S 2156 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELRCfRICAL PHSIT ND. 2156
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL PHS
BUILDING PROJECT IDENTIRICSTION
HUILDINGADDRI[.tiS'. ^^ `^' SANITARY NO. APPLICATION SUBMITTAL DATE
IT� "11
OWN SNAME: _ I PHONF CO '1'KACIYI 'SN E: LIC NO:
lT,r'J_'AV/ Z5377 ,149 NIC CDN'IX(lLM
t ARCHDTCT/INGINEER'. I.IC NO: AI /: p4DD ❑
CON'I'ACI': PHONE: / BUILDING PERMIT INFO
�b[�� ❑ Consultant Fees Paid by Applkaat(Initial) BLDG ELPCP PLUMB MECH
_J11 ! ❑ ❑ ❑
LICENSEDCONTRACfOR'S DI3CLARAUON QTY ELECTRIC PERMIT FEE
I hemny atlimt that Join 3r.:nm1 unmr Irovlsdons of Chalx«9¢nmmozing JOB DESCRIPTION
�aZ w'en union7axponrviantn3nnnexa.in�s and Pro rcannxawe,crinyhaanak RESIDENTIAL:
O PERMIT ISSUANCE
W• in full&rtro and erten ❑SFDWI. El KITCHEN REMODEL
�UV Licence Glu hieb 77 Y. APPLIANCH-S-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
�¢,w Dam Cnmm tiny
ARCIII'IIiCPS DIiC1ARA'I'I N ❑MULTI-UNIT ❑STRUCTURAL
Z 411
FO22N Z 1 uratenwnd Illy Plnnx,Mull he used al)pablic rounds PANELS' MODIFICATION
OZ- W UP TO 24)AMES EI INTERIOR El CHIMNEY REPAIR
Liccowd l'owcorwl 201-1000AMPS IMPROVEMINT 0SWIMMINOW0)1S
OWNER-BUILDER DECLARATION OVER I0X01AMP5 El PAT REMODEUREPAIR ❑DUAOLD'ION
y fX N¢ I nemny animal that I em exempt tram d¢Contraide,Liccnw Inw for tM EI
x3LL fell^wingm0.am (Smith7031.5,Booed-uu1 Protraction,Conte Any citymcounty SIGNS ELECTRICAL
OTHE
y which teynlres a permit to mnmrvc,cur,mtpmw,demokw or rptac any aractum
m it,i.CGIHIlca alert the learnt mal Intrde- fd moment `
�.+��' prim yo nic ITi panni g^ SI'1?DIAL CIRCUIT/MISC. -AL, Q.a
Eby dW M:tsan,lctl Section
kio Sot eBlawhr'e GcunwaLow lChulKcr9
lep (m be r,irngwithSmion hart of lBvisinpBohhas,oal escandtur Anyuns Gula)tr '(TMP.METER OR POLE INSTAL COMM F.RCIAL'
ap.c that nc i-.acmpt mcrefrtmt and tha hack Gtr Lha ulkgW cxcmgion.Any violatitm of ❑NEW HLI%'✓ADDITION ❑DEMOLITION
W^ Salnion 70313 by any F aporwit InNarldthe applicant0 a civil lwrwhyof POWER DEVICES
Way ❑TENANT ❑FOODSERVICE
not mora Mm five handled dnllury(ENP).
FZQ D I,mtwncr of the propcn%or my cntploy¢e with wages a,e lh7lr sdemm smion, IMPROVEMENT
SWIMMIN61YR)h BLECPRIC
]IN
CF$ rye.
12' wdltb thewtmt,and dv:xtrucwre to nut mtevded txottered[ails(Sm. 4.eacirccr ❑OTHER
W 3 aro Profc who
E U or imrc Cvnvacurls Liccnw l&A dola,rax apply w an awnof OUTLETS-SWITCI{ES-F1X'1'URPS
0' pt^M1nY wM1u IwtWc m impnrves dxxnn,and withal dcex such work himrclf m through
his own employed providW mad such impmvcmcnes ane not intended or oRcred htr NEW RESIDENTIAL ELECTR SQ FT
wle,If,however.the luildingorlmprovctrmnt i,-to within—ycerofmmpleme, he I SQ.IT.PLO(IRARL'A LSQ.FT.
oworm-bulder w ill hove t he fina of proving that he did not build tr'aar,w :for par-
pose
ar-
n1,afmk.),,ailowne,of the pro,mb,u xclnsi,ely comeeling with liwLwd entracte et 'f01'ALs
eruct Ill,Earr rt(See.7yi licesiona,and Ptnfes mLs Goa:)The Contracture Li-
ccLa.Jtxsa4alloy mrnfpmpcny wh�naihL ill imprnvo welcome,chat Q'T'Y, PLUMBING PERMIT FEE
who m
atmcte[ur ducM1 pnjmolts with wiN 0 contrnsor(s)liren¢tl punu0nnn the Gmtractrde
I tu:nw Law. PERMIT ISSUANCE
C) 1 um excel)atocr See .H&P C for thin rerun
Dom ALTER-DRAIN&Vi-WATER CEA) VALUATION
• O neo
WORKER'SCOMPENSATION DE CLARA'DON PACK ROW PN(JI'ECT.III?VICP.
hereby al3nn undo petal ry of Pf jury one of the fiilhwing Jeclnmtionp:
thaw and willntai by Sechow 3700 of ConuaOu Coace,fore for WUrreara CumpcIl-
DRAINS-FL(%IR.RWP,ARBA,CON1l. --�yNyR1-q�„� NS'fRULT10N
tion,m pmviAhi for mi Awa,h 371131 at the IsMr Code,for 1wrfoxmenm of tM a-
❑rc which will
pcmflt le taw W. FIXTURES-PI:R TTtAI' t_1
37 .O and alio mai,fee Worker,C racc olloi w rk far
an rearmed by SectMisread.
�1
J7fXl ufthc laMr Gdc,fonhc pcAxnwwcnf Ow.work roc winch Nis lwmtit is lrwt d. C/S-EA.SYSTEM-I INC 40IfITE1S V OCG GROUP 'N
My Wor f.,Cort n.wlirmnw C�Pin
Curia k,No t GAS_EA.SYSTEM-OVIR4EAU JAN 19 9
Oil C1V
CLIIICA'I'B(P TONFRWOHKF.RS'
C(1MPIlJSATIONSATIONINSURANANCH GREASFIINDUSTRL WASTE INTERCEPTOR BUILDING DIVISION t
Clhie ustinn nmdnuUcentplcmd dlM:)nnnu mf atw huntlmldttllarx($IU1) GRI?ASI?'1'RAI'
orltse) IIIiCK REST
Ie.nify that In the pcHornwnccol the wmkfor which this p:mtit in iswed,lsh011 SEWER-SANITARY-STORM E1.2IX119'.
tut employ any quoin I.any n0nneraa 1s b heeem mt,ed b the Workers Compcm ENERGY
7, mtlnn Law,of C'alirwarm,Dao WATER I(EATER R9V1'.NI'/HLUCfR
Applicnnt GRADING LEE
N
NOT'ICIS'IT)APPLICANT If,after ms4ing mu CCAGeam of lixcmpdce,you should WATER SYSTI?M?RPA'I'INC,
F lacwrw,-lapsh ,,Ne Worker's Cumpenmtitw pnwisians of the Ldtor Cate,yet mwq SOILS FHE
W [,v Crmhwith comply w.In arch pnrviaan.on mi,pcmr,ha11 he doems revoked. WATER SERVICE
a Q
CONSTRUCTION
uction LENDING AGENCY NEW RPSIDENTIALPLN11i. SQ Ur. PAID
yy
k for treatyethicalaw thattheresaam(tr3yl0oing agency for Nc perfommncc of RccOiplA
the wink for which Ni-e gtmtit in ixwtxl(Be,<z 3097,civ,C.7
Ictxlcr'n N'a.t0 'IYII',1L:
WU Leaders Address TOTA X
I ucmfy mal I have read thlx application and new thin ma alnrve moor naalm I, HUILDIN'F..
va] comm.I agree to comply with all city and county onfinances awl scale law,rade ing to QTY. MECHANICAL PERMIT FEE
Uz huikling conamn3n.and Notably whon¢mpareacomeves ofNip city banter uqm the SI?(SMI
ahuvcnncmi...tall proyee,in inspcnitn purpnow PERMIT ISSUANCE
(We)it"a..0 cove,hochandy cod krerm .v
p halaLha Cil,of C^pn' u a magaioP.LECTRIC
Iinhili3cs.judgnmms,coadarxl uxpcnrcc w hectically in any way.,me al,mar,will City ALTER OR ADDTO SUCH. -
rcqucnecM fares9 yyttling^ pcmtiL PLUMBIN G
A PPUCAN'I'ON : ffAN r5 A ) 'ILL.COMPLY WITH AIAL NON-POINT AIR HANDLING UNIT(TO 10,1X10 CPM)
MECIIANICA FF,F.
SOURCIilUiE1 ONS.
_ lissii gg AIR HANDLING UNIT(OVER IU,(XX)CIPM. CONSTRUCfIO. %
S.,im-co Baluunt/Cu^trvcur, lIax EXHAUST GOOD(WMUCD HOUSING MITIGATION FEE
HA%ARDOUS MATERIALS DISCLOSURE
Will the uppliden or future nuildne,uceuprmmore or hatolc hasaNtnenw0nal HEATING UNIT(10100,UW If IV)
as defined IT,Ne Ce,maro M^ntapal Core,C0p¢r9.12,aro the Health and Safety
Cele,Suction 25532m)? HEATING UNIT(OVER 100.0")BTU)
oyer W51. VENTILATION FAN(SINGLE RESID) PAID
a Will tl>L a Beam m future nuio0 t uvc r t or Jevius which
Data Recoils Y
pp goccapvn Area
AirQn HOILIER-COM('13HP OR 100,01(X)BTU)
tit hvarGns air atnlummunts m deft ti by the Huy Amo Alr Quality Management
IJ'estn'a? Yw ,�,( HOLLER-COMP(OVER UJIUV1BTU(
❑ Il{nn
I have read theme douen..make a fer 95
ui waChapter 6oftM Cali- AIR CONDII'IONER ISSUANCE DATE
y
fnmiu Hullh&Safely Cnk,Suiitms 25.Wn,a illy 0x125530.1 utoe iffy the
dal e,art NEW REBID ENIIAL MECH. SQ,FP. 9
hui Wing rkx_' col vhavcntz:l IM1uto ismy ..Ur Clemymrvxlfbuffvvpant /
of Jr rtqu msc Nr mm lxtabiewurm ora Cenifem ut( eupw y.
TOTAL:
Owner rr vuNnrivul n to / arc ISSUED BY:
OFFICE