S 1592 (2) ;k?n%GANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Bun DING.nxcrRICAL Pr:If`�•IT NO
BUILDING DIVISION APPLICATION/PERMIT PLII3LRING.MECHANICAL V 1592
BUILDING PROJECT IDENTIRICA'I'BIN
BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMIPIAL DAPI
0 11 e Re5v W I ��r "g
O NER:SNAME: PHONL COM'PACTOR'$NA.yyNII E: 1. NO'.
All ' / a,P. /� 2 O /D NIC CONTROLp
• A CHI'rliCq ENG P J!'. LIC NU: O AI>lI>It IY,iV ( ❑
44. CDo /Vh\ /f
CON1'n'. PRONG (� ',`` .. - BUILDING PERMITINFO
npyl Tlr�r yes-93i_ L&w El Pces Paid by Applicant(Initial) Ii.II _ I?LIiCT PLUMB MUCH
LICI?NSPDCONTRAC'IY)k:SDECLARATION QTY. s' IiLF;CI'RIC PI312MIT ' FEE
I Ranby attar Nat lam licensed under provisions of Chapter 9(cttmmendng r J013 DESCRIPTION
wi,h Sedion]fgl(1)of Oivisinn3afthe Bminos andip rofessit sde, dmylicenscis RESIDENTIAL:
WOO ry PERMIT ISSUANCE
is full forcead effem. Z-[� ❑SPDWI. ❑KI'IGf1liN REM110DEI.
�VU LlcvaavC Lia# APPLIANCES-RESIDE'N'TIAL. ❑ADDITION ❑PLUMBING RE-('IPI!
F 7 W Dom Coalcddm
Ak ITECTS )ECLARAI'ION ❑MUI.TI-UNIT ❑STRUC'I'BRAL
p0`4z $' PANEL MODIFICATION
OZh Z m dersmntJa plf:r� e u.sc I vs public records
=O - � I1PT02W Ah11'S ❑IMI'PRIOR [I CHIMNEY RIiPnik
17�n.F,V Lice ' 'rnfcsnional 201-I000AMIS IMPROVEMEMI E]SWIMMING POOLS
Z.4�, i OWNER .DLIt Oil.0 LARAHON OVER 1000AMPS - ❑RA'I'I I NEMOOEIJRIdPAI 11 D13MOI.ITION
C CCUGG]C I hereby affirm Ihul I un d"I"runt the Conlruumr's Liccow Law fins ibe
06,V following reason.(Seel nn 70 ,Buminess lmd Prof c..ban,Code An t county ❑(O'IEIiR
Any ciynr coone SIGNS F.LECI RICAL
ywhich requires a permit to consumer,tha,aims,improve.h gi nRit t or repair ed un¢mre
F 4J0¢ miss issuance,also then ileum for nitro fdeasi dsmmmem
NJ prior requires of pen gni SPECIAL CIRCUIT/MISC.
��y mmuchat o ,inhSr n lhep 'm 1',h Contractor's I - t (,Code) 9
Li00 (e'° 6 ithSwl ]IIfNI)off, Ixi130fish B : •w dP f:' 'Ct Code) '('LMP.ME'I'i?I<OIt POLE INS'('. COMMERCIAL:
ayoC tbid he is m,,bTa ithemfounionalto bsin lot tl IIgid vnbafuficcr.Ay ''nhRond - ❑NEW13LDG/ADDHION "V' OIJTION
Ixf1 tt .Seclinn]113 LS by any applicant fora pernm suM1jeca the applicant lnanvil prnalry of POWER DEVICES ❑TENANTFOOD SERVICE
r� not mme than five hundred dollars($500).
1-Z>- 01 1117R G ❑ Lar owner of the progeny, r myemployeesi mended with wagesmthei(See.led nnpema cress SWIMMING POOL ELECTRIC
1z.So will dol Rework,and the slnmmmixnol imm�declo Lawcoffered
......sale(Sec.](HV.liact(if ❑O'I'IIIiR
So anden,whio b Cad in in..Cnntmmw"r k ensil Laws such
nmapply,,It owacrof OUTLETS-SWI'rci ES-E4X'IURES
his voy who builds or ivided t a Nanton,and woo docs such tine Mussels nr Omnugh
his own cmpiny the provided that such improvements i, ,,Id arc not lorded or nlfcred for NEW RESIDENTIAL ELECI'Ii SQ Irl'.
sale.lLhowmxr,Nhave theburdmpmvenent itat he did noneild or iatmplctinn,he Al Ir{.a1T.00k AREA $/SQ.PT.
col odtdcr will have the burden of proving Not he did not build or impmvu for par- M L,.Jd
posm I"I )
❑ I f Ile,l fa B coilid, l 'r .will, T J t" us, a 'I(TI'AL:
construct tlo) l(Sec,](Wq Ba,ijmsdl f :Code)TContrador,L - - 1 - ' AY 5 AMn. Law does nm apply men nwnerof propenyx ho builds ' tprovn themon and QTY. PLUMBING PERMIT FEE ,
who conlmcls forsuch projects with a do tremmds)licensed Pnnuant m the Comm does
Licence Low. PERMIT ISSUANCEYCtI i IhV
❑ I'am excmpl under Sec. .R&P C fur ihiurc...n Ut VLI
ALPER-BRAIN A,V ENT-WAI'i?It ILA) VALUATION
Owner Dae
WORKERS COMPFNSA'DON DECLARAHON BACK PLOW I'ROl'EC..DEVICE 030,000 -
1 hereby affirm under penally of perjury one of the following duclaenion,:
n Ihav'e and will maintain a Cenilmale ofGmsem to self-inside for Worker's Compen- DRAINS-FLUOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCI'1(IN
cation,a,provided for by Section 3901 nr It,Libor Codi,Indic perfommncc of'he
work lm'which his,.....I is ix ed, FIX'PURIIS-PEIITRAP '
n 1 have and will maintain Worker's Cnmpensulion Insurance as required by Sdchon -
37W of the laNn Gyle,far the performance of Ne work for which this permit is issued. GAS-P.A.SYSTEM-1 INC.q OU1 LETS OCG GROUP APN
myAl,v's Cdnt io r1m lmicoome carrier and Policy
Cartiar:(lQ�'( Policy N..: GAS-EA.SYSTP.M-OVER 9(EA)
��pp f11 XI?M 11 )NFR�p WORKERS'
Ser K py1Yp INYMlAN( CRFASDINDIJSTRI.WAS'I'Ii INTI:RCF,.MOIt
rlTlssecti�n nccJ nm neutmple,ullthe permit is bar one hundred dol lam($RIE) - 13UIL1')INO DIVI61ON1'RE39
or
le".) GREASETRAP
PLANCBI:CK FfiE
I certify that in the performance ofthe work forwhich this permit isisamd,Ishii]] SEWER-SANI'T'ARY-STORM EA.20)FT
not employ any person in any manner so ns ht become subject,o the Workeri Cnntput- ENERGY FEE
Z s.fod laws of California.Dam WATER BEAT Hit W/VENT/111.EC'I'R
7�2 Applicant - - GRADINGITF
C. IaI NOTICE'1'O APPLICANT:If,utter making this Cenificum of lixemp,inn.You should WATER SYS'PI?M/TREATING
I-" > become subject to the Workers Compensation pmvlsuaw of the Labor Gude,you most SOIL FEE
Lak1
forthwith comply with inch provisions or this permit shall be devoted revoked, WA'I ER SERVICE
a Q
t, z C'ONS'IRDGTIGN LENDING AGENCY NEW RES IOlt N'IIAL PhMIt. SQ.IrT, PAID Doc Receipt#
hereby affirm l Pe lhcm is sued(,See.30 lending ugvtcy lits Mo perlitnnuna of
the work fin which this Permit is issued(Sec.309].Civ.CJ
Lender's Name TOTAL:
LLI
Lender's AAAdess TOTAL: BUILDING FEE11....,� I rectify that I have readthi ppl , d state hat h M r
UZi cos n 16 t Ily 'hall ty' Y lJ' ' d.rt f If gm Q'IY MECHANICAL PERMIT "' PI31i /t
V Z building t mmeft t. ndl actin t1 r I ea d v,oic "'ay nv.dunpo the _ 1a SI ISn11C 11111ce; V
muslotio nlindied popery knr Insputim,pudpnses' PERMIT ISSUANCE
(WO agree to sane.Indemnify and keep hatmlecs the City of Cuperino against ELECTRIC ITS
IimAIiuc,.judgmems,r.ux and expenses wbichmoy irony any twcmeagaimt said City AL'I ER OR ADD TO MECH.
an nsequetme of the grmtimg of this permit. PLUMBING LLE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(I()I0,0PX)CFM)
SOURCE?REGULAI IONS, MSCI IANICAL ITH.
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Shinaand of AEdmautlContruamr Date I- HAUS'PI IOOOOV/DUCO PIOUS I NOMI'I[GAT10N IPE
HA9.ARDOUS MAT HR1ALS DISCLOSURE
W III 1 le aPPlicunl al'fuulm buildhng necnliant pare nr handle ha'zatdons material HEATING ONI3'(r0 lbo'dhn HI'U)
as dm3ned by the Cuperino Municipal Code,Chapter 9.12,and the Heahb and Sudety
Code,Section 255320)' � � HEATING UNIT(OVER 1000s)111'U)
Q Yes y1 Nn VENTILATION PAN(SINGLE RLSID) PAID .-
-u�\ Dae Rweiptp
Will Na applicant or future building octagons use equipment or Jevicu which
omit harurdousair connmdnams as defimM by the Huy Amo Air Quality Molutgencent IlO1LF.R-COMI'OHP OR 100,000 BTU) TOA(.
District'! BOILER-COM('(OVER 100.000 BTU)
E3 Yes
I have mad the hmarlmn material.,requirement,maid,Chapter 6.95 if NC Cali- AIR CONDI'I'IUNER ISSUANCE HATE
to
Ile Ific&Safety Calc,Sectio 25505,25533 and]553;1 inuchoumd It.,if the NEW RESID1?N'TIAL MECH. $Q,FT. -
buil I ec dcei no,,omni y bout n Idnanl,Ibul it iv my dupmnih.b,to nnliry the x'oltanl _
I
c <quircmem tad�R I prinrin nwunee or a Cani�$y1e 1 .t ,
S
n nr authorized agar Dam TOTAL: ISSUED HV:
OFFICE