B 0438 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-E,E.CTRICAL PERMIT NO. � n
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-h5ECIIANTCAL. (.spy
BUILDING PROJECT IDENTIF'IC\TION ��S'
BUILDING ADDRESS: SAN'II'ARV NO. A%'I,IC ON SURN1117AL DAT
(IWNERT NAME: 11 'v :ONTRACTOR'S NAM& LIC NO.
E NIC CONTROL#
C-6 _erj4enF&LSOnj�
�ARCHITECTIE.NGINEER: LIC NO: ADDRESS: SY(� ❑
CONTAIMP PHONE •�,.� RUILDING PERMIT INFO
X� ❑ ConsWlanl Fees Paid by Applicanl(Initial) HLUG FLECIPLUMB MECH
❑ ❑ ( ❑
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm Haan 1.m IkemN at M,,isiom of Chapiv 9(rnrmsrcioa JOB DESCRIPTION
WoZ with Sation](1f1(1)MtiviaianJ"rhe BusittasaN Pmfexsions CoJe,aNm Ikrn.r i.
IVOp - y PERM IT ISS UANCE
F� in full force mad cRecl. L tC1ADDIT[ON
)WL ❑KI'CCHEN REMODIJ,
QV�j Lkcmc G^u� Lic.N AYPLIANCCS-RESIDENTIAL ❑%.UMBING RE PIPE
QL Dane /� - Cantretta
ARCHITECTS DE01 TION PANBIS I.TI-UNIT ❑MUCTMOI)IFURAL
ION
ZO°fZ I unikotand my plena shall be asclmlwMk rcuNv
oz- UY TO 2IXIAMYS TERIOR ❑CHIMNEY REPAIR
licensed Yrofeui«W XII-IOOOAMI',S IMPROVEMINI' L]SWIMMING POOLS
�dS OWNER-BUILDER DECLARATION
ti 6 E hutuhy affirm that I ani uecmpf frons the Canmelor s License Law for the OVER IOOIIAMI'S qq❑OTTHEk EM >I?I/kEPAIR Q DEMOLITION
�(3 6 U fdlmvin¢town.(Seelion 70)13.Hmiav aryl Pmfesinona Cob:An,city m e.uruy SIGNS ELECTRICAL. )"'
YI 1+•�; which mquirea a pconail m c Woad,alar,imPmve. lcnulisIn.or repair any smactur, f e C
01 p,isr to at issanee,also requires the applirnnl for suchprnnit in fik a sighed sarecro,l SPECIALCIRCUITIMISC.
aSyIY that tails llcvnsul puntarn tothcpmvieian,ot'the Conumaoda Lieenvs law(MN.er9
I+Ino (am
xnencing witKSMkn]W0)ufUivai.n 3 ofthe Hots.,seed Pmfei .Cod,)a TEMLT
P.MI'ER OR POLE INST. COMMERCIAL_
a 1 5 than he is exempt thcreffom awl arc basis for,he alkgcd eumpt:n.Any viduion of ❑NI;W BLDG/ADDff10,N ❑DEMOLITION
Sectioa'IO3L5 by any applic.m for. roarif mbjects the applicant mo mInI penalty M POWER DEVICES
El TENANT ❑I'(R)DSERVICE
n.,mom than Eve hwUnti dollars(SSW).
H Z Y IMPROVEMENT
f=G ❑I,as mvrcr oftk ptMaerY,amy employees with xage as theirs.k rompmvuion. SWIMMING POOL EISCf ❑OTHER
I... will dothc wak,ab Ne,neativc is rot inecNeJ.roHccd far sak(.Sce.7l•1q.Besircss
RW onl Profesniam,Cade:The Con trends Licrnse Law Jars nm apply to an owner of ONI.EIS,_SWTfCIIP_S-
,soy alto bund,or Improves IL-..and alto Jtcs such work himself or Ihtough
his own employes,provided that such imlvovarcnu ane not inteNN a ofierN for NEW RESIDENTIAL ELEC
oaksif.howerenlb,buillarbure.ot smrnt is nlhe iidtnrcyearufcparoc,its". a AREA S/SQ.IT.
rwncr-builds will hove the hutJrn ul paving that he didtan buildtan imlmvc Gr pm-
pnt of sale.),
1,se,name M the proper,can eaclusi,ely mntrating with Becat.1.to
v ..the paujct(Sce.7L .Husinss afd Prafca,iom Code:,I-Cmuxtols O
-
rinlawdicsanapply,.an owes,ofpopaly who build,marn,so .meoam.and QTY, PI•UMBING
wM tomcats for such pr.j¢w whh a enntfactut(,)liavcl pursuant to Jae Conlranors 19I.Is.lata. PERMITISSUANCIEnm csccgn uNuSec. ,B A P C fa this,anonALTER-DRAIN AVINI' VALUATION
0,,ocr Danc
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.D
I bereby aBiren uns rpetalty ofpnjury ce<of flat fnllm,'ing whramn,
❑l luvuandwillnwinlnino Cem O.... v:nnnself-insure for Wndcr'a Cnmpcn- DRAINS-FLOOR.ROOF,AREA.COND. STORIES ]TYPE CONST RUCTIO
aali.rl_a,pnrvidell fa by Section 37Wof ase Isdsr Cud:,for the pcefatmna of do
wak fa which this permit is is.uscl. FIXTURES-PER TRAP
I loot aN will mainl.in Wakes Camperraim hoarana,-requirN by Section
3701 of he Lahr Case,III,the
pperLmmnatrrwtc afd¢work fslr�which this Pencil is issuul. GAS-FA.SYSTEM-i INC.G DO['1.I?IS OCC GROUP AYN
C YartieT /Ytr h-(N— aPZ Noy nl`,�)na(^5 GAS-EA.SYSTEM-0VER J(EA)
CERTIFICATE OIr IIEAIPCION FROM WORKERS' GRIASFIINOUSTAL WART:INTIiRCE1'IY)R
COMPIiNSAIION INSURANCE BUILDING DIVISION PEES
(This o,,onnml not becomplsi iON,permit a for arc hurv4esl"Ites IS IVO) GREASETRAP
a fits)(This
FEE
I eerily than inns perfatmanceof dcwartk for which this permit is issued,Isbell SEWFk-SANITMRY-STORM EA.2IMIFT
nes eacploy any Perim In any mwmet,wi as to become abject 1.alae W.dem'Conde HNEROY FEE.
Q Z ..Laws of California.Dan, WATER HEATER WNEN/ELECfR GRADING
z O Aq Irani
ME-
at, NOTICE TO APPLICANT.If,aftcr making this CeeelfiewL of Ex,.Nma,you hooW WATER SYSTEMITkF.AfING
SOILS IIiE
Fes ' Mcome sabjml Io the W.,ker's Ceanpcie.non pl—ions of the Lason Ctde,pm must
Test ith comply wish such pssvi,isns or thispcnnit shall budeevred msokN. WATER SERVICE
ZD CONSTRUCTION LIiNDING AGENCY NEW RESIDENTIAL%.MH. SQ,1.7 PAID
,Z Uata RcaiptN
U Q IMebyatI this rant
7,Cine .) fin,he pcHmmvtcc of
� (•" the work He which Na permit ai,suN fgec.3119].Civ.C.1 TOTAL:
I.rndn's A"
14 IcnJc(1 MLlty ti TQIAL.
kS7 � HULLOING FTE
I wnity that I Iwve ruJ tM1lx yaPlicaainn unJ sw,e raft tilt atone infUlttwlinn k
vim) cunmt.I.gra to comply.itb 61 city aN county ordbarcu cal ranc laws alaingm QTY MECHANICAL PERMIT FEE
U Z building constrtim,ahco,hy authorise oTNenlansince seivcs M this city t. ler trisect the
SEISMIC FEE
ncant
.n ohne-ntentiawd porperIy for m,,se ,ion porTese, TERMITE'ISSUANCE
(We)a,=an-w,IDdcmnify and los,Fartnloss IhE CRY of Cupation,agaion ELECBIC PER
lisbilitis.judgmcu,c�w and eapms whicl,acayinartyweyaccrve vannas said Cily ALTER OR ADD TO MECH.
in m�seynccc aof the granting of this pc.,. PLUMBING FTS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT AER HANDLING UNIT(TO 10, MI CI'M)
MECHANICAL IlU?
SOURCE REGULATIONS. ,
PrjcX-- J it ^ n� AIR HANDLING UNIT(OVER 10.f(K)CBD CONSTRUCTION DIX
Stgwtmct AppltcunVColntcow -•l I_)/arc M% AUSTHOC)DOXMUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will JrcaPplicaru or return,building occupmf a«c oc handle hnanrdoas m aTial HEATING UNIT(TO IW,M BTU)
-JefirrN by the C.pmtitn Municipal CNe,Chager 9.12,and the Ilcaltb and Safely
Carle.Scrtitm 25532(0'1 HEALING UNIT(OVER 110)11(X)BTU)
[I Y. VENTILATION FAN(SINGLE RESID)
Will,ht applicanl or(mane building occupant use equipnsenl or devices svluch
cntit luen=d ms air cmtnmittand a,defined by the Bey Area Am Quelhy Marwgcmenl H(111,13R-CONI'MIT ON W IXXI If CID T
Disaict" BOILER-COMP(OVER IOO.000BTU)
❑ JUN 0 7 1999 ) 1
Yea No
I have,cad the hmafd
sna naarmals rnryirerren,a under Chapter 0.95 ofthe Cali- AIR CONDITIONERISSUANCE
fume BtahIn A Safety Cotk.Seclka 25N)5,25533 aN 25530.1 undcnueed also if the NEW RESIDENHAL MECH. SQ.Fr
building tics.emmndy beets IONnt rhea it is my mpornibilitY to notify the nessaf f
"the rea,donamn which an.be as ties t.ivamat of u Cmificom of Occupancy. y
Owncrmaurhuvsel't. Dec TOTAL I.SSUF
OFFICE