S2706 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OE CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILUING DR'ISION APPLICATION/PERNIPP PLUMBING-MECHANICAL C' 2706�OC
BUIS BUILDING PROTECT IDENTIFICATION U
BUILUING AUDkFSS: A16SANITARY NO. APPS.ICAI'ION SUBMI'I'INI.DATE
OwiNEHS NAA1E PEE NH4 CONTRACTOk'S NAME' LIC NO: `�
NIC COKIItOL p/1
/�L ARCHITI!CIINPIR: LICNU'. ADDII ID
A CONTACT: PHONE BUILUING PGRMIT INFO
❑ Consahanl Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH
LfT� ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECI'HIC PERMIT FEE
I hereby•Inner Inv 1 nen Iissnsed unifier provisiotls of Chapter 9(conertercins JOB DESCRIPTION
0�7_ sine Srclirm]Ilfl(1)9f Disisi.Jof theBu,imv ad Pmfeui.s Cr.k.erd my lkensei• RESIDENTIAL:
W O O PERMIT ISSUANCE.
Fw- in full fmc9 emi eB ❑SFl)W'L ❑KITCHFI.REMODIiL
aV(j Gcuuc Clash Lic.M 3� APPLIANCES-RESIDEN-DAL ❑r\DUITION El PLUMBING kIiI'IPii
w Unlc Cnnlrvc r
a ❑MULTIUNIT ❑MODIFICA IO
7r. anu holTECPS I. uhhe ANION PANUS
Z FO Z I umknnerW my plan.Dull h used m publk rttvrffi C MODIFICATION
O Z��-'� GP'EQ?gIAMP OINTERIGR ❑CEIIhINEY REPAIR
QF:tw lJarL4Yl Prefes•ii,a] r)1-1gX)AMPS IMPROVEI.II:M' SWIMMING POOPS
y' .J UVI'R IIXX)AMPS ❑HATH REMODEJREPAIR EI DEMOLITION
OWNER BUILDER UIiCLAkATION
y W Q I hcrohy affirm Inv I:an exempt hunt rhe Conttuclory Lure,Low t«me
�(�d V foRuxing.awn.(Section 91131 5,Bouimxs rend 14oft,sion,Craw:Any city carcoamy SIGNS ELECTRICAL ❑(7fIlER
W 3 w which requvo o permit to corNmcl,elle[inyrnve,demolish.«rePmr any Vrcchie
prwrm its iu.,aisa"ore,me•ppin.f«such permit to fleesigrNsmmtrcm SPECIAL CIRCUITIMISC.
�y
thin beislicrnseJn�.,.•Itotheprotisionsv
nflh,ConcieriLiansclaw(CleEer9
a
' po (�nremingwilh Scc11. .
71XXg11fIHrIJ3rDhe litumsx and Prolusiens CaP.fc)ur TEMM ER OR POLE IN
. -1COMMERCIAL:
o a The,he is cxmnpl Ihcict ....... the Ne,ix Lx [jthe nllcgcil cacnnl'nina Any vinlvlion el NEW BLUCJADDITION XUEMOLITION
o, Sau..7031 5 by any applicum f« w
a Permit hjmw the applicmn m a civil 1-111 at IYIW I!R DEVICLS �9FNANT LII�OOD SERVICE
F,y} one tnOrc Ihw fisc hufdmi Jullan(55()1), IMPROVEMENT
OQl,nowner fifth pgertY•«myemrlmae wine x�gcnmdtcirvAerorttpensaim, SWIMIJINGPOOI.I:Il:
� � wJl do rite.ark.vul Wcsaunwc is mlinlcrWcd«r�IrcrM f«file(Sa.7(11J,Bu.irxsa DOTTER
w m W Pr f s C sde:Th C tmmals L Lidoes x 111,1 an owner t l OUfI hIS-SWRLTILl FlI'NNi:
Evu,f 'h htudd. sr entries,thr,user,entl h tse,...h vih Ifor In gh
his Ilyce,pr ic1dlhtmch inn,ro,oncrot,are.o Jtd offrnll« NI:W RLSIDEN'I'IAI,ELICIH SUET SQ IT.FLOOR AREA LSV.FI'.
auk.If,htweveq rhe W nNin6 rr imprm'arcm Ix W J wimin one ycu M mmplaiun,tM
xr-builrkr wiB base tk M19Nrn of pmsin�Thu he diJ nen buil]tr imtaovc fm pur-
pure of ssieT.
❑I,of uxntt of the pnXeny,nn e.clusivcly ttmtrocung wish IkrnmJ c.racmrx m TOTAL: ��JJ
mrmfmct Ile M...I Sar.7()44.11numic,and p se,d.s Cush:)The Coal..let,I., 17J 3�I 3
chaw dnos...ep,ey to anowrerof lropcdy who nuilJs«i mPnvns thcrc«t.and QTY, PLUMBING PF,RMI'IFEE
who emessi t•fur ouch for,ects with a cinnoutua s)nicer.,l pursuant In the Cummins's
License La, PERXU T ISSUANCE
1 em escort.undm See .11 K PC f«min re.
ALTER-DRAIN A VE11T-WATER(HA) VALUATION
Go'...
Ilam _
WOR K INS COMPENSATION DECLA RAI ION HACK FLOW PRUH!Ch DEVICE i {l"7 J.hL�
IhcteHy aRrmnndcr pctalryufperjoryorc ufthe folfwing Ja .
hmJs: 1 '�
E] I lasewJ will rrninmin•Curnicateof Coruna.self-inure torW«kcrs Canter. DRAINS-FLOOR.RODRAREii.COND. STOkIES 'TYPE CONSTRUCTION
seri.,in, kd pre,irf«by Seri.3700 of me Lahr Cale,f«the perferf If the r / )
sx h hthi.s pant ': J. IINTURIS PER TRAP (�N
I M1a' ons]will reactroin K N :Com,ce-lion hesumoce,an" red by Section
37fX) nth I bo,Cr.h l Iine,f FII .kf rwh I Io,f,,nnitir'.' d. GAS-len.SYSTEM I INC. OUII.Ii Iti OCC. �RIIUP APN
Carrier:My k �.tAmL sCuurceevrt Polies,No nG19dA�✓8 +� GAS-CA SYSI'LM.OVIsI A
CERTIFICATE OF EXEMPTION FROM WORKERS' GREISViRcDU.STRLWA. I.TE:RCEPIOR
COM1HTNSATION INSURANCE BUILDING DIVISION IIFS
(This waiter nalmr he conrplecJ Tihcprnnit is for note hundred i3elvn lS lqO GWASI!TRA' Q 'J
«leas.) �� D -_.Q I'I NCI{F,CK Fl]i f
I ccrldy mm in the lerfunra«cufthe wad fur which this l tout is i.cwcJ.I slip SEWER-SANITARY-SI IIIA.31X)FC f�
1YS
not employ anyp.,I.ny maims,so es n been.sables,the Workas'Conn,n- E IRGY FEE o
O Z unimr I,w,.f C.Ihf«ni..Dai, WATER UEATEli WNEN'f ELECTR ZPAID
z' O NOTICE 11)APPEL CAN..If,after making thin CeniGeale of Eampti.,Pm shuuld WATER SYSTL1,10TR ATH G
N I.tnmc xuhy:n to Inc Wnrkok C.no,,wtira pei,ki.s of IN,[IN"Calc.lite
�..I fouth cme A,with_wchpmvixi.n«mixlenn1I ithe danml rcsoked. WA'U!R SERVICE.
= Z CONSTRUCTION I.1!NDleMer, iNC1' NEW RESIDENI'IAI.PLh1B. SO�F'L Rrceip0
I lercby affirm niton mnc u e caetmcniw knding agemy f«me rfmrarce ofU. O Wew«k Lr which this erson is x•ueJ(-Sce.HN7.Civ.C.)OULendersNue TlTALI,tabs AID,- 'I QIAI,0. Z0. 1 artily ma 1 have rand This application ond state mat theul.rve inf«mmiom isI uteroromply wineall city aril cowry adivrcc endsmrc hos mhtingm QTY. MECHANICAL PERMIT' FEEU ,Z buiYlir6eomauci..arnl hmelyinthorien reprnenwirexof Nis city te,emaup.mems ny for inspection Pn ensu. PERMIT ISSUANCE!
(We)ugme to rasa,wenmify mrd keep hanlev the City ofCupeni.i"inH
IlvM1ilillrn.juJFn�rn�.e«ntan«I cxpca¢•whlehtnay 1.any way imcrucagWnu ed Co, AILTHRORADII'I O ME CI I.
I'I-DM111 G R!li
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Alk HANDLING UNE(TO IB.gX)CIM) MECHANI A.WE
SOURCE UT 'ION v AIN HANDLING ONE(OVER I0,(X1f)CIM) CONSTRUCTION TAI
otyear ru mm� AC�pp'uanliunl JCnm at Uulc EXIAUSTHOOID(W/DUC) HOUSING Nil HGADON INH
HA%ANIDOUS MAILRIAIS DISCLOSURE!
Will the applitanl«fwwe W ilJing nccupam firm rc twJk hvvJ.ws mmerial IIEAONG UNIT CTO iw.(KK)BUD)
u cicfml by the Cupcnner Nlunkipil Cock.Chapter 9.13.trod IM Hmlth firs)Sakly
Clic.Scat.M532(e)] HIAONG UNIT(OVER 100,00f)BTU)
Yes Nn PAID
VI!NI'11ATIONPAN(SINGI,ERLSIU) Dam Raelpt0
Will dx:uptlicum ear fumm huildine acu,m us cpuiPnem«Jcvkus which
emit
Will
Teuhoon, Inure
Jefnnlse lh<Bas,Arefi Air(TulitYhfuagrhich IIUILEH-COMP13111'Ok lgl,gX1 N'i'U)
T(1T L
Diwkrt BOILIP-COMP(OVER 100.000 BTU)
❑\'n
NN.
I hfivo rwllM1C Mr.Wrws irelmulnn aunukr c;lw 5.95 ref lite Cult AIN CONDITIONER ISSUANCE DATE
yai um]
forma Ilrahh A Barely i,h e.n.L ital 125599and29.S.1J. III-dfwd mut il'Ihw NEW RESIDENT IAL MECH. SQ.19'.
building okrs my arrtnJy laveut.ana Jut it i•my mp.sibilitynrodfOccu acvpml S / f .P
d'Ce rtgaircmrnt yyT to .of aCmif.acd Ons
Ow r mond agcm R� � TOTAL: ISSUED BY:
OFFICE