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30904 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES`USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELFCI'NICAI. PERMIT NO. 30904 BUILDING DIVISION APPIACATION/PERMIT PLUMBING-MECHANICAL BUILDING PROJF,CT MENTIFICATION BUILD 7NOA PREW.� _ - SANITARYNO. APPLICA ONS MITTALDATE L f} (� (�� p/y{N/A) / OWN' F �/`' C P W v /i CONI IA Pr' ME:A-I 1 / !O�1 NIC CONIR ARCHITEC'VENGINEER: LIC NO: Vi YVJfJ^ ADDRRESISS J ❑ CONTACT: - PHONE: BUILDING PERMIT 1VF0 Jieg�t-4 t,4 1.1,4 4 ,•r-7?_/� IDCmsuhnnt Ems Paid by Appllcenl(Initial) BLDG EI. Lu e E.H / N ❑ Lm min ID CONTRACTOR dorder S DECLARATION ELECTRIC PERMIT FEE I Hereby affirm Net 1 am IieenseJ ceder pntvixiw of C r,l 9(nmmenr a JO DE CRI ION aZ Ih Scnian 7000)o1 3 of the Budnc,,v endl c c Cd liam ,, 00 wt PERMIT ISSUANCE JOA full force eml e!f �/� �q/!SI <FVZU Li.� �.2-0— �' ! ✓ ❑SfUN1 [3 KITCHEN REMODEL N6u Dae -- /—Gaunt APM.LANCES-RESIDENTIAL ❑ADINTION []PLUMBING RE-PIPE FOy AACHM--CPS DEC RA'I ❑MULTI-UNIT CSTRUCURAL Z 1 undnluad my plmx Jwll he u,,nl mr a reeordarp PANEL S Z O MODIFICATION OZ-p UPTO2W AMPS ❑INTERIOR ❑CHIMNEY REPAIR 'FBF•; Domatevi PmfeuiorW 1(11-1000AMPS .IMPROVEMENT Y OWNER-BUILDER DECLARATION OVER IgM1AAtP5 BATH RE D IR CDENOLITION y P1 < I hreem ul0rm Na 1 1 exempt Form the Comncmor Linme law for Inc x 3 a U following levan.(Secthm 00]13,Buniws oad Pmfeuiau Code: *city ucamty SIGNS ELECTRICAL OTN R wbkb riak.l ith"tornlsuuc4.11y,imfeeeademolish,rrrtpirmYRoemurt pnorlaimeemed alararyvu tlragptinntfe Comrermilto Ek.ngrr4 ntatement y SPECIALCIRCUIT/h11SC. - y lemhe isem,vediNcemrinlhi:at DivinnenfortCmnnne,i,iLarne Ww ;Cocelr9 (conurcniog wiN SntiwT(MIIO ofDivisim3of the Buxlnas sed ltofes.inm Cak)ot TEMP METER OR POLE(NST. COMMERCIAL a then he is eaem i tfrlcrmm and me Insist for the elkgd ucmptivn Any eiNiim of CNEW BLDGIADDITION ❑DEMOLMON Swim 1031.5 by any applicam fore remit subjecu rite applicant toe civil perok,of POWER DEVICES IIg..... ng morn Nen Five hundred dollen($5(0). ❑TENANT C1 FOOD SERVICE CO OLnvawnQ Ofthe pogaty,the mYcmploYmwiN wageamttriruAeeompcmntim. SWIMMING POOL ELECrRIC IMPNOVEMFM 1122'' will do 0r work,and Ne xmrlurt ix not imenlM a noned for We(sec.lout.Buniws OTHER W and PoNe vicars Cade:The Conlr ors License law doe,M.Igly to m oases of OUTLETS-SWITCHES'11 RFS prafsny who huilds m am m,u pirmon,and who does such work himself or though It,awn employ.,provided that each in,,ements one tot Intevled or ofkrtd for NEW RFSIDENTIAI,FL.EMR SQ IT. rote,If,however,the Melding or implovcmcm H e ld within one Year orcompletion,Ne SQ,FT.FLOOR AREA ESQ.FT. owrc-buddio will have toe bidden of Mein,thus he did not build«improve for per- pax of nlcJ. 1,vn owner of the Mupeny,am exclu,,ively enmrveting wIia ith namtm d ncon to t t wTOTAL: construct the project(S«.]OaL Business raid Profasioen Cade:)The Commictes Li- certain loo,doenot applytomwrrrafropiny who builds or itriprova lhurnn.ead QTY. PLUMBING PERMIT FEE whnmmrens fm such pmjms wiN•mntractu(s)littnud pursuant to the Cmtramor s Deer.law. PERMIT ISSUANCE C 1 ant exempt under Sec. ,B&P C for fir". Owner One . ALTER-DRAIN k VENT-WATER(EA) VALUATION WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE I hereby affimn trader Penalty of perjury one of the following dm=Ct nx •F (have wad will mvnuinv Ccnif tcofCm,,cm to self-irtoue for Wmtcr'x Cmnprn- DRAINS-FLOOR.ROOF AREA,COND. STORIES TYPECONSTRUCTION swim,v Mvided for by Section 37M of tlr labor Cradle,for he pe rommce or the - - wmk for which this pmmit k i,,aed. FlKTURES-PERTRAP C I have and will maintain Worker's Compen,ro.In.re.r,as reyoird h,Scot m . 37Mlof Ne lain Cute,f«the pefmriarcc ofthe wntk forwhich Nis permt iv wird. GAS-EA.SYSTFN-I INC.J OUTLETS My Wo �C luxe ad Policy j/{�f�} OCC.GROUP APN Cutin:pPdlry Nu.:M IWI • ' _ GAS-IA.SYSIT'N.OVBRJ(EA) E OMP( , TION INN FRO 1 E S' GREASEIINDU.STRL WASTE INTE..--. N COMPIiNSAT1ON INSURANCE BURRING DIVISION FEES (Thi„sstim rralvot hcomputed ifthe pemdl i.four Mmdnd ddl.n(SI00) GREASETRAP PLANCHECK FEE (certify Net in the tiny nieunce of stote,tfar whiyeet to pbe V/o i.,,ud,IJul1 SEWER-SANITARY-STORM EA.2001.7 nm employ.nY Irma in any mmnlrr w v,,m become nubjpcn m the\VMera'Catnpen- ENERGY FV E Z station laws of Caldomia Du< Z MATER HEATER W/VENT/ELECTR Z 2 A,ficiuNOTICE GRADING FEE NOTICETOO ,, tic Worlre vNcr nuking Ibis Ceni Ocae ofP at lode.yoohauW WATER SVSTEN✓IIIFATING C't bean¢iemb y tf1 Warkttk iv.omtinnprovisime of the TaMm Ctde,pu must SOBS LVL foMwiN comply with wch pmviniwmNin pnmit shallbodeemrd revoked WATER SERVICE - a � UO CONSTRUCT ON LENDING AGENCY NEW RPSIIIFJ.TIALPLMB. SQ.Fr. PAID Ihm hi,h dii,'tthem naed(Se 3fAC,nCing egexYfmtheperfmwnaxof Date RaeiptN O �-+ We walkfor wniuh Nis permit it iarud f5re.9119].civ.CJ I”' Lender',,None TOTAL WIrldcf.Addren TOTAL I cmify Na 1 hove mod Nis epplicaion and ale that Ne above information or BUILDING FFP N conal.1 egmc i comply with all city end manly mclim mxa and umc lawx reloting to Q MECHANICAL PERMIT FEE V Z building mrt,,tructim,and hereby auldhon[,,a Iepresaomavea of thus city to ever upm the SMIC LTR `+ above-rsviomd progeny for inspection gnpasec. PERMIT ISSUANCE (We)egrce m nave,io I mmirY end keep hvmkaa tlr City of Cuperthrm.gaimo CLECIHIC FFE Iubi111ien,jWgmenn, ucon,,and upernxv which may in my way ettnr again!raid City ALTER OR ADD TO MECH. in mmBm trcc of the,granting of this pmNt. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT SOURCE REGULATIONS. AIR HANDLING UNIT CID 10,000 CFM) MECHANICAL FEE AIR HANDLING UNIT(OVER 10,(1110 CFM) CONSTRUCIION'TAK Signarmof AWliamuCammctor Due P.KHAU,STHOOD(W/DUCD HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE Will Ne ytplit'mn a furore building occupml non or bulk harudwso iel HEATING UNIT(TO 100,000 BTU) - v deftN by the Cupcni to Municipal Gder Chapter 9A 2,and the Ilalm mut Safety Cock,Sntl..25591(.)! HEATING UNIT(OVER 100,"BTU) C]ye, ONo VENTILATION FAN(SINGLE REMD) PAID Will the a,icem or future huilding oceupmt u.¢equip ienl or dovEx,,which Dam Receipt M .it hmanbm in,contaminant,o,,defirrd by the Bay Aren Air Quality M.vegemem BOILER-COMP(3HPOR 100.000 BTU) jf� TOTAL: u F1 No BOILER-COMP(OVER 100AMI0 BTU) e mal tic havardottx"arinneln AIR CONDITIONER ISSUANCE D teyuirtmcnts under CheMa fi.95 of the C.li- de.Snow 25505,ii fty m 2553x.1 ul noilf d Nn If dr havicetvun ill 33. iwb0hy roe id NEW RISID[NTIAL MECH. SQ.FT. r vpuvN C 'oc 10 thmiudag m Don, TOTAL: ISSUED BY: OFFICE 2— /