25926 (2) APFLIGANI IU TILL IN INFVNMA I IVN all l MIN nets WNIM0-UOC PACT rvuXt rQIN .,ruI
CITY OF CUPERTINO
BUILDINGC- ' r1:RMn rvD.
BUILDING DIVISION APPLICATION/PF.RMI'I' PINGPROJECT IDENTICAL 5
BUILDING PROJECT IURNI'IFICATIUN J
IIIJILDINO NDDRUSS: SANITARY NO. AIg1.ICAT10N51IBMIITA1.DAlli
ICICold JAAjP`,�31DVZc"CLNI I I-al
I VINURSNAME: PIIONE: CONTRACTORIS NAME.'. LIC NO: NIC CONI Rf1LN
III 1 C I I'VI V rY7 '
CIII'IECT/IiNGINIiCIF.
1.11C NO: ADDRESS: El
Aortic �Az_ p
CONTACT: PIIONf BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT EEE .
BLU(: F;Lf:CIPLUM11 MECB
�. PERMIT ISSUANCE O ,R1 El
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RISIDEN'i'IAL JOD DISCRIPI'KIN
GCZ ihambyallimnhetl am licrnvsl undo PrnvicionsofCM1apmr9(vommeraing with
WOO Section RXXllol Diviainn 1 of the Bu,in,cs amnlnfeuinnx Cann,and my licence is in PANELS !�C I C I �1.}S.�r.. l pr j p—
FZWC fell bettered effect. iI i
<V Liana Ch.. t-��la' I.ic.x I4i S / �J' Ur10200AMPS 1
H=y Dam II —.alt comms VCE+✓`�X 2(11-I(XXIAMPS
/puke. . M. - �Z.
f7 SU.19'.ILt H)H AREA S/SU,1'I'.
Z~O�?_ ARCIIIIECTS UIP RA'll N OVER IUXI AMPS
OZ-0 1 understand my Plans shall be used as public records.
F y t W SIGNS ELF.CTRICAC
Lio esed Profcaionnl
Q OWNER BUILDER DECLARATION SI'F.CIAI.CIRCUIT/MISE.
YOa V I hereby allimm that I am exempt from the Cmn tern,Li9cn.a Low fit thin
W3LLya following region.(Section 9N[s,Business and Professions Crsdm Any city or coemy TEMP.METER OR POLE INST.
I'LLO J which requires a permit reconstruct,some.improve.demolish,or repair any Interum,
poor to its issuance.also requires The applicant fee such pennil rt)file a signedxraemem POWER DEVICES
M=<2 ohm he is licensed pnrxeart to w the famildcna of the Contractor',License la (Chapter
aS0 9(commencing with Section700Blnf Division J of me Businra and Preferences Circle) SWIMMING IOOI.FLECTRIC VALUAI ION _
yxj_y
cartoon he is cmmpnagefnner and the basis bottom allcgd esanp(inn.Any Anlalionof OU'1'LIN S-SW II Cl IES-FIXTURES
�Za Section 70115 by any applicant for a penullsubjects the applicant to a civil penally of
S 0 ma....Iran Eve M1unNeJ Au11ars1S5(XD' NEW RESIDENTIAL ELECIR _S0�1a SI OR his "I'1'1'Ii CONS I H OCT ION
C � ❑ Lonnwaernf rlepmleny.nr my employees wimwagnaerhmirrulecomptnw(ion.
a3— will do the wcrl,and the snnvorm is not intended oroffemed fnr mle(Sec.7IN4.Business I�
not PrnicssinCrile fit,Crilfit,Commctore license law does nm apply to era owner of V
PmperiywhnbuildaorinlM,,veahereon,nndwbodmaeuebwnrkhinrcelfortbrnugMTis OVC,GROAT` HITS.UNIIS
ownemployees,p1 ovideti that snit)improvements art not intended or offered for sale.If.
t— I
hen ever,the building or improvenem is veld within one year ofeomplelon,fle nicer,, 'TOTAL:
builds,rill have rhe hooker of proving thin he did not build or improve fee p.,,,a of
ole). QTY.
mPLUMBINGPERMIT FEE IL IONI AIN
I'N
El Los renhc pperty,amaclmbid,cr ncoming with licensed contractors 1.
ania me.,jet,(Sec.7044,Business and Protean s Code:f The Crmtmeor'a
Lieen.cel.awdcasnota,plyvmnur
w.moflmrpenywholmildserie.prmesrher /erm,mal PERMIT'ISSUANCIi
w hocanvaaa fm auco projects with o comrecmnq licensed Pursuant look Contractors
license law. AFTER-BRAIN&VENT-WATER(EA) FEESUMMARY
E] I oto unnPl under Set. .11&P C for this..,,.a BACK ILOW PROTCCI.DEVICE. OU I'S DI: {:I:S
SANITARY YN
Owner Date DRAINS-FLOOR.ROOF.ARBA,CON D. RECF1 N
WORKMAN COMPENSATION DECLARATION SCHOOL FAX Y N
I hemb,alfinnlhatlhnve ecenificam of mnammrel6insurc.macenificaa of MIXTURES- / RliClill'TN
l ,Yorkers Compensation Insurance nraanifiedrnpy thereof(Sec.311M.Fish C.)which d PER TRAP PARK ITE Y N
n all rmployce's traderthis pennir. RI!Clill'1 p
fiAS-IiA.ST'S'l1iM-I INCA(JUTLID'S /� BUILDING DIVISION FEES
I'clicy p
El Cee' GAS-P.A.SYS'U:Md1ViiR4tiA) PLANCIIECK Flili
❑ Cruised copy is hicfiled of dist)sty
�CenifioA copy is file)with the city inspttnion division. GRF.AS171NDI1STRI.WASTE.INTERCEPTOR GRADING IIiP.
CI:R TIIICATE OF EXEMPTION FROM WORKERS' CiRBASf:TRAP SOILS Rip.
COMPENSATIUN INSURANCE
This section—it nal he completed ifrhe ..it is furnace
hundred dollars IS Bar) SKIVER-SAM IARY-STORM RA.20017. FNFRGY FTE
lin Ices,)
leenifythm irvt)epenonemiceofthewnrk fm which this permit isismed.l shell WATER HEATER WNENTIFLGCIR
not employ any Person in any manner an as to become subject or the Worker, PAID
Compenwtinnlam.cof Cnlif..eige Dale WATERSYMITIAGRBATING Done Receilna
O O Applicant
NOTICIiTO AI'ILICAN 17:If.after mnkinglhi.s CMmn
ificnf Esenmlion,you should NEW RESIDIiNTIN.PLMB. SQ.FT. TOTAL
Z IZI haeme aubjecnn the Worker's Compensation pmvixiom or the laMn Cole,you meat BUILDING FEE
a 7 firth,int comply with such prevision..or this pemtir shot[he deemed revoked.
0. [� I(INS"I RUCTION LRNDING AOENC'Y SEISMIC FgH
7
1 trench,infirm"1131 therm:is a tomvucrion lending agency for the perfmnance of z' lac work for wM1ich this (is issue)lStt.Jf19T.Civ.Ch T EL1!(TRIC(Thi
V 0 perosi
D.. 5 L enc,, .s None
O Leaders Addma, QTY. MECHANICAL PERMIT t FEE rl.unlmrvr,GSE
r 1 certify that I have read this appli,mican end wa that the shove information is MrcuANICAL FEC
aa.l agree meontply wire all city mtdcoumy ordinances and stole lows mia"in8lc 'PERMIT ISSUANCE
�" Vy building construction,andlmrehy aulhoriro representatives oflhircity to enter upon the CONSTRUCT ION I'AS
V Z ,Mee namioncd pmlerty for inapemira purpaas. ALI IiR OR ADD TO MCCII.
(Wath agree at cave.solemnify and keep may in c me City ob Cupnnino said
Cityltabslitirx,jvdgnems.nnrsand expenses which mayin any way accrue ageirmt nniACiry AIR IIANIJLING QNII'(IQ IBJXNI CfM)
in c/nln.aynrna of the gr anti nor of oris permit. )
IIiX� AIR IIAN DhINC UNIT(OVIiR 111,(XXI CFn11
Sitcom eon plicam/Clmemero ' '-- D.a 17XIIAUSI HOOD(WA)LICD PAID
HAZARDOUS MAI TRIALS DISCLOSURE I FA'IINGUNIT ITO 100,000BILD Dare HmctipN
l Will threat lic:nnm furore buildingaccunat store or handle Imi:ndmis mater.,( IIVA'I'INO tINH'(OVER BXI,IIIm Ratio
n 1.11 ed by to Cupminn Municipal Carle,Charter 9.M2,aml the Health and Sure.,
Crale' nn 2551225532(a'! VI:NITLATHIN PAN(SIN(II.I!RPSID)
❑Yea ❑No
uAFJCE 1,71 r:
N'IID
thatdt
le applicant at Imore building mention use eyni pmcn or devices wonIIOB.ER-COMP UUP OR 100,000 For FU) N I a
melena air cnnwminats as defined by"he Boy Arca Air Quality Mameemen, BOILER-COMP(OVER IfXI,P(XI BI U) �"
•Ionic,? I lEB 16 1
❑Yes ❑No NEVI RISIDENTIAL MCCII.� SQ.R. C
I have mad the hazardous res iah requirements under Chapter I95 of me v4
9T
C.dilorom l ict&Salty Code.Sec(imn 25505.25531 and 25534. l i ndersand t s. UYr
if cu helloing mei nm omni w hover tenant,tom it is my Issuance
eihility rt)Certificate
the h I IIVI
occupant of the reyuimmen".a which meet he met perm to iccua„ce of•C<nifium of
Occupancy.
Owner or mnimrivcd agent Dare TOTAL: ISSUED IIY:
OFFICE