S 2980 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING ELECT RICA PERMITNO,
BUILDING DIVISION APPLICATIONPIsRMIT PLUNIRINC-MRCIIANICAL
BUILDING PROJIiC'T IDENTIFIG'E'ION
BUILDINGADDRESS: �SANI TARYIN0. APPLICATI(99PI)NIF
'6 11-59 Pa 'Aq,
OH'NIER'. NAME: P110NIi: CONT.ACIOR:S NAME: LIC NO
. Q SIC CONTROLN
�iANCIII'IIL'r/IiNGINl11?R; LIC NO ADDRESS: Q ^ ^'J ._-- Ute- S-t-
❑
S S& M✓w�
CONTACT: PBONE BUILDING PERMIT INFO
la p Z 1 179 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECCHH-
❑ ED ElL'
LICENSED COM RACTOR'S DEECLARADON QTY. ELECTRIC PERMIT' FEE JOB DESCRIPTION
hm Ay affirm Innl 1.,it 1'lanad made.pr^dl.d^nr nr Chapter n ITmnawaiting
CaZ wimsestion7000o,flAskimI lm me BOdn^..and ProfeW 1,Coale.and tat 6cmuc i. RESIDENTIAL
W p p 1'IikA111'ISSUANCE
C 41 t- Lfall htrceand clfeet. ❑SFDWh C1 KITCHEN REMODELicem
¢UU E.iccnw Class Lic.ro APPLIANCES_RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
p.Zly Oatc Cmnlrecon
m Q a ARCHOECI"S DECLARATION ❑M111:1'1-UNIT ❑STRl1CTURA[.
ZONZ Iundarsumminry Plans.hall ner.ed us public Mcord. PANELS MOU119CA'UON
UP10200AMPS
❑IN'I'IiRIOR CHIMNEY REPAIR
H,' taj hiacnu:J Protcxsiowl 2014800AMPS IMPROVEMENT SWIMMING POOIS
OWNER-RUILUER DECLARATION OVER 1000AMPS 0BAI'11 REMODEI/RF,PAIR ❑DEMOLITION
z ¢ 1 herebyanion that I am exeat t from me Commcorn License Law for me
i OAU a P ❑OTIIIER
x 0. following Mown.(Section 71111.5,liminess and 1'mfessiona Code:Any city or county SIGNS ELECTRICAL
413 W H which requires it permit to contract,aJmn improve,demolish,or repair any structure
.~.41p6 prlonoiulow.role,alnnnrpJrs,on,,pplicaut lwatch permit to life a signed am¢Inenl SPECIAL CIRCUTCMISC.
i �� dtaHteI,licensed Par xnannmmepookilfine Cotumnor',Lieemo Law(Cnapmr9
cr: p0 (commencing with Seminn]IXIO)nf Division lnf me Business and Prulssinnn Caxfe)or '1'IEMP MEI'IEN OR IY)LE INSIL COMMERCIAL
C.Q.e C that he is cxmnpt thercfmnt and the hasis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Nati
Sns JILL LS ny unY+tPPllcdm let n lermit wnjttb the nunm
pplicl n evil penally nl POWER DEVICES
nlmmn than lien hundred delta,,1$500) [I TENANT FOOD SERVICE
=Q E,as owner of the n SWIMMING 11001,ELECTRIC
IMI'RUVIEMIiN'I'
C ❑ pmpc Xor my intended who wages as alei(m.unnpou ' ❑OTHER
C F•m will dolne,ion,ands the structureisnn1lntendedn Law dosed of apply to an OwnrBusiness
�3 unA Pmferviuns Code the Cnnvenar's liemde haw dew.not uPPIY m an owner n( OU'IhETS-SWITCHES-FIX'I'l1RES
Inutility who milds or improves thereon,and who dues such work hineeclf nr through
hie own employees,provided al disuch m
imp ..orias ore not martal d or affirlJ lir NEW kGlID1ENf1A1.lELECTR S rT.
,all.If,however,the building or Improvement is sold within one year of completion,the SQ,17,FL(H)R AREA EISG.17K
er-nwlder will have the burden^rpm ing Ih n hu did not build or improve err pur
pone if.ak.). 'IY)[At,.
❑1,a.owner of the pmproy,am exclusively contracting with licensed cnntrecmn m
instruct the project Soc.704,1,Rosiness and Prnlasioln Lone:)Tnc C^ntracmr's LE
-
xeLawmevnotapplyloanOwnernfpropenywhobuild,or improves thereon.and QTY. PI,UMBING PERMIT PEF,
who urne,l, or,awti proill"with;wummehnlw)licensed prof u.tn h,live Commmorx
License Law. P ERMI T ISSUANCE
❑Iain ewe"" a&-,Sec. .B&P C Ior this reason
ALTER-DRAIN&VIENT-WATIER IEA) VALUATION
Owner Dam (/�
WORKER CUMofpergayuniUECnm1loJON E1ACKPLOWPNOfECT.DI?VICE l(1 OO
[have
and will
ander penahy of pefCo nwor of elt-ir son im doelfWorkcr`i Co:
❑ IhavennJ will mmmuinaCcnihcmcof Cnmemmttll-inmre(or Workers Cotnpcm DRAINS-FLOOR,ROOF,AREA.COND. STONIP_S TYI'li CONSTRUCTION
lino,o provided IDr by Semicon 3701 al the LaMar .Cildr.for the Ixrf.....o ce of the
work for which This N1 nil o issued, IdX TURES-1'ER'I'k Al' 1
❑I have and will maintain W'orkcr.Cmmpemalim Insurance,as Myuimed by Section
1700 of the Lahr Cote,for the perfnnaunceofhe whit for which this permit is issued. GAS-EA.SYSTEM-I INC.J OUT LETS OCC.GROUP NEW
MY Worker
Clan
CI CotpQaNlnngmT;ua1 'ole, reMir
M
UEM'nllydQLb�'
15 .rn
66GAS-EA.SYSTfMdWR4(EA)
air
r� EIRC I;XE SF;RONORKEkS
COMPENSATION INSURANCE GREASEtENDUSTRL WASTEINII
ERCEPIT)R
N1111,DING DIVISION IlifS
('1'111—Dion nucdnnlbecnmpliewd iflhe Permit is fornochundreddell-610) GREASIETRAP
PLANC.Iii!CK ITER
Or feev.)
toy any pconthc any
of the ork become subject
this the W kerma Compel. SEWER-SANITARY-STORM EA.200 ETI'.
employ any person in any manner w as to become mnjeul to me Workers Compere ENERGY FF;E _-
Z
nor employ
i haws at Cali lbrnia.Unto WATER HENI'F.R WNENMELEM R Gkl1 INC,FEE
ZO Applicant
y NOTICE'T)N'PLICAN'1';IL oilier making this Centeac of Exemption.you.should WATER SYSIEM/T'RBATENG
SOII,Iti FIEF II 1�
F bculme eabjecl ut the Workers.Cunipensamon provisions of the Irhr Code.you mum 1f t t
GQ Innhwith cntnply with such provisipermitons nr this permit shallMdccmcJ revmkcd WATER SERVICE1'All)s, APR 2 6 1999
= Z CONSTRUCT ION LENDING AG17NCY NEW RESIDENTIAL1'LMB. SO IT, Dan, Nccei,l9 U
U E hereby romor than here is.mmwamiun lending agency for the performance of
� . the work for hich,hi,purred is ls..Of(Sea fly)].Civ.C.)
QLcodc.'s Nunn TOTAL:
U lender's Address 'ITTE'AL: `
>' `a. E crnify that I have Mal Bois application and slam mal the alone information is SEI
�' g 'TY. MECHANICAL PERMIT FEE
i UZ uumm.lagrccmlroi,; Iwire allcilyan,umntymol,nccs and a Q' SEISMIC FEE
UZ n^Edingc,tnlmamnnamautor:nymdnmd cMos emm:wm onmscny mentumpott me
ulcmca(we)agree
wsc lire imnify anjolp es. PERMIT ISSUANCE ELIEC'IItICF
(we)agree tu wee.indetllmrr and limp namaex.the City Of emreninn asal.t
lahiluien,judgmmiu.c^stand expenses which may an any way forme against said City AITERORADDTOMECH. PLUMBIN ,FE
in malnattoa of lie granting nt this'omit.
APPLECAN9UNDERSTANDS AND WII.L COMPLY WI'111 ALI,NON-POINT AIRHANULINGIINI'E'(TO IILINIIICPM) MECIIANI L B?
ULAT'IONS.
Sf 'IE HEG
Q ,n 442JCAns l I I Q� AIR HANDLING UNIT(OVBR 10.IpRCF1,) CONSTRUCT )N TAX
Si8'I ApplianJCnntrecwr 16�bl Icl EX HAUS'I IIOOO(W/UUCI) IIOIJSIND MI'I 1A'IION ILEI?
11A].ARDOUS MATERIALS 1HSCLf(SURE
Will the applicant or future building oecupam slum or handl hom
edmus material HEATING UNIT(To IBound It IU)
ar d,ime,by the Cupcntnn Mart;ipal Cola.Cnnpmr 9.12,and the Ilulth unit Safety
I IEATING UNIT(OVER IfX1,IXk)BTU)
Code.S,,ein 25592(tpf
❑Yes /No VENTILATION PAN(SI NGLIE RESID) PAID
Doc Rmipl a
Will the ,,licanl or future building occupant use equipment or devices which BOILER-COMP(3HP OR IIX),(XX)BTU) O
toil hn'earJim,on,o)rantnamx ax dcfmmd by me limy Area Air Cambay Montagetnem OT 1.:
Dlsofcfl BOILER-COMP(OVER Plugs)BTU)
❑W, 131
o
Ilot,c road mm hvard^uun,amols o Lv mm der Chatcr(n95 Of the Cul i- I At R CONDE'IONEiN � ISSUANCE,DAT ESS
yuimmcn 'p v
Tui i Madre& fame tivla Sections 25505,25513 and 25514.1 m)notify th Our 11'thc NEW HI!SIDBN'TIAi,mi. H. :0.FI'. G
nui Lies not calrmmly have umnant. Iris my,rc.rym.ibiliry l^notify the«�cupum
( •ntt whish moa be fact pm+ htiseuanccufa Ccnihc f(kc c(y] r•1
iMtO^ A/Y O /�Y LC5-; .1.OT
U r mnhulieed agent Doc ISSUED Ii Y:
OFFICE