24783 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OFCUPERTINO -' " 9UrMINT( A. PERMG'NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL ^ J/N/1
u,�ai�L.'jj,BUB.DINO PROJECT IDRM'IPIG770Nprj,..,x;yR L / l83
BUILDING ADDRESS: //yam/ �4N
. . L1At4 L� SANITARY NO APPLICATION SUBMfITALDATE
(UNIT k LOT. 11 '
OWNERS NAME1'k ONG: // COn ACTOR'S NAA LICNU: _ L
C�'y7/�) - - •,l cJ''l' R'f .A/ NC currlxal.«
RCIII' .CT/FNGINEER: LIC NO: ADDIIYSS� C 14 f/ ❑
COACT: PHONC: ��' "- BNLDING PERMIT INFO .
QTY::11 .:•"�.-;_ ELECTRIC PER MIT. _ = FEE
1 _ BLDG F1 FCT PLUMB MECH
`(- C,I /G. ��J-7—��C_3 PERMIT ISSUANCE l ❑ ❑ ❑
LI mittI CONTRACTOR'S DECLARATION pPPUANCES-RFSIDEnTAI. OBSCRIPIION�w
.=Z IhercbYaffrLIcENsmli NTRACORSiECI_ARATION commencinFwilh CRIPTI/`S�'j�L
J00 S¢tior TO(OI of Division 3 of mi,Bonino%"PPmfc ons Code.and my limit is in PANELS qvAIIav
-UF (Wlfm¢md cff?-IC--E l;_ J�/�C� UP T02IXIAMPS
,ZUUIy Ilccmc Clan G
jGy Dale Contreaa 201-IOW AMPS
yZ ARCIHITBCT-S DECLARATION OVERW IOAFIPS SQ,IT.FLOOR AREA Q.ET.
1 u crams my plans shall ba oscE as public otcordo
�!s_m SIGNS M rCIlUCAI,
_1 Lian.ad Prof¢,imW
'ci OWNER-BUILDER DECORATION SPECIAL CIRCUITIMISC.
LIEU I hneby aff mai I am s.smgs foam me Cmm¢ar'a Ira...Law fm th
=0v~i following n,irssm.(S Po 70316,Buaimecs and Nofesims Codc:Any city a aunty TEMP.METER OR POLE INST. /
Q which"mry a pnmil to comhuch WI¢,umrrove,demolish,or repair any mmcbrt
?> pior missiswace.alar rt cirt3 the itph ao farwch mnu'm fika upoi,so ocm POWER DEVICES
'<0 dw h u llanwed 1'uDsuant to th pom,b of the Ccwacrer•Licrnu law(Quple
Cz SWIMMING POOL ELECTRIC ANON
eLL 9f memcse xempthamfrom ityl Divisor Sof da,Bu3inm and PmfeWm3Cule)
mdul hi313bynyar,ranm fi61,abnisf r iNc subjos kgWeveithim m.MyviWwimof
_Z< Sectim]03156Y mY applianlfsap¢mit aubj¢u dr app!iantbacivil pctWtY of 011'ILCfS-Swim iFS-Fl%'NRFS
=C mat nnore
than five hwdrtd"lms lS51X)t NEW RFSIDFXIlAL F1F,CIR _SQ.FT. STORIES TYPECONSTROCTION
i_� ❑ I.nowmoof thepvpe+ry.mmyemploymwith wage nseirsolccompcmatim.
J, win doda,w'art.CWc: 3pu Coomilo inlendeaoroffered oar t&PT,.]fWi.cwe of
_5—
and Pvfesicvu Cade:The Cmnaeraf'a Liccmc low tloe not apply co an owner of i
pnopeny who builN a improves thereon,and who don such wort himalf a dvaugh hu
sun mtplwcupmvitlni mu 3uchinryrwmnrnrsart mtimcrddaoffcd la Wc.U. OCC GROUP RES.UNrtS
tyiil ¢,dre Wildingmimlmwcmrnt u andwilhino, .roofin,rovc n,thcowm- �r
Wilda will lure Ih burden of pco.wy Nat h did rol builtl a improve fa purywe of
Ws.). rr'
QTIT. PI:ID.SBING PPRMI7r' .1 L. � . '` D APN
❑ I.an fli oM the Sint. .acneaelwivelycvnmeunS wicooa:rnedcmpanasco wa,•spwc+e.,d+.ca ..r-.
comae the pmjat W]y ok B rofprab whoblass Crim,The Cm,on.an3
Ucmv�law don rotepply manawarof property who builds aimpmro therem.aM PFJtAITf ISSUANCE
wins emvecss for such pop.wiNacoomic.'s)licemN pw3u.m coda,CmoanQa
Us.taw. ALTER.ORAIN&VQ.T-WA'rFR(EA) FEE SUA4A_1_A_R_Y_,ti'L+' :;.
❑ 1 am evmpt rodeo See ,B&P C fm thu nam BACK PLOW PROTECT,DEVICE
SANITARY YN
ra...ARADRAINS-FLOOR.ROOF.AREA,COND. ���«
WORKMAN COMPENSATION DECLTION SCHOOLTAX Y N
;,F ❑ Thereto affmm NatlhrveamtJou afcrosrnt msclf-in3me.¢emtiRweof F RFS-PER TRAP RECEIPT
WOhen'Cmnpmn.utim lnsuanaaacenifed cgry dcrof(SecJS(p,lab CJ which PARK FTE YN
--- van Jl enplmyeisuM¢thu permi�
RN
GAS-EA.SYSTEM D
-I INC 4OUTLEIS DIVISION
Pdiry N BUILDING DIVISIOFEES
Carnpwl—N V`✓r k_� GAS.EA.SYSTEM-OVEII 4 WA) PrANCHECK HE
❑ Cmif"copWyyici Meby famished.
CrnufJ iwith da,6tyinpectimdiri3ion GRFASEM'DUSTRL WASTE IMTRCEPI'OR GRADING FEE
CERTIFlGTEOFEXEMMONFROMWORKERS OREASETRAP SOILS FFE
COMPENSATION R.ISURANCE
(This section mW not h cmnplaed lfdre pemit u fa am htmI dollar IS 100) SEWER SANITARY-STORMEA.2WFT. ENERGY FEE
m 103.)
I cenJydw in de pafaanss¢.e of the wmk fm which this porn is uciani I slug WATER HEATER W/VENTIFYFLTR
his,employ any pamant in any macre so n to bacon subject to the WorkerPAID
Canprnmtion lawn of Cdi(mmla.
IN's WATER SYSTEM/TREATING Disc Reeei,
z Applicun
2 NOTICE TO APPLICANT:If.afc making this Canif"a 9 Excnnpion,Yoo shod NEN'RFSIDFNTIAL PLM&. SQ.FT. TOTAL:
V) becma,wbj¢t to the Worker's Compvv um povisiw of We labor Co 'you must
> forthwith cwnply wi th such pmvi 3iau mthis lcmil shall be decmM rooked. BUILDING FEE
Q CONSTRUCTION LENDING AGENCY SEISMIC FTE
z I Iy, fr.mm sec iso c.1im lcndin,ninyy fm me p¢faorcEIECTR
mc M TOTAL IC FEE LAC Aiiiiiia__
) 0 the wort fm which this prnnil is lssm (Sic.304),Civ.C.)
IsndaY Nems .. PLUMBINGFEE
F lode'.Addnas QTY. MECHANICAL PERMIT FEE
LL7 1 mufY dot 1 have read Chia applicmim ant!state mat die ahnve ihimmoiaTI:
n is MECHANICAL F
c
1 mat.IeFrtcm comply withal)shy and c.1,adinimce endmx,lawineNJngm PERMIT ISSUANCE
buildingc aruoim.a 1F ch'nmhonv<mPresenuuvesof Nisciry men¢r upon rhe CONSTRVCfIONTAX
Z abnvr-mrnuaed pmpcny for insp¢um puepmn. ALTER OR ADD TO MECH.
(\va)agree m save,indemnify and tarp lommka3 mc Cil,of Copcm.against
liabilitie.judgment eaprn.ms which maylmmoy way¢cres.'.mv aid Ciro AIR HANDLING UNIT LTO 10.1Nq CR\ti
to tmi,c rvmmg n[mi.)amu"
G3AIR HANDLING UND(OVER 10.00CFM)
gtgmbm of mmFoneracw Dae EXHAUSTHOODIN'MUCII PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 1000M BTU) Dale R¢ciriy
Will Ire Vplicam m ftmuc building occupant score mh ehvasdou3 meunal
as def red by da,Cupen'ub ._
M r�N CMcCM1epi¢912and the Hcahh and Saf¢y, . , HEATING UNIT(OVER I W.000 BTL)
Catle,Scrim 235321UT al' VENTILATION FAN(SINGLE RESID)
❑Yn '-" ISSUANCE DATE
Willthcapplimua(umebuildingoaupaetuere egwpmev¢derice whicbrnw Pow-COMP LIPP GRIM,"BTU).
aunt comaminmrs u fad M the Bey Am Av Quality Mmugemem BO 'Bc-COMP(OVER 1001000 BTV)
:.. DiamctT 3
.. ❑Ya No ' NEN'RFSIDFNIIAL MEM 5Q.FT. R ,4 1 D
i. .
r I Tuve nod ala hanrdwa nureiala ot,t, w ued¢C1up¢695 of the
' C>,ifani.HW�aW¢YC� a,%2s�5anit4m�u53.. bt,wiyodd�w FEB 21 1993
uth Wiwng dao rot cwDanlr h.,e.e+baman nieicsiso .wduymmdh me .. .
f Nc muss h mn pia b Iv.of•C¢sfiou Of
Doan _ZZrj CTT' V u
rot Dic sTOTAL LSSUFD BY f 1.1
OFFICE