S2526 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO
BUD D:NG-ELECTRICAL. PERMIT:NO.
BUILDING DIVISION APPLICATION/PERMIT rINGPROJECTNG EDBANIFiC S 2526
BUILDING i'R(1JECI'IUENTIFICATIUN
BUILDING ADDR> S SANT"1'ARYNO. APPLICATION SUBMITTAL DATE
5 3 .- s - 29
QW NH 'SN1E: I'll NII: CO 'IA ORS MIS: h1CNO
NIC CON'IROLit
ARCHITECT/ENGINFER: LIC NO: ADORES69
'94WI 1 ❑
C0N1'A(Z7L PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) RLIXI ELECT PLIUUMIB� SUCH
❑ ❑ LCJ' ❑
LICENSED CON I RACI'ORS DICI \RM ION Qpy ELECTRIC PERMIT FEE
w'h\et 20,,frn lel I� f :m d p : fCI 1a 9( s -- _ JOB DESCRIPTION
heads, : i. RESIDENTIAL
W0 dO Jf0-Uux dI'rferAn:C d.and mylice
�O PERMIT ISSUANCE
F�° in lull f d R�_3 3'l'- 3 M'DWI, ❑KITCHEN REMODEL
C z U Lia CI . Lie k
6 U APPLIAn CLS RISIUIiNTIAL AUDITION ❑PLUNKING RE-PIPE
F Z W Uam 7S DELL
In¢1 []:11U171"UNIT' ❑MODIFICATION ARCHITECTS DELLA
)
o oTURAL
7 w PANELS MODIFICATION
Z°14 Z 1 undeatand my plant shall be used as public recorrk.
OL=C UP'f02(O AMPS ❑IYTI[RIOR ❑CIIIMNEY REPAIR
F4tC,4J Licensed Pmfcaeional 201-I000AMPS IMPROVEMENT 0SWIMMING POOLS
C yd F,j OWNER-BUILDER DF,CLARA'L'ION OVER IOIXIAMPS [I RAI ItREMODEI/REPAIR ❑DIiMO1JTION
C W d 11 by B II pt I theC I I 1 for'he
(pyU Bli [�'(.rflllilt
N w g (S ' 011115 Business dP f :C e y it, nu try SIGNS ELF.C'fKICAI.
man q Permit' , d p I I:n p r:weare wO QLD.// PC Al
cal
pr ort I cmmoic,d:.rcqurc: h..applicem fnruch panii m flansgnedmamment SPECIAL CIRCUf I'/MISC.
, �}� Ihahcieliccna
Iemm�cncing with Se,liunnnn9O(TMbIoopfrUviivsiiosinosno3f nThfe NCeoBmurveimncosrs'and Prorafeclseiwon(sCChWuleduT
TEMP. (H POLE INSfCOMMERCIAL
0
d 10 5 'hal he is exempt therefrom and the basis for Ne alleged exemption.Any violation of ❑NEW RL.DG/ADDITION ❑DEMOLITION
Sectimn70315 by any applicam for.permitsuhjecc•'he ap,hoan'm acis'l pcnzlry of POWER DEVICES TENANT
FZY am.rote rate five hundred dollars S500). ❑IMPROV ❑FOOD SEkVICE
2d° QI,as mwmi-otme in,xii,ranryemployees with wages as lhuirsolc comlls.
,aion, SWIMMING FORK.ELECTRIC IMPROVEMENT
H
will) IM1 kaMth :I r ' n d i II df (S 0014,Bmin,,
vull f Gd . 11 Counual.......Latorse Law doc, air'pplyt an.'a"of OU'rLE'I'S-SWI'ICIII:S I'IX'NRIiS
prolarry who builds or hoproses diction,and hoducv such work h mself ter through
his own employees,presided that.such impmaemcn"aronmT intended or offered for NEW RESIDF.N IAL 1:1 I CI R SQ 1'f.
sale.IL howevc[rhe haddingur imprcemei.,oild within encyearnfemnplenon,the SQ.FTFLOOR ARCA SISQ.FT
crbuAder will have Tbc burden of proving that he did nm Wild or improve for pur-
e n of sal,.).
D 1,m owner of rhe property',am exclusively contracting with licensed convacme,to TO EAI"
ommat the project(Sec.71141.Business and Professions C.de:)'Me Crum m as Li-
seLaw does mo'apply le an owner mf property who build%or improves thereon,and QT'y, PLUMBING PERMIT" FEE
who contract for such projects with a con'mc'ar(s)licensed pnrsaam w the Commends
Licun.5c Law. PERMDISSUANCE
um exmnpnander Sec. .R K P C rot this mason
ALTER-DRAIN k VHN'I'-WATIiR(EA)
VALUATION '
Owner Din :
e WOR KER'S COMPENSATION DECLARAl'ION BACK FLOW PROITCT.DEVICE +']�
1 M1and weRmi under penalty teperjury one of the followinsure'for Worker's
50T/•
0Ihave
as and iddnaimainaCcdifca ofConscria to Labor
Cook,wrefor Worker'sm,of the URAINS-FLOf1R.H(l(:)F.AREA,COND. S'IOHIFS "TYPE CONSTRUCTION
smirk,as himh Ohio far ul Benson JOW of the Labor Cak,for the performance of the
work for whichillspmmiT is issued IRXTURES-I'F,k RRAI'
1 have and will main min Worker's Caar,of he
rk or la h required t i Beeson
9]1X1Mthe Labor Core.for the p.rfonnanec ofthe work or whicM1'M1ia permit ie lzsueJ. GAS-EA.SYSTEM-1 INC.J OUThN.PS OCC GROUP AI'N
My Wrrkc C - tin n rand Pulley nn :
nlnpq�'n�aa-/U uburnuw
Canicr�r-Lc.(-f(ry� c R1IvIIDNy FROM
Y ��P wf-trop GAS-EA.SYS'1'BM"OVI?Rd(IiA)
CERI'IIdCCO PE SATIONIINN FROM WORKERS' CiREASEJINDUS'I RL WAS Di INTERCF,I'TOk
COMPENSATION INSURANCE BUILDING DR'ISION FHIS
(Thi,action need nm be cnmpined if the .oil is for one hundred dollars($RMO GREASE'IRAP
or less.) PLANCIIECK F[iL
I certify Nat in theperfonnunecoDnework forwhich thispermit isinued,l shall SEWER-SANITARY-STORM EA.200 FT
not employ any penin in-ny manner s}s q�cpne mhjcn m the K'orkers'Cmmpem ERGY 1r1:I=
Z satinn Lows o ,,at. Due IJnla J Na 5� — WATER fIEATfk WNIiNT?LLCIR
Z Applicant + ^^ //G/<• / NU 17 '
az.� h NOTICE T�( I. :AN'll II;all making re G.rtitinnc of Ere poor,you should WATER SYS'D?M/1'REATING ,;hili
F bennnc ambjea1.Bre Work,,,Cmnpenmtia r pmvix:m:...r the Labor Code,you nor
Ia1J dmhwalo, rply wjob such pruvi,ions ter this prmit,hall he deemed mvakd. WATER SERVICE YI I
Q
0. CONST RUCTION LENDING AGENCY NEW RFSIDEN I'IAL PLMB. SQ.19'. ) '1
U O (hereby affrn That there is a construction lending agency for the performance of Dam Rtteiprk t
[k. (•-' the work foe x hicn This penmen i,issued(See 3097,Civ.C.) TOTAL
Q U 1<ndefs Name .
TC
IAL:
Address "1'nl.:
I comity that t have mad this application and Floe that the above information is BUILDING FEB
FV) m n.I agree .,,imply with all coy a mdroumyordlnmmcand 11.1.laws remringm QTY. MECHANICAL PERMIT FEE
Z hnildingnm,tmction,and bcroby uwhna'izc mprcaenwivcx of Ibis city To cmm�mgnm the SIi15MIC Plili
0
ubnvoniemioned peppery tar inspection purposes. PERMIT ISSUANCE
(We)agree m wvc,indemmd
nify and kap bucxr the Cimy ofCupertino against ELI!GI'I<IG I'lil3
liahili'ics,judgmcnts,roam and cxpcnscr which may manywayaccmca,romosaid City ALTER OR ADD TO MECII.
in Boa aamof The gromingof IM1i,Perri': PLUMNING I�RIi
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON'POINT
SOURCE REGULATiOl�SqIR HANDLINGfINI'1'(TO D.000 CFM) MF.CIIANICALPEL
SOURCE REGULAT O,'ti
'/tt�y`' / /� AIR HANDLING UNI'I'(OVER 10.000 CFM) CONSTRUCTION TA
ti� ul o APPL<anp � a5EXHAUST IfOO1J(WIUUCq HOUSING MI IMAT10N FEE
HAZARDOUS MATERIALS DISCLOSURE
Wdllheappllcum art fou cIslding occup'nol,poreor handle h,,,d meatal HIiNI INC,UNR'11(110 100,1000 BTU)
as dOF Od by Inc Cup:mine M......Nal Code Chapter 9.12.and The Health and Safely
Code.Section 25532m)V HEN]ING UNI T(OVITR 0O.(KKIBTU)
0Yca ON. VENTILATION PAN(SINGLE RESIDE PAID Date Recia"
Will the applicant or future Wilding ismupant use aquipmem or devices which BOILER-COMPUIfPOR 100.00 BTU1
Omit ba.dou5 air cnmuminin s as defined by the Bay Arca Air Quality Manc,com nt TDIAL:
District, BOILER-COME(OVER IWOMO BTU)
pYea ON.
Alit CONDITIONER ISSUANCE DAA P Q
fonnin 11.10,A,Safict)CI S , 25505,25533and25534,1 ad,r,irr,lOh,d he NEW BESIDES'i'IAt,MECH Q.171.
ha.1dm,do,,aa,,mmd,boe ahromat.,hat iten,ny'aerym ter'hd'ry muddy'be oa.pat 3 pj
nfhc mqumemem. arhamnthcmnnormnr m crifcae.r epancy. ✓✓✓
m amhomed agent"." /{[LCL c TOTAL: ISSUED 111':
OFFICE