99110088 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY --- ,1'�7' '�P''d e-'(i..//
crry OF CUPERTINO BUILD ELECTRICA /0' 1;7
B�,ZC� ELECTRICA
APPLICATIONIPERMIT PLUMBING NIECTIA C L
ING DIVISION F— BUILDdNCPR0JFA�FIDF' FTCATION A013V
Il-DINGAIDIDRFSS. SANITARY NO. APT`f,IC/AlON S BMITT L DKE
/050 -C I . A
A Gem W Gill - 06
'S NA E: PHONE rNTRA
I��R S NA CONTROL 0
LL 7�7
-940'-' ZNC,. CM63 El
CONrTACT, PHONE BUILDING PERMIT INT
4e� El Corionuibant Faeat Paid by Apvlk=t(Inifiad) BLDG R FCT PLUMB MECH
LICENSED CONTRACTOR S DECLARATION QTY ELECTRIC PEP MIT FEE,
n�z I hereb, firm liat Imin licensed!tincle,,oul,on. fCUtcr 9(eemonxicin, JOB DFSCRIPnON
L. I I I "I i'lfiL11wI1 RESIDENTIAL
0 "ImSest 7M)) If) I ti It Im" I Vm"ry PERMI I ISSUANCE
lw_ In 1.11 0 SFDWL D KITCHEN REMODEL
wu� u nic
r<z u P, r E APIPLANCES-RESIDENTIAL []ADDITION 0 PLUMBING RE-PIPE
ARCHTIECT� EE@1SP OmuLTi.uNrr CISTRUCTURAL
'Doo PANELS
zonK- I chilerinind my phnss shall ba,used!a,,Nblic or,hanf, MODIFICATION
CZ- UPIO�AMPS
L1 ibrrERIOR El CHIMNEY REPAIR
Lq Licer,ecl Po)fix4ional NPROVrAl: [-]SWIMMING PCX)IS
'NI
zS47- OWNIER-DUILIDER DECLARSHON El BATH REMODELEEPAIR El DEMOLITION
'R� I hereby itiffirsomm I..exem"froome Coon.t."Locim�Law on'lhe OVCR 1000AMPS
�C:) U follosion,..(Section 7031.5.Hcoh.x anci Poselicon,Cods,Any cit,to comit, SIGNS ELECTRICAL El OTHER
wtich respite,.Permit to c.t..1ter. orm,demolish,co refan,arry 1—hoo
�E 0 SPECIAL CIRCUT(MISC.
C, ....... LEMP.ML�R OR PC)IJ7 INST COMMERCIAL
lom be,,acors 11herelfiromiumffie hasix f-floo Wl,,,d ex,rofnion A.,viol....n if El NEW BLDG/ADDUHON El DEMOLITION
Sax.70315 by any applicam fi(�a Omit subjeces me a,,licant to a civil pervalty of POWER DEVICES LI TENANT El FOOD SERVICE
d"U'd,65M). IMPROVEMENT
not.than Its,moclivid
[:] SWIMMING POOL ELECTRIC
wiU do me ivivi and!tho hure is ron imehol ca.fFereli for.1,pis,e�7CW,Businei,
W and!Podfasimu;Code:The Corthraclors Li.Law doe,not apply to an mv.1,of O�E'-SWHCI �-FIXTURES
poocri, is,hodth,o, on,m,ca,haroon,end vsho i1o,s...In o&himself hon,h
his own annplo,oc,p,.,i&d'hei such or,m,anicho,me ior N I I, R SO 17.
,al,11,hiewove, he buildning or invirsovement is sold within o f I I th SQ.fer H.00R AREA SjSQ EL
'y 'a ciion�rc —
ioxnar-Niltlar will have dhe forden un Moving thin lh�did rm'1itT-mn,=
pose of side.). TOTAL
L as owner 4 the property am exclusively cormnaching with licarisev!conmactor,to
,..,the .jmt(Se,,7W4,Rosin-and PovIessimi,C.,I or —.--
%a Law ck,not ii,ty 1.em..ocrol ii,perty.ho budd-nor,o,as mior,m,and QTY, PLLTMNi��%Rmrr FEE
who contricts lor such po,rtv w ith a onnimcnim s)licciewd pinsonen to the Contoictilr v
Licii Law. PERMIT ISSUANCE
I am exempt uml —.B&P C for Unix tv. — ALTER-DILAIN&VEJNT-WATER(BAN). VALUATION
ly�ha
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE +
I heirchy ffimn tinsfer ovini do,eine.1 pea Iollewon,che,larroom — IM,
El I have n.1 wilhoemone.tiCeinfi,me ofC000,m ,,self,mme to,W-km,C....i,,on DRAINS-I'LOOR,ROOP AREA,COND. SIORIES TYPE CONSTROCI ION
smom.. om,icloc!for by Sacflon 370()of pic Lisho,Codo,forhe me —
$ for hech mix shorm,is i,.d FI.WUlUE!s-PER T"P
have and ill initiation.Woolo,'v Cmrcrounion Irsomence.a,res,eiren!bysewti —
61 GAS-EA.SYSTTiM-I INC.4 OUTLETS OCC.GROUP APNI
My%Vi arrier"miocy GAS-EA.SYSTEALOVER 4(EA) An'
GREASHJINDUSTILWASTEIN'TERCEMUR
COMPENSATION INSURANCE BUUTHNG DIVISION IM
Is,,)(This�ihh read.heishorrAchad iftho penmio,for mia mooned 1,41.(S H10) C.RHASETRAP �CHECK FUE
1,conf,that inthapen-fivotionva.fflnewark for.hoch Ink cmu,i, xiard.I sbafl SEWER-SANITARY-STOdVI EA. IT
roo employ any .in mr.,.,-.1.beco. bJeon to the W�aix'Cohn,r- — ENERGY HE
0 Z smi.n.Lays,of Citlifutoot-Ehhe WATER HEATER WNENTIELE-=
z 2 Ap,licart GROaDING]]III
,r, NOTICE TO APPI.ICAN `If.allih000kon,this Croirancof E,oeon,fim.yon th-ld WAI FR SYSITMUTRHAFING
bacorint,subjoet to ft Wcsrlbcr�,Conn,rismi..provisions I dho Uthor Chile,yom must — SOILS FEE
moh.oh amoil, iffi,.h prooitimm,or this -if shall k cloamod revolved. WAHERSERVICE
D z CONSTRUCTION LENIANG AGE2cCY NEW RESIDE"AL PAH)
u 0 1 hoo,by.firm man thare ix a conshructiort londing.garoy forthe Performance,a Medpri-GAR- compWn -luc--ip-
Phe vvo�for vii premi,is issued(See 3097.Cis,C.) or acce -1C
U Lenders Santa V �e TOTAL:
W r—'—Sibilh(nt
I cortifffian I have and,ona that the abe,a infimmonion
comesh,I aF=to comply with all city and ceenty ordinances nod wite,lawx refining to QT-Y. MECHAbfijM wism
Z Wilifin,,ahosmicn�amd hemby numotio,representative%of his citv to armor upon de,
alwoe-morlomed for hopoctimn',voi PERNIFFISSUANCHCO
(Wa)h,roc to sove.inchommify aod kcap harmlex,ith,,Cit,of Co,,coi- .ihsl M0 Imras. ELF*CI--j.VuV
hathhors.jusl,00nh,coon,and c, ro-.1,.,h may in y is iy�croa ni-I id City ALTER OR ADD TO PoIrmit nodfor (Mthirtip G 1171:
in corisectherice ,I ithe ramm, fmi,psimi,
APPLICANT UNDeILSTANDS AND WILL COMPLY WITH ALL NON POINT AIR HANDLING LINII(TO I0.fK]0CFAH CAG ME
SOURVREGUI IONS. ( it AIR HANDLENGUNF"10.00)(OCU(06
Sige,UfAppfie 964M h4ff I . , UCTIGN TAiZZ:Z�
ho,Ccomactor I D,tta EXIIAUST HOOD W/DUCT) HOUSING MTIGATION FEE
HAZARDOUS MATERIAI-S DISCLOSURE
in on.buildin,oc,iiam,norcor mmoRc haiunilon,on.ocirml IICAI ING UNIT 0.)WNW
ins defirthl by die,Ch,coma Mumcpal Code.Chapter 9.12.invi me,Health andSidel,
'j�odia' �5120)`. Ej No HEATING UNIT(OV IW'"BM
VENTILetiTION FAN M919
F - Done Resecio 0
Will be aWfireot or future thhilifing hvc�npom use cqui,ontem or chievea,which
com,"cardho,m, oven-mism,-bofined he dre 10,Area Air Qmality Mimigement BOIIJ'R-COMP(3HPOR 100,"BTIH TOTAL
Di'mu? /I E]Ish, BOILER-COMP(OV ER I W,0fa)BTU)
I baos,resal tho maxamids undor ChWer evy5 4 thc Cadi- AIR CONDITIONER ,,ISSUANCE DATE
1.Handth&Sidbaxy Ccda-�imix�905.15533 and 255�.I minclarrhand Ixa if thic NEW RESIDENTIAL NIECH. SQ,FF.
buidtion doonoic I,b...
other I Is, .1'rimorissiotei,cof M/jt&u,,arq.
0' ri,amohri,ad tho IDTAL: ISSUED BY
OFFICE