del'be Business and Prafesio.,Cotentin mY license is RESIDENTIAL:
W p PERb11T ISSUANCIi
1-lyy� lull force and clYcc CCfT ❑SPDWL ❑KITCHEN REMODEL
QUI Liccmc Cl s 1.icM `��T APPLIANCES-RESIDEM'IAI. [I ADDITION ❑PLUMBING RE-PIPE:
r Q L pale Cnonraaur ❑MULTI-UNIT Q S'IRUCfURAL
Fpy ARCHITH'i SURCLARAHON PANELS
Z p,oZ 1 unde...m d my plans shall N:used as public records MODIFICATION
pZ`N^0 UPT0200AMPS El INTERIOR [D CHIMNEY REPAIR
W Liccnnd Pref..omit 201-1000AMPS IMPROVEMENT SWIMMING POOLS
lin F
d OWNER-BUII.Dli12 DHCLARA'I'ION
C d I M1crcb (firm that con cxcntpt from the Contractors License the OVER IBdd AMPS ❑BATH RF:MODha/RI?PAIR OIiM01.1'I'ION
❑01 HER
X 3OrU followingnerom.(Section 1X31.5.Bus.ne,xand 1'rdasamn,Code Any city......only SIGN
ELCCTRICAI,
W a-h which require%a permit to Consumer,alter,improve dlor repair any smmcmm �i r
Fop¢ prior to it%issuance.also nations,the applicant for such pen++it In file a signed statement SPECIAL CIRCUIT/M ISC.
f s�Car
�- that he is licensed premium m the provisions of the Contractor's License Law(Chap¢r9
WEE 0 (corrmencingwith Section l0(IB)of Division Sol the lousiness andlvatesdo,Codc),r TEMP.METER OR DOLE INS'C COMMERCIAL'
y y c C that he is aempt therdmm and the basic fist the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Xby airy applicant for a permit subjects the applicant to a civil prealtyof POWER DEVICES ❑TENANT ❑FOODSERVICE
�y Section 9031.5 can
m inner than five hundred dollars(5500). IMPROVEMENT
ESQ ❑I,its owner of the pmpcny,or my employees with wages as their-le Compensation, SWIMMING POOL BLECTRIC
W t: willdo the workanJ the,mr,Rov is not olcoded..ndfurod[.r mle(Sea.70,4.Business OTHER
W j3: oaf V,oI ewiun,Code:The Cmmrnclnr's I-went c law does nm apply ,,an owner of OUI ITTS-SWI'I CH Es-19 )
3^ �lof,n,sub..loold-a improves memo..,and who doer Inch work hiotw:Bnr thmo.n
his x m ,plo,te provided thatIncM1 Imprwaacnp are et intended lir Cleared for NI?W RESIDEN'I'IAl.Ii1JiC1'H
sale.it.howe,e,mc bulldingor in+pu %mo ose cold within one Yearov, nelcoon,the SQ.'FI'.II OOR AREA S/SQ.4T.
owner rudder will have the burden of proving that he did not build or improve For par-
posenlwlc.L TOTA '
41 0
❑L us onvnur of the p,anm nm exclusively conaa
oing with licensed rac
contnm%m
enncor the pmjea(Sec.l(ClBusiness and Aufesxi.nlCWc:)noCommunes Id-
nscLaw(lots not apply to an owner of prnpcny who builds or improves thereon,and Qty.. PLUMBING PI7RNIIT FEE
who omtm.tl for such projects mirh a Commands)licensed pursuant to the Contractor's
License law. PERMIT ISSUANCE
❑I an,exempt under see. .B&P C foe this reason
ALTER-DRAIN&VENT-WATER(EA) VALUATION
wiser Dae
WOR Ke,pCUM enalyeff,SA'I'IONDECLARlo ne, HACK FLOW PR(YI'HCT.UIiVICIi
1lwreI who,ntma penuryor Saticoy CoCol e+.rouowf Wordeckks-oro:
In.as nalwill for
Se Cion 37ofut lot
r Corensum forWimou coutfa- DRAINS-PLOOlt,12(IOI:,AREA,GOND' STORBZ6 'I'YI'Ii CONSTRUCTION
semina,us pmvacd for by$e,,..n d. lit the Luhm Coln "unhc per!noun..nl the
k me which this Iodm+it is Issued. FIXTURES-1'IiR TRAP
I have and will axle,Rot Worker'I mme,ol he w Insurance,th required by Section
37
GAS
laM+r Code fonbe perlormuntt..l me wed for which this pemtil is issued. GAS-EA.SYSTEM- INC.J UlIT1.E'IS ` - OCC.GROUP AYN
MY Work-`Cisyy+pens�+o� Ise+�ttcarricr and Policy nu
Carries �r^ ('1�'E(G� n I'n1icY Nu.: 3�.'s7.—�J GAS-EA.SYSTEM OVER J(IiA)
CERTIFICATEOFHsros;IISURANCE E PROM WORKERS' GRF,ASEANDUSTRL WAS III 1NTEHC8
COMPENSHON INSBUILDING DIVISION 11,
OLissecomeneed Imbe Crmplemd ifthepennit ixforanchundreddnllavOS100) GREASF.TRAP
1'LANCHECK FEE
less..
Ccnily brain the po'rformmcc..Ilhe work for whicM1 tbispeomit is ianuul,IsM1a11 SEWER-SANITARY-SlY)RM EA. IT yr
not employ Imy person in say manner sen as to be,o to cooled m the Workers'Cn iten. IN &D
FBC
Z 9ariun Law, A C'ulilinnla.Uwe WAITR DENIER W/vid,ri iFLECIR
C) O APPIic'wn TEL'
NO WE Uy APPLICAN"C IL atter n akmg mix ceodi'am of Escuprim+,You sIt..nld WATER SYS'I'IiMITRIiAI'ING
h THE
hamm�c subject m Ibc W..h rs Compeor his pmvit hal nl me Laboreedr CUJa You swat
limhwilh comply with such provisinns nr Thi,pennil shall M1e deemed revoked. H'A'TER SERVICE
1.14
0. o= zCONSTRUCTION LENDING AGENCY NEW RFSIDENTIAI.I'LMB. SQ.PP Dae Receipt pU O I hereby affirm don them is a Conswction lending agency for the perfonnaace of
,4 the won,fur is Inch this permit is isued(See.10al,Civ.CJp 1•" Lcralm's Name 'I OTAhU Lender's Address TOTALI cCoify that 1 have read this application and srac that the above intnnnalion is FliF,nmett.l agree to Comply with all cry ami County ordinances and.ram law%relaringo+ QIY. MECHANICAL PERMIT FF;I? FEEzi hnlldingcon4maino.and hereby unit no,relfrocntutivex of this city to aacr ups thunbvcnan(umW pnrpcny rnr innpccriun prposcx. PI?RMIT ISSUANCE C FEE D(We)ugrce to save mcnifyH I Xarp LauJees the City al Capenino agoi i"yay:...... adrel%old City ACI ER OR ADD10 MUCH. G FEE
in cou,ayucnee of the foaron,of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOCI'OINT AIR HANDLING UNI F110 ILIXNI CFM) MECHANICAL FEE
SOURCEIj�:GUf l'IO:V'. •���T
%Y///a � lq/ OY AIR HANDLING UNIT((IVIiR 1o.WU CEN) CONSTRUCTION TAX
SigEamrc.f Ap i. nU'mmmcmr Da, EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATI:RIAI S DISCLOSURE
Willlhe applicant Cr future hindingmcupar,o.eor handle hmallous material HEATING UNIT GO Hindi B'I'll)
a%de incal by the Cupeniou slunicipal Code.Chapter 9.12,and the Health and Safety HEATING UNIT(OVER Ill Hl'U)
Ga1c,S Section 255)2(x)?
Will the applicant nr liRr Nu PAID Yes
V ENTILATION PA N IS I NGLE RESI D) PAIa-atc RmciptX
rebuild....oa sup... use cyuipmcm nr daviwn which BOILER-COMI'(llll'ORIIXI,INXI11'I'U)
it,haranloms air Comer inmms.,,Joined by the avy Arca Air Quality Mana.emea 'U TALI s
U'ntrict l BOILER-COMP(OVER 100.000ItI U)
[-1 Yet,
I have real the h:nardnusnwterials«yuimmtcnu under Chapter 6,95 of the Cali. AIR CONDITIONER ISSUANC17 DATE
our.Ihealth&Safety Cod,Sections 255115,25531 and 25 534.1 understand that it the NEW RESIDENN IAL MECIL SQ.FT. r^^ v[ UQ
building dere, wmenev have a imam.in.,it it msporoibiliry m notilylhe"cupant V U
of m m m is which list he n¢I prion.issuwrcc of sir a Occupancy. a (�
erg t S Dae TOTAL: ISSUED BY
OFFICE