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24175 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY BuildingM Pro Identification "° 141-75 . tlullding,bddms: ''1o361s Vo G CITY OF CUPERTINO•BUILDINGDNISION �m D APPLICATION I PERMIT vp Ardua Red/Englr :r. •m BUMMNGELRCIRRALPLUMBINGMFLHANICAL CATEGORY (DNTROL# QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Add. PERMITL%UANCE 9= =1 Proraw—MECF17— LICENSED CONTRACTORS DECLARATION 1:1 El El IMmby aRbmthella lit seduederpm bimsafChepr9( APPELANCRSRE9OFNTIAL jusDFSC IngwilhSetlbn7Mof Divi on3oftheB"S udPmresdm Coci,ndnV Ibnnse bin fun form and efka. PANELS Lkemrap♦37 LII Date��'j�_g Contmdm ARCHITECTS DECLARATION "1 mQZQ Iuedema plaro Shen be weed s public S. - OVER IBW AMPS nFLFLOORAREA S/SQ.FT. fire Lkmmed Prefefflonsl SIGNSEIECTRSCat rn$NWNW OWNEWBUILDER DECLARATION Imam PA IhendryalRrm<hetlameYmpt(mmtheCammofSLimneefaw(wthe ZZ foWwing reeem.6emm 7nil5,Bush®aha liobrbnS Code:Mydtyor 5 oamtywhY:A mqubnapemJlmamtYmat,dter,improve,durolbh,wmpalrp.ME17RORPOIP INSf. Yyatmmrmprlorwibbwamgalmrequlmstheappllmntfwmchpmmw )q)yEg DBVICPS IpI file a diand Settlement that he b nonmed purmam to the p ovbbns d the 3 --� CmtrulotsLkxme law Chapter 9(commencing with Smrien 7610)of pv4 SYNC POOL ELSCTRIC doe, aon 3 oftha Suelresana PrdmbmCede)orthat he b exempt lhemf,,,d VALUATION the bads for the alleged exemption. My ,violation affiedbn 70315 by any OUSIFISSyJITCFESFI%11JRES '1 applicator fora pemtlt mblemmeapplleanito a Gull perukydnd murethan Z�Q #� fivLjYndrdddWehepr. mob NEW RESIDEMEAL ELEC R_SQFI'. STORIES TYPECONS7RLCTION z�e LJSYowmrdlhepmpenyornyemture is wahenadgeedaY fferdfor O com05a,70KDoldothend Pretenders Code. bndbtddedmoRor Law C eek Sena 703,BuSbws and Pmdesbro Cedr.TheCodmaors Llaensefaw �B dmsnd appym owmar dpmperty who bulbus orImprovmthemmha,a £^ whodomisuuddwom rkhim Umthrmghhbownemployee%pr idedthatwch CCCCROUP RES IlN17B Improvement,—M intendMmoRerrdfmYb.Rhowever thebulMbger T07AL• Impmvemedbsddwkhlnmwymrofcmq dimtheowmr-buWerwUlhave I dandprMngllut MaMnYWlldor romforpurporedYb.L QTY. PLUMBING PERMIT FEE L as owner d the propemy,am eckol dy omeradbg with licensed FLOOD IDNB APN contraetmsmconslmdthe poled(See 701�Budnes and Pmfesbro Code: PFRMIT155UANCE TM Comredofs Limnse law den an apply to an owner Of property who bull"m Improve,theme,and who connote,for such plojab with a ALTEWDRANAVENT-WATER MU r9innarctorlidlimused pumuant mmeContmdds License Law. BACK PIDWYROTECT.DEUCE .FEE SUMMARY Lj I am earampt miler Sea B A P C for thin mann . Owner Darr DRAINS-FLOOR,ROOF,AREA,GOND. SANITARY Y_ N_ WORKMAN COMPENSATION DECLARATIONRWM'T# [31 hereby affirm that I have oe ve a dlOml of ensued eew to "Sum, a FDnuims-PERTRAP SCHOOL TAX Y N wdWmtedWorl,OWCampevYBminmmnmwamrdfiedcopytherra(Oce. GAS EA.SYSI'FAt-I WCd01717.kT5 PARK FEB J Fong RBCE7r# 3S0Q,LbCJ N CAS-PA.SYSI'EM-OVERd(EA) BUILDIINN'GDI CC evDIVISION FEES dgied copy Is hereby hrmbhed. Bled cREAsg/imuBIRL WASIB 1NTF%FrroR PLANCHECK FEE copy In heed with the mY inspection drvwm. CERTIFICATE OF EXEMPTION FROM WORKERS' GRELSETRAP PAID COMPENSATION INSURANCE SEWER-5ANITARY-SMEM EA 211X7• Date RDDei # OTbeedbn reed nil Meompleld lithe peened bfmoonhundred dollars alamtilr.J WATER IEATERw/VENT/ELECTR ENERGYFEE Y N I mdltylMblm Prove many he manner lwwWmtloS pe mat ctto11 , 1 orkhan nm empty any person f any main. oo r Y became wbjen to lM WATERsYS1FM/TREATING workman Compewebn IawsdGllfamb.Dile PAID O Z Applicant NEWRE%DpMiALPLME SOFT. Date Recti t# ZO shmldkWU� 0APPLmwtb,ager rYCongb tionpteofsxemmppthe yon jr shonldbecomesublh-Uh eWorket marproabf=mvbbrooflhe Labor TOTAL' Cedgyon newt lmthwah comply wlthmrh provYlmSwthb permit andlM � � deemed revoked. BUILMQ FEE ''na ll CCONSTRUCTION LENDING AGENCY SEISMIC FE I Mrebya(flrmthatthem bacoruWdton bMingagereyfortlepefir r .fOC,W, ELECTRIC FEE Z a=ofthewmkforwhkhthbpenMisk rodSm3Wy,CIv.CJ (� O heede/s Name PLUMBING FEE LL H Iardees Adder QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W to ifytMlhawmadthbappgotbnandmabthdtheabovelnfomdtlm N a brred.IagmWm plywamu handlyandntywdlnar mdddelaws PERMIT ISSUANCE FEES PAID: >- ndeing tobunding construction,and hembyauthodY mprYematbes dthb j_ Z mymenterupontMabove-memtbadproperty(mlnspeenanpurp— ALTERORADDTOMDCIi. Date Reeei t# V — (We)agree W Yvg IndenWfy an d keep hermits the City of Orpeabo agabut lbbWtim,)mdgeans,rant,and experum which my In anyway Smut NR HANDLING UNIT(TO 10030 CFM) SUBTOTAL - of Yid City renaquemeoflM gnmbgd WSpermK. AIR HANDLING UNIT K)VER 10,000 CFM) CONSTRUCIIONTAX h and p ill/Contraetm 0(HAUSTHOO)(W/DUC) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE III the appllmm or future building occupant mom or handle harardoro HPATINGUNIT(T01MAIXIM D DeM• Rech t# •, material as delirod by lM Cupedlon Municipal Code,Chapr9.lZ and Ne Hea Yesd SafelyCede Sec id on25532(x)7 )EATING UNIT(DIVER 100,610 BTU) T A El the applloSt orfurom building cmupantuee equlpmemwdeuke, VEN71LATION FAN SINGLE KFSID) ISSUANCE DATE wNrh entll MYrdous ab omtsMnsmsasdeilad bylhe Bay Area Air Quality Management Wtrlrt7 BOUFR.COMP O)EOR IfD,WO BTU) Yen ❑❑FIo ve read the han.9 mdedab requirements uaderCMpptekr6.95 of BOILER-COMP(OVOt 100=BTU) q the California I ImIth A Sally Code,Sedro kn75:0%MW and 235.34.1 P A 1 understand that lfthebunding does rol currently he.a Imam,that it is my NEWRESIDINHALMECH SQ.FT Trop.nslblWytondifythea pantdthemqulm or swhkhnumMmd ElCae ` prim m lmrance da CadlBab dOcapanry. /. ,7G I/����a��� Owrormwlhodad agent Dal issma,ni 7�jrVg r v TOTAL: r ren.. . OFFICE COPY •MltldVVMO NOOO1'ON NO O3INIW L{11{{ J C`Zr 14 L V s° V Qo U� MOVED � 4 SEP 21992 D M40 j— BLDG. INSPECTION DEPARTMERL lrt[rr rLnns ; v CITY OF CUPERTINO CBEC D BY ING DEPT. " Df.. DFM'. tv • � � ��77��TT OFFMV • U2-Z Ake 3+�3 �fj I l ' � 12 ! Z I 5 , i i . . . . . . . . . L' g 1 I - f _ Y II l / i Z C � i � cf�