B0334r
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES—USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.F,I.F.CTIUCAL PERMIT O NO
BUILDING DIVISION APPLICATIONIPBRMIT PLUMBING MECHANICAL `,0001 ;80334
BUILDING PROJECT IDEINTIFICAI'ION VII
BUILDING ADDRESS: � l• \iv l n \V SANTfAR1'NU. APPLICATION SUBMITTAL
DATE
I� I
OWN, NOAME: ?-A
� MGM:: CON RACAMS NA LIC NO: NA 11 COKPROLX
T�
•ARC :CF EER:a1 I I G NO ADDRESS: ❑
8
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consulu l Fm Paid by Applkanl(Initial) BLD 1].ECI' �PLUMB MECH
LICENSED CONT'RACTOR'S DECLARATION CIT ELECTRIC PERMIT FEF, l DES [n��
1 hertby e➢irm that I lien f¢ensed under provlslono of Cnapter 9(caa..ncing JOB DESCRIPTION
O d'Z wiN SsarWn 9000)os(Disisivn3Mthe Bttsirr¢svml f4ofe,sioru Code,ural mylkrnxi, RFSIDFNTIAI'
u1OO an
PERMIT ISSUANCE
1- -n full fmccand cRal. ❑SFDWh KITCHEN REMODEL
�UU Lianm Clue Iie.Y APPLIANCES-RISIDIW'f1Ah ❑ADDITION ❑PLUMBING RE-PIPE
111 Dolc Caroacast
l�isQa ❑MULTI-UNIT ❑STRUCTURAL
g.Oy ARCHITECTS DECLARATION PANELS
MODIFICATION
ZOnZ I mdnsumf my Pn .aFysiiqj=oblk reactant UP T0200 AMPS INFERIOR CHIMNEY REPAIR
OZ-0
��C{y L DECLARATION 201-IIXXIAMPB IMPROVEMENT SWIMMING POOLS
1 hcrtbY^ �mle H DER I Creor':Licenx Lvw fm the OVER ISM AMPS ❑BATH REMODEUREPAIR 0 DEMOhII'104
Q
K O a U fo,,,,mg Icuan.(Saclioo W315,Baca a sad Pmfe+tiom Cuda:Arty city m rnuluy SIGNS ELECTRICAL
OTHER
LL]3 y. which tnryireN a r'ennh m emzWc'I,do,impm.e,denwlish.or-repair onY Ws..
FLL0< or to ila iuovcc.aim rcquires thc:rppicnnl fmsuch pc,oiuo fila asignad.wmttrcnl SPECIAL CIRCIIITIMISC.
that her,llf.Npmsuunl to the pnwisicna.r laa Cuntmctoi.Licenw Low'(Chaps,,9
(cumncraing w'idt Section 7")4 Division Sof flat Boom,snd Profc,,.Ctdc)or RIMM'I'LNG
ER OR PCIL INSf.
a a dw nd is cxrnµn thelefmm and Nc buffs foo do alleged excmpien.Any violaion of ❑NEW RIDGIADDITION ❑DEMOLITION
XII Smlinn]0?I5 by any nP,ian,for.permit wbjal,tic-1liant to s civil Parody 4 VICE QgRJANT ❑FOOD SERVICE
nuunrc0on f,e hondmd dollum(5500). IMPROVEMI p /N
f=0 Lmowrcr rA thcpmpmyamy cmpH9ax wlN xagnuRtcir.wk compensation. .li IC n n P1 C
will do th<warL end Incwncwre is nal amended m o1Tma1 for sok(Sc,."IDU.Busim,, ❑OTHER
p F V
a 3 snd Profnaiorx Code:The Codmctots Liamc Lew docs ng.ppy to an nxrnar M I 51VRCIIFS- s
pgxny win hild,m improve,tharm8 and wan owes aueh wak himaclf m through
his own employees,provided that such Impmvanctns we teX imended m oR.n'J for EN'1lAl.I!LCCI'It SQ FT
uk.IL best, ,ha huiWingnr impnnxtmm is sold within ore ycarof contpleliun.the SQ 17.ELWRARI!A LSQ.FT
m 1fiolder will lave the buNcn of posing that he dW not build a hopouvc for Por-
0,rywx of uk.).
1,ase.of the Progeny, no exclusively mntrnebng wits licensed arnraeto,m �C D
rnaun the pnrj al fin, .POW,lhlsioes,and I'rnfee.....Coe,)The Cuntiu:mr',Li-
`cmc Law tlocsnnt.,dY to ar—notaofpopcnywlto buihlsor impavcsthrcon.and QTY
PI,UMHING PERMIT FEE
w ca000c taw,fa such pojettL caauseto")h"coscd punuont to the Contrttctoi,
liceme Law. PERMIT ISSUANCE MAY 1
❑ lam exemp rS<T. .B&PCfm lhivaw I
n ALTER-DRAIN&VIiNT-WA117R CA) VAhURI'ION
O•nc Dal f 11y
COM SATION DECLARATION BACK MAW PROTECF.DEVICE! JJ r
I hachY.IRrtnundn tYet perjury omen odic fAlon'ing dc,latatioru:
I hoc and will maintain aCcniliateofCon.wnuosclf-Imran fm Wmker's Comprn DRAINS-FLOOR.ROOF AREA,COND, STORIEti TYPP,CIINSTR ON
mlion,as pmvW i for ay Sm lion 3901 of the I.Nr Coale,For the Iffomnume or tnd
work for waich this permit N o,aal. FIXTURES-PER TRAP �•
❑I Fav[said x'it ossa cin Wo d,,es Contpcmmnn Invuwrce,xt naquucd by Section
3700 efdle Labor Cac.for the perfamuttt 0the words fm which this Parini,is iswal. GAS-Flt.SYSTEM-I I NC.J OUT'LET'S OCC.GROUP APN
My Wmker's Compcnsuim Invuarec canner eaT Policy numR am:
Conic, Policy No GAS-13A.SYSTEM-OVER i ORA)
CERTIFICATE.OF EXEMPTION FROM WORKERS' GREASEJINDU.SfRL WASTE INTERCEPTOR
COMPENSATION INSURANCE. IIUILDWG UIVISIOH FEES
Mi,N,,,earo,d nr ac armpinasjUra,rynmif i,fa one handrail"I—(SiM) GREASETRAP
m las.l PIANCHECK FIJ!
Ieenify that In the perfumtona oflhc wank for which this permil is issued,],hall SEWER-SANITARY-STORM VA.200 FT.
not employrot any parsoy nwnscrsaru to aue ccrsubjnl to the Wakcts ConaPari ENERGY FEE
Z avian lax',MCslifamia.Due WATER HEATER WNENToTILEC IR
ZApplican I GRADING ITE
NOTICE TO APPLICANT:If,alter nuking this Cenif mol E.em,ocon.you should WATER SYSTF,M1TRHATING
? Maontc mbjal m the Wake(a Canpenalinn pmviainn,of the labor Crda,Ynu mov SOILS FF,E
� " fmNwiJl comply with such psovisinnaatiis prmtit dull be darted mokeLL WATER SERVICE
PAID
CONSTRUCTION LIiNDWG AGENCY NEW NtLS1UENTIAL PLMB, SQ.FT D.a ReccipI
hereby nlRmt Ilan lhcm is a c rlstiumion lending rectify for Lha perfntmvrcn of
L6 - the wsxk fox which this permh is iasoad(Sec.dIM.Civ.C) TOTAL:
C) U Lerskts N.
Lt7 IrrWrt Aofdreen TOTAL_
1 ecoify then 1 have nasal this application and stet`that do idovc infe.c.is BUILDIN
C LAiI ccn 11 l agra to comply with all city and cvnmy tmlinanceii and rate laws misting to QTYMMIA MECHANICAL PERMIT FEE SEISMIC FE
L) Z hoildingc...lion,"torch,ouJeri,c mpna.amaher,eflo,my m calcrupon lac .e�slnvc-mrnuacd poprny fa impmtimt psnlroxs. ANCE! C/ ELEC Ild(W it rsinx w use,indemnify snd kxp h.mdess do City of Cupcnino.eimjoHlitic,,judga,ra,rnsn arW cspcnsa which may in soy waYacen+e agvna said CityDD TO MECH. PLUMBING FEin n"e'rece of tInaC ilMYLICA UNil STNUS AND PLY WITH ALL NON-POINTNG UsliraB 10,M)CFM) MECHANICALFFE7b,
ILATIONS. ING UNIT(OVER IO.BBBCPM) CONSTRUCTION TAXcenUConDot OODIWIDUCp HfIUSING MITIGATION FEL!fATERIAlSDISCLOSURE
thiamlicent or Boom building aNpann vac a aondle hoccarinus matterialIT(TO 111(1,801 BTU)
y the C.pcnirnMunicipal Cook.Chaacr 9.12,and tM llcdth end Safely
n 2t5?2(e)P ` HpATNG UNIT(OVBR IW.II(x)BTU)
, 11'E'i,` VBNnLTION PAN(SINGLE RISID) I'AIUDateip X
the applicant or fumna Wilding occv .nn nae equipram oo d ices which BOILER-COMP()IIP OR 180.gyJ BTU)air NWV W roan as ekfrcd by the Bay Arta Air Qality M.v,. TOTAL
BOILER-COMP(OVER IM( M)BTU)
❑Ye
I ha.e read do has srtNuirtm[nb center Chapter 6.954 the Csh- AIR CONDITIONER /1 ISSUANCEDA�TE'1
funis Health&Safety C '5505 ' ?and 2553x.1 urderstaoJ tau if do NEW REMDENr1AL MECH. SQ.FT. r /�
huilJingd mtcurmulvh toytc,rymvibilitytoreifytheacoo t J
ofthc� nwhichm tel Odor to , aux MuCrnlf-et of ry. �)
mace T( 'AL ISSUED BY:
OFFICE