31301 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF C.`UPERTINO I BUILDING-ELE C'TRICA I, PERMIT NO
BUILDING DIVISION APPLICATION/PERNIIT PLUMBING-MECHANICAL ( 1 3 1
BUILDING PROJECT IDEN3.LTIFICATION 1.
BUILDING ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DAIP.
o co 3 1 F 4�t✓w�� o�-
OWNER'S NAME: 1'l1ON@ L
[ONTRACIOIi'S NAME LIC NO'
U JDkR
`� ?:1, L �5 `� NIC COMHOLY
ARCHIIECTIENGESEER: UCNO: `�J DDRFSS:
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Connlltant Fees Paid by Applicant(Initial) BLDG E�EGZ PLUMP MECH
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE J018`DI{E_$CRCI rPTy—IIO�N—
I hereby atheam � au n I licensed ucr povixiof CMmm
pter Y(coencing
1�1yy�Z with Sauon]aAMM),o Division 3ofthe Butt.uta Profeuinn.CMe.undmylicrnx is -
1-13j In full forte and dT PERMIT ISSUANCE RFSIDENTIAI
�F�.U� licrnx ills ��g Iic.Y � DWL R-HUNREDEL
NQ1 UMc - Conitncmr APNJANCES-RESIUEM'IAL '� �+ (]ADUffION ❑PIAMBING RE PIPE
ARCHITECTS DECIAHATION PANELS ]MULTI-UNIT ]STRUCTURAL
ZCa�i Z 11lrldClLlrld my plain,tWl be usd uppblic record, MODIFICATION
OZ-M UPT030(lAMPS
[]INTERIOR ]CHIMNEY REPAIR
Lccnxd Profcaimnl IBI-II)WAMPS IMPROVEMENT
OWNER-BUILDER DECLARATION OVER 1000 AMPS ❑BATHREMODELRFPAIR 0DEMOLITION
Q I hereby arm dan I am exempt from the Cmrracttda License,Law for the
K�a U fnllmving¢man.(Section]0113,Bueinnx vrd l'ndevinns Cede:AnY city or c�wnlY SIGNS ELECTRICAL �OTHER
4134, which re9uiresa look to tenntruct,alter,improve.demolish,or repair eny,mn'lure
1"'LL�g prior to ill issueacc,also hapaim de"Reason for such peranith,file.,igad,uenem SPECIAL CIRCUITPIVW.
Qf thin lte is licmxd phwan to the porvi,iomofthe Contractors Berns l'w(CTmpta9 ('GMMFRGIAI:
u]a0O (commencing wit Salinn]IMXB of Uivlxinn3oftW BufirlL�xaW Pmtbvinns Cialda TEMP.METER OR POI.E INS.. -
6 that be is ecmg dlcrefrom end aro basis for floe dlegd exemplar.Any vinlat:u of ❑NEW BIDC✓ADDITION ❑DEMOLITION
'4+� Section]B1136y any vppliont faaprmdr wijccu de eppliewrmaeivil pe.elty of
POWER DEVICES ❑TENANT ]FOODSERVICE
rpt nrlae than five Wndoed ddlar($So0). SWIMMING POOL ELECTRIC IMPROVEMENT
E I,vowna of the pnyeny,or my cmpinytts wllM1 wage as lkir woe nxrrpcnwlxm,
will do the wort,and de snumwe u not inwrdedm offered fm We(Sec.]B4i.Besircss ❑OTHER
3 and Profiewhorn Cade:The Cwrranol,Liceme law don not apply to en tMMr of U"DEfS-SWITCHES-FIXTURES ��
prnperry wW Wilde or imp-oven the ern,atre who dtes.uch wM himwlf or Ihnagh
hi,own employee,provicad that such intpmvemenm are not inreded or ofere l for NEW RESIDENTIAL ELECTR SQ PT
side.If.howve,the Wilding or innrpnovemcnt is old silbiome year Mamrplctim,the SQ.FT.0.b(*k,,FE0 IISQ.FT.
o 1ouildcr will have tk hasten a pnwingtrotheclod auW'ddmimposefor pur-
❑Lesgixofwlc). OCT 22
owner of the M ,70,am csinessi veli canoactieg with Bcemd contractors w 1996
ennorrum de prvjm(Sec.]Ou.Basins eM Pmleulmu Cook:)The Contranar's M- l�Vf�IJV/JLLVV��
cans law dors not apply to an owner of Progeny who hudda or lmpmve,therbo,end QTY. PLUMBING PERMIT FEE
rom
whontcr for wuh projects with a contractor,)Iicrn,ed pursumu.theCwtrachon, CITY ur
IJcscaw' PERh1ITISSUANCE l:UrtMIINu
0 1 an eaemq under Sa. .B A P C for Of,rcaup
Owner Date ALTER-DRAIN&VENT-WATER(EA) VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
IhmehyeffnmuNer pen.hy MPalury om of the fallowing dalarMionv: L.J"'` vcla
] I have eml will maintain.Cenificme UfC.ra,,self-Inwre for Worker',Coogan- DRAINS-FLOOR.ROOT,AREA,COND.
union,as pmvidd for by Sectim 3700 of the Labor Code,for the psRamaws of the STORMS TYPE CONSTRUCTION
wink fm which this Perron i,itcued. FIXTURES-PER TRAP
1 have ad will'ouinmin Worker's Grmpeowflon Iururaace,as reIaircd by Smliun
37Woftie labor Code,f«dis perfonrunceafthewmk forwhich thi,penmit is uswvl. GAS-EASYSTEM-IINCAOULETS
_ - (JCC GROUP APN
MYWakcr,'a��}',�nm l amen sed lWlicY numbm are:
Curicr:S/Kr f- RIU> a Poliry No.: GAS-2A.SYSTEM-OVER
CHR'I'IIICATE UP HXEMFDON FROM WORKERS'
COMPE.NSATIONINSURANCE . GREASFANDUSfRLWASTEINTERCEPTOR
(This xGiont need not hcconoplmml if the peroo,is for.humlml dollen(SIM) BUILDING DIVISION FEES
«less.) GREASE TRAP PI.ANCHECK ME
1 certify that in the performance attic wort f«which this pvmii is issued,I EdI
mrt employ any perm in any mover w ax to become subject to the Wakens'Conpmo- SEWER-SANITARY-STORM EA.3B0 FT. ENERGY TLE
OZ scrim laws of Califomia.Date WATER HEATER WNRNTARLECTR
Z O Applicant GRADING FEE
M NOTICE TO APPLICANT:If,after making this Certificate of Exenrptitxr,yin should WATER SYS ENIGIREATING
1-' — Iemnre wbt to rhe Worker,C«nprnswion po miom a de,Labor Cede,you mus, Sons FEE
Wfrmhwilh comply with such Pro,ki...or pconit shall be domed evoked. WATER SERVICE
aQ
7Z CONSTRUCHONLENDING AGENCY NEW RESIDENf1ALPLNB. SOFT. PAID
U Ihrrehy alLrn shat there isaconumctim lrndine egcrcyfm tie perfotmvec of DateRcipN
OP tie work for which this permit i,i.cxued(Sm.NbO.Civ,C.)
ULender"NomeTOTAL
leMm's Address
1 I«nify thin 1 hove read this epplicmim and.vee thw Ibe nbave infmrerinn iv BUILDING I ° l�
Z? correct-legret to comply with all city and county ordinances errs swe laws relating to QTy, MECHANICAL PERMIT FEE
UZ Wl",onuuucriuo,mill lnehyaurMice repcsenuri.ssofNi,city N ocarrupm tre SEISMIC ME
above-mooched pmpenY f«ins,ecrion porarss. PERMIT ISSUANCE
(We)agree to.co c,ock,nmify anJ keep hunnlns dx:Cily u[Clrparinn ogainn ELI3CIRIC ME
inconseusenbe rnu,cmtsard npcwnrifil. rimy io any way accrue opsins aid City ALTER OR ADD TO MECH.
crosyucnee of the granting M chis pemdt. PLUMBING 12E
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR I IANDI.I NO UN IT GO 10.000 CPM) '
a SOURC,REGULATIONS. MECHAN1G11.
GG AI R I IANDLING UNfr(OVER 10,000 CFM)
CONSfRUCHON
Signmureuf Air,ocenUCmtmclw 1}tc EXHAUST HOOD(WNUCT) HOUSING A1fIlGATIO ME
MAl':RIAIS DISCLOSURE
W 11 de applicant afwwe Wilding«cupuv u«eaharxllehvudm,marcriel HEATING UNIT(TO 100.000 BTU)
v dcfin 1 iy the
15532(a2(. o Municipal Crak,Ceaptcr 9,13,anxl rhe licallh,M Snfny
G.1e.5ecdm ')? HEATING UNIT(OVER Rp,lYp BTU)
❑Ye ON. VENTILATION CAN(SINGLE RFSID) PAID
Dole R i,
Will lore applicant or future Wilding by Pbs,Ht nx ea Air n1 it devices whichenent BOILER-COMP IMP OR 100,000 RTU)
mit haanrtbus yr cmumieenu us Jetiml by flc Bay Area Air Duality Management
um? TOTAL
Oyes ON. BOILER-COMP(OVER 1110,000 BTU)
I have read the,harnr4aa,marenial,rechirtmcnu,under CTaper 6.95 a(the Cali- AIR CONDMONER
ISSUANCE DATE
Tornio Health A Safety Cor".ba tests 2SNI5,is y ant 25534.,udnvanl that if the NEW RESIDENTIAI,MECH. sQ,FT.
Widingdoninnvwhic y hast a tact l.Thuo ismyreponcibililycue,ofythewcapom
Of tfr nryuinemenu which mut W met parr lu iwa«c Uf d Curifene Of(kxupency.
Owrerw eulharireJ again Dare - TOTAL: ISSUED BY:
OFFICE
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APPROVEd
IN ACCORDANCE WITH THE CITY OK I
CUPERTINO CODES AND ORDINANCE1
DATE (0Z—Z`,t45
SIGNED��ffy(��
This set of pians anu .,pcc,;.,21ions MUST
be kept on t^e w z'. ,:I times and it is ub
lawful to m-ke ary c Lobes or alterations
on same with-ut w:!,an permission from
the bul;ding DAD;,, C:'ry cf Cupertino.
The stampicg cl :Irs p_n end specificatiotlis
SHALL NX be he d p;rmit or to be an
approval of the :e ia: n cf any provirro5 0Cr2 p�
of any Citi ^.d�^ _:�-:.e cr S;ate Law,
84,D Q/Nsp 21g96
C//),FCT/CNC
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