S 1446 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OP'CUPERTINO BUILDING-E:LEC'FRICAL Pr: ff No
Hu11,UING DIVISION APPLICATIONIPERMIT I'LUMBIN(:-MF,CHANICAL V 1446
BUILDING PROJECT Ho 1FICATION
BUIL DING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
OWNER' 'AML PHONE CONTRACT NAME: LIC N6
NIC C NIRDI,
FCO
CI ,'IANANER: LIC NO ADDRP_SS: El
L
1
CTNEpBUILDING PERAfI'I'INFNFO
�10J E:] Consultant I'm Paid by Applicant(Initial) B ELFCI' PLUMB MICU
T
IJCENSI!O NfR
OACTOR ''S )FCI,A AQTY ELECTRIC PERM IT FEF:
L hereby amrthat I art eanNd arum prod�sia.of Chaper 9(eanmeming ]OB DL'SCRIPTION
m
�0Z widr Scene.70b(o oflArisian 9 or the limincnvud Pofc"oh,Ede,amt my fielose is F
O pPBRMIT ISSUANCE
in 49 lull fora unl clfecl. 3 TDW'L [I KITCHEN REMODEL
�UF
Liccne,Cluv Lic..r
APPLIANCIiS-NESIDTIAL AUDITION ❑PLUMBING NF
P
IPE
NZ D
Qa
FOy AR UECLARA'I PANiS ❑MULTUOS'IRUCIURAL
ZO-Z lumknmml my plana shallbe uo,aW uspWlk muds MODIFICATTN
'OZ-,, UP To AMPS El INTERIOR 0CHIh1N11Y REPAIR
f Ltw I,iccnvcd O-ote,imel 201-INX)AMIS IMPROVEMINT 0Stio INC POOLS
OWNER-HUHMER DECLARATION OVER 1000AMPS O HATH REMODELfREPAIR C1 DEMOLff[ON
I1 CC Q I hereby aI irm Inal 1 um exemin from the Cunlmcmr's License law far the
XOiUE. following rc�nn.(Sectirn703".Business.M Profcssirn Cock:Any city cur cranny SIGNS FJ.ECfRIC, ❑OTHER
413 4-y which own..I'emrit to comm t he,.impovc,demolish,tr to any suunurt
[p-
U.0n
mono un,issuance. do issuance.also rc,mr- applhvnt fmxnrh f crinit to l file a signed stwercu SPECIAL CIRCUIT/MISC
L(rTY (commencing wd pursuant 7000)of Dorms of the C,Rusun o,and caw lawe,Casa 9
flu he
(commencing with Safirmar and
the ho
es for of ualege ax ernIdlr.Any mCnkl a TEAII'.h1E1tR OR POLE IN.ST
a a Sorn fiC is 31.5 b Iany aM Inc basis for de alleged ucmpia-any d Incon of ,W BLHGIADDIITON ❑DEMOLITIONUSERVICE Salinn]U31.5 by any applievnt lure Permit whjecla fid:applklml loaavll penally of IY)W IiH DEVICES Q'I ANT OI'OOD SIiRVICIi
ma nm ne m than live hundred Jollm,(3500).
IMPROVEMENT
G=Q ] I,uowrcnd Nes propcnXamycmpMyttswith w.ge%as Heir WccomPem.ainn. SWIMMING POOI.FJF,O'RICIQ
E., w'illt notewho and the urvemmisnol interuleda Mfertd Towle(Sce.T601,Busircsa DITHER
3 m amt I'mfe.esims Code:The Cmlmcnio License Law docs nix apply to an owner of O1MAU`S-SWITCHES-I IXIT)RES
prupcny who nuilAX a inlpmvcs thcaax0 ndl who tkwrs mesh ooh M1mi,fur through
his nun empoym:Provided tha 5tch impnvemenu ane m7 immdW a offered for NEW RESIDENI'IN.ELECfR SQ IT.
wlc.If.M1osvcsa+.Inc building a imprvemem iswd xidm coeyarofeir"Icroo the Q� SQ,EE FLOOR AREA SISQ.17.
mucicWiller will too,the hartkn of pawing resat he did me Wilda impmn for Tref- ���
of salc.L
rcr of E,Pr.,a,,an eselmively c-,—I,n,war lianscl armrered.m
fact the project(See.]nil,Business ud Ioonfic ons Cade:)The Cmviscom's V-
nwlaw des mu applym an owner afpmpcny who boad..a impovcn dcmn..rd QTY. PLUMBING PERMIT FEE
�. who crmnack on such projecu with heommemns)l icrnvN lnaaml to the Cummi
laceroc Law. PERMIT ISSUANCE
❑ 1=stirrups adcr5ec. ,B Re P C an lhiumwn
AMR- IN de VENT-W'ATER(EA) VALUATION
Owen Dales ^ �n
Wm mop COM of mr,T'ION'DI ofthefolicevON HACK (ifECT. iV ICF, L` /
Ihcrthy afB,m uWa pcnalry of Perjury me of the foliwing Jeclu.sinm: -i 1
Q thea aad will mainuinaCrnifnc MCamer+m.¢If-imwc for Worker'.Compere DRAINS-FL( .ARIA.COND. STORIESTYI'F.CON.SDtUCf1ON
wtirn.m povided for by Senior 1710 N the Later cock,for the pedamana of 0c
work fir which this permit is %wed, FIX'I'USES-PER'I'RA
❑ I hon ins!
will
maintain K'aters Cma cnvvion In.,v imus!by Secure
MV WOfder aytyn ��m7� o and Policyfn+rx�hLiclAlM1iylclgtif;Osa� GAS-IGAS �A.SYS STEAi-OVI:RaIF:A)-1 I �S OCC.GROUP AYN
Cartier. �l-I � ecartierivey Nn.:14f�k�
( ` CEROFICA'IT,OF EXEMPTION FROM WORKERS' L \
COMPENSAHON INSURANCE GREASIIaNDUSTRL WASTE INTERCEPTOR IIUI 'INION FRS
(Th4s.vethnn This he nrnpk+mliflhe panat is roars hndrM dalliers IS IM) GREASE TRAP
or lis) I PIANCHECK Ili
IcrnifylM1w In the pdrrmmttnflM1c waWur which thl,a p+nrir tv ievuW.l Jull SEWER-SANITARY-STORM EA.10f1Ef.
m7 employ my Person in ay rmnner w or,to become subject 7o rte WlrkusCanpen- ENFit GY FEE
O Z scion Taus offCehfomie.Dela WATER HEXIT:R WNEM/IH.F,CrR GNAOINC FEE
Appicant
y NIIHCI:TO APPLICAN'11 11,ufter must,Ibis Cer nicmc of I!scnynlon,you should WA117K SYS'UM7REATING
F become,subject to the,Worker's Cma am mer,pmvi%irs of Ne later CMe.you now SOILS TEE
faNwnh comply with such povemou a this permit stall be deemed se,vakcd. WATER SERVICE
f` 1z CONST RUCTION LENDING AGENCY NEW RESIDENT IAL PlAO. SQ.FT PAID
V0 thereby affirm that desk a cambrommh lauding agency for the Performance,of Dae NaeipM
the went for which this Permit is isstcd(SIL.304A Civ.CJ
U IrnJcr's Nuns O TOTAL:
L) LemlvPs Achim, Ilii
0. BUILDING } L
I crnify 01un I neve with
this andlcor ud cele Ihv rbc aMwe inlnmution is
ra/) .mnec7.1 vgna m campy with all city ad'cwmy,aJimrces ahil neve 6w:relaiog Io QTY, MECHANICAI.YERAfI'f FEE
L) z building cau7rveUunb end lcreby iut anir,reps,sentenvevoflnis coy mrnrer apo die .SEISMIC
eMrvonaa rimccl lm,pefy fa ur ocl tm orrpca. PERM I ISSUANCE!
(Wes)apo no saw,mdnmmfy and I humbles%the City of Cupertino against EL1!CI'N 'V
Iiablli7iajudgnrcrm,cmU nut<epensn which my�baby w aimtsaid City ALTER OR ADD'TO MECH. O
in mnenpsnhr of the gnn7in6 Ml�apermi7. PLUMB Ply
APPLICANT UNDE ST/aN !(AND WII 'OMP WI II AI ,NON-POINT AI R I I ANDLI NO UNIT U 010.000 CITU 0
S[ 0 ElE� MEGIIANI 'AI,InGE
F N AIR HANDLING UNIT(OVER 10.000CFM) CONSTRU ON TAC
Sig j of App' ,.vdl.aavan"
( Dmc EXHAUSTHOOD(WIDUC) HOUSING MITIGATION 147E
IIA%ARIX)US MA'. AL ' ISCIASURIll
Will the appliranlafmure huiN oacapae tae ar hunJk harromms nwrenisl H EATI NO UNIT My 100.000 HTC)
v tkfncd M Jc Cupenim M1tunkilml Mc,Chaffer 9.11,uW The Heath anal So
Gdc.Section 25532(¢)'! HEATING UNIT(OVER 100,(100 BTU)
Yes Nn
WN'1'IIATION EAN(SIN(II.Ii kF_SIU) PAID Ildre Ntt ipl
Will the so cent or home building occupant me acuipmcn7 a dc.kes which
amt hvaMvs it coommimme as defiled by the Bey Arm Air Quality Muugcrenu BOILER-COMPCHPOR III ."BTU) T
District^. BOILER-COMP(OVER 100,0IXI13TU)
❑Yee ON.
AIR CONDITIONER
I neve nml The hvmJoas rwmele rryuirtnrmn urdec 1.1 Din fi 95,,f ouc Cali, ISSUANCE DATE
bmId'mgdrcsnmcummly Laraawnet.been I,myiin1295:W.l undcrvmd dwriflM NEW NESIDIiNfIAL MECII. SQ.Ff. \ -qg
Tania Ifullh S Snfa7y Csde,k time 25.41{ (S
II in my rty.'avinillry e.fairy the acalunt
t+the rtyairtmm7e onto nu4 Ec ren pda m�W�of a cemhemn or Ixntpamr. T
P.vnera ordion N.gem Ilam TD ISSUED BY. C(I
OFFICE