99080223 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY o oaa
CITY OF CUPERTINO BUILDING-ELECTRICAL ERMI
BUILDING DIVISION APPLICATIONMERMIT PLUMBING-MECHANICAL
BUILDING PROJECT WENTFICATION
46 1LDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
f-IT Gf. - 3 / - 9
OWNP,II:S NAME. PIIONL CO CTOR'SNAbI& Ih e � f IC AIL'O'.
II/VA IlOpp NEC CONTROL
CHITIiCT/pNGINE�R LIC ljO�/� ADDRESS: ❑
r`r ' /tlivQ V Pr f?2 - Qo 4,—s e
-CONTACT PHONE: BUILDING PERMIT INFO
Y87-0386 ❑ Conaultant Fco Paid by Applicant(Initial) BLUG E E PLUMB ME
❑ ❑
LICENSED CONTRACTOR DECLARATION QTY ELECTRIC PERMIT FEE
I hrebr Kp mmtu1a.Iiam<dundopmshdo«ofcham<r9!or,Inense I, JOB DESCRIPTION
DaZ withH pereI0010eet, tion]orth<Bt.imaand P.r«afrocr&,and mY Incense I, RESIDF,NTIAL
O O PF.RAIR ISSUANCE
F in full luta ora dfat
F..UV I.iccns<CIµ C-Zd Iic.N w�IbI ❑SFDWL ❑KITCHEN REMODEL
NQL Ilw< n` Conuaclra APPLIANCES-RFSIDFL ❑ADDff10N ❑PLUMBING REPIPE
ern ARC[ITEM'S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
Z O 7j un& na shall h<ourl m hire rerordv PANELS MODIFICATION
pz` _ Up TO 300 AMPS
F N F'W lift I4oleasi m ❑INlTR10R ❑CHI.MNEY REPAIR
201-IfN)OAMPS IMPROVEMENT
<Y�: Orl BUILDER DECLARATION ❑SWIMMING POOLS
eu 6 ) I herthy affum flea .esemp fru.the Comrncmts Li<enec Lew for th OVER Il1IXInMPS ❑BATH REh10DET/REPAIR DEMOLITION
1111 in
Ieewn.(Seenioa 7031.5,l udwess vd Profesvcrs Code:Any city orcounty SIGNS ELECTRICAL OTHER
which require,v permit In cmarvct.note,impose,&mohah,-rrlwn any sl too,
� prior to its iswrrce,also resrin,the,applicant lmaueh permit to file asigevelmatemenl M1:0ALCIRCUI'DMISC. T7
�y moth is licensed purwant to th gtvuiau afth ControctWsliccmclaa(CTaper9
HMC) (m.mencingw,In Section 70f)(01nrD,00n3uf the Hunn«'a aro Pmfeenoru Cede)we TEMP.Mfi ITR OR POLE 1NST. COMMERCIAL:
a e y thnt he ix exemq Ih<rtfmm end me lb is G.the Wkgul cxetngiun.Any v;oWion of ❑NEW BLDG/ADDRION []DEMOLITION
^m Shinn TOJ LS ny any applirnm foragmlit wbjcct.Ih npplicant lnecivil MouhyM POWER DEVICES 0TENANT ❑FOOD SERVICE
FZi not more than rose hundoad ddlws Wor
❑ Lasraxrafl epotteryor my employee with srdg«.beirsolecanlperence, SWIMMING POOL ELECTRIC IMPROVEMENT
E- will do the work.and the aa"cture is not intended or offered for ore See.7W.Husin«'x ❑OTHER
W and Itticsuom Codr:'IJe CmaarlUrs Liernrc law does for apply W an tnvtwr of OU1LiTS-SWITCHES-FIXTURES
pro I who huilds on inlpoves therein,std wed doex such work himself or through
his own enynoyeer,pruI ma wch inlgtsemrne,art na imeNvl or offereJ for NEW RESIDENTIAL ELFCfR SO Fr
,le.If.hoxevcn the heiUngor intprov<.cm ixsold ,n ieorcycan.feentictioq the SO.FC FLOOR AREA LSO.FT,
owner will Mw the burden or pnoing mel he diol not III or impmp
s<for r-
Pr¢ofwIt. ).
O 1,as mrorr M the po pert',an xclusrvcly contracting with IieI cOwrYlg3 to T
WI oil
Sec9fW,H,o—,and 11 froosr CtdThe ConwcmYs Li-
W . pm an own«of pmpery who,builds or impnrvcs Fernon.and QT'. PLUMBING PERMIT
.M mntncu fw wch gajecta wimecsxxracvr(s)Ikrn ipumuem mth<Contrmv�r'n
°nsc Lew. PERMITISSUANCE 1 7,11111111,
Ivo exemq older Sar. ,B&PCfor his reawn
Owner UweT
ALTER-DRAIN&VES -WATER(EA) VALUATION
WORKER'SCOMPENSAHONDECLARATION BACK FLOW PROIL I'.DEVICE
Iln<byafRrenunder purely, If perjury one of thefollowing deelvrwiono
d wmai y (rJ
I hast,aill ntei n a Ccnifinla ofGwwnuo self.insure for Wo Acr'a Cvmten- DRAINS-FLOOR.ROOF AREA,COND. STORIES TYPECONSTRUCIION
tion,a;ptvidcA for by Seeuon 37M of the Ivbn Core.for fe po fmmurce al the
x'ork For which thia permit is issued. FIXTURES-PERTR,sT
❑ I hose on.]w'Il.alnurtr W'mkef.Con cnswion Inwrsome,as reyuiml by Seems
J]W ufthe WhrCode,forth lcrfmnwecefthew«k forwhichlhispermit is ssudl. GAS-EA.SYSTEM-1 INC 4OUTLETS OCC.GROUP Aly]
Aft'ter. \C mlyttayon lnsumrae culieraed Policy olNlm z3) GAS-I:A.SYSTEM OVER 4(EA) / / O
CarrMy
I-`iWo Yd;cyol,e F�1"11
CERTIFCA'IE OF ITI PION FROM WORKERS'
COMPENSATION INSURANCE GREASFANDUSIRL WASTE INTERCETTOR
(Thi,reerin.nein not be unnpinnl ifthe prntut;s lar arc hllnfred dollar($100) BUILDING DIVISION ItitS
or 1«s) GREASE TRAP PLANCHECK FEE
Ic<rify mw in th perforentreoflInc w'ork I—owb this permit I,issune,1,hall SF.WPA-SANRARY-STORM EA 2f)()il'.
wlempby"nyp m any morn, o xs tja 4�,jeenothe Work ars'Cmnpcn- ENERGY FAC
O Z aetion Ww. f o l \ WATER DEALER W'/VENTIELECH(
Z O A,I.. GRADING FEE
h NO RCE IV)A LICA p IL ai¢ rmUng thio- eniticnm of larlrynion,you should WATER STSTIE UTREATING
t F� > h Borer, o me Water.C—,.iin gosidint of me lahtr CM<,you.tel SOUS F E
funbwinh cmi Ywim web pmsinrrn wIII pora ilwll he dared rtsvked. WATER SERVICE �, )
Q
= Z CONSL'RUCense,LENDING AGENCY NEW'RESIDENTAL PLMB. Sp.FT d) 11I
L) C Ifor hiefirmlhanrneisecol peer,tun leo ding egenry frcthe perfmomncca Dine RacigN
IN,work r«wmm this petro i.ixwed Lst,e.Rroz r-;.�.e.) y
oU Trnlers Navy I A 3 1 AL
Lender;Adams TOTAL: 1111
F 0. 1 renify Ilou 1 hove real!thin it"Aicwirm and..,.t,that tnc III iefrnlwion is But ING FEE
rA corrmr L agrr¢w comply with au rift'and mrnly mdiwres and n.e loam alining to QTry_ MECHANICAL PERMIT FEE
U Z building corutrvctian.tool hreby authorise regewounnlv«ofrlesanyln rnl<r upon the S IsAlty FEE
abrvu-eentioued property f,ievrctiin orpo.es. I'ENMI'f ISSUANCE
rWo);gra or ass indemnify end sure,hwnik.the City of Cuppolm again; EEE
liabliticaj Mgooenu.coaenM cxpcns«which mtyi "eyviceroeagainaseid City
in caucqucrrc m 0sc,mining of thio perms. ALTER OR ADD TO MECH. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPL ALL NON POINT
SOIBAIIOAIR HANDLING UNIT(TO Hil CITE) MECHANICAL 4
URCER `
AIR HANDLING UNIT(OVER IB000 CFM) CONSTRUCIIONTAX
Sig ore of Ap ion 'ontr r t EXHAUST HOOD I WIDUCT) HOUSING MITIGATION FEE
HAZAIBDOUS MATERIALS DISCLOSURE
Will the null or future buildingoee,gent son,or hwodl<huurdrus lvtmal - HEATING UNIT(TO 1 M."BTU)
defined by,he Connor-Municipal Cede,Clwpter 9.12,and the Health and Safety
.ode.Sxnrro 255]2(nR HEATING UNIT(OVER 100000 BTU)
FjYe F1 No PAID
V ENTILAf10N FAN(SINGLE RFSID) Due R
Will the ap A..t or future blildin6 arupont use equipnent ur Justin which eipl N
azar&au or cintemieema as&fired by Ile Bay Area Air Caulk,Manr,neert BOILER-COMP(3HP OR 100.000 BTU)
TOTAL:
it h
:atraP
LA I AP
❑Tex ON. BOILER-COME OVER IMI BTU)
L huse Dead the h:vertkrvx nutaluls AIR C'ONDIT'IONER
reyuimann under Iines6.95 Mthe Cali- ISSUANCE DATE
fmlia Hculm A Seery Code,e L once 25505,155]t end 2Ut6.1 uMawrd mol if th NI:W RLSIDEMIAL MECH. SQ.FT.
building rkew tcur<ntlY haaul<ner,thw ituo ifydeacvpml 1Q\/ /,' /1 9,
fir the rots net oft Cmifcwe y. Y
111
qe
Owterrtr tM'sa+l og<nt ate L TOTAL:
ISSUED BY: �
OFFICE /