99070037 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE B L POINT PEN ONLY
CITY OF CUPERTINO BUILDING-MECHANICAL 19iNMR N(/�.
BUILDING DIVISION APPLICATIONIPERMIT PING PROJECT
CT IDE HIFIC snow 1
IIUILUING PROJECT IDENrIFlCAT111N W
HUILDING Al1DNESS: SANITARY NO, APPLICATION SUBMITTAL DATE
0 o FDRF—S VE#
O N-RNAM' PHONE,. I � CONTRACfO�R'S NANV� O:
5 I^T fes NIC CONTROL Of
JUI iCIENGINEER: LIC NO: ADDRIitiS:N O L ,y/(,.
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CONTACT': PHONE: BUILDING PERMIT INFO
❑ CtauXultanf Pees Paid by Applicant(initial) BLDG 121ALCl' PLUME MECH
LICENSED CONTRACTORS IIEGIARATION QTY ELECTRIC PERMIT FEE
T berehy uffrm slur 1 en liansel muter proviaiom Of Choper 9(corerturcin
O g JOB DESCRIPTION
�Da'Z w;th St inn]oon)of Dhislon Inc Batineiad ,C myretaeia RESIDENTIAL O PERMIT ISSUANCE
W_ in full force �SFUWI. ElKTfCHEN REMODELIQ1-..U�j Lkcr< Lk.♦ APPTJANCGS-RESIDENTIAL ❑ADDRION ❑PLUh1BING REPIPE
FAN DVE ARCHTTECTS EI ARATION - PANELS ❑h1ULTFUNR []STRUCTURAL
Z 0r2 lundmuend my plu ,Mj bcexed!a Public nxvxdt MODIFICATION
OZ—� UPT02WAMPS ❑INTERIOR 11 CHIMNEY REPAIR
W Liccn.rd Profesaiorxl 201-I0gpAMPS IMPROVEMENT SWIMMING POOLS
OWNER-BUILDER DECIARATION
C 6 E
Sao 1 am exempt com the Cunwnrx's Licrnsc Itw f«the OVER 1000 AMPS El BATH REMODI'Il—RI;PPAjR [I D
1 hereby anion ' OLITION
3 U h lnwin .1Sevlinn 9031.5.Bosuns,and Prufcaione Code.nn I t ❑OT�{VR — .•��22
gji,. Yc;y«ranY SIGNS RLECIRICAI. q,!/]� �Fi IMI J
which ae9ware u ia,u-re c vrvd,all,ph,,I rase,do:nouil,«EINir any urvewre FY
FLLOat pd«toslicensed ai Ito uba ldeuppresof for aocnpmlh esE a,,,I-n (Chap ant SPIiCIAh CINCUIT/MISC.
f �'y thwhe aoraneing with
Pweuent to We puvlsiaxiwl1le Cn usireaNtLirxnmlaw(GM1aPtfr9
I0,, tc"mncrcing with Scwinn]UW)of UiOo%fr the laged! aadrr'M vi C«Ic)« TEMP.MITER OR POLE INST. COMMBLDGAI.:
a y o Sn he is eaempl t.,ii di etd the.Pair for IM1e ct,die c.�emryion.Anyil Penam of ❑NEW BLDGIADUITION ❑DEMOLITION
uX1 �tiff 4ction]0315 ny any epplicenlf«vprmiit wbjat the applicant wecivil Penalty of N1WI:N DEVICES ❑TENANT ❑FOOD SERVICE
t mac tMn fie hmatrcd dolbnrs(55110).
F Z Y IMPROV EMPM
ft ❑Las owrerMthc p�op thur myempkweea with wegc u,ad,(Sdc compeeswion. SWIMMING PINI,P.I.F.CrRIC �OTHCA
=L.. will art dtcwnrts Coa,ond ewixlwekamintianded Ea.LiRetd nitriSly 1. nBuurcss
ad 2 end Profasilmr CMe:The CanaxlaYa IJcenae ,Asea m apply Io en wmcr of OUILITS-SWITCHES-FlhTURES
a 3— ,alFeny w builds or itnprova deaaP,end alto dreg%ach work hionsi or through
his—a employee,provided tier wch irepos'attenla ere not imeda.,or offered for NEW R,SIDEN.1IAL FJEC7TR SQ FT.
side.If,bo,,eor,the budding«improscatent is.,]it within one ycu of c�mplelion,the SOMI'.II.fX)N AREA SISQ.FT
rnlPider will leave the bunkn of Proving thu M did nu build or improve fest pur-
rya of vk.).
❑ 1.as rsoe'of de prupeny.em caclusivdy contracting with licensed!conuecmn to
cavi the pmt's,(.Seca 7IM4,Bonaaa n .vl Proons CoJ-)Tba Qmtnoor's I,
,eit.law Jrrx nx applyuan owner of pepwty whO boldsor thcrcam.road QTY. PLUMBING PERMIT 8
won cumwclu for.wmh pojmis witn v cOntnueMx7.Teat W Putwum m We CanINCI«s
L—nw Ww. PFRSUI ISSUANCE
C3 IvmeeeupuMtt Sec. ,B&PCfarthai.
ALTUi-DRAIN&VENT-WATER(EA) VALUATION
pwrc OUE
WORKER'S COMPENSATION IIECE,ARATIOR BACK FLOW PRQI-ECL DEVICE / r�9/_I QD
I lereby elrladi Edi pcmlry Ofpmjury orc of the f.Fit,hclvui«a: ES a('
J.M1uve ora wiedl fa nein• 37W a{ he,LaltnCads.For fa Worker's Cor ,op en GRAINS-Fl.00R,ROOF.AREA.COND. STORIES TYPECONSTRUCf10N
action,a pON thi far by Section JIW M Bu Lobar Code,For the perhxntence of the
wakfrcwhich fllapeiona is iswd. FIXTURES-PERTRAP
I lease cold will trYinitin Wmkcr'a Cantlrnwtin Ivararee,m Equird by Sa,:n
i]IMlot lite lsMr Codc,f«Nc perfurmarec Eric wrvk he whieM1 this permil is iaxteJ.
GAS-HA.SYSfEM-I INC.4OII71.ITS OCC.GROUP API:
My Wrak stud Nrliry
Carnal ',Airy Na.:�a�-„r, l A 'f 0' GAS-EA.SYSTEM-OVER 4EA)
CHIEFFICA O FJOJNPTION MOM WORKERS' <;RI?ASI%INUUSTRL WASTE INTENCI'.PTDR
COMPENSATION INSURANCEBU11.DING DIVISION FEES
IThiv uclinn nal notla contplctcddhe pmnil is l of ores hudnd JrJlartlglIXp CREASE'I RAP
or lar) PLANCHECK FEE
letaifydwt inthc perf.,ofthcwork Rnwhich.his parrot is ir.,asd,l leell SEWER-SANITARY-STORM EA.21X1 IT.
not ara,loy any arum in any ran w �dr.�te.whyygq the W«keti Compeer ENERGY FEE
IJIEA
Z O q at'*J f m1iv.Dec _Clik —.f ! WATER fIGTPJi WNFJsT/ELECTR GRADING FEE
NONCE TO APPLICANT:If,efts nuking Nis Ceti of Ewearsmn,you should WATER SYSfEMCD EATING
1-"-' borne aubjccl to the Worker`s Comprn.suirm Provisions of Ik labor Code,you mus. SOILS FEE
fonhwith ttmply with wch porivaas in Of .if shall lee deemed revokd. WATER SERVICE.
0
O. CONSTRUCTION LIWDING AGENCY NEW RISIDPNIIAL PLAID. SQ.FT PAID
7 Z IhrrthY+ffiam thxl there isomnvrulirm lending ngrnYf«Ihc perfanrorec of Otte Rcccipx
O 'ha work for which This permit is iawed(Sec.21097,Civ.C.) TOTAL
I" Lender's Name
V LcndcfeAdreas TOTAL:
BUILDING 14311
I acnily that I hove n:ad this'upplicvnwl and Wore hat dm ulwve infumwlion is
F y axt¢I.1 agrcem comply with all city aad county nminxna std,aae lawn a,Awmg It, QTY. MECHANICAL PERMIT FEE
V Z buildiu,c wrvdiun,ed beaby vulhnrue mPmwnmlive ofth Lreilylo cnlmupun tlrt SEISMIC PER
do O-roar Totted pra,,ry for it apierwo purryr¢r. PERMIT'ISSUANCE
(We)agra to save,iMcrnnify aM keep hnmtlaa de.City of Cis acro to vgainsl ELECTRIC FEE
habilitie,jdgtremn sts and nprnsr which may in any way ecc against sad City ALTER OR ADD TO MECH.
rnnrcgacrcc of egrani of Otis feamil. PLUMBING FEE,
tAPPLICANT DE A S ANU CO PLY WITH ALL NON-POINT AIR HANDLING UNIT(f010.000 CFM)
MECHANICALFEE
SOUR R aU NS.
A . �p AIR HANDLING UNIT(OVER I0.II(IDCFM) CONSIBUCION TAX
Si ate of ApPl0.1,Conussl Dmc EXHAUST FOOD(WfDUCO
HOUSING MIT1GA110N FTE
HAZARDOUS MATERIALS DISCLOSURE
Will the aWlarnt or future building occupant sluts Or h"Ie nzrardmu materiel I tExrl NG UNIT LTO 1 W."PTU)
stn defiled by t1N CO,nino Municipal Cde,Chaper 9.12,and Ina Health arta Saba,
Gxle.Section 25532(x)] I]HATING UNIT(OVER I WAW BTU)
❑Ycr NNo PAID
V HN'I'lIA'I'ION FAN(SINGLE RES]Of Date Reee'TIB
Will Inc ap,,f,.0«future handing acia,r o ux r,ipacit,or&a,-wnkb
aut hurallous air coroun Irmo as delind by the Huy Area Air Quality Marwgvm:m BOILER-COMP(3HP OR IN).(")BTU) TOTAL:
Dinh.] BOILER-COMP(OVER W,OW BTU)
❑Yes IN(
{No
I lave rem baaud,ca, ri�Lrrt =nen.cab CEtp1mfi95 of th Celi- AIR CONDITIONER ISSUANCE:DATE
tomo IIeIN&yE y miom 253(13 255JJ aanp1o2 SVL I utdavmd tlmr a the, NEW RESIDENTIAL MECH. SQ.IT. ,,a ' ^ 3 n
d10e��d ��jry efi sl elcrlm� ria yrr6f e�Cmiflrue of Oc «wit / (/� 7
mM1ari vgrnt W¢ TOTAL: ISSUED BY:
��
OFFICE