S 1937 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILDING.EI-EcrRICAI. 1'1=gp11'I'N°' 1937
J937
BUILDING DIVISION APPLICA770N/PERMIT PLUwnNG-NIECHANICAL VC
.BUILDING PROdEC'IABiONTIFICAI ION
BUILDING ADDRESS - SANITARY IN APPLICAI'I ONSUBMITIAL DATE
D33-5 ra,�' dlz, Dr. e- /9.- 90
O NiR;S NA P: PHONE: > CO/NIAC'IYDR:S NAME: LIC NO:JSA'RI.dS• IV/Ov l� �:«�J V / �� i✓7 NIC cGNTRDL«
IRCHITEC1'IENGINEEk; IC NO: ADDRES.: ❑
-OINTACT: PHONE: HUILDING PGRMI'I'INPO°
04,kC4— C>618
Q. .
❑ Consultant Fees Paid by Applicant(Initial) ELECT PLU I MECO
LICENSED NSCD CONTRACI OR S DECI ARA1'ION TY ELECT RIC 1 LRM IT .
Ihereby-B due I' l 1 J e : ICI PI -1)(r: l ,g _ , , t •' I IEE. JOB DESCRIP9'ION
WQWaZ
PERMIT ISSUANCE RESIDFNTIAL
L-
in fans ml tarot 11SPUWh CKUCHENREMODEL
4�F
aVV License Claes Lich
FmF Z6�eII.I '
El PLUMBING
RE-PIPE IPE
Dmv Contia,amr APPLIANCES-RESIDEMIAL ❑ADDITION
ARC bT'SDECLARAI ON ❑MULThUNIT [5 STRUCTURAL
ZoHZ undcsfund mypunxshell e JeA rte public records PANELS MODIFICATION
Off"ID NNIAMI'S
C INTEI210R [I CHIMNEY REPAIR
rrtAF Jxx Lee oil Professional - 201-I0XIDAMPS EMPROVEMENT C]SWIMMING POOIS
dd N OWNER-BUILDER DF.CI,ARAr10N tl MODEIJRI?PA1R C DEMOLITION
CY J OVL'R JAX)AMPS C'RldkLl
a Q I hereby affirm that I am exempt from the Cnmmmnrs License Law for the
WWOa«V Ibllowbt COTHER
pq 3 WI F g airc,a (Secdn1 ]umnowe a,u1ncss and Pmfde o demolish,
h,or Any city orcrnmty SIGNS IiLECTHICAI.
to which mquims a permit 19 cnnswct,ul¢L improve,Jemnlish,or n'pnir any dwnure
F.ti.�� prt 1,konn,c,alko re,rinc,dic a"Plicautf h Prime,f 11 g I,"wervet SPECIAL CIRCUI I'IMISC. -
f Y-. Ther] .I Jp ,1 B P a - fd t t C r License Law,(Chapter9
�ab0 (a,Dtcnigw'IbSort t07000)of Xvixon 3 of Btsnesvnd Prfv'.' ,Colledor I Hi M ITER OR POLE I NST. COMMERCIAL:
d G e C that he is ceemPt tbertfrom and the hncis for the alleged excntpfinn.Any cialmian of / ❑NI?W❑hUNADIJI'f1pN ❑DEMOLI'I'ON
R- Scutiun 7011S by any upphmmt farm permit subjects the applicant nt a ed Penalty of POWER DEVICES -
inmatefindfivehandeddollmzWOODY RNANT CFGGD S[RVICIi
9SFZQ C I,usawnerofihepr(pKnyorm I9secwifhwv theirsoleunn tion, SWIAIMINGPOOLELCCIRIC G[HER EMIiN'1'
Q yemp 8rs as .edea
al will duff"'! rk,moulo:T e Com lsnof intended ljorroraw Jo,fofrar apply ](u4, ,me,of CO'I'HCk
aim and I'rnfeoions Code:'Rrc Commcusr's hicensc haw Aces not apply m an owner a( OUTLETS-SWITCIIIS-Iq%TI/RFS O
pmpcny who bouldx 0r improves linemen,and who cuts ouch wurk himaell'nrtl:mugh
his own employees,provided that such improvements are not intended or offered for NIiW RIISIUENTIAL ELECT R SQ FI'.
,.I,.If.meve,cr.the makingnr'nnprovcnval o,ld w!,him one yeandemnpletiou,the SQ.FI'.IB,OOk AREA 41SQ.Ir1'.
et-builder will have the burden or proving that he did not build or improve for pur-
rocc nl pale). T(Yf O
❑1,as owner of the property,am exclusively commeling with licenced eantraetnrn m
construct theproject(See.1044 Business J Professions C I.)Ba Contractor s L - - - !
ase La 'Je.not t ref t 1 build' 'Ontaon,aul t -
'apply f o P pc Y QTY, -, PLUMPING PERMIT n ' FEL'
who mntioefs fnr such Projects with ncomruanrfs)h<ensW pursunmwfhc Cnmractorx -
LicenseLaw. PIIRMI'I'ISSUANCE
C l am esempl under Sec. ,B&PCfor Nismamn
AM ER-DRAIN&VEN9'-WATER(11AJ VALUATION
Owner Date
O a O
WORKER'S COMPENSATION DECLARATION PACK FLOW PROTECT.DEVICE -f"J�fln` U
I hereby alRmt under penally of ofCon one of the fallowing J Worker's
ionv,
Ied.a,um,will far bynectin370eofcomcnlr Code f..the
Wore/a Compom DRAINS-F1.00R ROOF ARM.CON0. STORIES TYPLO CONS'iRl1CTION
:lion,ax hioh,hJ for n Section J1fN1 of the lyhar Cole,for the pedhrmvncc of the
01 for which ldis diner
are
slued. PIXTURIS-I'IiR TRAP c -
37 I have and will ewe'
n Worker's Cmnlenvule w Inwmnec,vx required by Suction
P(Xl of the Mn CoJc, 'ut Icperlisrman<e of Ncwork fotryw�hyi'dneh�is pundit is issued. GAS-IiA.SYSTEM-1 INO40UTLIifS OCC.GROUT' MIN
C door' �Cnntp•r Enol 'n cnrric Pol cy No.IP I YT+•�J GAS-G A.SYS'p'EM.OVHR4(EA)
CI;RTIFI PIR FROM WORKIikS' CIIIEASI'JINDIIS'I'It I.WAS'I'R INIEN(JA'fOli
COMPENSATION INSURANCE BUILDING DIVISION FE S_
Ifhie smdon decd nal hers::nPlemJ ifthe permit is fnnmehundreJ dnllnrs($IIXp GltfiASIi TRA'
or loss.) PLANCI ECK FEE
Lconifylhanuffirpc'rfnnnmmmfthc work fnrwhlehthispennit is issuW,Ishall gIiWER-SANITARY-STORM EA.NEEL nut employ any person is any manner so us ro become subject la fim Wmkcrs'Contpen. ENERGY FEE
O z uvtion Lows of CvliPomia.Date WATER HEATER WNF,N'1'717LECIR GRADING FET?
Applicant '
NOTICE TO direct
ev let
W IL after making dtix Certificate of Lab...C I you should NATER gYSTIiAt/TREATING
a brriesoc comply it warkeLc G,mpensmmnhrovipinnp of l he Lted r evoked.you man,"
sous FT1R
i {!a hmhwith comply with such Prmisinnconhis pemtiLhall be JeemeJ revoked WATER SERVICE
Q
CGNmesit
it cION LENDING AGENCY NEW HISIDIiNTIAh I'L.MB. Sp.PI'. PAID
V pIherehy uffimtlh;n there ianennxwmiun lending agency for prfannance of Dam Receipt
Ir the work for which this permit is issued(Sec.3091.Civ.CJ h(7 ent
Lender's Name '1'GTAL:
Isnder'n AJdrcxs 'IY fAl
II) - s _r BUII DIN('ELI:
G I rt fy that 11 a d th':application and state th I the M1 f o l _
0 eo f Ing w ptY 'd II d' d ty di l I gl, QTY MFCHANICAL'Pl?RMIP r, rs` PFI_'('
Ula building construction.and hereby author repro fi of this city m enter upon the v + ( I 1 SIi1SMIClIa: ^
alv,ve-manllanul pmpcny lnnnppeefien no" o" FERMI'I'ISSUANCE N 3 ,rco
(0.'O)agree m save,indemnify and keep handless the City of CLpxsnin r agaiml ELECT 1.F Y
liabilif,,.mulgmcmp.cuss and expcnsec whi hnmy many vayvc,oura 'liet void City ANTER OR AUD TO MPRH. O
ine onseq.crucal the gaming ofd' peril. P IMBING PIH!
APPLICANT ON}L.ySTANI ND MPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,00I07M) I; I I .E
SO C7 TON
f/S 4 AIR HANDLING UNIT(OVER pu.(IfNI CFMI ( i�pNSTRUCOON TAX
Sign Oliu
Comicieli (J Date E%HAUSTHOOD(WIDULT) HOUSINGMITIGATIONFLl�
1IAZAkDOUS MATERIALS DISCLOSURE
Will the applicant or future building mompwnt store or handle hmardou,s mamrial MATING ON]LL 010D.00)It'TO)
as defined by the Comminn Mwticipal Code,ChuPmr 9.12,and de,Health and Safety
Creta Section 25532(0)? 1 EiAI'INO UNIT(OVER 103.0,N)RTW
Fl Yc• No
� - VIiNI'ILATI(IN PAN(SINGLE It HSIUI PAID -D to Itcu:ipt« -
Will the uPPlicum or\' future building occupant use equipment or devices which t it hvmnlnus oir mmeminvms ns defined bythe Bay Aran Air Could,Mnnugemcnl B011-Ek-COMP(3HP OR I n0julI RI'U) 'IOTA.:
tnm7 I101LFi
❑Yds E]No R-COMP(OVEN 100,000 PTU)
I have rut,the hmuminusnme'la"requircmenlp tamer CSapmrM1 0'of t he C;" AIR CONDITIONER ISSUANCE DATE
tomer Health&Safety Cots.Sections 25505,2553]and 25504.1 understand that if the NEW RESIDENTIALMECSQ.14. ^/ 29 Y (max
hnllding Arcs urn eurrvndy h:rvcuwnvnl.Nmlt is my rcxpansibilltymnrnify fhm:mnpnm o /
of yuirc
die ren ord,x hlch omit be met prior nt ice o
ssuanf a Cobificme of Uscupancy.
Owner or tannin...I. n Date 'IOTA.: ISSWiD BY:
OFFICE