99100045 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY !q Q Q
CITY OF CUPERTINO BUILI11N6-F,LFCTRICAL Mx TNO.
BUILDING DIVISION APPLICATION4)Ell %AMHLNI:-aMECHANICAL
BUILDING PROJECT IDENTIFICATION
tlI11LDING ADDRESS: SANIFARYNO. APPLICATION SUBMi TAL DAM
SNAME I'll(ING_ C Nf CMY yR:ti NAM LIC NO:
_ 11 NIC COMRai.TO
AffialCHITECIYI? -INFER. LIC NO: AU)$Ii S: y� ❑
COM'ACT. MAMMOSE !1) 1 h BUILDING I'ERMI'I'INFO
❑ Consultant Fea Paid by Applicant( i ifial) HLDL FLECII'LU.MH MECH a
LICENSED COST RACMOK'S DECLARATION �'ry ELECTRIC PERMIT ITE
I nanny amml ISO,1�ml hccnad nII Ac,prmgsioas of Clioti 9(rmmnrminy JOB DESCRIPTION
C) w1,h Smi.700 o mon Jofdae Rmirl and liter ons Code,and my licrnec is SIIF�AS
FSB in Nll ftra-talc ,te: . %iRMIT ISSUANCE ❑SITIWL ❑KITCHEN REMODEL
< C) DocwCl Caamat APPhIANCES-RESIDENTIAL El ADDITION PLUMB INC,RE-PIPIT
V' ARCHHTCI'SUEC ION C1 MULTI-UNIT ❑SMIJCR1RAL
z O h z I on&eland my plans shall k u.d as I,ohlk rmNs PM'EIS MODIFICATION
ozN�u OTTO't(10 AMPS 11 INTERIOR ❑CHIMNEY RI7PAIR
Q�FJ Liarascd Profakmml M-10(XIAMPS IMPROVEMENT F1SWIMM ING POOLS
OWNER-BUILDER DECLARAIION OVER IOro AMPS ElRATIN REA10DELRI-PAIR ❑IHiMOLITION
y I hereby-Nora chat I um c,imo l from the Canteaam's License Ivw fur the
x O6 U fuTeatng teumn.(,Section 70313,Husiac s and Profs sitm Calc Any city or mainly SIGNS ELECBICAI. ❑OTHIiR
LL7 3 u 2 which,,00a,v prrndt ,,Cnnatmu.neer,improve,denteh'i.m re'r u e,ara"a"
C) IT ITm cut iswncec.Wm cactim the applicant fw sacM1 levmit to filcaxigmJ nlmcnunt SPECIAL CIRCUI'Ioff ISC ,l Q
lny I hat le it l kenud Noodanl to Otic provisions of Na Cmtnctor'a Lkctta,Larw ochann 9 �/i
O�O COMMERCIAL:
5 Iamnencin8 with Section 9IXXU of DivisiunJnf,ha llusirccr Sal l'n?areium Cudelw TIlAI'.MEfCR OR POLO INSI'.
a a ce K the,k is exrnlpl therefrwt and the basis fur the alkgnl eaemp,ioa Any loAmhn of ❑NEW BLDC/ADUITION ❑DFMOLITION
Smoon)11315 by any VV4cull for a wrout othjecu Ile aMIwanl to a civil pcaT of POWER DEVICES
not more than Eva to dleA dollars fS50.0) ❑";NANP ❑F(K)U SERVICE
1-=6 Les owmrof,k pr4enY.wmY cnnpbya_a with w.gcx astkir aAc anmprmainn, Sw'IM1IMING IGGL F,I.FCf IC PROV11dIiIT
f G willdt) :work.mdlhe+l tmcirauintc oroRemlfnrvak(Sm.](W.11usieev OTHER
6 w arc Frofcumm Code The Cunlrvnnr'a License Law,h nal.pply 1u an,ei of OUR TOT-SWITCHES-F9X'I'URF
luk own wlu kie,m cicicd cs tknmo,eel who ales a ouwok cRal or larmugh
bis awn em cr.cr,prolding ,het rush imni is"nts are rax imen(et o phare..for NEW RESIDENTIAL ELEC:R SQ F1'.
evW.IL Mwcct,he Miilding nr intprovcmcnt ix add within 2(w yrvof cmnplwiun,tk SQ.IT.Il.IX1R ARL'A 5/SQ.FT.
oratter,tal will have the huNcn of pasvine,hat bedid Test build or impra.e for pur-
01nr cl
,owomofthc qn%oro oxdnsiroly cnmmcollg..In l Lcn.¢dmmmmawm TOIA t-1
mencreac,the project(tics.](WL Boines.Orel 14uf—ons Cade:)The Coroomim'x Li-
sense
i- I I
c se lyw docs raxap,4y to mtowrcrot'proerty wN.kOdstrimprovcx tk,mn.ad QTY. PLUMBING PERMIT FEE— IJI
who mm
n, conOrrharcM1 D jcets with a conlmclar(n)Been,,] ran
p t[it the Contractor's
Lccmc Lrw. PERMIT'ISSUANCE __
Iumcxcmptuodm Sm. ,B&PCfortJak vwm � '�
ALTER-DRAIN&VESIT-WATER IFA) I 1IV LUATFN
Osvmr IL/
WORKERS COMI'ENSAI'111N UIiCIARATIOTION BACK PLO"'PROTECC DEVICE
I Fcn:by dErm,tri R-,nuhy of perjury one"life.folewing dtclmu,io o
,J 1have and will mnidiMn a Cmaricvte,ofCtonwn,to self insure farWrkds Cwnlen- DRAINS-FLOOR.ROOEARFA.COM2 B TYPECONSfRUCI'ION
m,1on,vs pruvl(lal for by tiec,ion 39ro nl W2(lahcr e,ex p
Coal reRvmwrck
e of,
w
for which this pcoot Is issuM. MIXTURES-PER PRAM'
haze ant will maintain Werke's Camlrnselvn Imam et.as nryuiatd by Seclim
39roaf do latexCoale,Oxca,perks-uf,M1ework for which this permit isissued. GAS-ITA.SY,STS1-I INC.a OUTLETS OCC GROUT'
My W r�p pa iiun ImTamnc�rCN r and Policy lY� Ip
Cattier ""ITN �..W�Pat No.: L ��I GAS-PA.SYSIF.A1-OVFJt J IFA)
CF,RI'IIICATE OF EXEMPTION PROM WoKK17RS' O
COMPENSATION INSURANCE GREASIIWDUSTRI,WAS INTERCEPTOR
BUILDING DIVISION FENS
lThis.sec,wm rand nowlecunylacmiftk pnmic ixfw the hutted ddlan l5l ro) - --
ur lax..l GREASE TRAY %ANCHIiCK Hili
I certify No in the p,doonerce of the work for which this Fenein h is,ocT Is hall SEWER-SANITARY-STORM EA.M()FT.
rot cmplay any percent in any remoter m to haemeN
iubw to c Wmkeriml
Cpe t- ENERGY 111:
O z s.,iun laws of C.IiOwln hate WATER HEATER W/VE1afGFLFC R
Z GRADING FE?No applicant
h
NOTICE TO APPLICAM':If,-flat nuking this Ccnift.ce of F.acmpion,you shauld WATER SYSOiM/TKFAIINO
a ["' hacalow suhjec„n tk Wokcls Ccxnpensution pmvisiom ofthe Irber Code.you mos, SOILS FEF?
t� Lmhwi,hamply with .h firiomens m this Fannin shall lw nacawrl mvaAed. wAPER seuvlCe
0.
CONSTKUCI ION LENDING AGENCY NEW RESIDENT IAL%AIH. SO FT PAID
U 0 Ikrcby elEnm thm,hncixornwrvc,inn lendin8.gcncy funk pafnmtwanf Data Rcaipt
U Le wlxk Nwh'Ich Ohis lermit ix i.wcd lSn.l09).eiv.C.1
Q I .r Nane TTI.:
y1 easily Bait 1 have reac,his applicei ar l slate chat tk akrc Infi.I,m is BUILDING IIF
h cortex.)agree mcnmply won all Oity.td coumyadio co and vmc law.murine to QTY. MECHANICAL PERMIT FEE
V Z kildingco—o—itm,ond Mreby aulnixire remcxma(ivcv ofdnisci,y locnt—'a.l k SEISMIC FEE
Shoe-mcntiwed prtrpmy for irryeaitm"o,a'. / PERMIT ISSUANCE
(We)agate to rave,itdenmlly and Lac,hnmless floc:City of C'ulcnirao.,.a,, ELECTRIC FEIi
hTdTIoics.jadgmcnu.clKu 2(M cxfenwe which may To any way accrue ayaimlmel City ALTER OR ADD'FO MECH.
vr,segrcncei ice gral M,his FenniL PLUMBING ME
APPLICANT UNDI3RSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.N)0CFM)
SO I RIiGULATIONS. MECHANICAL FIE
AIR HANDLING UNIT fOV1iN 10,f1IX1 CIM) CONSTRUCTION TAX
S' n. rca AlrplicTaCamx
r ,or Ion HXIIAUSf II(x)U(4II1UC1) HOUSING MITIGATION FEEHAZARDOUS MAMRIALS DISCLOSURE
Will the applicant or furore huddingnxvvlwn.r,txc ce lumlk hovfdnus material HEATING UNIT 070 IM."BTU)
in,nYfinal by the Cupertino Municipal Cock.Clean 9.12 aryl the H.:ilb-rant.Safety
Cada.Scaub:5532(.)'! HFATING UNIT(OVER Iro.(Mlfl BTU)
❑Y'cs -1 No
VENTILATION PAN(SINGLE RISK) PAID
Will tk.'Tfama or furore killing occupant uvc c9uiprrcn,or de,ice,which Date Rncip,X
rah Mmrdwr nif conwoinanu as lk0ad by,he Bay Areu At,Quality Mom6cmcnt BOILER-CO&I'(3111'(lR l(X),(XX)H'I'UI
Tf 11'A I.
IhawB BOILER-COMP(OVER WIT000 BTU)
❑Yes EJNo
I have cad Me W—Jkoas mmedds r Ncoam Cm 6.95ef rhe Cull- AIR CONDITIONER ISSUANCE DATE
ryuia per
fani.health&Sal Code, imlx 15 ,25533 end 25511.1 unkrsam Ohvt if,k NEW RF_SIDI:NIIAI.MEC.H, v1.17.. / _ a _ 9 y'
hui agg' Ily Uva LLrmi it is mY ncspasibdiry en naify ce onvF m, l// 0 D 1 /
o[,Je ralai a Dora Towne}of a Cenilicow Iry
(h au,htrved agent Dae TOTAL: ISSUED BY: I ley
OFFICE