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30656 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES=USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITN030656 , /�3 O /1 r/� BUILDING DIVISION APPIACATION/PERMIT' PLUMBING-MECHANICAL Vh`h. 6 BUILDING PROJECT IDRNDIFICATION ILDINGADDRESS, I 0 SANITARYNO. =SUHMITTALDATE 10,622- Ga OWNER'S NA E: PHONE ONBAC R NAME: LIC NO:SN 2/ 6 73U G ?57 77 „Q R 7/ /07 '/S CONTROL" ARCHITECTIENGINEER: LIC NO: ADDRESS: ❑ / E O nrit.,e Fp. PHONE BUILDING PERMIT INFO 7�� /�^� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH n Pq L J / J ❑ ❑ ❑LICENSED CONIRACIOR S DECLARATION QTY ELECTRIC PERMIT FEEarn wt I am lice under I rovisims a Christer 9 fevnrercins JOB DES IPTION �z .rDl.1.imJanmBadte...naPmfevimncax.mamylk��rei=Wlo ' RESIDENTIAL ��FH fem. /O� PIHtMIT ISSUANCE ❑SFDWL y'RffCH&N REMODELLie if ��� ueo f-Z O[—Cadracla APPLIANCES-RESIDENTIAL ❑ADDR70N ❑PLUMBING RE-PIPE i-D d A C i1TF.CfS DF,CIA TIO PANELS ❑MULTI-UNIT ❑STRUCTURAL. z O 1 urdentwxl my plan,shall IN,uud ar puhlic ettcuJx MODIFICATION OZ G UPTO200AMPS ❑INTERIOR El CHIMNEY REPAIR I"'�nLisemed P^'f t; eesi°"°I 201-I000AMPSOAMPS IMPROVEMENT y OWNER-HUIIDER DECLARATION OYER IWIIAMPS ❑BATHREMODEVRI. IR [IDEMOLIT[ON y 1 hereby rifrm that I rim nemq from the Canlracmr's hiceme law fur the x 3 a U following Anson,(Section 7031.5.Busixv rind Profe.vraa Code,Any city re county OTHER u] u.F SIGNS ELECTRICAL Iy. which ryuirn a pcmdt b crosha.'t+tier,imyrovc,dcmdish,a,r air sly.aacnm F•�O:} ithat mminnumc0.elmutto theror prothe visions n for Cobtrustichrmivaierose Lrcd9uemem sPIiCIAL CIRCUIT/MISC. fp��} rtw he is licensed puauant l.Iheprovisionn uTde CmmxlMs Licrnulaw(Chapa9 - - • I+O�CO (cmurcrciry with Secdm 7000)a Didsion Jaftle Businm riw Professions Cade)ar TEMP.METER OR EINST. COMNIERCIAIL a c y That he is exemp tMrtfrom rind The,had.for the dleg d esempinn.Any nolmian of tt• S lion 7031.5 by any applicant for.Ilemtif,id itc i the.,licvlt m e civil penalty of POWER DE .V 5 EITENAEl NEW NT '.DDITION ❑DEMOLITION y rent me dun five live hunJrcl dollen(55(1(1). . IMPROV ❑FOOD SENVICE E3 1,uer.wtof de poirmt,or my emPloaa th Ywith eEh1FM rigcau ir wk eoncnvtiaa SWIMGPOOL ELECTRIC IMPROVEMENTp pEFG will J.there,,or,endi, Obe Curt telrinmtdedorufc-nota,[, o0U,Hun of C1 OTHER a v i Pmfurlons calor no,over de ors L si sa Law yv not apply ns if owrcr of OI LETS-SN'ITCIIIS-FI%llJR15 pile.whom oy..m ilnprovn,Mem,ud wh.Jac.ouch wart dexo o l m Ihroagh his own employm,pmlding Thu..ar,ato iaycovenenw thin sort iyeardcd m offered for NEW RESIDENTIAL EI.ECIR SU FT. svlglL.dik, rillht ding o,crof b,inl inmWwiihinarycer,binw,aio,I., SQ.Er.FLOOR R f75Q.FT. nofsaldcr will have the huNcn nfpmving dal he did nm buil]or improve,lar par- ¢ )� pose,of vwne ' ❑ Loci the jec, is e.7propeme,ibess aly mneriin,with The Econaenmm TOTAL ronumet me nr.im(se,,.7tu4,narircss etd 1'toroohx,.cmeq The C.natKhY.u- 1 O me Lowd,vnaripplre loon aprogeny who huiWsorimposcs lhetam,erd QTY, PLUMBING PERMIT FEE - DECGY Fi wlw emtvcrx fm such pojccuithit with a mmrmlMsl licemN pursuant m the Cmmmun's License Law. /� TV L ❑Ian eacmp ualer Fc. ,B&PC for do,. PERMRISSUANCL. y111I ,UidU1J LM I',IN Owner D— ALTER-DRAIN&VENT'-WATER(EA) - VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE 1 hereby M.mdcr penalty of perjury are of the f.d.win,declaradms: ❑ Ihvvs rim)wilt mvinmineCmiOcuc of Conunuu sdLlnwmla Worker'.C.nlpen- DRAINS-FLOOR,ROOK.AREA.COND. wi.n,as povidN for by Semon 37M a IM labor Code.fm the prrfmtmnEx a the — TO STORIES TYPE CON UCTION wuh rn for which tNr pnir is issued. RXTURFS-PER TRAP ire" f Fl hast Cnal will tbarin Warkd,Ce b b.smion Insurance,u rcyui,M by Section 3701 Lehr Cole.Porde perfornmet,of tie work far wbiel this permit in issued. GAS-G.SYSTEM-1 INC.4 OLMLE'S OCC.GROUP APN h1YW 1 e rend Polky nun er Q} Cvrrirc if Nn:� GAS-EA.SYSTEM-OVERi(PAl CERTII ATEOV EXE 1NI NPRO I R. COMPENSATION INSURANCE GREASF/INDUSTRL WASTE INTERCEPIDR BUILDING DIVISION FEES (Itir wcdm lyd rn be compMcd iflhc perrtJt is forarhludrMJOIW.(SIW) GREASETRAP orlesa.) PLANCHECK FED 1amity Ibninthe my ceof Ne heolarwMjM1Ult,tto ths,Wlr issued.Corxha SEWER-SANITARY-SIORh1 EA.200 FT. cmpby,ny perxm in riny mvnnn.a ria m M rte whjM to Ute N'ohen'Compo- ENERGY FEE Q aim""aC ie.Der WATER HEATER WNEMlF1FCIR GRADING FEE Besot NOTICE TO APPLICANT':If, fla nuking lots Ccniliculc of Esempion yen should WATER SYSfEM?REATING - F Neave wb*t to the Wake's Ccmycnwion pb viavrc a the fudsi Code,you nota SOILS EM fonhwd,comply oth.ach povisiana or this per-on,sM1nll Ne,deemed rev.kal. WATER SERVICE Q - O DCONSTRUCI'IONLENDINGAGENCY NEW RESIDENTIAL PI-MR. SQ.FE PAID I herebyvffion That the • m re is Imrierc dur, , y fm the pexfwnlance of Dea, Raeip0 0 do work fm which this permit is iswd(Sec.Jf197,Ci, ) Q U I<Wcr's Nvmc r - TOTAL: } 1<mkrI Adlra's ,OTA (-' y I cim Inst I hese,read this rippl cmnrid sue Ihet Ane uccithross,l irfontwinn is BUILDING FEE Z huddinirigmo,bor, ly with,y..ahrird ce,c artinureend cine,lawsrdaingm QTY MECHANICAL PERMIT FEE U z Willing e.n.wetio,ert foreby uulbtmacr,oe¢nlalivCr of this city to can upxllM SEISMIC FEE •"• abnv<.I DVr)rrJproprty fmimpifly keep brr. IWe)vpeemvve,iMermdfY vd kap humles the Ci aC , PERMIT ISSUANCE liebilities.ludgroents.costs mal ex hich ma ry amad City ELECTRIC FEE ptacsw yin any w'vy m<wc+gains said City ALTHROR ADD TO MECH. in vmuqucnc of the,Rnlin,of IM1i.r plmmil: PLUMBING PEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(1010.000 CFM) MECHANICAL FEE SOURCE ATIONS. sal �� ��� AIR HANDLING UNIT(OVER III IXNI CF CONSTRUCTION TAX �. m of AppnevnUCararmn Dem EXHAUST BOTH(WIDUCT) HOUSING MITIGATION HE HAZARDOUS MATERIALS DISCLOSURE Will IM rplicenlor fmlae building acupamu.reur hiodle bvardous nlemdvl HEATING UNIT(TO 10f( TO) u defined by the Copcniou Municipal Cade,.Chnper 9.12,and die Health and Safety Code,Section 2553200? _ HEATING UNIT IOV IW.000 BTU) '� ❑Yn C]No PAID �� VEMI IATIU' AN'I SI N0LE RESI DI Dme RaripN Will Ile eWlicmt a furore building acupont uv equipment or devices which BOIL COh1P CHP OR I1q.000 BTU)•odt harudws air contmnimnD m definal by Be Briy Aro Aur Quit,Mrimeertem TOTAL O Dislrin7 B ­­1 Yes E]No .ER-COMP(OVER 110.000 BTU) t I have rmd lk heumdnce,bee ivls regaire.mtrr Clugerfi95 a the,Crib AIR CON'DMONER ISSUANCE DATE faniri HersharSefgy Cade.Sectors t,bias i;33 byerd85bity uNemvd IMIifdhenot NEW RESIDENTIAL MECH. SO 17tho - asthengtarrr cw hichheseri.pior oInmyrcyf.Cestimnasifydoetecapml a the mquirttrcna whirl)muY be Ira prim b ivwarre of v CeniOcvm aOccupary. ' Owners emhori'md ogenl Dam TOTAL: ISSUED BY: OFFICE