99110087 APPILICANTTO FILL IN INFORMATION WITHIN RED LINES-U ��L
CM OF CUPERTINO limit -- 1 -7
APPLICATION/PERINIIT P Ujillu — HA tc rfwlm'lzirr�
BUILDING DIVISION BUILDING PROJECT IDENcIn ---ffV"0ur7
RUILMG ADDRESS SANITARY NO
(1/1 1
tow 94� iWl.DATE
OWrRSN PHONBi COFACTORISM: NiC CONTROL 9
RcHrrk� G N L ADDRESS
r191iWINJA� C I"�q,072 —
CONTACT FeAll-AVe, WjA 0,117 INFO
Consultaint Fm Paid by Applicaint(initial) BLDG Ff FCT PLUMB MECH
f�AAia 5553-�5-ft- 11 0 E El
LICENSED CONTRACTOR S DECLARATION
M=z I hereby affirsh Bull I arm filearsed unci povisions a Cbnaplc�9 QTY ELECTRIC PERM IT FEE JOB DFSCRIPTION
P�,0 0 wlm� '70(g)) f D I f C"sh"anraylke'll.i, PINMUISSUANCH RESIDENTIAL
-,- to Pill f=ard Ifirz is [:�NWKe I EIM:GwT. [I KITCHEN REMODEL
,<u� I . , far. -
P-ZW 1 Coca to APPLANCES-RESIDENTIAL C3 ADDITION C1 PLUMBING RE-PIPF.
on<� ARCHIDECIrs lic , IfN Ej MUUTI-UNIT 0 STRUCTURAL
1-=on PANELS
zo��z I understand!or"I.stball the used as publia.&, MODIFICATION
oz- UPT02MAMN 0 I?rMRIOR OCHIMNEYREPAIR
4t:= —
W LicatUcA Pri,fie,ximal 201-10(a)AMPS IMPROVEMENT [D SWIMMING POOLS
OWNER BUILDER DECLARSDON
M� OVER UgX)AMPS [I BATH REMODEL�REPALR [3 DEMOLITION
Mc)w� I thereby mYim that I am cxmpt form the Corearactors License Law for the —
il:�U follmeml;...(Section 7031.5�Bmanex.,road Preficssimm,Codk�Any lily or loarty SIGNS ELECTIUCAL [I OTHER
�I- which oxm,a per-ono(o,colortio,after.m,ro,,c,dcmT,h,moToo-ta,aroamoc —
C,oli
�: � SPECIALCIRCUFUi
der he ll Electrical Thosaeaht to t1be,providaci the Centralia,Line're",Law Chaplet 9 —
(ccormosecovin,with Section 7000)of Division 3 of me Bioam�and!Po,resions Code)or TIAR METIR OR POLE INST COMMERCIA
ONEWBLOGiALLE-DoN EIDEMOULTION
POWER DEVICI� EITENANT [I FOOD SERVICE
hat.Bonn five hundred]dallars,(See(i(E, IMPROVEMENT
0 SWIMMING POOL MCTRIC
C, 'jIjd,,mvort,.amj assoxama,noolmacocle,ormffload fa,,alc(Scae�70TL Besinces OTHER
W and profession,Cods:The Contractors Licc.La,doc,.app,1.an ow.of OUTTETS-SWITCHES-FIXTURES
prolserry,alis,builds or tolt who desca,sach work himself inflovint
his(o&n employees prosicled that soch maIpmvertherax are not macri,dcal or officrcd for NEW RESIDENTIAL VLECTR SQ EL
sall.if.l000cc,be buildiiiii.,toproolimcm,,sold the SQ FT,FLOOR AREA 5s`SQ 17,
will have ithe bandeam proving ban thedid not Wild mornprow,forpor-
posamf icil'). TOTAL
[-] I,a,owhc� if'he"'Toloy.am evela'sel,"'am,"ar,with li,etts,d]ecoo-ax",o,
'ch.,Jo,parvaject(Sce.70ccl,Havoicssmid Primessim,Codc:)Hae Contractors Li-
esmse Law vices not apittly to an owner 4 property who houlds ho imlsoaccat�andl QTY, PLUMBING PERMIT FEE
1""..Low, PERMIT ISSUANCE
E]I arm exempt under Scs. —,IT&P C for Unix reactor ALMS-DRAIN&VENT-WATER(IDO VALUATION
whal Date
WORKER'S COMPENSATION DECIARAI ON BACK FLOW PROTECT DEVICE
I thereby ifficarromider Pearsall,4 ptarjory one,of ft ellowns,dcc� log I W-�
*Fj I Ionic and will madro.m.CerEri'me in Consenno,sciff-i.fair Worker"C.Pen- DRAINS-FLOOR.ROOF AREA COND. STORIES TYPE CONSTRUCTION
artion,as pro-ded t...by Scefi.ti 37(10of the 1,sha,Codle.Lx doe of the
�1. . a is'rao. is" FIXTURES-PERTRAP
I thav,and will marannin Wat Cloopeastaxion Insurance.ax roarrived by Stanton I V-tj
4))of me LalswCoxi Jor the perforhalarice ol wovi,for whach bisperrair is issued. GAS-FA.SYSTEM-1 ENC.40UTLETS OCC.GROUP APN
My WoAcr��v carric,and Policy
C . PoIstyN &*T30q-- - GAS-EA.SYXMM-OVER 4 BEA) '3V,-Iq.6&1
CERTIFICATE 01;ENE1,IPTIONFIfOM WORKERS'
COMPENSATION INSURANCE GREASIVINDUSTRLWAST-Ii INTERCETTOR BUILDING DIVISION FERi
or less.)Mi,occumi aced a,,,hv,,m,k1co,l he parmat is fe,ine mitered!doolms(SI00) ORWETRAP P[jANCHC KM��—�
I camil"mad in the perf.of me.1 for witillidn' man is tumed.I shan SEWER-S ANTEARY-STORM CA. iiR6Y PEEZ,��A,\
a'.,comey any pe-m in ch, ammer vo it,�oroc .neu at be Wcs&erv.Coorpen.
Z almol-atwxotcaliforma Deal 11 it
WARR HEATER WN�� ffi[.ECTR
0 E,IG RE
Z C) Ablificaran
p , NOTICE TO APPLICANT.If.hol,anal,ol,this Certificate 4 E,clationiont yor ithoull, WATER SYSTEMff REATING rsAuv 16 1999 111
beconalobjec, ,,the Worl,er,C,am,naa,vsa fmoi-...of me I.N,r Ccci me,, sl�
fo�wfflacmroplywmr vachiparovislorms orthispenedt shadl edlecoved revolical. WATER SERVICE
z CONS�TRUCTION LENDING AGENCY NEW RESIDENTIAL I11-MB SQ.FT Tl� Recriol#
u 0 1 berchy affirto meat there is a construction lending agency for thic lefformarcu of
dbe ci for which this permit is l,ted!(Sol.30N7.Ci,C.)
leader's N. I ul I I u ur dr y
0 U
Cal Leader's Ad,oxs
2. 1 clarity Ithat I ba,v amid this al,oficaniom and,tate that the jilhuic itiorromilin 1 BUILDUOF�
u(zi correct.I alarectocoroply stabled city andlatate Ims%retamat to QTY. MECPjS0�#PN6 0 pla n CH&k G
Z alloseveriat'll-I'millitYbealisr-Prolft Ft volefion
aN,,c tormi tcd pmEcqy t1m,lpeclion 11,11, PEEVE ISSUAfAntractor and/oy Owner a e
(We)agree 1.sms. ocktomil',not ke,,bn-rnIc,,me City 4 Coperum. aaren oftw*te
coas and esperei which may in any way acecrue against said City ALTER OR ADDrti)SMsibilh for arrechno
in convexacrice of IM naming a this plarril, a"Ork
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIRAIANDIANCOMM(MS reV SI*OnS Of) MECHANICAL ME
SOURCE REGULATIOI�rrj AIR HANDLINCCOMPietedIRM CONSTRUCTION TAX
kw,~ 1 tN Liq
Sitinala of f1llican�Zomoclur ' Date IcKHAUST 110(flefaftood fnr( ING MITIGATION ME
HAZARDOUSSIATEIIIALS DISCLOSURE
wu afEliGm,-folool Nilditilloce.Imot material
u�(lefored by be Coper-oroMernicipl Calle,Cherpocr 912,amr]me Health andSerty �AUNG IN
,UN)"00,000 lfl[�
Code S,,Aa�532(h)? IT miltall4ill -
nNo VENM LATION FAN(S INGLE,REsIIE PAID
W Dme Rese"A#
W11 dc.,I,,.uor fratin,huildmiluc,ttIpar,ttva,eu,nsartoc devvcs Iorh
kit air comenromants u defiread by to,Bay Amat Air Quiahly Manatilment BOILER-coAMul " TOTAL
F bo, EOB-ER-CON 21E T.-D
I base recast ribi,ba,mmem,marcreds nextimmcnc,ander Chapacr 6.�4 lo,Crdi- AIICQNDff[Oyffl'o
7rANCE DATE
ficarnias Hiaim&-Sality Code.Scaclion,15905.21533 ant n5�.I that if rise NEW RESIDENMAL MECH. SQ�Er.
bc�ldmg di,�im,ta�cntly have a tellmt,derat it is my re,loonsiloh,.......fy foloce,plat
of he N, to x,am,sc of a C1
ri- - i lars
2--t 21 Nxic,a] I Dib, TOTAL: [SSUEDBY
OFFICE