99120140 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY I Z O O
CITY OF CUPERTINO Bull DI NC-ELECTRICAL PERMIT NO,
BUILDING.DIVISION APPLICATION/PERMIT 1'LUTtBING-MECIUNICAL S0001BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: SANITARYNO. APPLICATION SUBMITTAL DATE
/oleo A.I.
7a�nov cora /s ,� /G t. �P
OWNERS NAME PHONE: ccy��f nCTOR:S NAME, LIC O NIC CONTROLg
GBrIO CoyPvrcl2 //�A�!I/i Nl4rc Wiu[ 6710
IUTECTdENgqINEEj LIC NO'. ADDRESS' ❑
eJ"OD Aozot.L WS O 3 .0 /+I✓af�L Ad& ID CCAaQA
'ONfncT PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid b)'Applicant(Initial) BLDG ELECT PLUMB RIF,CH
❑ ❑ ❑ E,7
LICENSED CONTRACTORS DECLARATION Q'ry ELECTRIC PERMIT FEE
lurchy nifirm that 1 ant liacnwd under Do's ens of Clwptcr 9(co mtrncno, _ JOB DESCRIPTION
M�Z IhSmlion]gxB of Divisinn3nf the Huainnz aoJ l4ofcssiam Conde.cad my liccnc is RFSIDFNTIAI'
WOO wi PFRMII'ISSUANCE:
Fit to full force an ctTm ❑SFDW'L C3 KITCHEN REhIODEL
aU�j hittn. Clf eaa �' ZO Lie Y AI'I'LIANCF_S-HI!SIDHNI'IAI, ❑AUDITION ❑PLUMBING,RI PIPIT
F+7w Late CmDC1 ❑MULTI-UNIT ❑STRUCTURAI.
NF C�y A CIfIECCS DECIARATION PANELS
zc)nK- I modentaed my piens shell he used m NNic records MOUIfICATION
OZ-O
UPFOIgtAMS ❑INTERIOR El CHIMNEY REPAIR
[=SFW IicmcJ NofcasiaW 3fll-IBfIB AAfPS IMPROVEMENT [I SWIMMING POOLS
26' .3 OWNER-BUILDER DECLARATION
Q I hereby utOmt that 1 am esmp trap the C'nnweun,Licmee Law for the OVER IalO AMIg ❑OTIi RIiMODE1JREPAIR DEMOLITION
W 3 F following rcnwm.(Section 7031.3.Buaiocu%W Profccdom Codc:Any city a crony SIGNS ELECTRICAL OTHER
which r�Nrts o P-rmo m con.rttixL alta,impoi dcmnikh,or repair any stmnate
�.1ipricire,irruencc.erica tc,arox the applicmt fm,.hpemenu Ncuaigdd ummrm SPECIAL CIRCUI'1'IMISC.
f y that he is licensed pursuant mthe In,Isi—tithe CmR IOods lice.law(Cnnptn9
W Iyy aC)y (comttencing with GSlion]OfM)uf FhYidm 3MtM Business and Pbs5miennCWe)w 'IP_\IP.MEILR OR K)LIiIN.ST. COMMERCIAL
that W mN
Section
DEMOLITIONs exciorA Tor E3 NEW [ON
FWDSERVI
m4. rmil wM1 Ddx applicant to ac:il 1perulty of PO55tiR DEVICES_ TENANT FWD SFAVICF.
= ). IMPROVEMENT
2S� l)1,un itwner nrtM prtrysany.nod mY eml'Iuycce with wagumlM7Lwdemmp:mwinn. SWIMMINGPOOLF,LEC-IRIC
F willdto He.d-mdla wuchare is renttnrendNmnfleml for svlc lSec.]BM,Pu.dnas ❑OfEIER
W 3^ and Pntfecsions Coda:The Conlneta's license",x does Itm aPpIY to C
pmpenY w1w htid.or linpmvcs tors nn,and who Ams xmh wad hiniw or thrtwgh
hie own elb,loyeev,possI d then such itro me menu oR not intended t 0efix!for _11 E-
side.If.howsycr,one building al,intrionant mrold wahin rete yru of co Mem,the ..- .FLOOR AREA S/sO.FF.
Mn
crhuidcn will have the huden of prtwing dol Ire did not build ur Imlxove Gtr pur-
pure-(oleo) a
L es awxr of de Intmdty,am exclus cwrrcting licenml ewtrurnrs to I ...-.i
v�.1rw:I the prnjccl(.Sec.]IWJ,Nuxiness and!utd Pntfeuinnn C.nkD TM Commctetr'raL �1L11 `f 1
cmc low Joan mtagtlY in an owner or prapmty watt builds nrimpmvcs tnerean:rend Q"I'i�.`:C�� ..`¢talNull Fre
w nn NllaYlF rm such pmjcas win arnntsstw(a)Iiarnrd put.wlo lie Cmtnclars 1
Liecnw law. "' ')\ +' 1 M,RMI'f ISTiUP IJCB1
l am exempt unci-Sec. .BAI'C c'r,,s—care t
V - VALUATION
Owrcr Date o
WORKER'S COMPENSATION DECLARATION BACK FLOW PROIECf.DEVICE / O O O
I hereby aRrm unci petully of nedilo r me of the folloaiug hcWmtiaos:
Inavcand will mortal.CcndicaoofCauemIll mlf-invure Gtr Walker's Cmtlsn- DRAINS-FLOOR.ROOK AR W.COND. STORIES TYPE CONS I KUCIION
as ItmvidN for by Scrum 37W4 the tabor Code.Rx iM petformarbo Of the
wad:for which this petnil is issue. FIXTURES-PER TRAP
1 Mre and will ntaintaio Wntken's Canpcnwteon Insumne,m retained by Section
J Iofatth{'e�Labrr Con,
for the perfamtueenrtbe worle foyrwhlch lhinpmtil is issued GAS-IS.SYS!'P.M-I INC.b OUI'LER OCC.GROUP / APN
Mem`c�sA/T1d C.� md)NIa.W bcrwc: r
f GAS-i?n.SY.SIIiNt-0VER i 1[n)
CE.,,MCA)A OF EKEMI'I'[ON FROM WORKERS' GRFASE%INWSfRL WAS'PP.INTERCt3'IT)R
COMPENSATION INSURANCE! BULLDING DIVISION FEES
(This senior reed.be onsopoed!ifthepcmtiti,f«mc hudrel ddliai($100) GREASE'11L\P
r Ecu) PLANCHF,CK Il?E
I mtirytluu iniM perRnrurccoftlewert lh which Udspermit ixias-ed.Ishdl SEWER-SANITARY-STORM EA.200 FE
nor employ any pawn in cry tnonncr w u to become whjal to tlx Wortkna'Canprn- FNF.RGY PID?
Z moan Wws of Califomiu.11 do WATER I IEAILR WIVENIIELECI'R GRADING M!
O C) ApplKem I
z y
NOTICE TO APPLICANT:If,filer miline-tl'is Crnifimte of Exemption,yw should WATER SYS1tO-REATING
h ; hemnc whjml ,the Wak Ys Compcnmliun provision,of the Whir Code,Y+Ic must SOILS ITE
as forthwith comply with such pbovisimn or this pcmdt dwB h deeme!cooled. WATER SERVICE
LLl z
t Al,
CONSTRUCTION LENDING AGENCY NEW RESIDE ' PI,MH. SOFT PAID
Dote RoscipM
U 0 NI
dty 1bendlimt that then it a cmVNnim lending ageltcy for the perfnrtnodc or
V. Ne wood,oda which this l ermit ix touted(lice.30)].Civ.C.) TOTAL:
QU lana',Nana _
Ct1 1<ndera Address TOTAL:
I cenifv toot 1 nave ren this epplicatem and due that the ollowe itdarrmulm 6 BUILDING hF.E
V0.) corners legmc mcompFy wlN ell cisy end county aJittwtscx and xtmc lows mladngm QTY, MECHANICAL PERMIT II:E SEISMICETI! .._. U U Irl
V Z huilding comtttutiom,astJ herthY aulhaue l<ptercntatives of thio city lo.entr upon the L
abo'e-trentiaed pn,cny for impectien purposes, - PaMIT ISSUANCE FLEC1. FF. II
(Woo agree to a,indm
cnly and ccep ammeu lthe City of Cupertino a¢einxi
iublln,esduid,m .covets cad capcnwx which may in omy way.. said City ALGER OR ADD TO MECH. PLU.. ANO FEE
sarcopercc M the granting W'this penton.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT no 111,gx0CFlt) MFC IANICAL I9217.
SO IRC7 LRLGULATO R'"
/',yMw�w,..T�✓, �Z-1s-.99 AIR HANINANG UNIT(OVER 10.000 CFM) CONfS1AlICfION�TA%—A
arc of A,,EL oCm Dwe "I IAUSIHOOD(WIDUCI] HOUSING MFf cwu)N FEE
HA%ARDOUS MATERIATS DISCLOSURE
W511 the a,l Organ,building occupantamem,handle hazztdxus material I IEMING ON"(TO I00,000BI11)
cs define by the Cupcnino Municipal Coad,Clwper9.12,and Use linin and Sodely gJ Cl
Code,Section 255324)' HEATING UNIT(OVER Igle"H'ITT)
E]Yo, 0N VENTILATION I:AN'ISINGhE REST U) PAID Uwe RmciptM
W511 de applicant a mturt handling accupnnt use Nuipmcd a deviscx'bionBOILER-COSH'(IBP OR IW.gp PN)
On hveNoux her cwa-nimnts no define by the Bey Area Air(yo.ity}tanapanrnt TOTAL '
,small BOILER-COMP(OVER IW.gPHTU)
E]ye,, E]NO
hared in
have read M1.vurtWas nwlUiWx trynino neutz undCh:iptur fi.PS of le Cali- AIRCONDITIONER 2 ISS-Z TUA^]CI',DA
Ul
forma IIWta R Safey Code.Stt+ions 25Sn.25533 and 255?f.l Ledrnudl tau if the NEN'RF_SIDEI.TIAL //MECIL SO.FT. - l III///
huilJine dices not euemttly hale•'amara.that it I,in,"ismaloddy to turify lore omtF n
eftnu rt4uilnrvmn which must on"x1ol m iomutcc Of Ccnifiww of Ocatywtty
O,vnr sr autMnze ngrnt Dntc TUFAL: ISSUED BY: ` {�—
OFFICE