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30803 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.ELECTRICALPERMRNO. 30803 (� BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL, 3 O H O^K J BUILDING PROJECT IDENTIFICATION BUILDINGADDRESS: - ,SANITARY NO. APPLICATIONSUBMITTALDAD 1! 7 t4ft 72- OWN E R S A L D� 1 r PI I(IN[:� C MRACIDR'SN 1,113 , Orns LIC NOItil : 1YIY11Py NIC CONTROL UTLiCIENGINHI7R: LIC NO: ADD ESS: /`/ 'L 00 lit AIT�O 9S TV . CONTACT: PHONE: BUILDING PERMIT INFO ❑ ConaRltant Fees Paid by Applicant(Initial) gLDO F11iC1' PLUMB MECH LICENSED TRACTOR'S DECLARATION QT ELECTRIC PERMIT FEE I�]•N� \Ic'fSi` \p�` M m Z 1 lemhy.ram IIw L E d ander provisions of doper 9(eammencing JOB DESCRIPTION ith$canon 7000)d Division 3, Nusirlesserd Pmfeasiom code.eM rtry lkcmeis ( FCC on full fmce and cRal. .1! PERMITISSUANCF, %U�j Liarcse ClrulJc.M iFS FOWL ❑KITCHEN RE MODEL ZL Due(� L � p� Cam,xur AP%.IANCTS-RFSIDENTAL ADDITION - L1 PLUMBING RE-PIPE ARCHITECT'S DECLARATI N PANELS ❑MULTI-UNIT-' ❑STRUCTURAL. ZOyZ ladcrsmarnd my plans,hill he uxdmpuMic sada MODIFICATION OZ�❑❑ UPTO200AMPS ' r- NI Liamed Ymfcviorul ❑INTERIOR ❑CHIMNEY REPAIR 2(11-100DAMPS IMPROVEMENT OU OWNER BUILexempt R DECLARATION e OVER 1000AMPS ❑BATH R�Aff1DE1/RSPAIR'O DEMOLTION 5 a 1 hereby affirm OW 1 It exempt fmm,hi,Contractor's Lknue Law for the }Y �s 1LJ! 3a followieg no.(,Sesior,I(Ei3.Buaircz.and Pmofesmacts Code:Anycit, county SIGNS ELECTRICAL [j OTHER a which regaires a penman a con.ruct,filler.improve,dribi.h,or refVir any,immure (}— C prier to its i.svwae,also requirca me appllkau fa such permit to Bkadomed.mmomf SPECIAL CIRCUIT/MISC. m(•II DCnan pipgns' Ws he is liernW Up purbouo die ovisi,ms of the Caecrarn ljoem,e law(CM1eper 9 wl: I+I�00 (commencing with Scbmm700)of Division 3 of he Budnbs and Professions Code)or TEMP.METER OR POLE LI frST. a a y them he is exempt thereomd the been for the all,exi exemption Any videti,n of pJ CteD70N ❑DEMOLITION xx•�4• Seaia 7"71.5 by any applicant Lr a emot subjects the opplicwl I.a civil pc emy or POWER DEVICES vu. C'(I Way ❑TENANT N(/OFooD SERVICE F u Z Y °°,nc than f vi,hwdreJollas d ($5(10). , IMPROVEMENT 6pI,mowner athe"breny,fir my employes with wage.e+,hcir sole comPnsetiun, SWIMMING POOL,ELECTRIC EI=.a will do am thewoA.admearuceNnotimmd � alofofleralfor sale(See 70,14.Busircss ❑DTHEft W1: 3�_ end ftofsavwm Cute:The Ccotrctara License Law does m apply a an owner of OVfLEIS-SWRCHFS-FlXTURES �• pm etfy who huildv,r impmvu Ihcxnn,and who floc,such work hinnnclf a thwagh his own earRoYcca,PovidN that such imposemcva are not iaesded or offered for NEW RESIDENTIAL ELF.CTR SQ PT. vide.If,however,the,building oritnpmovemenm is wild w ithin acYcarnfrornpletion.lhc SQ.FT FLUOR AREA $SQ.PT cr.huildrr will have the harden of loving tam Ie,did not build or improve for pw- pox of sale.). IL E] I,as mvnsr of,he property,an exclusively enntra,ing with hcem+vl comm tori of TOTAL: amucm thepaned my .of Noone adrty who bui Crde:)Thc Cootracwis li- 1 who wiwerdpropeny wemnuts ldsorimprovesCurcon.um QTY. PLUNGING PERMIT FEE who ion,LAW for each PojNs wish•conlrvemrta)Ikenxd puna,unuoIt!Canxmore Ocrnx law. PERMIT ISSUANCE ❑lcon cxcmpr umkr Sm. n ,B&GC for rraran Owner [)me ALTER-DRfIN&VENT-WATER(EA) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE I I heathy Mian under under prnalry of perPay ae d de folB,wiog declamations: l- O I� J Ihnveemd will mvinainvCcmticvc nl Gmxnunsdf-inwmu for WuAdc Gmnpcm DRAINS-FLOOR,ROOF.AREA,COND. STORIES TYPE CONSTRUCTION ided for by Section 7100 of Ire labkthe or Co, ,for permurce fo *of the wmka provforwhkhmi ,,trootisisa,ed. FIXTURPS-PERTRAP ❑I have old will Inanraln Workcra ComPmmia Inwmrca as xyuirN M1y section JYWoode labor Code.forthe pemercamccofmAcwmk fmmmerM1 dtis pemdt ix isarcJ. GAS-EA.SYSfiAt-I INC.40fITLLTS OCC. APN MY Worker's Cmnlprnwmia lamw,la carrier and Policy numMr ac: Cartier Policy No.: GAS-1,:1.SYSTEMOVER 4(FA) CERTIFICATL OI,EXEMPTION FROM WORKERS COMPENSATION INSURANCE GREASI%INDUSTRL WASTE IM17RCEKOR ULIDING DIVISION flFS orI..(Tua accmian recd nor be compinedif the Rnrdtufmme,huMmeJ dollen(SI00) GREASI?TRAP PLA 1 unify that rife,Prfmmaee of the work for which his pmnut is it ucd,1 shill not employ any person in any main rc son my tIn Els Wnmlo"'Callen- SEWER-SANRARY-STORM E.A.200 FT � F., i pus- ZZ sada law w(Culif Dafc _\ �� WATER HEATER WNfMIELECTR GR LNG O Mpie.nt jN h NOTICE T� li APPI,I AM:ILii t ni&Ari me of Exca ioa,yw,u should WATER SYSDEM?REATING ea Nvr cubjec,fo Be Worker's Cun Lion positions of mate Lubar Codi,,you must SOILS FEE WfoMwith canply with aueh provisions or lhispamir sM1all be,kemed revoked. WATER SERVICE a. 7z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PI-MIL SQ,FT. PAID U0 Ihcxhy affirm lam dart in uca..runion lcMing ugwcy�onnepMumnmcc of Uva Receipt V. .r the work for which this Permit is issued(Sec D099.Cr,C.) O U Leader's Nems DOTAL- Istdcrs Addri TOTAL: E" 1 1 emit,mlmt I love rad this epplieau,m and some NH IN,above Iofwr,n.>tion is BUILDING FEE h mrmect.I agme w comply with ell city vN cuunmy ordinances and state ww<mlmmg In QTY. MECHANICAL PERMIT FEC U z building CamslrwXtia.eM thereby authorizexprexnwivs ofthuciryacne,r upon the SEISMIC FEE ahnvc mentioned p,tem y per inspection purpoaca. ' (We)figrtewsavelaknmity ad keep tlamle.0 me Cimy of Cupmin,ageing PERMIT ISSUANCE CLECpRIC HE liabilitica.jwlgrrcas,costs and ex,emes which may in any way acme egalmf said City in nnxquence of the grenti ng of this profit. ALTER OR ADD TO MECH. PLUMBING Fti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT ITT,10,000 CFM) S1 CBR IATICKS, MECHANICAL FEE . AIR HANDLING UNR(OVER10.00aft CONTRUCIONTAX Aprili ructar Date EXHAUSTHOOD(WIDUCI) HOUSING MITIGATION FFR H RDOUS MATERIALS DISCLOSURE _ W,Ihle tm fume building rucupantsao or hamdle hmvdom numeral HFATING UNIT(10 00.000 BTU) ux defined by the CuPniaa Municipal Cmk.Clepler 9.12,and the Health and Sefay Code.Semon 2 532(.0 HEATING UNIT(OVER 100.010 BTU) ❑Yes ❑No PAID ' VENTILATION FAN(SINGLE RFSIU) W II IM a Deme KeceiP N pplicvN or fame building occupant sax equipment m devices which BOILER-COMP(3HP OR Bp 000 Is ID. t hemNoua air contaminants m,kfml by the Bay Afee Air Qati ty MwtiVour t TOTAL: ? BOILER- COMP IOVI?R 100.00a)BTU) C.� ❑Yes 7N I hate read the haralloru nomerala requbemrnts umda Curtner 695 of de,Coli AIR CONDITIONER ISSUANCE:DATE Rema lkelth&Safety Cade,Smias 25.505.25537 oral 25511.1 a,dasmrd mho if the NI?W RESIDENTIAL MECH. SQ.FT. buildiogdocs mcwcer have•mc*ml4 ma imumy regraesiUlirywmdfY IhC,eY'I,PImM of Be,r,mor ,a which,,,..hems prbr w i.mmce ora Geni(eaaor(kc. nut Owrcrm eelMrird ogrnt Dore .TOTAL: ISSUED BY: OFFICE