S 3220 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECIKICAL Plirr No
BUILDING DIVISION APPLICATIONWERMIT PLUMBING-AIECHAN'ICAL 3220
BUILDING PROJECTIDENTIFICATION
BUILDING ADDRESS: SANITARY,, APPLICATIONSUBNI=AL DATE
Ivr7oi D (qep 14
OWN' "NA .OP ONL CO A, OR'SN ML
JJ N C C(N ROLR
'ARCHITECENGINHER: LIC No ADDRESS'. ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Con,uhanl Fxg Peld by Appliml.,(Initial) BLDG ELECT PLUMB MECH
v v oTo a ❑ ❑ �a ❑
I.ICINSQD CONI'NACIORS UECIA AnON QTY ELECTRIC PERMIT FEE
I hereby anfrm mat I am ba emf tit render previam.of Chnger u o*nntneming JOB DESCRIPTION
0 z'G wlth Semlm](Ia0lef Divr' 3oftbe Busier.,"Is,IcuW 'c a dmy licrncis RESIDF.NTIAI:
POOO m VERMITISSUANCE.
Fly, full l�nc mxl eRa , ❑SFDWh ❑KITCHEN RILMODEL
� Licence Ina Lc.X
U� APPLIANCES-RHMDFN'IIA, []ADDITION ❑PLUMBING RE-PIPF.
W Uvte Cmvacut
L ANCHITECTS DECLARAIIpN ❑MUI:I'1-UNfI' ❑STRUCTURAL
~vZ IumkntutW my plain shallWusel vs publk eeemd� PANUS MODIFICATION
O-14- UI't02IIl1AMPS ❑INTEKIOR []CHIMNEY REPAIR
I.icrnr.W l4ufcsximel 1111-IIXXIAMPS Ih1PROVF1.1 h1.'1' EjSWIMMINGp00LS
CCC 6 hereby affmo that I exunq ILDENt DELT mme ConrrucoNr's Lkenm law for Elm OVER 1000 AMPS ❑BATH REMODELIdEPAIR ❑DEMO49 LITION
L O a Uy. followin .(Sariun]0313,Business mrd Pmfcaima Coda:An t t ❑OTHER
g rmum Y ci y w coma Y SIGNS ELIiCfRICA]. �c
3 LL N which meeires a permit In coxrsweb alter,improve,denwlLIA,u repair any souaure Q
Paula its iswancavlw rtyuiru tneepplirem furstrch permil ,,File.signed uaou,m SPECIAL CIRCUIT'/MISC.
���.� That hcol'rcenrW punuwtto the pmviskms of the Cmtrxmlx Lcemelaw(C'Wgv9
�p(Q� (connnnxang withSa'tins]fXXI)nfDlvlsion3al'tW NurincsnnJ lhofuavmsCrxkpr TEMP.METER OR POLE NST. COMMERCIAL:
e.p. y that neo exempt thaeftom mrd be tussis tar me alleged memgrm.Any vlulmim of ❑NEW HLUGIADDITION ❑DEMOLITION
x�N Section 90313 by hundred Jolla,($5M).any upplieum,for a pemJl ahjeehl the vpplatram tea civil ImmY of POWER DEVICES ❑IT,NANT ❑FOODSI vicE
m4 rut cthan
W Bvn
IMPROVENIEN'T
Q F)I,soana oftW prnpaty.0 myemploymwith wagcssthrirmkrnmpenwinn. SWIMMING POOL PLiCfRIC
well do tWwork,and Ne stmcmmk nntlmaakd urottertd for sale(.4eA0XJ,Bvamev ❑OTHIik
Lag aN I`rofcsomoCut The Comtnaoh License law ogxs not apply to an owner of OUTI-ETS-SW ITCHES-FIXTURES
proopcny whu builds or impnwe,IhmNe,mW wW docs arch wale himself or hurt
his an employav,prnmJul that such Impnrvmrmurs are an intarxkJ or offercd far NEW REST AWHAL IiI.ECI'R SV IT.
tale.If,M1owo'othe Wikhngor imgovetrcnt is sold withinone yerrof ecnpletion.lhc SQ IT.FLOOR AREA SISQ.14.
rcr-builder will base rh WNcn of proving that he did ma burl)or impose for Wr-
pma of rale.].
I.¢.wmr of de pupeny,em exclusively mnexWg with IieemeCounrano.. - TOTAL:
rnanrn Jw psgut]Sons 911th.If¢sirseas aa1 Pn,fo.00mN Csxk:)the Cmuur on,need
wn¢lawdnexnmvpplytoen sim a ufpropcny mobs Mril Ime imp roves Cemen end QTY. PLUMBING PERMIT LEE
he rostrate..Rrr such projeeB wits a caurata(s)IkenseJ punuwt Lathe CmtnetMs
L¢Ynrw Lrw. PERMIT ISSUANCE
❑lam eaemp utXkr Sec. ,BG PCfa this re.,
ALTER-DRAIN A,VENT-WATER(as) VALUATIO
Osvncr hie N'
1 WORKER S CO.SIVENSAGON DECLARATION BACK FLOW PROTECT.DCV '
1 homy nt irnr miler penny of perjury ars or W fulhrm'mg hwdamdanr, (JJell
0Ihave eeWwill maintainaConiOemnnf CnnsenunsdGtnsurt fu Woxker'sCmgcm DRAINS-M-001 R sA STORIES TYPE CONSIRULTION
,alien,as pnwimal for by Seeman 3700 of the labor CNe,for 1W pernnourrce of the
u fur whicM1 this pemtit it i�wN. FIXTURES-PER I'RA
Wsc urd will trointein Wakela Coxnfearsmon Emurn ee, ela,mund by SReu sn
)oftW laMvCodc.R,rtW prl'omumcoftW wwkfawM1icM1 thispermit lsioud. GAS-EA.SYSTEM-IIN .JO OCC.GROUP APN
Alywma /jf���(I'�t�+r���r'�o�Ineon]Pnliry n�I',1�^�'�n]��/��ly��
Currie'.-e(p�y.'f Policy No.: AS-FA.SYSTEM-OVFAJIFi\)
CERninCA'ITOrleXIJNIlnONIBOMWOKKI?M V
C&PINSATION INSURANCE GREASFANDU,SI'11L WASIT!INTERCEPTOR
BUILUINC UD'ISION'HiFS
p his..Greed net he cmnpOof.f the prnnit is brturc hutrdmlJMlae,151(1111 OR PSE TRAP
m las.1 NANCEIIiCK FEE
1 eenify that in th<perfmnrcc nI IW work fu xhkh Nispamit in issuM.l shall
SEW'I?N-SANITARY-STDRM IiA.1g11'T
not um1, any pemrn in any mwrwr w r u t m 1W Wnrkeri Cmrpen- ENERGY FEE
Z Appli lavF��tt``f��Callfmrre.Da c (sc WAFER HEATER WNEN FXILECI'R
z Q Applicant�Lrr� GRADING IEE.
zy NOTICE TOAPPI,ICANI':IL ober mmking lhir Cenifeacoff r:nrNet.yin Ju+old WATER SYSTEMO'KE.AIING
a besome,wbjeci to the Wait Crnrpcnsatinn pmvisim,of theur InbCache.You must SOILS FLIT
Ibnhwith cuntply wilh sathpmvisinmor thin perm,dull be dccntedevokOl, w'ATF.R SERVICE
� ZCONST RUCTION LENDING AGENCY NCWRHSIDFNTIALPL IB. $Q.IT PAID
L.) O I huaby I that lhercieunmemcuon htagency[(,r the Perfnnnme of ate HeceipX
dm woM fu which his permit is issued(Sa'.31197.Civ.C.) TOTAL:
F" Lancer',Name In
Wlender's Addles i(Tf BUILDING
1 cenify that I have real this apgicetion sort ataoe Chet IW vlxwe inrmrvtiun is
F- h mercer.I agreeer mnrply with all city andcmny uodiraewes and smote law,autumn,to QTY. MECHANICAL PERMIT FEE
U Z Wilding constmelion.end hereby vuthrmx repo—,leives ofthis city lncmcruryn the SEISMIC IT.
�' abrove rrcnliurrJ gopeny for inapeOim perpaus. PE:RMITISSUANCE
(We)ng,,to save,indemnify and keep Lunn X:ss do Chy of CuPeninu ugailll ELECT RE EI?
liabilif s,'Ipme ,.coats aril eaprnse"which may in any way e¢nue against said City I ALTER OR ADD'TO MCCH,
nwymrIse site 'n6 of thin permit PLUAIBIN '
APPLICA rNJ .T NDS DW . OMPLY WITH ALL NON-POINT AIR HANDLING UNITGO I0.000CFM)
SOUR/' .GU O' h11iC11ANICAI. E
/�� AIR HANDLING UNIT(OVER IILOOIE CONSTRUCTION TAX
rBnaturt al ApplicandCnnuactu Dwc EXHAUSTHOODIW/DUCT) HOUSING MITIGATION LEI!
I IA9ARDOUS MA'MIUAIS DISCLOSURE
Willthcapplewt a BE.buildingeccup,w wxc or handle M1nunnms matcrivl HEATING UNIT ITO 100.11011 BTU)
as rkEimd by the Capomm Municipal Coes.ClwPter 9,12.mW sire Health argil Safety
Cost Section D532(a)9 HEATING UNIT(OVER 1O1B)O BTU)
cl Yo IIpG
VI-;NTILATION PAN(SENILE HPSID) PAID gte Receiga
Will tlrc epplicnn a future building occuTum u«equimtunt oe domkcs IshicM1
emit harurJuus at,cunumitunn s deftrai by the Bay Area Air Uualily Mamgenem tlUILEH-COMP(31{P OR Ig1,I11X1 BE U) 'TOE AL'.
Duarkt? BOILER-COMP(OVER IW,"BTU)
Yn [7N
AIR CONDITIONER
I have real thehvludmsnmt luimncnts utxkr Cfugerfi95 nf1W Culi ISSIJAEIJA"'F�l7
fomu stdoes.F Safely C Sao u 3 erW 25511.1 utvkrarW Ihit if the
NNJing Jrtc nxc ylavca M1 y¢spum'ihillty oo rrMily the ovc t NEW RP_SIDIiNfIA1.MCCH. SQ.I?
of thereesch mew McCrniyF
WeT mr,r ' 'i r uOyrr
tbum�• I, M r i"��'� Uat'ter,r`t�lsi�'j TOTAL: ISSUED BY:
OFFICE