S 2588 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING..ELECTRICAL PERMIT NO.
BUILDING DIVISION APPIACATION/PERMIT PLUMBING-,ECILWICAL O 5 O O
COO
BUILDING PROJECI'III:RIIFICA'IION J
BIILDINGADDRESS. f SANITARY NO. APPLICATION SUBMI'I'I'ALDAI'li
OWNER'S NAME: PI ONE: COM CIURS NAME: LIC NU'.
l ) NIC CONI ROLA
rGAc1�12f� Q) 2s S�-9G 3 5 ❑
ARCUI'IEC'U'UNGINHER; LIC NO: nUDR1itiS: /
h �_ l Easttklarlu' ,� '014 ,74
CONTACT: FIJONEi Ii UILDING PERMITINFO
_ ' E] Consultant Fees Paid by Applicant(Inlltal) BLDG IihF.C'1' YLIIMII MliCll
LICENSED CON'I'RAC'IORS DfCl.ARAI'ION Q'I'Y HLECIRIC PERMIT FEE J013 DHSCRIPTION
I hereby anion that I an,liamncd under provixious of Ch-pler 9(cannot ncn,g
acZ with Section IIN0lnf Uivision3ofthe Businossand Prof e..tons Code.and my license is RESIUENTIAL
W"
cc PERMIT ISSUANCE
F� F in full fnreuand aftca. ❑sIsUN'L ❑KI'1CIIEN RIiMODEI.
QVV Licosa Class Lick APPLIANCES-RESHAHN'1'IAh ❑AUDI TION ❑PLUMBING RI PIPE
F Z ec Uwe Color maor
enQ1 ARCIIITELTSIIr;G,I.\RATION ❑A1ULI I-DNI'T ❑STRUCTURAL
F t,Z i understand n, Ixns shall he awed ei public records PnNCIS MOUIPICA'I'ION
pZ4— YP UP'102(O AM PS
(]IN'fER10R ❑CIIIMNF.Y REPAIRFmFW Licensed Fandesslon.I 201.10C1AMPS IMPROVEMENT []SWIMMING 11001-S
o'Cy _3 OWNER-BUILDER DECLARXI'ION OVIiR I(NIf1A,P5 ❑RATH REMOVAL.'l E1'AIR ❑DFMOLIT10N
C Q I hereby aflinn it,,1 I ucmpt Innn the Cnntman,r x Licase Luw far the
3LLF tollnwin6«ss.sm.(Section 7031.5.Ihnin, and Probe,......Coda:Any cid.......rely SIGNS 'T"O tICAI, C]OITII!R
y which requites a Fallout to con,aaet,don,improv-,demolish or olisrepair any structure
Prior to its issuance,uLo requirevM1e applicam(nr men penniunlile a,ignsd stamnl
meSPI3CIAL CIRCUIT/,ISC.
thud bar,licensed purxawn to he Fanwi,lel,n of t e Cnnauw n,Li aro.Laos(Chapter 9
W 0 Icm
omcncingwithSmionDi
e9lNNBot visioo3ofthe Ruxinc,,.rd i'rnfc,xiona Cndc)or 'HEMP.ME'I'ph OR POLE INST. COMMERCIAL:
C
a a e C that he is islandIherefnnn and the haai.v for the alleged...union.Any violation of El NEW BLDG/ADDITION ❑DIiMOLI'I'ION
f,y Section 70315 by any applicant for a Ovarian%objects the applicant m-civil penalty of MOWER DEVICES ❑TIiNANT ❑FOOD SERVICE
n mom than live no died dollen(Asn)). IMPROVEMENT-
F. Q1.asowner of the prnpeny,or eirdo,eel,with wagestax mulr,ola comlooloon. SW IM M LNG POOL ELECT ❑
RIC
E. will do the work.and the structure is not intended or ored for sale 711at Business O'TIIIi
lEcR
i 3 w and Pmfcxsion o Cui the Contraries License Law ditto not apply to an owner of OUTLETS-SWITCHEti-IIYi' iS
prnpc ly wlw build,o,loop n'ves thereon,:cod who Joe,verb work Into,lt'....nro,.sh
his Awa are
eployax,provided 111-1 Inch imprweurcul are ant intended or uttered Lor NEW RBSmBN'FAl,1d AHCVR el'.
sale.If,hrwevcp the building or improvement is veld within one year ofcomNaron.me SQ.1'1'.la.00R nRliA SJSG.1'1'.
er-milder will have the ba dro of proving that he did not build air improve felt par- /
cons rr lulue 'rcl'rN,:
1,.,,own,,of the progeny.nil,evewxivelr ulmructing wim li.nnad a,mmemn m ✓//
ohne La the project Ise..o an owner
of and Professions CWeq one Cnntrvaon.and
wL.a...rwrwsaol l,rojo wowncr ofpupcey whobud lar,rand,,,he nmreon.anc QTY PLUMBING PERMIT PEE /
.. ,mnmtx mr,rdt DoJca,with rcnrtm.mtq taet„ad n..n,wm In me celmtuane, I
License law. 1.17OMFF ISSUANCE "Do
I am ceanpt under Sec. ,li&.P C for Ibis reason
en , I to ALTER-DRAIN&V17YP-Wool ER(EA) VALUATION
Owner p�
WORKCR'SCOSIPF.NS NIIiCL ,(A )N HACK FLOW PROTECT'.DEVICE p �lJ. 0 0
1 hereby eBinn under penally of 11.1 one of the bouncing declog c O
❑ IM1avc nndwill ntimainuCanlfcam nfCnnsenuri mil-inxumhn Workeex Cnmpcn- DRAINS-FLOOR.ROOE AREA.CLIFF. STORIES TYPECONSTRUCUON
.anion,as provided fn by Section 3700 ol'the Labor Cndc,for that I'crlumwnm of de
work for which this panel in issued. FIXTURFS-1'ER I'RAV 1 '
Fj I have and will maintain Worker`s Compensation Insurance,us required by Section
3900 al the Labor CLIC far the pertermaoce of the work for which this peorit is issued. GAS-EA.SYSTEM-I INC.4 OOrFEFS OCC.GROUP AI'N
My Worker's Compenxmto,hour an a carrier and Policy num,err.
Came[ Tolley No.: GAS-EA.SYSTEM OV HR 4 0A) /�
CERI'IIICATE OII EXEMPTION FROM WOR KERS GREASFIINDUSTNI.WASTE INI'IiRCEPI OR •`
COMPENSATION INSURANCE BUILDING DIVISION FEES
ITbi,,eclinaneedartheIo.odoredit'the permit ix fm oar hundred dal hex(g 110) GREASE'I'I(AI'
PhANCIIIiCK DCII
rir lcxsJ
ICeni1Y thrombo anrfnnnanceo(thework luccon,wutbecch t,phe itis Worker,
Colshallford- SEK'[,-SANITARY-$TONAL IiA.2flUlel'.
un cnlpluy unY pan vnY^• larnn.a mbxnme,un)mnothe Workars'Compan ENERGY FEIi
Z xalion lawxof Culi4,min Dire 111 Wn'I ER 11I!n'I ER W/VCN'I'/CLECIRf
Z O Applicant GRADING FEE
x h NOTICH IO APPLICANT:If,after making this Cetifente of Emmplion,you should WATER SYSTENVIREATING Scams FEE
t"t become xohlwl e, Ie Worker',Cninpansntin.pmviki...I,ofthe Lbar
uCo re,you..If
lonfewuh comply w'ithsuch provisionsor this permit shall be drained!revoked. WATCR SERVICE
Wj
,CL a J z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMR. SQ.IT FaAIu Uwe Receipt a
V 0 Ihcrebyal'linrthat there is it conslmrtin I lending agency for the pcnimranceof
the work lot which this pe—it n issued(Son.3097.Civ,C.) "TOI
F IcndName IOTA L:
'A L
0 a's :
V Lender',Address I/2'011 '
I Certify that I have real this uPpwadiun an I swth
a that e-hove infurmatinn h H1111.DING 19313
FV) enea.l agree to comply wim all city and county rrAlnancex and.gam law,orhomgm QTY. MECHANICAL PERMIT FEE MIC p::
V Z building amswaion,and hereby aothorLa representatives of this city to enter upon the
-hoveanontirined property for impaction purposex. I'IiRMIT ISSUANCE :rRl
(We)ngrec h,xaw,Inecmnify and keep III rmlex,me City al"Cupenino ii,ano
r Iiabilitics,ludgmcnls,c-1,and espenms which antri any way accmuugninst vld City ALI 17R OR ADD'll)MIiCIL MBING hili
L`O
APPLICquNIUNof DIRSI NDAi.permit.DWIL 199
AI'PLICAN'I'I1KUIikSTANUS AND WILL COMPLY W'TI'll ALL NON-POINT AIR HANDLING UNIT IT In,IXXI CFM) fECll Nld 1'
SOURCE Rill IONS.
AIR HANDLING UNfCtOVi?It 111,1X0 CFM) CONS'1'RUC'I'ION'1'A%
S'gnatu'C ofApplimma/Comm. t Ilwe il%HAUS r I IOOD(WIDUC ) ,Y GNIHIGATIONITE
IIA%BROODS ':I1IALS DISCLOSURE
Will the applicant orfulumnu mg,xcupam pore nr handle haTallous maleriul l[RATINGUNI'1'(Ioloo,on)E'1'll)
as defred by the Cupetino municipal Code.ChaNrT 9.12,and the Health and Safety
Code,Section 255320Q' ,-..! HEATING UNIT(()VER IW.pNI❑'1UI /p���
0Y., IS"•' I'AII�� -ll-a-k
VENTIhA'IIUN PAN(SINGLE RESIU) Umc Nampt p
.� v WIL the applicant or future building cecupam use equipment or devices which =RESIOITNIIALSIECIL
11PDR 101(,1X0BTU)
mit humrdrn,air ronmmin:rno as delinosl by the Iluy Are.Air Quality ManagementTQIAL:
DouretP OVER I W.INNI H'1 U)
❑Yes L
I have uwd the haricot,ocknialk d under Chapter 6,95 rl the Cali. R ISSUANCE DATE
rcyui a p n
lomin Ileuhh&tiufwy Cndc.Bcain,w 255115.25531 DIN 25531,I untctntanA thin it'the NEWI.MEC11. Sp.FI'.to III it Icuocn11yhavcawnant.thalilismym%s sibilitymndifythcoxcup t
Yui ¢ms citinu,tx '1Fan misvuanccUfa Ccnilu elfo,
z �eeroraathelnsW.genttalc '10'PA L: ISSUED BY:
OFFICE