S1649 -APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPFRTINO BUMBIS:-ME CTRICIL PERI"o 1649
BUILDING DIVISION APPIJCATION/PFRMIT PING PI(NGX71'ID N-rIGL
BUILDING 1'ROJE[T IDR.NfIF'll'ATION
BUILDING ADDRESS: SANITARY N(1. M�ICAION SUBMITTAL 1)
N V 2/��
OWNS 'S NAM �� I'IIONE: CONfI�ACJOHS NAMI� LIC NO:
GV � 11..^ LMA WC o COM'It01,<
�'A ❑'..f/ENGINLER'. LIt:I� ADDRFtiS'. ❑ 88o y
I U r.1
CONTACT: .......F BUILDING PERMIT INFO
G^�� ❑ Consullnnl Fcep Paid by Applicant(Initial) 'I T/ I'LI1MHECH
1fL u' D' C�'
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT j—jr
I hcmby affimt that 1 eta bcem;eci under M ono of Cbaper 9(conlmming OB DESCRIPTION
MXZ with Secrian'1000)of Uivisiun3o[Ihc Huxim+wd Rofcsxitxu COJc.otd mylicemais NTIAL:
PEHMI'I'ISSl1ANCE aLLO� in roll tome and cRal. OKITGI{FNµFMOUEL
au� Liccnxc 0. I,ic.NAPPLIANCILti-RESIDENfIAI. OR ❑PLUMBINGµIi-PIPE
FZW Deae Contlatlx
URAL
FDH ARCHITECTS DECLARATION PAN ELS ❑MULTI-UNIT ❑MODIFICATIO
ZO�Z Ion,[c.taw ory pane ilRtll be uceJ as'N k«ctrJx MODIFICATION
OZ�� UP TO PMI AMIS El INTERIOR El CHIMNEY REPAIR
F��.E7 u1 Llccnwl Yrolccxiooul 201-IIXMIAMPS IMPROVEMENT SWIMMING I'OOIS
OWNERBUILDERUECIARATIONOVEN IOIXI ASIPS ❑HATH REN/ODEIJREPAIR ❑DEMOLITION
C C 6 I hemby afiren that 1 aexempt frorn the Cuntrucmr's Licence I,nw for de
K�1am exempt
folk7wine rcmm�.ISmtun]NI5.Busimm and!Profcc.cioru Cottle:Any city cr calory SIGNS f:LELTRICAL C]OTHER
3 LL which rcyuirec a I'ernk to constrvn..Iter,mtporc,dm
cnlich,or repair any xtrachre
�.LL+01 pric -. re.nl 4 a ppl' If hpt Ill II :'g vl.lax Icon 51'PCIAh CIRCULOMI.
p�ta�r• barbC :dPum I to theEt Sxm :otlh C hr I (Chapter9
a� fco etc nG 'ith Sccl 7DX)I fDvi.donl ftheBwtrs oral Pmt. sCak)m TEMP MINI: L1i INST. _OMM R JAL:
a a a K chat he Is ewmp etc fnxn oN the cads for ilr alegM exempton Any violotioo d ❑NI: LDCJADDIL0N ❑DEMOLITION
^^,m Section TUL5 by any applicant for.permit xabjsts tlte.ml.,m a civil penalty of POWER DEV NANT ❑FOOD SERVICE
not mare thin f vc handed dollw.($.51X)), IMPROVEMENT
I,aa�wncr of llM pinicnY,army clnpluyccx witF wngce ua dcir sole crolnP:ncaiun, SWIMMING M)OL EL. C
C will altOrw�d.and lW slmewre is not intetxeJ croRemd forsule(See.9144.Buxincss ❑0'I'HPA
�^ 7�
W otd ef, Mals Cale:'Enc.E Contmemnr's License Law Joss not apply to if mer of OUTLIOS-SWITCHES-Il\ F_S
L 3^ hit n wW o,e,m,tIM Ba thcmut,and who don xmh wort:Iumselrli thrrxtgh game
hid m1, call,%ccs,tmvklN them such iminut u)ld s our nal iYeaahsl a olTeted for NEW HIIMDI:KIlA1,I;I.I:C'R CV F I'.
ulu.11:hnu'o'cn tW WdJiaB^rimpovcmmnl is r<Jd wilhinnm Year the SQ.FT.IE,(IOR AREA 5/SV.FT
crWiklcr will have Ina he Jon of loving thin he did oat build or improve For caclPdr-
poscufwlc.,. /oG.su
1,as 1c.), M ratePM'cnX yn uxi.xly..it.,with Berri TOTAL:
cartrvct the pr.,cr(Sec 7(44.Bw.and N.fexxi.Cone:!The Corumctds U
,cLa.dle,alt applym an ownmof,r.,,rr-y who huilJcor impmvn therrnn.wd QTY, PLUMBING PERMIT FLEE
wMwnnlmcls fornuch pmjmv with a e�mwcnr(s)liccnvd pirsuvnt m the Cmm�anr's ����11
Licenxv lsw. PERMI'I'IS IANCIi 0
❑1 am ea m,I under Sec. .H k P C fur thix v
ALTER-DH 1. -VENT-N'ATLR(Il) O t VALUATION
>t (�O
\ Oly of S'"ON DCCLARATION HACK II,ON 'R IiCT. I: Cli
Ii,mr aEHm�nnder pe,aer•'r pe Jury our none na6.wmgceulambanx: 75—) OOU
i � IM1avcuW will mainminaCcrtibcmc of Conmmlo xdf-insum for N'odeh Cumpcn- DRAINS-I1-OCR.R( ' .A,COND, SFORIES 'IYI'E CONSfNUCTION
,action.a protolul for by Sectio^3700 N the Ilbor Cxle,be IW herfunaaale of the
war\fm which 11ut permit i.iwrN. FlYW RES-PER TRAP
I bade vdl will tttainwin W«kers Cmlpensamion Ituunae,m reyuireJ by Satin
37A)eftWlabCl
hr xlc,fn In,Perfnmmmndthc work fm wbiohthixpcmtil it i,s . GAS-E\.SYS'IEM-I INC. )N ..Tti OCC GROUP MIN
My Wtxker'v Cumpcasatitn lnsu a e ec Ler uM Policy numlmr ac:
Carrier; Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF ECEbIMON FROM WORKERS' GREASF%INDUSTRL N'ASTIiINIERCIJ'IOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
IlTix rttliim mN na he contPkred i(thcpmtdt iv Bnire huMrtd Jolles(SI W)
GREASE MAP
orlccx.7 I'IANCHGCK 11:17 �(��•
Iccnify lhul in Ocperfmntanac eflhe work for whill,this))nodi ixl,uucJ,I hall SEWER-SANITARY-$'IDEM EA.2(X)I'I'.
not cia,loy any petaun in any n—m w m became subject be Warker,t Confiner. ENERGY FEE 2-0
O Z setiun lawc of Cali(mmid.DocNATER HEATER WNl f/FLEC R GRADING TEL:
NOTICE
Z nl
'f0 APPhIC Work If,ober nuking thin Cenibeme of 1I-al,"nn,You should WATER SYSIY.MT03ATIN0
sous lu
Wchwi,hoa,pl, iwwter ,potCmnpenwaon crrna,hai a e delnWr Crim,yea mode
W titnhwhh comply with xueM1 pmvisionc tx Ibis pemtiuhall W J¢nwd revoked WAI'HR SERVICE
a �
CON6TRUCf10N LENDING AGENCY NEW RF_tilUFM1AI.PI-NIB. SV,Ff. PAID
VD IMebY alBmttMt Here ix.coruwmka leMing.get'eyfm the Pertotmarec of Dxe RecripN Y.v r]^J
{Li--I the work roc which Ilak))moil ie i.uoc l(,tics.1097,Civ.C,) TOTAL: •C
L✓ Lxrckr'x Nano
U Lendkrx AJJnr 'rOTAI,:
�- CF.1 BUILDING R:E y�/•CtD
y 1 certify That I have had the,applicut'Imt am wee'ha th<ahave iobmnmion ix
f' N cmmcl.laemc to canPly with Vl city mtd county«ditivtcn end saloon.lawsmWieg to QTY, MECHANICAL PERMIT FEE SEISMIC FEE _
U Z Wildingatnatrudinn,and hereby authorise b,,resenmtivn cOhiscity to rnmr upon the
aMrvc..ncnllnred,o,cry f'r ir,,ccI on l h,,,ct. PERMIT'ISSUANCE? -7-D N/ l • S
1 Wc).sac w wvc,indmnnify old kccp hmnlcxv the Cily orch,cnimt againxl IiLHLTHIC Ib?E
liabil'niujtdgtmnH,emis otd expemes which relay in any way mcrueagaifa mid City ALTER OR ADDTO M LCIL 11-UNIBING NEI!
nconxryuerec of enuopo ' SriAPPhIG\T ON DIiH STA NUS MPLY WITH ALL NON-POINT AIR HANDLING UND7(U I0.IX(1CFM) MECHANICAL ME
souucF 'culAno•. 8' r 9
AIR IIANULING UNIT IUVICH If1,IXXI CI'MI !C01'NSRUCTION'fA%
Sigmtureon D c EXHAUST HOOD(WNUC) MITIGATION FEE
HALARDO . RIALS DISCLOSURE.Will tine chilblain m future Wildingoccupent store m handle he,andos ntheral HEATING UNIT CR)100.000 HTU)
Jetiml bythe Chrrhro Municipal C'nk:,Ebola 912,W enc Health and.Wa,,
GxL:.Sccliun 25534(.)'! IIIATING UNIT(OVER I IX).(XX)li'1'U)Ycc VEl,THAHoN FAN(SINGLE RFSID) �qy"}
BET[ .app. 73.2 a
Nill Ne epplicwm m f.11tm ildin8 mcWant uu eyuiptmnt ur Jn'iccx which BOILER-COMP(311'OR 1(1(1.000 BTU)
14 emit b...rdeas air contanirann,n defined by the Bay Aro Air Quality MuugemnR C�I V (/f U V t t_ifOTML
Di4reC BOILER-COMP(OVRH IIMkfMMI HTUJ
1'ca
I have reed the hvaAIW, irttmrH user Cbupw6.95i3Obe CNi- AIR CONDITIONER ISSUANCE DATE
f Hml'h Saftey Cde.. 3534.1 unbNavl thm xtle NEW RESIDENTIAL MEER. SQ.FT.
outcum 'ahakm pwsibllirywfdXif"Ite-apant
aaa�ielt Ie all}VI % Toe. �w�u�cc;
Smc TOTAL: ISSUED BY
OFFICE