S 2945 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING,-RI.ECI'RICM, I'll NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
ce�' BUILDING PROTECT IDENTIFICAf1ON
S 2945
BUILDING r� ry{/�'] / p. tiARll'ARY NO. APPLICATION SUIIMITfAI.DATB
OW A fill ON � c( IeA-( AMy. ��./ � 11 1.
FIC GGNTRGI.b
nrE 7TfENGiNEF : �s�x c s ✓� ❑
ail OrCACO ACC: PHONE rye Lf Dilil BUILDING PERMIT INFO
(/N.✓rl'�r /��/l� ��/1 WyL ❑ Consulfsnf Frays Paid by Applicant(Initial) RIJK EI.ECf PLUMB 7
LICEN, .l C(1NTlAQCORS DECI-\RATION QTY ELECTRIC PERMIT FEE
Ilrrmy air...I Ilmnlia,m 'unmrlxovi.imv nrcnaplery(rr„nmelrmg J09 D&SCRIPTION
��Z aim Sia.700l :vnia3nf urinenaand 1 6 : cant i licrnuis RESIDENTIAL
O PERMIT ISSUANCE
F� [[- in full tincc nm1 c I� �s ❑SFDN'L ❑KITCHEN REMODEI.
NZ C... APPIJANCES-RISSIDIWI'I Al. ❑ADDITION ❑PLUMBING KIT PILIN
VFIOy CH ' DF,CLIRATION/J [� PANELS ❑MUI,TI-UNIT ❑SI'RUCTURAh
ZpyZ Jul.r4n ns heo-ad vpuhhc me.,s _ MODIFICATION
OZ4ss UlIT02MAMM ❑INILRIOR ❑CHIMNIiY REPAIR
i,12EW Liccnvd l9d 'm 201-101XIAMPS IMPR(IVFMIM
g� ❑SWI\L\11NG F'OOIS
s1 q OWN R clear,I f DELI Coirr UN OVER I00XIAMPS ❑BATH RENIODEUKEPAIR ❑Gi MmITION
lY C 6 /I h Illrm Ihol e n eFcmpl frmn the Comcmmr'x hirenw Law for the
1060 fowowing¢ a(Sa,in IIS,Business as!Pmfcuions Coal Any city or cwnry SIGNS ELECTRICAL. L1mIf� �7y''��y'
W 3(L y ieh ra, n pcm o am.amm,alio,.Improve,flat h,or n iir any anclam /,.,[ _ - / n n
Feet prior to ill .Wm rtquim'the applicant for such tennis m Ilk. quctl ,a..t S%iCIALCIRCUITIMISC.
�y Ibat he ialrenrrJpursuuthobo trtrvicims MlM1C Cammchl(n hi¢nrr loot((Taman
{C Icomnrt ar,,.ith Sa'tion]gMB of lTvisiun]dlbc Purina.and Pmfeasiau Codelm TTM1s MITERORPOLEINST. COMMERCIAL,
K Q
a S thin he is acmlh bererrnm and me f, ie for lBe alloyed ca.mlptiim.Any violation of ❑NEW BhD,U/ADDfI']ON ❑DL'N10Lrf10N
Sf Section 7031.5 by Tiny ula,lieant for a pcnnit suh*ls me yrpl'icant to a civil toothy d POWER DEVICES
m El TENANT [D FOOD SIiRVICI?
int rmnc man rive M1uldreJ dillan(5511(11.
�Lmowncrof ristruy,nnnye earnil,daimwagesmmeirwk704L ij,irr . SwIA1S11NC POOL FIECTRIC 0P14ER FMFM
will dolh,,los,vd me Im Co structure is ren air,Lirvks,isawr doead s
nas ol5«JWJ,Bu.incu ❑O'fH[R
6 3 Time 1'mfessiort.ill e:im %o%t hu'n Licence law docs not A hi le an urcr of OUREI:S-SN'IT(:IIFS-FIA rURES
his own whooyet,,pr iemial lair
i and who don wch work himsdf of mnugh
his own anpley.ths,pmvlJnl lou weM1 ruent is sold w thin Iry:model or olfrtal for NEW RL'SIUIiN1'IAL ELEL SU 14.
vee.IL hossrnT,me Wilding lar imtnn'emem is sold within arc Yes of nxnplainn,the LSV.FT
crhuildcr will have the hei of proving mut W dod not hould or improve for purr- D
pore ulule.l.
I,in ow nor d Om pn S,ony,um esclurively ar owting with IivensJ conlmcturs to F
crnswa mr pri(Sa.]H41.Badrnn aand Prdr,..i:m.Cooli The Coltman,,Li APR 16 1999
cents, not apply to an owner of princely who buillvor ilnln .w ryRonson,land Q'PY. PLUMB FEE
x,
w W asevxv for wch In'lccu with a camrrcnxia)Imco,W pursuam to the Comra art
License law. PERMIT ISSUANCE
0 1 am coarn,uNer Sec. .B k P C for this maw
ALTIiR-DRAIN&VEM'-WATIiR(EA) By
Ossetic, DomVALUATION
WORKER'S COM%NSATION UP ARA'UON BACK E9.OW PROTECT.DEVICE
I hcmhy affirm Tinter TrniltY lar l'crjury of me 4voingliveluuinls:
]IM1uvcuW willmuinmine Ccnihamnf n.¢nl u:mlf own Gat Wndcr's Comlun- DRAINS-ITOOR,ROOF,AREA.COND. SCORIIS TYPE,CONSTRUCTION
wtior4 m ptovidN fn by Scetim 3] l lhr LaboC C ,fnr d prdofrn r T u I W
work fat"ichlhiyrnnit ie i.0 N 14KI'ORES-LRTRAP
❑1 buve afW will In _,a Wor r'a Caatprncatio mc,l by Setion
3]f0.D1m Ioban C:dc,firth r0mmurc oft 'ink for which this cront ix i.ccuol. GAS-EA,SYSTEM-I INCdOUTLB15 OCC,GROUP APN
re.
My Worker's Camprnnti, taPal'ry numhcr the
:
Curio, r dicyN(,.: GAS-EA.SYSIL,AaOVER4Hn)
C17RI'I CAPE OF EXEA ION WOM WORKERS'
CONIPHNS - ON INSURANCE., C,REASFANDU,SITU.WA91T INfERCITTOok
BUILDING IlIV151(1N
(Hillis nut beau Wil Bin permit is orxf W) ILES
or Im.l GRIiASE TRAP PIANCIIECK THE
Iaeo nlly W .n 'lad to ',permit is iouW,lahill SEWER-SANITARY-BTORAIEA.POFT
ma emlNoy an Nu' ��� j lnlM wmkrn'Cornpon- ENERGY 19:11
O Z cation I, Call tc WATIR HEATER WNENI'/ELECTR
`Q Applicam GRADING IlE?
h NOTICE UAP 1 .IL IT,matin,thin Catifx-um of Pcmption,you Rwukl WATER SYSTEAVBFATING
? havoc Worl :omlrmvdn Pro suor,of the Lahr Cele,y,mist SOILS Iq:E
fonbw' l n whh such to 'i ors or this l conit shall be hcmod mv:tm WATER SIIVICII
Q
Z CON, RUCILENDING AGENCY NEW RESIDENTIAL PI k1B. SQ.FP. PAID
U 0 1 mbyini:m Bat slNellIXlkMinB ego yforlM tcRornufrc of Oso Receipt
W. IM1c :r -w which this x c' (yse,31Y1],Civ,C.)
U N. 10l
I ad.Y. Mies TOTAL:
y1 cast y Tho hast real lc elry:licuion and smm Jot me vMvc infuunuion is BUILDING FEE
.�. Z) norec agnm omPlywilh Idry incl uwnly ordloanc-aWstme lows rcWting to QTY. MECHANICAL PERMIT FEC
U Z huiWineeona Hiomv.lne yeum:mee repesenwivcs or lM1i tb rnta uponik SEISMIC M:
ahove-nwmli ed P,.,,.y ninepalinn pu Baes� PCRAIIT ISSUANCE
(W agver:sa .imkmltifyanJk nine Cityof Cuprai.,sjf f.sr I O %ECfRIC FEB;
livbiliB. lodge nu, sls and oalrn - ach nwy in cry way aconin agaiorl said(:try Yr l gmmingo permit. ALl'ER OR ADD TO AIECH. %.U.MBING ILE
spm
TI C1 RST AND WILL COMPLY 'LTH AL1,NON-1'OIN'I' AIR HANDLING ON['I'(TO IO.LY111 CIsM)
SUI t( ' kl TIO !! C MECHANICAL LLE �
AIR HANDLING UNI I'10VICR 10,001 CIM) CONSTRUCTION TAX
Ap cant/fonlmcbrzv Uac IFRAUDIIAUSFRAUD(W/IIUCI')
II !ARE)DUSMAT17RIALS )INCLOSURE HOUSING MITIGATION FEE
Will nP,l 'afthme buildingncwpam comrhmdle Wfenkws motorial HEATING UNIT CFO IsOorsI HTU)
n JefnN y me scroll Munic,al Cod,Charyrr v,12,and the Hea1m and Safav
Cruel S 32(a)1 z<”-
[BEATING UNIT(OVER 100,XO BTU)
res
VENTILATION FAST(SINGLE RESID) PAID
Will thin applicant lar,Tion Wiling:rcuyant use eyuipment ar Devices unich �1 Ilve Raciry N
omit war:bis Tia cauarni:ums uJcfmLhy the Bay Ama Air(jvality Menagcmcm EtGILER-COMP(3HP OR 110.00X)BTU) ;Sr ZO
Ilinlricl'; _GN TOTAL D
C1 Ya BOILER-COMP(OVER 1000.000 LOCH)
I Ince call the,hvarhus octalmoltaifenrtns unM Chalon 6.95 Mho Cali- AIR CONDITIONER ISSUANCE:DATE
forma Health&Safaly Coi So'nolu2550d,25533 ast 253;41.1 unknrnN Jwt irthe NEW RFSIDPMIAL NLECH. SQ.FT.
.011b, 6rs na avnen0yhas"alarea" int oismy""Jai"ll neacthe�,al
.OlM nYluircnunta whin nm,a Na area priono ietluna Til n Ccnilluuu d(k.viwxy.
(Mimr or uuthurceJ aCeal Ilam T(TIAL: ISSUED BY:
OFFICE