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