S 2329 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
Ii CITY OF CUPERTINO BUILVING-ELFMIIICAI, PERMIT No
II BUILDING DIVISION APPLICATION,"PERMIT PLUMBING-.MECHANICAL.
i BUILDING PROJECT IIANTIFICAr10N S 2329
BUILDINGADDRESS: ^/ /f _ /� l / nA, q50 11Z
SMTTARY NO. APPLICATION SUH\Ir .HATE
OWy R'S NA 1@ 6, IIf N11tA N'I'�yNAMFI/.//' LIC
� /y y'/I�O / r( /J��� �1 n+' f /1 NIC CONT'Rol-M
ARRC-/11ITECTnNGINEER: /'(J LIC NO:�✓� d- ADDRIi.: C L ❑
CONTACT': PHONE: BUILDING PERMIT INFO'
�/ / O/, ❑ Coneallant EccS Paid by Applicant(Initial) HIAG ELECT PLUMB MECH
IJCENSI?U COY RACIORS DEC1ARAHUN
r I perch,'enirm that lam licen,m Utxkr Inn'i,iwn of C",9(".i., Q ELECTRIC PERMIT HTE JOB DESCRIPTION
aprn -- Bu�lnun ntxll'mfc�.inn.Gale.m,a��� rcu_nw i�� O RESIDENTIAL
�G -n9Ec(mn OfNXpnf Dlv, PBRMII'ISSUANCE
"full force ? ❑SPDWL ❑KITCHESIRGMODEh
U�j licrnw Clw ..x t APPLIANCES-RESIDENT'IAL ❑ADDITION ❑PLUMBING RE PIPE
FQ I},uc - Commix -
N RCHTEC'S DECLARATION ❑A1ULT6USR ❑STRUCfURN.
Z p(,n z 1 understand my plan.wnill M usal u Public r,"s 1'ANEIS MODHICATION
OZ—n UP'IONX)AMPS [I INTERIOR E:1 CHIMNEY REPAIR
P:(?FW Licsnvd Pedhexsinced 20I-1000AMPS IMPRONEME.YP C]SWIMMINGPOOIS
rE yC J OW NIR-❑UILUI?R DECLARATION OVER IHCAMI'S El HAITI RFJMODEi EPAIR ❑DEAIOLl'I'ION
C < I belch,aRmn tMt I wit memPt from the Unrea t«s Licenw law tilher,t
K6 U fnfleming rta'er.(Semon 703L5,Buv'ircu ad Prnfdsitma Cock:Any city«county SIGNS ELECTRICAL F1 OIHGR /1
3 u, whOr(moll,,a Pcrnnt m a,nnmm,Ntcr,Intpmvc,dene,likh,«e,valr any stmamre
E't=tn'Cg pdtr taus i.sumce.olso require,the a,,liant fors fi Permit to Bka,igrcd'.(,taco( SPECIAL CIRCUEDMISC.
that he is lawd,wiPerwsn'.de,'visica,of the Gmtractnrs Litt",,law(Cnaplu 9 .
W a00 (c.... ny with Scnirm p(XMUnt Uivisi«IJ nfthcltu ircs,wW lhafc„ion,C,xlc), '1'F R METER OR PULP INSII COMMERCIAL:
C d e Out he i,cum,,0ercrrwn eexl Bte bmi,for the alkgcd c,o,on limn.Any vidni.d ❑NEW BLDCIADDITION ❑DEMOLITION
�y Section 7011.5byany ofmlken(farary.+mor wbjeme the aWicanl to a civil penalty od POWER DEVIL.ES
not mxetlwn live huMrN JdlwxfSSIXH. ❑'fl?NANf []FOODSERVICE
Z Y [AIPROVEMFM
a E] I,,,nw'ternrde pr�eny.«nty emdn><e,with xagcwu Weir sdc cuntprnwtion, SWIMMING hBII.F,LI:CRtIC
❑ win tk,(hc wnk.a«I Inc amcmmin not'mmndctl oruOcrN fnr wlc(Sm.91NJ.Rusinc,a OT
X
Wand Pmfeuiotn Cade.The Commcter,Ix'rnm I.w doe,not a,1y to an owmr of OUTLIi LS-SWITCHES-FIXTURES
pe,,v ey wln Wilds to itrgrcnves Merin and who d,,ouch xM him.elf«(Magor
hisown a PIU,t',prt)vided da(wen in,provcnrm,are ivx inte7lrTW or pl!e' fur NEW RESIDENTIAL ELECTR SQ IT
.1c.If,hmwever.the Molding«tmpmvement it r,Id wiWin Une year of contPlni%n'We 4T.FLOOR ARIA iasq CE
uwnQ-huildn will haw(nc huNcn Ix proving that hE did rax build or imPn,w her Pxr
pow a(mk/.
Pt h m wmr of the prop,",,am eadu,ivd,'mntme("g wiW Bern.i amuan«s(o TOTAL
«tvtmct thE,,nee(Sec.FIW,DUnineaa ntd Rd�.don, lore Crmtmaor's Li-
l«wd«,nm apply(o an uwter of pny+cny wnuilUd<.,u nur lntpnrvcs(harm".red PLUMBING PERMIT TIT PEE.
reeve canavctr f«,uch prujau xiW n cmmn«I,)licmavl funuxm(00e Cm(tac(ur.
Elaine Law. PERMITISSUANCE
1 inn E,emp toll Sec. ,H&1'C fnr Wi,m„w,n
ALTER-DRAIN&VENT-WATER(IA) VALUATION
owner Dwe
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
• I hereby aRrm under prndty of Perjury gyne of de f dlewing dttlerminns
D Ilmvc anal will maintainaCumlicmmdCun.renuorel(-'mwre f«WorkUr'x Cuntpcn- DRAINS-FLOOR,ROOF,,AREA,COND, STORIES TYPE CONST RUCTION
,vino a prlvi f«by Smian 37W of the Earlier CoAl Sack perfmmvice M(M
our k lerwhicn Wl,Penna i,i,wd. IIXTURISS-PEItTRAP
Ae and will maintain M'otlefw Canlpvn.wlmn Im'uramc.a,rtyuirtd M1y S¢(ian
Iro of the (
labor Ct.k.f«tore pert euflhewM fur which) ixpttmi(i,i,wN. GAS-IiA.SYSrPAt-I INC.J OIfTLLTS X:C.GROUP ANN
My Wo l 0 s ed Pulley numnc h N
w Lf
Cartic dky -Ie.SY, iMOVEftJ(LAI
CIRTmcATE OP ExPlau ON FROM WOR ' Q
COMPENSA'1'LON INSURANCE ASCI rRL WASTE INTCRCHPIOR
BUILDING DIV ISION FF,PS
(Thi,,actim mal ra(bc conlPk(N if We pEnni(i.f««e dWlars$1001 GR -- --
ur
leve) -) PIANCH[CK IEE
I certify that in the lerr__,,Ufle work U,which this m T�i II _ RY-STORM EA.41X7 FI'.
tit employ any peon”in any'ran�w ar it,becone wbjec(to r17e ENERGY FEE
Oz ,,ditn Laws of California-Ilam WA'll?R II 7 W`VHNT/EhLCTR GRADING Elf:
2 A,l con(
N NOTICETO APPLICANT.Ir,ar(tt making thix Crnif rt of fi mp0un,You,Mwkl WATI?R SYSO_S HATING
> he......vea to We W eTu emnPrn,mitm Pnrviainn,m We I e.Tru mw,t SOILS FEE
futWwith caa,ly within such Mvumn,«do,p .it"I nc tkc ATERSIRVICE
z CONST'R UCI'ION I-NDING AGENCY NEW R PSI DCN'I'IAL PLM B. SQ.ITE PAID �.
UQI herehyalBren War there,I,a crest tim ItWhey f«(he pert«rtet O RcceigM
the wort f«which Ihi,permit i,iswecd(See.3W7.Civ,C.)
U lender's Nan,LLJ 'T(YI'AI:
0
yU Ictxkr,Addrtu TOTAL
C 1 certify Ihu(I have aW this a,licn(inn ntd 4aty IM(We uMrve mfnmtutiat is BUILDING I
lit-^^^ N a�.1 agree to atmPly with all d(y and county nNlnatac,and,tate Uww mbumg(o QTY MECHANICAL PERMIT FEE
U z building c«nttuctian.and hcrtby euJwrire rtpre,emuivn of(hi,ciry toetaeruPm the SEISMIC FEF,
aM„'c-e,cnuo ad Ptnlcny Lr innpcctitm purlxr.cn' PERMIT ISSUANCE 3 f
(wq ap¢m w, lakm y Ory Mmdcvs Ile City of CUfertma against ELr:CfRIC FE
lla resjudgmenu.co s d s which rtay in any way accrue against,aid City A ITER OR ADD DO MECH.
t cls
c re llw had, Ifni. d L PLUMItING 1 eE
I REREUTA 'TAN Sa DWILL COMPLY WITH ALL NO -POINTpIRHANIILINGUNIT(T010.I(10CFM)
I lUR GRIiGUTA'TIl VS. Af
/1 ECHANICA �Hi �
1,g1
to yq/q AIR HANDLING UNIT(OVER 10.NX)CFM) COVSTRU LHON' X
SignammnfA,licart Ctmtixmr `V fate EXHAUST'HOOD(WIDUCT) HOUSING MITIGATION FIT.
IIA%ARDOUS MATERIALS DISCLOSURE
VIII the ep,ofi.t«fu(un,building tcevpantnhere«lo Mlc lb ar ,mveriel HIATINGUNIT(TO 100.(1 ITU)
a,deEmd by the CUPrni ne,Municipal Gxlc,Chalxer 9.12,and Ibe Anal,mW Safe,'
Cudc.S,e itm 25512(a)? HEATING UNIT(OVER IW.NX)BTU)
❑Yew ❑No
VI:NTIIA'DON IPN(SINCLIi RUSH I)) PAID -
-�
Nccip N
Will the applicant«fmurt building«cvlao(use equiprrcnt or device,which Rt111,ER-COMP(3HPOR UP,"BTU)
Uve
m � our r mitams as defined by the re
Boy Arca A,,Quality Matagennt
c IUTAL
Dlatricf;
❑Yea Fl N. BOILER-COMP(OVER 100.Ig0 BTU)
l
AIR CONDITIONER
Ilww tad We naeardon,natmaln mluitrntcmxuNa Chyverb95 diM CWi- ISSUAN
CED TE
fmtda Health&Safay CNE,Seai«n 25505,35533 and!25511.I uNentmtd Ibt if tle NEW RISIIIENTAL MHCH. SQ,IT
building d�tee w,t Wound,MveuIvwnL Ilut i(in m..rmgxnihileyn.n,ady'l oc"' a
ofd,laluirtntcm,whwth rnuq be rrcvprior(U i,wane ufvCmifeucd(kapany. (//�J
_7 U71
'g Owner«au(huriaNagcnt IIIc T t ISSUED BY: v
OFFICE