S 1754 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUE.mrvG-F.I.KCI'RICAL PEtfr NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 1754J
BUILDING PROJECT IDFNI'IF'ICATION
BUILDING ADDRESS: SANITARY NO. AI'PLIgA'IIONSUBMI'ITALDAD!
3 FA1 LEJv N E -7Z
O NRS NAMXQ� r_ QO'I;: ` fON ACIUN'SN�D I.ICI: �U
LL ,L•V�l/� l� L NIC CON)'HOLN
ARCH PI!CD NGINIIRR: LIC NO: ADD S: ^, f �L„ ^�, / /)Q ❑
F.��titxOUX))ol
/� Y'. PIUNG /lYn /Vn / ,/r,T IYYVJ c BU/IL'Mpi(1`(�Q�e q 7�1 D` ❑ Consultant Fees Paid by AppllC nl(Inifial) BLDG ELECT PLUMB MECH�91V 1/v h ❑ �LICENSED COKFRACIUK N DuCIARATION QTY ELE(TRICPERMIT FEE
am mat 1 am nese 1anter pnwinasof Chapter 9(eoro nine JOB DESCRIPTION
Zol Oivisim 9orlMHueimtam l'ndcWonecmr,and myliana it RESIDENTIAL:
O PERMIT'ISSUANCE Ofect ❑$Fl)WL ❑KRCHFNRI:NODIiI.ULk.0gppl,lANCEs-RESIDFNTI,\l. ❑ADDITION ❑PLUl1BIN'G RE-PIPE
N 6 6Zw Ihlc Cod_Im
ANCIII'I'ECI'S UIiCLAH6IION ❑MULTI-UNIT ❑STRUCTURAL
F.D. PANITIS
ZOv2Z lutxfcruntd my plyns Dull be used..'wic raeonh MODIFICATION
OZ-D UPTO?XIAMIS [I INTERIOR ❑CHIMNEY REPAIR
FaBF' Lienal Prar"iar,l 101-H")AMPS IMPROVFMENT SWIMMING POOIS
CYC OWNER IIUILUI!H DECIARAHON
law for dw OVER 1000 AMPS (_1C\1
BATA k0D1/RFPAIR E ❑DEMOLITION
m
C Q 1 thereby a0it Jut 1 urn nempl from the m
Conlcon'x Lictma
6xx 010 fallowing reemn.IS Usarn 7031.5.HoorRsx and Prafca.a.code:Any chy or county SIGNS ELECTRICAL ❑OTHER
W 3 a.vFi which mynirn a p[nnil m c^nrtmal.alw9 Impmw,Jcmoli J., h rtPeit any nlma,rc
^�0q prim to ie, ounce,alsa rt,naes tba.11ieam for so,h 1-1 at file.1i1n,,1 aashashe SPECIAL CIRCUFUMISC.
Yl. tlmt he u liccmcd parman to ale potioorhT of the Conitslnts Licerssc law(CM1npter 9 e
RI�00 (mmmcneing wim Section71)00)ofDoi,-J.Bse Buvitlevv haul l'rofcraiora Cale)a TFJa1P METER OR POLE INST. COMMERCIAL: l
6 6 e That The is exnoN Iherefmm and the breis or the alf,,,eJ exemption.Any viol,......of ❑NEW BLEGIAMATION ❑DIIMOLI'HON
-� Sndi.h 70313 by any,pplirra for a pcm.sub U,me applicant t^a civil pnultyaf POWER DEVICES [I TENANT ❑FOOD SERVICE
td E-Z more Nan Eve hundred dtdlan(5500).} OTHERVEMFl.T
xQ QLathawA.the d pnmcnymmy cmphrytax U InDagcsasmcirrac,um.B.,iTnn. SWIMMING N%)I.ELECTRIC
w(..,D wall llaer.im,.anile xwcmmlcher'.mntk,n Lata sksesaM ade(Sc"a. tlasimb. ❑OTHER
la�j-' am elly o be Calc:The Cmtdxlor's Eiead o ,Ik Joa ata ark hi s if awner of OVfLEI:s-SW'rrCHES-FIXTURES
a 3- In^Ec^y woo builds pr impmvn thsuch and who fires conn wnle caec!(lf a through
M1..own nse er, he beildi , , .too in.pmvrn Id le arc not i,a... on ota-Ins NEW RGSIDFMIAI.IA.I!CI'k sQ FI'.
.It.,lM1 ldlear lhase aehmen.17 mum tflaah did hatnWildor nhorsetxm.mc 0 U.F7.
starts(-tuilJcr will have the hunlen of provin5lM1u k did ata build m impnne for pus- 0
❑
F1 1 of rale,]. D
I, a owmrn[the Sec.7 y,n. eina simly cr.tteei ng wim liacnsad annnan%I1^ L
fNnw Incprojnd(.Sec.o.r kh.ofar ryPrasVysirm C^Jr:)The eS thstram.I.i
chorea Jon mtepPly to an Dara,oflegety wcrassd Po-rat tovhe mcmm.ead QTY. PLUMBING PERMIT FEE JUN 2 2 1999
wMa c^mrsrc fa wen pmjmis witM1 n nomrud^r(s)litrnsed purxuant m IM1e Ctmtmdor'n
License Lt, PERMITISSUANCE
1 am exempt,Iger Sec. .H A P C for Nis rtvun
ALTER-DRAINR VPIO'-WATER(PA) " VALUATION
O rcr DIO
WORKER;SCOMPENSKOON DFCLARA1 SACK FLOW PR(JIl!CT.DEVICE
I ne,eny affirm urdcr letmlty of perjury orw of Be,masure n5worloe imo:
❑IMa<vnJwkeilo mwnahwan37 tcof CanehuaC,e.arm he lVCNdnCanpem DRAINS-ILOOH,HOOh.AHIA,GOND' S'IOHIP_S lYI'13 CONSTNUCfI11N
work(r Pm.wcd Ins ,i Ss T,u IJIXI of Ile 1aM.Clde.fns Ilm�:dnmtu.ec of the
F1I for arch ill .,itisiaueJ. IId'NHIiS-PER'[RAP
1 hare rad will atmietaia h"p ro C n-oftthe w Inwzxc,u requiml by Scdian
i9lptft���{{{'''labor Crdc.fm the pclfnmumenf the work for which tn.e pe�Jlx loon). GAS-Ila.SYSIlA1-I INC.)OUTLETS (KQ CROUP AI'N
Aly Wo ({)�N �M1ROf yol'icy nun W� rQA
Carder /f l/l�' -L/N/ Nu-: Y�Yw/ CAS-IiA.SYSfF'M-OVENJ(EA)
cu rficAns OF EKE.MP'NON FROM WORKERS'
COMPIIJSATION INSURANCE GRFASMISDUSIIC,WASTE US IRCEPTOH
BUILDING DIVISION FF.1!S
(IM1in.vstnn txrd ala be aanplded it the pennil is furore M1uaharl lh.11an($100) GREASETRAP
a Ins.) PIANCIIECK FTE
I eenifylha inlhe peffrTmmmafthe wM fawhichlhis carrell fd.aoad.I stint SEWER-SANDARY-STORM EA.200 FT,
ton anploy any Par, in any nunoor m ut u.Mcdne vmlect m Jta Wnrt,d C-.,.- ENERGY FEE
� z vtilm WworCWifani.Daw WATER HINTER WNEN'DELECfR
Aph.I GRADING FEE
Z
NOTICE TO APPLICANT:If.after melting this Cenilicac of Ilacmptinn,you whoa d MATER SYSTDHM/1'BEATING a SOILS[THE
bc'vaa - h a,T to me WoA"Cnmµns deo pmvihi,n..nftM IubnrOtt,,you ntusl
� .. Iamsmnomply Mtheuch provisions a this remal dull be JccmcJaesoka WATER SERVICE
a �
ZCONSTRUCTION IGO aCADS L h AGENCY - NEW NLSIDENTAh PLMI1SQFC PAID
UOMrtny.tins.tem there uarmmnwnkminge yGxme pHnnf
Detn RttciptN
Ile wort for which mit perom is iteacd(Sen.3097.Ci,C.)
U LcnY+l Nutre TOTAL-
U I,Mke,Aidreaa' TOTAL:
0. 1 ceoify tem I have tneJ this apphwatieo anal slate duet the above in0.totinn is HUILDI il'
F V) ennM.l egacememnply wim all<iry and camlY m4nnalcex and slue tear.rtlatingm QTY. MECIIANICALPERMI'F FEE
U Z building camrndion,am lwreby surnanm haMscntmivn ol'Ihixnity matter uprm the SEISMICF-
aMrvomcmimRd pmp+ty for impv<tion pi.Ux..cs. 1'ERAf IT ISSUANCE
IWea 4rtt to.so,iMcmnify and lcmrw
ep hatkv the City of Cupcniagaiml e ELECITtIC
Iia1,ldies,ludgmmtr.cors entlea,n,,s which may in ary waY attrvcageiml said City ALTER OR ADD TO M1IECII.
n¢IlwrceuftM gteanTne Adis pcnnir I'LUMBI 'FEE
APPLICA 'I'U O!RS'I'A )S AND WIL COMPLY WITH ALL NON-POINT' AIR HANDLING UNIT(TO 11.17(X)CPM) ./�
SOURCE ll!C 'IONS. � 9qqqq MECHANIC .FEE. ll
'] AIR HANDLING UNIT(OVER 10,(U)CEM) CONSTRUCDON TAX
SI . AV lir nl/fonttm'he O� Date I'XHAUSC HOOD(W/DUCT)
HOUSING M11ITIGATION IIHi
IIA%ARIx)USM iR1,\IS DISCLOSUkI!
WIpCh,sar no Mumhil mgle,Chaptsuncot hurdle thealtha Saical IiPATING UNIT TO IfIU.IXM)BTU)
as defined by IM1c Culeti.w MuniciptJ Ci.le,Chapter 9.12,wJ ale Ilcallh anal Salety
Code.Scdim 2351200,'
BEATING UNIT(OVIJi I W.IpB BTU)
E)l'a FI No PAID
VPMIIATION PAN(SINGI.Ii kEN1U) Date R"I,ipt5
a Will the applichnt m future luilding iy the B um hTa Airttem or 14 ana mr,ot
mitM1valloun xJ eauamitwar4liad by lM Nay Art..Air Wality M1latugrnrnl HOILFA-COM11P()IIP OR Id0.IX10 BTU) TO 1.
Doltict,
❑Yes 71 NIT BOILER-COMP(UVER IIXIJMXI RTU)
AIR CONDITIONER
1h <r vvdaus itvcrials rryuucnenu,.fins CTaltcr693 Mthc Cili- � ISSUANCE DAT'In
Inmia He nR yCide.S 'ns 235113,23511 and 3551.1.1 ttlramd ma if'M NEW RISSIDLNTIAI.MECII.
it n Indy ha �m Lltwt it i.my rrep.s.bilil/li'mti tlm rccvPnnl
ill Lu amkn Ipltir ufaCM r
[Tviiern a .imd,guns U,m LI ;SUHU If Y:
OFFICE