S 3262 (2) APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL Plitt r No.
RUILnING nIVISR)N AI'1'LICATION/IeF.RM111T m.uhlxlNr..MEcunNlc^I' J 3262
BUILDING PRIIIECr IDF.\rIFICATION
HIIILDNG ADDRESS : SANITARY NO. APPLICANON SUHMI MAI.DATE
1 ks'�s �R A /lohc, u r�i,(/�� ('-4 r 9s�/ -�3 -
OWN` S NASI is / - TC �� I'I NG'^^� �n CY)N AC( (�a1 Fy-^ n IC �� NIC CONTROL«
ARCI 'ECI'/ENGINEER: LIC NO:L,Y Y A H//.,�/N G� ❑
� ��s'l-�re�iVc
C( ACI` T PHONE: EUILDINC PERh11T INF(]
/�In/E�C ❑ Consultant Fm Paid by Applicant(Initial) IILDO LLECT PLUMB MliCll
LICIiNSHD CONI'KACfOR:S DECLARATION QTY ELECTTICPF'RMIT TFL
I frothy dEmr tM1m 1 on Tosca.,,&-rpm keen,m Cmmrc
arr,v mnemg JOB DESCRIPTION
with SaGon7000)of Division Jof Um BusinesseM Pmferams Carta.ad my lies is �>�
t+l O p �I(meq/-/r / PERMIT ISSUANCE V 0 RFSIDENTIAI.
aWF in full f�ncm-----� '} dJV-%/J ❑SFUN'I. ❑KITCHPA RIJNODHI.
V ficcnrc Clanx Iic.1
Qy V AI9I.IANCES-RGSIDt1SfIA1. ❑AUDITION El PLUMBING RF.-PIPh:
6 L Dam CmI1ID:mr
ARCHITECTS DECI.\ HON ❑MULT'h UNIT ❑SfRUCI'URAL
PANFI$
Z O'"Z I u aw
rr.l my plan, tarif be awa cv
awl as Icrdz MODIFICATION'
CZ- UPT0200AMPS El INTERIOR ❑CHIMNEY REPAIR
1=r?Fw Liccmml Rote,,,msl 201-EMAMPS IMPROVEMINT (]SW'IMh11NGPOOIS
OWNER-❑UILDIiR UIiChAxAI'ION OVER 1000 AMPS ❑BATHREMODEVREPAIR ❑DEKIOLITION
oC
3: w Q I hien, if,.then I..cacmpd from IIs Comnamnl x IjOm-Lew far tM1e
xx O6 V fall wing rnaam.(Sec,o.70315,9mine r mod 14n ofessimCode:Any city or carnal, SIGNS F1ECfRICAL El OTHER
W 3 u.E' which rtyuirtx a Wermit m rnmm�,ct,anti,imprnaa,dcm,lixn,m rcluir anY mmc,nrc O
C, SPECIAL heificaool TomlwntTo the U,nepitans ufw Contrannin^far,e Lavlamtermm SPECIALCIRC,UR/h11SC.
J nM1vt M1c in licrnrcd nnlbc ftM Cmmm�nLaJ,ian.u:Law
CTD l (
C) pndsaxn rmvixmnxn ( noir
ad C) (commercinp with Scdinn]gp)nf Uiviridm JN Ur Narirtos oast Pmfeaums Cndel nr TEMP.ML-TER OR NTIJ?INST COMMERCIAI:
L e E Ihw he in cacmp flarmfmm and 1M M1uxis for 0r alleged caenption.Any vi^Iwion of ❑NEW BLDGIADUrrm [I DEMOLITION
4•� Section]031.5by.,.Mixanl f^raperrnil auhjecstin,aroieann n^ecivil penallyM POWER DEVICES y ❑TENANT ❑FWD SERVICE
mR nwru,han Five nanJrrJ ddNlun(SSIMp.
IMPROVEMENT
SQp doars, oofthe the IIm is
wvgcseuM1eCiock cnW,Branum. SWIMMING POULIiI,ECD2IC
and P,the imk and the r e Com is r«,d inumlcd mothered!dd fr.Hale lSce.](114,Baidtcss ❑OTHER
W3m and who
G,o:'ITc Cmt mab. wocmc Wwa sm,hwrL him,ani hmagh OlJ'11.LTS-SWITCIIIS-Ie0.'NRI'S
hone own who M,ikb aio,pmveat.,h I,udoan—who kca n some dee it
ofehd!for
M1n awn cmploya:N Wilding r in.inch impdnvc Id w mm rcx intended mf m offered!Lx NICW NLSI DI1SfIA1,ELECTR SQ PI'.
sale.ILM,weay.gr buldingmimpnrverrrm is sold within case par n(edmpknirm,the SQFT.MOOR AREA USVFr.
owner-hailcier will neve the handed of oving,hul he del not build or improve for Ino-
Pose of sde).
0 1,ua water M dM1c Enycny,mn c nelua,vcly runvanin8 with Iicv,a,crmvactmx do T(ITAI.
on moa,the pmjrv'I(Sec.70-41,Huxm¢a and Pmfncrmnn Code',)T -Comair',I-,-
ca.
rc Law does no npply m an mwnu of mPcny.1m builda m iroff—,nerom,most QTY. PLUMBING PGR IT FEE
whocomrs,s 1-s-11pn,jcne with a aenmto s)licvnttmem m wm
d pxuthe C^ncr'x
Nemec I,- PERMIT ISSUANCE
I am ex—Pt adder Sce. .H&V C Lr fiat.reuwn 1
Owner DateDIiC1ARA'HfIN AhrEH-DRAIN&V - :K(FA) V U
WORKERS COMPINSAfION HACK II.UW I'RIYI'ELT.UEVI APR
e Ihenehn ya1lirtmmatr penalty of perjury die of Ur follwing deslard.
Ej I havonml will maintain a Cenlfcate of Consent to wlf-inxare for Worker'.Compen- DRAINS-11.00R.ROOP.AREA.00 STORIES TYPE CON UCf10N
scion,n prvicad for by Seeman 3701 of,he I� Code,for the performan,em of the ^
k whch,M1I x mIxvnnuaidinis WIwmp,kcclls Compcnsatitm Inrunrrc,a.rryupimd by Satidm FIXTURES-PI?R ANAP
GAS-I .SY$lA-1 INC74
aX1^fdh=- Coo,.media cda.rde,wnhfayJ
B.T.GROUP APN
My W'orkc Nsel I mores asst Policy
Carrier g arse Pdiry No.: rL GAS-IA,SYSTEM OVER 4 IRA)
C?RTI1 ',OPIXNPI'IONIItO.MWORKERS'
COMPINSATION INSURANCE GREASFANDUSTRL WASTE INTIBCEPRIR
BUILDING DIVISION FEES
(flu—:Dian tai nm M1acumpkvd It thcpron IS fmdmn hunleaddalao(Sini) GREASETRAP
m has,) PLAN['11EGK FEE
I emit,that in the lrifis arlaofdr won,for which thio pcman issued.I shall SEWER-SANITARY-ST(1Rh11A,210 IT.
mg adToy any pma m in any manner so m to became subject to the Wmksre'CooT,ei ENERGY IEE
wk.law.of C.1im ia.Ilam WATER HEATER WNINr/ELECIR
z O Appliaam GRADING FEE
in NOTICE TO APPLICANT:If,eld[r making thin CcniOrndc of Exemption,you ahendd WATER SV:SfE Ii RIiATING SOUS HE
a ; hem....c bjna kNs m me W^, C^..dNa,unn mo,kin t,m mob
e los Calu c,yomit
Lk7 rWtwi,ne^mply with h Nooi,mm,orthix femur roan the dan.drevul.ed. WNUE,R SERVICE -
o.
CONSTRUCTION donna LENDING AGENCY NEW RILSIDIiNfIAI,I'LMN SLIT. PAID
UO Tofu hichdh.Nadnoi M...ISr,..V)k.Cing agerlry,for the pcdmrrercedR I NacipN
O (✓ Inn wdak Gr wnicM1 Uin feint in ianunl(Src.31x1].civ.c)N
L<rT HAL.
dcr's uru
V limlcr'x AMmj. TOTAL:
I ccnlfy that l have read this application nd aam,lml the.Move iarmnmion is BUILD :j:
.�. tq mdmvlar,cb,cmply won Wl miry ud cwnry urUirarxv.into.lawa«la,ingm QTY. MECHANICAL PERMIT FEE
V Z hoildinec,entmOom,ad M1emM1y his chy ae mui,m U,e SEIS. CFEP
" ehove-enendiorrd Wrt,peny fae irr, m nPllrpocrs. PERMIT ISSUANCE. �_
(We)agnc m sole,inlemmfY a,.1 kdxp ban,,] .the City of Capmino ak'ainxl 0 I?LI?CC ale
liebililiee,judgrnena,cws enduperu Tokio mvyinanY lay accme.gaina raid City AIXER OR ADD'FOMIiCll.
I he rranWtg ofthis n VWMB GhFE
APP UNUIiRSTAN A WILL CUM PLY WITH ALL N HNT AIR HANDLING UNIT(To IOp00CPM)
S I E EGpULA'1'ION1. MECHAN AL FEE
mrcm o
�5�� AIR HANDLING UNIT(OVER U.W0 CIM) CONSTRUCTION TAX
Slgnumrc ufA n racmo y Hate EXHAUST HOOD W/DUCU
HAZARDOUS MATERIALS DISCL(AURIi HOUSING MITIGATION FT!H
Will the epWliram mfmum balding dreupant VrucanaWlmFv urk,du nuacrial HEATING UNIT TO 100.000 BTU)
a defrost by the Cupcnirm Municipal Code.CTapmr 4.12,and tem Health and Safely /
Cede.Scmmn 25532(x)! HEATING UNIT(OVER Ifgpfl(1 RTU)
❑Yes 0N VENTILATION PANS INGLE R PSI U) PAID
Dam RcadH«
Will the n,amnaur Tam«building by upnnlyArauipnam^rdeviseswhich BOILER-COMP CTP OR 100.000 BTU)
edit M1uardoux air rnnamiNnrt as dcOrvl by the Nay Ana A,r Quality Mvnegcmcm .A,.
INrnirl
E]ye, ❑No HOILER-COMP(OVER I W.WI,HlU)
AIR CONDITIONER
1 vc r�adtk nmxnfol mans Jn rcyuirenocnn uNnr CTal«c hYS std me Ceti- ISSUANCE DATE
It &Safety Cd . 505,25533 asst 2SSJJ.I uNe TUde NEW RESIDRNITAL MECH. SQ.FT, 7 l�
M1d angp roto artcnHy My n.mw in it my elnmsiNlilY ton ' ,hc vvfunl �/s 1
m 0i M1mu. rt facenifr /
Ow m emb.i'reJ vgcm I>tm 1 L: V ISSUED BY: 1
OFFICE