27594 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPESION '•ELECTA PERMIT NO, rl 7
APPLICATION/PERMIT LING BING-MECEANICAL G
BUILDING DIVISION �. r.r•+-.,r,a BUILDING R ! IDBNTIFlCATIOn��.
594
RI111.DIN0 AOIJRFSS: f��y� SANITARY NO. AI'PIICA I��'1UN SUBMITTAL DATE
O I G !w-�+Ir UNITN LOT#
_NERS A :: CON CTO 'S NAME: LIC NO: ' `J
p6 o N& CCONI/ROLN
Ill' + WGINEF LI O: ADDRESS: ❑ �/
L lV_
ON'TAc: Np.� Q +1'ci », ELECTRIC PERMy'R014 t81 'Ad 0tH y ' BUILDING PERMIT INFO
PERMIT
ISS rx.p Awa y k•.,?:�: yrt Aria ELF.C7 F'LLIryfR MECII
PERMIT ISSUANCE /� �l"TCJ/I�.
LICENSED CONTRACTOR'S DECLARATION APPLIANCCS-RISIDCN'f1AL 10B D1'SCR IITION I
O'Y2. I hnehy affrnn'hat l Am licensed underproviaiom MChapmr9(commencingwi'h
w00q fullSectionrelaal efeNvisinn 3 o the Brainless And Professions Cale,and my license is in PANELS
CUU fullforceameeffter.
4Z vw Licrnae Clave Lic.N UP TO)(XIAMpS
vFaQG Date Comncmr
H 201-11MAMM
F ayZ ARCHITECTS DECLARATION OVER I"AMPS SQ.FT.FLOOR ARCA S/SQ.ET.
Ot 1 uadearead my planx shall be uaM a pubic steorAa. �j�2 03.
SIGNS ELECTRICAL JJJ r
Licensed Professional
Y� OWNER-..map. ROEbe Cmar caro SPECIAL CIRCUIT/MISC
OaU 1 hereby affirm Ihn 1 s hemp Tann the CnnnamA License law county
i0� fn ichacgnam.ISaai to 7031.5,Business star. And P vA4 demolish,
Cade:Any oily orcountyTEMP.MEIER OR POLO INST.
yg our t rtquisanpermit toconsumer,the dmr.impmve,h Permits firepair any swmurc
a� thiunnldiaeuonce,ehnmqui th the apsions fthe ConammRto LiceseLaJ,[atemrnr POWER DEVICES
0p 9(c lm(commencing
oloant Seddon TOM)
Provisions the Ce Businno ess
amt Pre Law(Chapterodd)
9lcad be Is In with Division to Allende xeueno.Any vilaCMr SWIMMING POOL CLCCIRIC
o gw ) ���VALU
_y mthnl heli nenlpr therefmm end the basis for the alleged exemption.Any violation of OUl1.ET5-SWITCIIES-FI%TURT•S
SamiOave5t I
I I 7031.5 by onyale dollars apumir subjects the epplinmloeNvll panels f
0
r mon'ben rrvrhtcproHurdldullaa(g90B. NEW RESIDENTIAL ELECI'R _SQ.ET. SIORIPS '1'YI'l:CONSTRUCTION
3$ ❑ 1,tanwnrrNns pmpuny.nrmyempindeeawhhwogmaalhduole rumpcnsiness
will do Profesion%and the stmcmmianol ow's Licenseed
Law
ed doe nor e(.Seeapply to an Business
and property
wh bu Code:The Convas s Liceme Law doh nn'apply m rt owner of
pmpero whobu Wsmimpmvesthereon,andwho doessuch wok himacefm Nmughh his
ownemployeee lifing edlhmxvis impmvemenmanaRitnandadornRmcd fluaames. OCC.GROUP R L. Nll'
hardr-1Mavetngorimprovenlem easold lse didna Wild.
0eowmr
builder will have the huNrn n1 proving Lha'he did m build a Improve fa purpose of
once {,.�, ;r 3tPLUMBINO PeRMIT♦�- `-'tYI: Bt• FUHIDZONf: APN
AllLnownerofrhepropenY.amhclusivelycanmsting with licensed contractors Y!!_' P2 ' r'�•i• •r}g:Y+IT siL �.
Imre the ptnjecr(Sec.T .Buainen and Prof"A".Coda:)The Connector's
Lie I.awdmsco epp1;loan ownarofpreperry who builds or improverthercoganJ PERMIT ISSUANCE
wrue poets for such projects withs comraam(s)licensed pursuant theContractor's pLT1iR-ER VENT FEE SUMMARY'
License w, (EA)
❑ I am nempt under Sec. ,B A P C for this reams BACK FLOW PROTE .DEVICE SANITARY OUTSI
Y N
er Pete DRAINS-Fl.00R RCA,COND. RECEIPT'#
WORKMAN COMPENSATION DECLARATION SCTOOLTAX Y N
t hereby affirm that l have.certificate of msent to seU.maun.or a eradicate o! FIXTURES-PCR PRECEIPT#
Wmkc Cmnpenwliminsurameorecenifredeopy'hermf(Sm.38M.Lab C.)which PARK FEE Y N
ecouratill employee's under this Permit. GAS-FA.SYSTEM-1 INC 10 Ef5 RCCEI N
Policy BUILUNGDIV ION FEES
Cornpany GAS-EA. -OV
❑- Cenifiedcapyhhcrebyfumisbary PLANCIICCK FEF.
06
❑ Camaadcopye.Rledwithlhecityilupeclinndivision. GREASEJINDUS MI CEPTOR ORADINGFEE
CERTHTCATEOFCXBMPDON FROM WORKERS' GREASETRA $0114 FF.E
COMPENSATION INSURANCE
(This aeaiml need nm becmmplead ifthe Permit ix fm am hundred dollars(SIM) $EWE ANITARY-S P. ENERG
or leas.)
I certify that In the performance of the work for which this permit is issued,l shall WATA4IIP.A :NT/ELE
Iwr employ any person in any manner so a an becmme subject m the Wluken' ppTD
Compemodnnl.awsof Celilomia. Date WATER SYSTEMfrRCAefI Date R
Z Applicant
0 NOTICE I'O APPLICANT:ILsRer making this Certifrcam of Hacmption,ymilhoold NEW RESIDENTIAL PLMB. .14. I TAI:
In becane suhjen m the Wmker'a Compeomion pruvblona of the lebn Cade,you most
fanbrhh comply with such Provisions m this peranp shall W deemed invoked. It 11 i V♦✓
(] CONSTRUCTION LENDING AGENCY CPRE
Z 1 heathy affirm ibar ahem is a cnnstmnion lending egemy for the perflum.me of
Q the work for which this perm'is issuad(Sec.3097.Civ.C.) CrweFTE
leader's Nus
lender's AddressQTY. .1` -,MECHANICAUPERMIT •��t�"�''i- il'IPE9 # di MBINO FEE
I acidify that I have read'his aCL. pplication and sun that the above information is f
cluster.l agree mcamply with all city andcoumy ordinances and pale laws mining PERVB r ISSUANCE. Ir FRE
y Wildingeanmatirm,end hereby authmire rtpnaentnivesal'cad city tocmmupon the ONSTRUCDONTAX
7 shave-morom M ryapeny lar inspretion purymee. ALTER OR ADD TO MECI I.
G (Wel.gree m cove.in,cmni! cep harmless the Clty of Cv al gain,[
liabilities,judgme rr,cmaond penanw icesmaylnany way see tart uy AIR HANDLING UNIT(TO IIt001 CFM)
a lluenc (hegr�lj moil perm t.
`a �� AIR HANDLING UNIT(OVER 10.011)CFM)
gat I Appmanl/Conim-L Data EXHAISTHMI)MMUCII AID
IIAZARU MATERIALS DISCLOSURE IIEA1[NO UNIT(TO 100,000 BTU) Dam Rtecipl#
Will the applicant m for..building occuperm a'me or handle haardnm quart
As dermd by the Cupertino Municipal Code.Chapter 9.12.and the Heshh and Safety HEATING UNIT(OVER 10.(I(IB BTU) TOTAL:
Cade.Section 25532Ia1T
❑Yea ❑No VENTILATION FAN(SINGLE RESID)
Will lheapplic.mmfuture building acupanruse equipment ordevicesIwhichemit BOILCR-COMP(SIIP OR 100,00 BTU) SIW A NE1V EIJffE
sus air contaminants a defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 101LOM BTU)
JUN 41 1995
_ ❑Yat ❑No NEW RESIDENTIAL MECII. SQ.FT.
1 have read&S femNaua materials rtqulrtmena under Chapter erst of thethat
if the buildinia ng
does,[ tcty Code,Sections
rant,that itis md2353C. lundenotifand that C1/7 ur
iftheanto tJmsnmmems yhaveast W AIca,[i'Is myssuance of
taonlaythe
cups of the rcyuintrmnn which mu,[h din pear m issuance of a CeniBc.m of
fkcuponcy.
flwnrr or uwhnrind ngrn' Data ISSUED IIY:
OFFICE