S 2098 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
8CITYRBUINGEAI
CPE8RNo. LO^
OF CUPERTINO PLUMBING--MECiANICAI
UILUINGDIYINHtry AIPIdCATION/PERMIT PUILDING PN
BUILDING ADDRESS'. SANITARY NO. APYLICAIION SUBMITTAL LATE
Z - RDA) LAVE -//- y
OWNERS NAAIE: PHONE: CONT% ORIS NAME: LIC NO:
-CLAvD — — NINE CONTROLx
ARCHI'I ECi/HNGINEER: LIC No ADI ESS: ❑
CO/NTA�C'. A1 n PIIONI BUILDING PERAIII'INFO
Lila /'+ /&-y ❑ Coneullanl Fein Paid by Applicant(afoul) BLDG ELECF .UMB MECH
l -S0_0._ `7 % ❑ ❑ ❑
LICENSED CONI'RACIOR'S DECLARATION QTY ELECTRIC PERMIT IEE
I rxrchy air that I not Bcen.tm under pr%t%a.id>�of emPler ¢ r
9 mtmmialt JOB DESCRIPTION
WoZ
O O wiTM1 SCOion]a1J)of Divisknld>r the Ruorec,,ond Prufa%iorod Codc.eadmy liocreaci% RFSIDENTIAL
PERMIT ISSUANCIi
F-y- in full forceandcRm. ESFDWL C1 KITCHEN Rhl.WDF1
Gg.ZW Liam Cluvx ComLucAPPLIANCES-RIISIDI?NfIAI. []ADDITION ❑PLUMBING RIS PIPE
lnQ6 Dau Commerce
F.,ON ARCIII'IECI'$UIiCIARATION PANELS ❑MULTI-UNIT' 0M0DRrI ATK;
_ v2Z 1 unordand my Plain shall be uta!ex Public rads MOUIFICATI(lN
ZOZ-Q UP To 2(9 AMPS El INTERIOR ❑CHIMNEY REPAIR
Fr/-+FW Literati FmB,,umuuT 2111-1000AMPS INIPROVENFI.T E3SWIMMING POOLS
OWNER BUILDER DECIARATION 0_y!3µl(MO AMPS O BATH RFMODPJJREPAIR [IDENiCIATION
y O C Q I hereby at Ind I am exempt fmthe Contractors xe's Licemlaw for The x,LRimm
U ❑ nw
illingron...(S¢I nn 70315.Ratio.,and Profccddmv Cddc An,,k,orawmly SIGNS ELECTRICAL 0(yfHEk _
LLl Ir, which regain,n pvrmn To eotelarel,alms reprieve,deTmlish,or rduir any .,are hal
1"'4Tn'O Prior To in intererrc.alw,meant v llrepplicam Rrsllch pamil To fknsi'md rim. SPECTALCIRCUITIMISC. - �— 6L
f ylT� Phar he is li,cat punsoanTm do,pmvk%idu%of the Connection,license Lao.(ChapmrIT
(Commencing with Sectimt 7000)oflHvicidu 3 oftlrc Bu.ircsi and Prnfcumn%Cola or TEMP,LIFTER OR POLI:INS.. fJ COMMERCIAL:
a a e C door he o uempt tlw+cfrom image moi,for the till Bred c.elnryim.Any vidam of ❑NEW BLDC✓ADIIITION ❑DEMOLITION
�LLy' Scetiou 70115by any T,liann htr.peout xabettl the apPl'Ieanl lU a eivll Penally of TOWER DBVICILi O' ENTANT FOOD SERVICE
man Tose than E,hundred dtllun(S.Wn,
MPR EMI:Yf
G=O ❑La%Newcatf The pmPeny,armYemPk'Y"�m w'nh wago ar Thdrmule,Fl fgumion, SWIMMING P(%)h liLIiC1A1C
F. wBl VOlhcwor,ands The numisrce,,oat Licence Low der,
not.(.Sec.]641. wneir-of
Wcey honx CNc:Thero,theerx Liantsc Lawdorm gapplymIf ,Ther of (11I11J:fC-SWITCIIIS-fLKIlIRIIti
hu,ow y who builds Ir imp le IM1da,h a nu who dxv such gunk him.%clfor Through
his.wnnophryrex,Ieilmedrin suchiearm I, Id are Irl IntetlkrlroB'cm1 for NEW RI?SIDFNfIAI.ELECTµ SQ FT.
ace.If.hdweven the building orimpmvcmnnl is.-Id ,Thin onerimu(contplcoiun.the SQ.FI'.ISL(%IR ARTA SISQ.I%n
rcr-balder will hove The huMcn of ponding Not he did nut build m impotc fur Pur-
pose N vlc.).
Ab IC
0 L x ow.of the Ivrtlroey,am cach,4,cly.1.,with li erecd emtncua.m T
r_u.,Be ryoiec,(See.71100,Bmircsx"Prnfi i—Ca l Pre Camm,11r'1 Li-
wrlawdkNsn.apply to ml owner of Toi who b.Bds or in.Truvex ThrnrT,med QTY, PLUMBING PERMIT FEE
whoaNlT tisfor,tuch Po Ijeel with.comranort-V liwored puna:nnote Conlneurm
License law. PERMIT ISSUANCE
1 on rucmmT Mater Sec. .B k P C for This marten
ACIER-TRAIN h VISYf-WATER THAT VALUATION
(]%vncf Dole
WORKER'S COMPENSATION DECIARABON BACK FLOW PRO I.CL DEVICE
I herby.Bion under pemany of Perjury ale of the fUh,wlng datlanTiIro:
� IhuvewdwillmalnminaCmiliea¢nfCun¢mmulf-Insure Bx Wuher't Cumpen-
DRAINS-FLOOK,ROOF,AREA.GOND. STORIES 'fYPECONS7RUC7ROF
cation,uPr
s ovided for by Section 37W of Th:lahm Code.for the perfmnvec of oe
l
wad for which dais parniT u banned. FIXTURES-PER TRAP
0 I Irate.rd will maintain Workers CmmPcnertinn Imunrrc,vs trainloadM S«Time
3](9 of the labs Gee,fm the Performance of the work for which Ibis Permit is vowel, GAS-EA.SYSIAI-1 INC,4 OUR,EIS OCC.GROUP APN
My Workers Compenwtion Imannee earrucr and Policy numltir ar,
Carrier: Pulley No.: GAS-IIA.SYS1'BM-OVER 4(EA)
CERTIFICATE OF EXEMPT ION FROM WORKERS' CREASF%INUUSfRI,N'ASTE INTERCEPTERCOMPENSATION INSURANCE BUILDING DIVISION FEES
Met it..aced tial ba umplcTM if The Irani,is ftrore Vantin!dollEI 1001 GREASP,TRAF
w It,.) YIANCHECK FTai
Ice,lfyl eirmonelrerfu area, of ,b,gokfnembhlhie dic Weloriaed,IWn- SEWICR-SANITARY-S'IORM EA.210 FL
nm cntpluy any frnuu in any nnnncr m ar In tumor subja'I m thu Wcrkea'Cdwlpen- TNI?RGY FEE
(] z
..on Law If Calderon.IAtc WAIIiR HEATER WNEYIEELECfR
z g APpfGRADING FEE
^'"
N NOTICE TO AI'PLICANI:If.efter rreking Thi%Ccrtificure a ExcmPTicn.You should WATER SYSTEMIRILVDNG
(•"' ? laYome xubjeci To the Worker.Cornpentation pmvivwls of 11h,labor Coal yen nucr SOUS FEE
forthwith tt 0_d,with o eh nov,kinm,'mi,peal..Jwll redeemer!Invoked. WAIER SERVICE
Q
Uz CONhere". o.ti'DWGAGBNCY NIiW RESIDGTIAh PLMB. SQ.FT. 11'All) Rtt<i N
U � IhenMy vdirm lbs there iaaconflN[Tidm lending al;enYfm lhcpm'amunre of N
dr wink for which mit Permit i%io%tml(,Sac.3197,Civ.C.)
U. F" 1<tderl Nanta TOTAL
� � Lcndmr'%Addn%xs TOTAL: BUILDING FI';1-nlfy mat 1 have rtad dliv aPPheauoll,I.1 alae IMI Phu ur,ve iummu ion is
Val comet.F arra to comply with WI city and a%,my ordoancc%m rl mute laws relating to QTy, MECHANICAL PERMIT FEE
U Z buidingmillemo ear.ardltrrebyeanhri=e mfor,crmtives d to,cRy nemerapm tti• SEISMIC
almve-rrcaiorcd papmY lor ilbpSTion P.rryo%es. PERMIT ISSUANCEO
(We).gm to save,irdentnify toad keep hmmlexc The City of Cuper ino agaime ELECTµIC FF.
Inthilitias.judgnrnrs,cdxioxnndcxPcnwl which Tay in troy way accmc again,said City AI:HR ORADD'FOM17CH.
Imyuelre of Ihic granting of lhix penult. PLUMBING FTI Za
APPLICA N'1'UNDERS'T'ANDS AND WII.I.COMPLY WIT IT ALL NON-POINT AIR HANDLING UNI T(TO IWO)UNIT
SOURCE:REGULATIONS. MECHANICALl1Ji
AIR HANDLWG UNIT(OVER I0,000 CENT) CONSTRUCTION TAX
Sigrmmm el AfFlicenrrZoodtrTor Date EXHAUST FOOD(WIOUCI) HOUSING MIT]GAT[ON FEE
HAZARDOUS MAF12RIAl S DISCLOSURE
Will me,applicant or future holding-Onaan some or h.nlle hararker,material HI:A'PING ON[I'R 0111%00013'1'U)
as dcBlyd by doe Cupertino Municipal Cork,Chari 9.12,and TM Health and Safe,
Code.Section 25532(0? HEATING UNIT(OVER 100.000 Bill)
ye, ON.
anti VEbRPLATION PAN SINGLE RF_SIDI I'.\ID Dae Receipt#
Willmar d applicam nr famrt Ix,fired by the B u%c Area
Airrcm or review whoa,
omit M1umulouv air c'onnminnuln.n dcdrcA by do Hay Ara Air(Awlhy Mewgcnrnt IfUILER-COMI'pIIP ON IIMI.q%)BTU) (
DisTrin;
E]Yc, ENn BOILER-COME(OVER 100.1100 BTU)
myu ocurre Chaper AIRCONDITIONER
1 have and The haauddus rnwrrials Ts Tinder fi95 Mahe Cd] ISSUANCE DATE
famia Health At Safe,y CWc.Sectinm 25915,25533 rax!255E I mrtler mnd Ilial if the NLM1V RESIDEN'IIAILMECH. SQ.PL r- Q
huildillg d1Kx mM anently lave u lenuni.th.T'll isur,re%,roinlity In notify the IY',founl a
of 1)r nyalM1mcmx which Illus Ir Ire,prior m Iti<ttvice era Cenilicdm,of ekcapancy,
TT%'rcrmaulM1ud=eJ Vent Dam TOTAL: PSSUEDBY:
OFFICE