30336 (2) a. . .APPL;CANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY , '
CITYOFCUPERTINO BUILDING-ELECTRICAL PERMIT NO. rkO3
BUILDING DIVLSION APPLICATION/1'E"IT PLUMBING-MECHANICAL J( J( Jj 1V�
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
10610E FARALLONE CuPEF_-►ND , CA clSbt4 6
OW '';N MC PHONE: O CO nCjl'lt'S NA tph `/Q� C `q14� Nrc CO••vIROLN
1�ARCHITECUE.GINEER:KU M LICNQ U A DR 51/y!'A1 M RtI`flh7 IV� ❑
COMncP. 1,.(pJr�JJrMb 1 � h l BUILDING PERMIT INFO
R '�/`^A 11-CH
�,tail 1�� L V b N'HI ElConSWlenl Fes Paid by Appb=t(Inlllal) BLDG ELECT P U_A MECH
❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERNIIT FEE
I M1neby affirm Elul 1 am liccnsal oder pvaskince,of Chapter 9(commencing JOB DESC IPTION
�OZO with Semon] )of Division 3 of the B usima..aM Po,feesinns Cads,ad my lianseu VP,RMITISSUANCH RFS:IppNT�A)"rea _;
UW 'Lialiuer Cl WcBmf3 Lie.♦ ❑$IUWL ❑KITCHEN REMODEL
�W Uulc l.. Conlrenm APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
LCHI'ILCTS DECLARATION
F.,mow PANELS ❑MULTI-UNIT 11 STRUCTURAL
y O n Z 1 understand an, 1y Alam xit be uxd as blue rccards MODIFICATION
OZFO UP'IIs 210 AMPS ❑INTERIOR El CHIMNEY REPAIR
Llaeesed l'mfessiotW N)I-1(WAMPS IMPRO�YEMENT
Sym J Oal IsenBcnrptf DECLARATION OVER U00AMN ❑BA REMOVEVREPAIR 0DEMOLITION
Q 1 hereby affirm la 1 ensBUILD from ths,CL RATIO«s License law f«the
X 3 L U fdlowivg sea m,(Section 7031-5,B.sirev and Pmfcsxims Calc:Any city yr county SIGNS ELECTRICAL ❑0 ER
u1 O whlcb rcyuiru a permit m conurucl,.alley,improve,hmdirh,or repair any maximum,(�"�y prim l.aou.wurca oleo rtyuirn the 0aplicim fa sucM1 permit an fileenigrcJ swtcaa.:m SPECIAL CIRCTIIT/MISC
�} Wet heulianxd putt,..m the,provisions of the Comram✓s License Law(Clxgcr9
r �00 (nxnnrrcinywith Satim](()(T. Divisio130f I1cau
Bme.and Pmfeasioms Cutlet or TEMP METER OR POLE INSI'. COMMFR_ CIAI,;
qeC
flint he is exemp therefrom and the hasis our the Wegal essmptien.My.idaioe of
xmLL Smion l031.5 by any appI astalf«e Permit sub*ts the upplicam m e civil pemlty of POWER DEVICES ANEW BLD ITION ��DE4f ION
F'Z Ni- Ilan mac then five hundred collars($500). ❑TENANT FOODS RVICE
�O �1.u owner of clue propeny,a my anpWYere With wegn u their sale c«nprn-solum, SWIMMINGPOOLELECIRIC IMPROVEMENT
wall du the wart,ntd the..,,..mrt u Id inuvlM«dTucd fm role(Sm.]DW,Busineu ❑OTHER
L3 and Frole"ions Cute:The Crauraccor,Liana law Jas not yryly to sex meaner of OUTLETI-SWITCHES-FIXRIRES
mr,aEl who milds or improve McmW,and won doe..st 1,work himself or through
HE awn eafihrYan,Provided IHQ such iunlmwclems we rot intended or uffeml for NEW RESIDENTIAL ELECTR SQ FT.
,ala.If.hnwesn,the Wildingerr mutations.is sold withinlneyanr.fconnpkii ,ma SQ.PT.FLOOR AREA s,sQ.ET
r-builder will base the buNcn of Proving dot k dd no ibuil l or improve for Par-
pmcof.wlc.).
0 I,an uwrcr of be M piny,am exclusively convxting with licensed cavaectvn to TOTAL: ,
.tared the projnt(Sec.](WI,Busircv and Pre llcas ens Code:)'D a CalWact«i La-
i cear Law deas rant apply to an ower.or property whs builds or improves thcrc«,end QTY. PLUMBI PERMIT FEE � (]
whols[
aw -f«sua ch prajecwith a cammcam(s)licrorni pasuant m lit,ConlmcluA {UG.2 11996
Licvnsc law. PERMIT ISSUANCE
❑ I am exemp trader Sec. ,B&PC fa the rtauv It. I
ALTER-DRAIN&VENT-WATER(
�DWaR Date �'"a VALUATION
WORKERS COMPENSATION of jjus,, DECLARATION BACK FLOW PROTECT.DCV
I hereby alErm under peuW ty of perjury ane d anC fdlawley dee Watians:
Ilmvaamd will maiaaoine Ceaufw-alc of C...nt msalf-ienee for Workers Compere DRAINS-FLOOR,ROOF AREA O STORIES TYPE?CONSTRUCTIONnation,as provici for by Saction 3]00 of aluc Lahur Cods,fa the,pama.. nm of Etc
V"for which his pennil in issued. FIXTURES-PER TRAP
1 have ad.will auintein Workers Cunprmoliam fine..a,m raquiml by Senium
W olthe laM1or Cale.f«cur perfammurt ofdc w«kfm wM1ich this paadc is iasaual. GAS-G.SYSTEM-I INC.40UT '
OCC.GROUP q1'N
My Woher'n Cuq�epe cla carrrr erd Polley py�{�rA ugsw A/
Conicc �Pdlcy O WORKS 1�Y11_7` GAS-G.SYSTEM-LVPR 4(EA)
•/ CERfIFI COMPENSATION
WORKERS'
COMP mpila 10F INSURANCE GRGSI%INDUSTRL WASTIi INTERCEPIDR
BUILDING DIVISION FEES
Ghia.ectiam neaA mabe couragaad if the prmua isf«axae hlmdred doilms(310f1) GREASETRAP
«leu.) G ANCHECK TEF.
I savify Oat in the any manner NawMf«which lads pamuit isiu,Cono,Wl SEWER-SANI'LARY-STURM EA.200 FT.
red cmplaayany rc ifom many moaners vt M old n bjccl co the Wohm'Cvrtrym- ENERGY FEE
z swim lawA MCplifomia.Dye
z O Appliavm Mua n _ I W'ATI:R HP.ATER WNFMO?I.ECIIt GRADING FEB
y NOl ECB TOA (CANT. ,]fan m :ivy the Cmificate of Cscmption,you sh mid WATER SYST iM TRBATING
� ? becoasesubjemmahe Woh 'n Coney im Mp is oft Labor Code,Yeamue SUITS FEE
0. ti forthwith comply anal wchpro'iumss.'this perrnil shad]be dearmtI revoked. WATER SERVICE
Q
az CONSTRUCTION LBNfaNGAGBNCY NEW RESIDENTIAL PURL SQ.FT. PAID
VQ l,frwhich thith coWereisscrxuanus. letdis.ayearY f«thcperRmaance ar Daae ReaigN
Ile wash r«which this
pcmdt is iuual 15a.309],civ.C.)
Q U Iantkrs Nana TOTAL
L) t.codc/s Address TOTAL:
,a y 1 eenify clan I leave read thin applieaioa and Slee able lc ubarva iafrmaim u BUILDING FEE
y correct.Iagree mcomplynnithall city"roomy udinaaaces and stale laws achaingto QTY. MECHANICAL PERMIT FEE
U ax ,bei Wing ccsm lime,aid hereby amharlre repmeneuvn of ane city to cnterupm the SEISMIC FEB
above mcn0vnal proprny f«luspedion Puryoscs.
(We)ogee m save, adcmnify old keep lamde.s the City of Cupcn rso,a ut PERMIT ISSUANCE. ELECTRIC FEE
Esblliliee,judgmano,costs ad expenses which may in any way name eysina said City ALTER OR ADD TO MECH.
l comequena of the"ears'of Thu permit. PLUMBING FE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT CDI 10,000 CFM)
SOURCE REGULATIONS. MECHANICA�WK,I� QAINr� �_ AIR HANDLINGUNIT(OBRIB. MCMI CONSIRUCII
Si fAPplian tractor ��V"I-_' D 'Dona EXHAUST HOOD(WIDUC1) HOUSING MfIlGAT10N FEE
H ARDOUS MATERIALS DISCLOSURE
Will the applitram or furore Imildly accupun stere or handle lureacous macral IIEATING UNIT(TO IW."BTU)
u def,nad by the Cupertino Mumicipd Gado,Oogv 9.1;atd hale Health arta Safay
Cale,Nation 25531(.)'1 HEATING UNIT(OVER 10(1,000 BTU)
❑Vn ❑No VEN IL,V[ON BAN(SINGLE RMID) PAID
Dae Reaipl N
Will ie appli-ant«fwwsu bulWiny by ft Hai,A an Air Qat«de.ias which BOILER-COMP CHP OR 1(0,(100 BTU)
emit IwzaNaus air rnnlamirwu.u akDval by tic BNY Arm Air QwOty Mavgalrcna
IHsain] TOTAL:
❑Yn F1 N') BOILER-COMP(OVER I00,000 BTU)
i love rtAJ Ile haxaNws .seals AIR CONDITIONER
raryirtmms alder .I ares ora d the Gli- ISSUANCE DA
(matte Health&Sofny Code. , you]55115,is any and 25534.E a na the
Ihaa if the NEW RESIDBMIAL MF,CI{. SQ.FT.
Wahl;ng des oa cuorncly Kant a raantp chat.Is my eupamlbiEly le IaotifY dac mvpem
M le re9.iremmu wnian m..a m cant prier m iawena era cemfiam arclaapaay.
Owmerorau0axamdagent Date TOTAL ISSUED BY:
OFFICE