S 1057 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
5ILDING
OF CUPERTINO - Huu.DllvG-eI.ELTRICAI, PI: MIT No.
LDING DIVISION APPLICATIONIPERMIT PLUMBING.MECHANICAL 1057
BUILDING PROJECT IDE.NTD'ICATION VV
AUIIHESS: SANITARY NO. APPLICATION SUBMITTAL DATE
S NAf� PHONE!' COM'PACTOR'S NAME .I o ✓L
tA.
E NIC C'ONIROhM
ARCI TE CCDENGINEER: LIC NU:M.
RESS: _ ❑
e il-raa 1ta
CONTALT: PHONE: BUILDING PERMIT INFO
❑ Cmlgtlltant Fees Paid by Applicant(Initial) PLUG ELECT PLUMB MECH
❑ ❑ ❑
LICPNSEID CONTRACTOR'S DECGRATIONQTY ELECTRIC PERMIT FEE
1 hr«by aPr t thew I am lio lhvad ander provn«..iof Cnapv 4(earrocecing JOB DESCRIPTION
W pZ mfFS ileo 700nof Division Wflc BuxiaexxaW Pnxfcnxior,G.b.aaI my license iv RR SI)
w' PERMIT ISSUANCE
ttul�Rcc L'0 1� ' ❑SFUWI. ❑KI'ICHLN REMODEL
J-1
U I.ic,xxc Clmx Lic.. 3 APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
Ihtc - G,mmcmryt - �' •�ARCHITE9DRCLARATI)N PANIi1S ❑MULTI-UNIT ❑STRUCNHAI.OoZ l utldmtanl my pill shill be trad as public rt rdx UP TO 2(p AMPS AfOD11ICA'f10N
El ❑CHIMNEYREPAIR
f.�Ftail IicemN HofcixiaW 201-10N)AMI;S IMPROVIiM111iM' SWIMMING IYIOIti
�y 3 OWNI!R-BUILDERDECIARAI'[ON OV12RR OAMP. E]RATII REMOIJg4REPAIR ❑DEMOLITIO'
y W Q I hnchy affirm that 1 am exempt from the Contmciri Licrnsc law for the
x aU following rtawon.(Stenos]0313.Burins ad Pmfextias Cale:Any city m county SIGNS ELECTRICAL ❑1TfHFR
{il 31v, which tcquit a Peoria to eonaruct.uher.improve.derholM,or repair wry slrvnum
prwan its isvu ,ldwtrttryirmtleapplicam fmmch pcnninn rik a limed.vatcarcnt SPECIAL CIRCUITMISC,
f r�Y that h<ix llcrn foarant«the provlsiom of dxc Contfanatx Licm,_a,(Choper 9 COMMF,RCIAL'
�a0 [emm�tcncing ill,Section MMI
. tinn 7( 1gl UivinitwJnflMllusincva wd l'mfol Ctak) '11?MI'.' MITER OR POLE INS'1:
.R:11thin k h,exemp Iherefmm IoW tot hi fee the ellefr d e.mVion.Any violmim of [INI?W BI.DGJADDI'I]ON ElDEMOLITION
X N Section]031.5 by any aWlcoa for a permit subjects the applicant to o civil tsnnity of POWER DEVICES El TENANT ❑FOOD SERVICIi
FZY ntho—than five honNWdollan($500). IMPROVEMENT
SQp D SWIMMING POOL ELECTRIC (]OTHER
will do the work,ano diecrtxvute it not natural noffched fns c(.Sec.7004.Husirai
F and plofexsimxx Ode:The Cominco-Liun.ro law Nee nal apply It,un own¢of OUTLETS-SWIICHIS-FIXTURES
6 3 pgcny wan huilJx a imposes themm,W who don such w«k hi if or through NI:W RESIDIiNTIAL ELBCIR SQ i'f.
his ten unpaycet,pmvidal Ino ouch improvement are M immlJed or otfacl for SO.Ff.FLOOR AREA SISQ F1'.
sak.IL Mwwcr,the hudding«impnvelnm is mW within rine year nfcuntpldiun.IM
twrrr-builder will hzve the fach m of proving that k did nm build or improve for pu-
'o,of role.). TOTAL:
I,ax owner of the P open,em e.ehixively committing with Iict"I canmcntrx to
cmturun the poi(See.704a,Buro.and Profcuiom C.:1'I ne lamina x li-cchP A ' Q
me law Nxc.not apply,,,an Ownerof Protany who MAdwor improves Ill...mrd QTY. PLUMBING PERMIT FEE
who aetmets for with pmjcas oh.mnttacmdd liccnmd Puauam to the Coatnmadx
Lie me law. PERMIT ISSUANCE
0 1 am c-rat.utder 4c. .it&P C for th'o wem
N.TIiR-DRAIN&VENT WAl]iH(A) WT2 VAJAM
Owner D. �1
onurWORKERp COM of aS rFON UliC1AHAl'ION BACK FLOW YHOI f:CT.DEVICE CITY UV t,UI'Cll l It a..
IbertbY ltflirm utdn Pcnelty MperPtrY me of the fnlW.vine declemiom:
❑loins and will mwmdnu CcnBkv¢ol Cravmtto.¢If-irou«Ter W'nrkefa Cnmprn- DRAINS-FLOOR,ROOEARIiA.COND. STORMS TYPE CONSTRUCTION
,mann,M Fm,ided Ira by Stcm,n 37110 of the Iabtlr Call ,for tan perfamtafec of he
week for which this pemm is iowavi. FIXTURES-PE1t TRAP
1 have and will maintain Worker's Cornpmxat'ma humarice,ux reeryirtd by Section
)]Dlo(NclahorCMe,Gr Ne perflmnercenfthc sunk forwhich l bi"lmmitixi.c,L GAS-EA.SY,STEM-1 FNCVOUILCIS OCC.GROUP MIN
My ,c lh Contpcnwim Irao..Tuner and Policy number a«:
Caniuc policy No,: GAS-A.SYSTEM-AVER 4(A)
CER I ICA E OF EXEMPTION FROM WORKERS GREASUNDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(This ae,lo,a t,,1 not be eomparddthe permit ie for ow hurklmd dollnn(SI00) GREASETRAP
m len) YGNCHECK 1'Eli
Icenify But to NClcrformvrcafthewMfor.luch this permit it ixtucd.I shall SEWER-SANITARY-STORM A.200 FC
rix etWloy any pew.In any intra,so us to hemllte xutiiec o the Werkerr'Cnlnpcn- ENERGY IFP
OZ ration law-of Calif�tt�ia.Date WATTR NEATER W/VIAT/ELECI'R
z
Applicant ^�T-, _gy—*Jiff GRADING FE
NOTICE TO APPLFCANTI,ahr,aaoigllx Cemficueof Euanxption.you.hould WATER SYSTTU RGTING
SAILS AEI:
banana subject to the mprn
Worlds Coution Pntvi mill of the y LilCode,you maxi
forthwith comply withlauch provisions«Nis pmttit xhall be dremN revoked. WATER SERVICE _
QPAID
= z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMH. SQ.FT. Dare Recv t 0
UC) IfenNle.01.thm then is acvnureal]an lending aprncy for tbr'M« --A
the work fm wnich this pennit is issued(See.3097,civ.Cr)O Icak/s Name - T)'rAl:
W Lok/x Ad . l()TAL:
}I I comfy that I have rtW this application and acme thin the aMrve inf—ertion is BUILDING FEE
L rail corrtcrlagrte to cmtplywithdl city and munty tvNwaaaW sate lnwx«Imingm QTy_ MECHANICAL PERMIT FEE SEISMIC FEE
U Z nuildingcawmcuan.a,d hcmltr ambadrr rtnrmmativex armixchy roam,apn ae
aMve.mrntiard pofcny fru inspection ptrpxxex, PERMIT ISSUANCE ELECTRIC FEJT
GVe)ni to rove.irdenmify sal keep J uMeu da,City M Cupenim against
Habil hittjttdgmenu.cats and cxpcn¢s which rally In any way utero-agvmt said Cl tyALTERORADDTOMECH. PLUMPING FEE
n caowco cMthe Booting ell permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT ITO III"CFM) MECHANICAL RIi
SOUHC REGULATIONS. r
AIR HANDLING UNIT(OVER 10,000C M- ) CONST RUCTION TAX
.ignatu 'N'.t/(.mincutn Plate EXHAUST HOOD(WNUCTI ' HOUSING MITIGATION FEE
HAZARDOUS MATERIALS D. LOSURF.
will the applicant«future bonding occupant stm,mhulle hawdwxtwenal HATING UNIT(TO 100.000BTUI
m definW byte Culmina Municipal Ode.Chap,9.12,anal the E eAll aM Safely
Ctdex Section 25532(0? HEATING UNIT(OVER 100.00(1 BTU)
❑Ya No V11Tf11AT10N FAN(SINGLE RESIDE PAID Due Receip Ill
will the"blama futua building occuum.'unIonam or dcvkex which BOILER-COMP(3HP OR 1(11,110(1 BTU)
emit hvardoux air conn oury m dented by the Bay Arco Air Quality M1laragenent T(TfAL
Diatnm5 BOILFA-COMP(OVER 100.000 PTU)
C]Yes ❑No
Marc rtW tie lla muedda IxuWrr LTapu M145 of lie Cali AIR CONDFHONER ISSUANCE DATE
mryirt
fano Hua11h&Sdmc Coda.Saxioxxa 255(15.25593 and 3531.1 uMvuvd Nat if the NEW RF_SIDENTIAI.MF.CII. SQ.FT
bonding,uto nmc when have uluratatort it iwmymxpxmihali urn«ify dtcoccupant
M the rryuurnems when Tarso k met prior'.ixsuarce of a Cenitiwc M(lavparey.
(wrcr«autMrired agent Ulm A ISSUED BY:
OFFICE