27589 (2) Adrrw rAN I vu TILL IN In rVNM/g 1 TUN WI I MIN MCU LING)-USNt FALL YUIN I F'l UNLY
I-UILDING
ITY OF CUPERTINO ''- PERMIT NO, p
APPLICATION/PERMIT PLUM G-MECHANICAL O
BUILDING DIVISION OP OJ TI c n'u
(AppRPSS: �� SANITARY NO. API1lG71pN///SURMrII'AL DART:
- UNIT# LOTN
�v�,IOWN NAME: �� P CONTRACT R'SN� LIC NO: 1 ,
NIC Col OL N
14 Full] ECT/ENGINEER: ,1 /A ADDRESS: ❑
ONTACT: - PHON& siV�• car:., +y. pu.{^ n
.i ss r+ r.., :.x t ..
F .M w. tN t;r .: YB .,I'.r :5 k:41+ rBUtLDINO PBRMf1'INPO 4
T & r J3 Djl Fy PLUMB MPERMIT ❑ ❑
C :.
PERMISSUANCE 1vJ/, II-Jt�ry
LICENSED CONTRACTOR'S DECLARATION APPL"CES-RESIDENTIAL
F'yz Ibercbyefr."'hallamlicenadunderpmvisimsofaapler9(cwnmencingwlN ` O N
00 Sc¢l.00(0)of Uivisinn7aftbeBusinaamd ProfessionsCMe.mdmylic.nubin PANES VV
roll force and ercea.
F zyl Ucenne Cbu Lic.N UP TO 200 AMPS
m y Dote Contractor 201-1000""
1��
b ARCIPTECTS DEMARATION OVER 1000 AMPSSQ.FT.FLOOR AREA $/SQ.Iun knatu d myplans shell beusN u public acmd.. SIGNS ELECTRICAL
Licensed ProfessionalOWI a. BUILDER OF.0 Cturam ON SPECIAL CIRCUR/MISC.
V Ing no .form thatlad 1 em esemN Tran the Callores o License Lew farco the_H!Ofhich ,.hasao.(Smtinn la)LS,Buafteimpr Rofcermih,carefAnyul,
city
anmcaumy TEMP.METER OR POLE INST.
Wom'S which requimn a permit m conatroc6 cher,improve,demolish,err repair any etmnurc
] �E 'imm it,lu......1'.ragman theepplicanl fosuch pernitto RleesignMmlernent POWER DEVICES
G oNnhe is licensed parent m Be provisions of the Coarse o'er Licenx Lew(Chapter
Y. 9(commencing with Section?W).f Division)of the Business and Prodm ism Cade) SWIMMING POOL ELECTRICVAIXA ON
chatheis.ampnhertfmmmdlbe has[.for to dleged cnempkn.Any 0.1.1iomol OUTLETSSWITCHESFlXl11RE5 S�
CFoQ Section 7031.5 by anyappliceel far epermit mbJecu ue.Ppli<anunecivilpandlyof - - —�•
50mmathan Dv.hudy, .m
nolatm(5500).
0Lennwnttn(tbepmpropnymmyploymwilh wegesutheirmlecoon atim, NEWRPSIDENTIALELECRI _SQ.FT. STORIES TYPECONSIRUCIO
a willdot ew rk,aMlhesuuaumisnminwndedmoffertdrm W.(S .7m.Bmi.n.
and Pruraninnr CMe:The Cnnbaclor's License Lew does ml apply men owner of
pmMny whnbuildsmimpmesihemon,andwhodmasuch work hlmxlforthmughhis OCC.GROUP ES.DNI T$
ow n employecs,pmv ided thatroch impovcmen a em mU m.ndd or offerM fm role.IL
however,the buildingmimpovcmmnt in mid within one yearofcomplc0on,Ibeowner-
builder will have the burden of proving that he did rot build m improve For purpose of y�<���
xO.61..eowner ofthe property.ens endmivelyconhacting with licensedcomnnonto r'�y�'+t.yp.Pl:U1.1BU14 PHRMIT` W �. k�'N'.1 '(1�� LOOD 20 E APN
!<rlrgs.. _dJA41nY.�.g'e.
Imunmel the project(Sec.7W,police.and Profenians Code:)11.Connor's
Licence Lew daesnm apply manown.rofpopny who buildsm improves thereon,end PERMIT ISSUANCE
whncontncts for such projacu with ecanvectm(s)licensed pursuanumheConoaclolx ry+qv.•'µ V N
License law. ALTER-DRAINAt VENT-WATER(MA)
a ❑ I em emmpt under Sec. ,B&P C Ins this aamn BACK FLOW PROTECT.DEVICE Oul SIDE FEES I
SANITARY Y_N
Own, Dote DRAINS-FLOOR.RtIOF,AREA.C0 0. RECEIPTN
WORKMAN COMPENSATION DECLARATION OOL TAX Y
Rir
I hereby em that l have.cenificaue orcoment to o4f-insum,or a eanifrcem 11
a( FI URB Pf:RT P RECF.IPfN
akerr Com,msetlon lmmenceara cenlBd cap,Ihermf(Sce.JggB,Lob C.)which PAR FF,Ii Y N_
Case,,all employee',under this prmh. GAS I C. S - RF.CEIP
Policy BUILDING DTVI. NFE'
Company GAS-EA SY.I M-OV CC ) P
LANE
❑ Cmiliedeopyhherebyfomished. 1
❑ Certified copy is Bled with the city insisted.division. OREASE/I ST WASTE INTER
CERTIFICATE,OF EXEMPTION FROM WORKERS' GREASETRAP f
COMPENSATION INSURANCE
(Thi,serion need not be,completed lfthe permb is froom hundred dolian(5100) SEWER-SA TA - T EA.20017.
mlem.)
I cenifY Bad in Bte prfmmanccaflh,work fm which Nis permit B Issued,[.hall WATER TE .LECTR
not employ any Anon in my manor m u to become subject to the Workers"z Cnmp.nsation[AwsofCdironia. Dau WATERS TEM/TREAT Rec.IptN
Applicant
0 NOTICE.TO APPLICANT:If,after making this Certificate of Exemption,you should NEWRESID: ALPLMB. SQ.FT. TOTAL•0 PA
become wbject to the Workeri Compensation provision of the labor Cale,you must forthwith comply with such provisions m this prmil shall be domed revoked. Q9 1
y CONSTRUCTION LENDING AGENCY SF,ISMICFE
❑ Z I heathy affirm that the.in constmction lending agency for the pr0mnance of
ELECTRIC .E
�) O the work which this Permit ininnued/Sec.7098,Civ.CJ
1 Na LenderY Nome Ys ^Ty.r- - - - t
"v+ Ht s t y-r i, lie,t. PLUMBING ,E
Isndert Aadrcv }l MBCFIANICAL PBRMIT.� 1 ABB+'e.
J k.:
I ttrtify that I have red Thin ip arrolcou.rd sate that the above information refning la
correct,Iagr.emmmply with dlcity eM cauoymdin.meaed cine[ewerrefiningupon
pm PERMIT ISSUANCE
MECIIANIC ITC
Vy abovengationed proert bercl.yamhaiurtpaenudves of Nlecity menttt upnlh. CONS'FRUCIO AX
j
above mentioned property fm impnim Puryosa. ALTLR OR ADU TO MECIi.
•7 (We).8.cave,indemnify antis head .the Ci fCupnirmegainci
liebiliticn,judgmcnu,aosu mdcxp ichmo yaccnteagdnn mid City AIR HANDLING UNIT(TO Igap CFM)
In ren mgr gal ono(.
AIR HANDLING UNIT(OVER Iggp CFM)
g' n sere of li a ur eu EXIIAUST HOOD(W/DUCT)
HAZARDOUS
eMA'gcu DISCLOSURE
HEATING UNIT(TO m."t RTU)
will theor holding
occupant nnte or handle un l
as dfineA byffieapplicant
Municipal CMq(Rnopmr 9.12,edB<Health MJ Safety at Rem o N
IICATING UNG'(OVER Igl,glflBTU) 'I 1'Ala
CMe,Section 25532p)7
❑Ycn 11 No VENTILATION FAN(SING(SINGLERISID)
FNEWRrSIDENTIAL
P OR 100,IKKs RTU) ISSUANCE:DAT
Will the epplicanni olum,.befliveg by the ay useArea Airn reality which caul
,�
flet? air conuminmu u deHnd by the Bey Area Air Quality MNn.getmmVER 100,0lil BTU) 410
A
❑Yen ❑No MP.CII. SQ.FT. �JI hove sadthe rc[y CM.materhB 5505.2ntenta under Chapter brad nd the 0 �8Celifo ha a ead t SafetyCMe,Scctiagh on th255n7 ant S37hapter .mmdthattthe it ,if the building does ren currently have.tenant,that it is my responsibility ro notify the / YIcmpam of the re0uiretmnts which mol be oat prior m imam.of a Can!ncne of 4Q
Occupancy.
Owmr or millri.d agent ) Dou _TOTAL: ISSUED BY: