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31188J APPLICANTTO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY CITY OF CUPERTINO - BUILUIN' - ]CAL PERMITNO BUILDING DIVISION APPLICATION/PF,RMIT I ANICAL eq B D FNTIFlGTION 31188 HUILUINO ADURES l9 �\ w , r/'yV•_sst SANITARY NO. APRLCATIIOONNN IUBWIT77AL DA J OWNERS NAME: -PHONE: 11H80L.AT1 - CONTRACTORS NAME: LIC NO: -4 51 C`fir NIC ❑ CONTROL X ©t11^ 7,RCHITECT/ENGINEHR:" LIC NO: ADDRESS: CONTACT: PHONE BUILDIN,O P_ER`MIT71(NFFOO OGfJ SI LVAD Sjr M 94oJ 130 ❑ COnaellanl I m Paid by Applhe t (Initial) y EC P ME x LICENSED CONTRACTOR'S DECLARATION I hereby affirm Iwl I am hcemwd ander Piovisims of Chapter 9 (comn.mdng QTY ELECTRIC PERMIT FEE JOB DESCRIPTION . . with Satiov ]000)of Diviai tofCM Budrcss amT Pmfeuims Cale, and mylkemeis in full fma and eRrc L Li«mc Clea Lie.♦ 9806 Dem Co ha,' RESIDENTIAL ❑SFDWL ❑KITCHEN REMODEL ❑ADDITION [3 PLUMBING RE -PIPE PERMIT ISSUANCE APPLIANCES-RESIDENHIAL ARCHITECT'S DECLARATION 1 urdeniam my P1nm shrill W used a public rscnrds ❑MULT1.UNrf 0SIRUCTUli MODIFICATION PANFlS UPTO2 AMPS [I INTERIOR ❑CHIMNEY REPAIR IMPROVEMENT Liccmcd Professional .201-IIIIXIAMPS OWNER -BUILDER m the Com ION 1 herthy affirm IMI I am attempt from the Cmlreclora License raw for the following roma. (Section ]OID3. Cute: A dry ar caunly far,z sad ❑ BATH REMODEURF,PAIR DEMOLITION El OTHER OVER 1001AMPS SIGNS ELECTRICAL afiich t i dierlons «repeig any stracusernart mor • pmrdt t, a the char, improve, demdit SPECIAL CIRCUIT/MISC. luiuuun!Tursu nequira e, Law swpter9nalt its re remit t for auchpermi's ,barWor Lice to Che povisiom of tk Cmaactar•x Uceme Iia (Chapter 9 BW he is Hanwd pS msisi rtso TEMP. MLTER OR POLI: EST. (cat Nano or xempt Scnlm]Oln)of oftheegdnesavWcen. Chef W is caembC Chcrtfmm am, bostimt f« Ne Any the excmar m. Any violarim of he is Mode)tion EW BI,DGIADDITION [I DEMOLITION ,basis L, Saliun]0313 by uny eppliconl l'«.pcnnit xubjalr the epplicwnuecivil penalty rel nal more Chen five handred"1.($500). �1, es uwnern(Ihe Trop'nX ormy empleyan with wuga.alMirxal<Compemvatim. will do Ch,'oiard datimasurt isn«i«ndal«oxarN for We 7044, Business EWER DEVICES ❑IMPR V ❑FOODSERVICE IMPROVBA11iNf�g 11 OTHER —�i�� SWIMMING POOL ELECTRIC red PndeaJrms Rde'. Tbc Coma....'. Liccmc Law dna m. apply m on uwrer of OUTLITS-SWITCHES-FIXTURES properly Oho Wild. or inµnn. Jrrten, and wW docs suds wart hirci or Chmugh his Own employes, movidsd that such in rovemmm sm not intmakd or officmd for NEW RESIDENTIAL ELECTR SQ 19'. SQ, FT. FLOOR AREA SISQ. FT. sale If. bot Chc Wilding orimpormrnC is sod within os ycu ofcurrEation. the ter -W ildm will nave Iha W Nen nr proving Chas he did not build or imprma for,or- JI 301 15a 9,0$ ❑ 1, ati twat P of ct aO. 7 . rim square! cmassi ng with licmacd nnwcnxx m comuuct Ne pmjm (Ss. ]Ou, Nusi�s eml Pofessiwu Codc) The Cmaan«'s Li- crnwlaw dss ax apply men rrwrar of prnpmCy whn milds fix improves thernm, anJ / T Y O/� QTY. PLUMB>G75ERMIT FEE wascmweCs f«xuch pmjxu wimecantrenmfx)rremed parsunat mllr emrvectar. (IIT I'L'RMIT ISSUANC UO. turn esto ❑.1 em exempt unJer Sec. . B & P C fu Ilea ream o a //ss �/)a./�� ALTEN-DRAIN&VENT- (EA) Owocr Dam '� IraNy aflimuxEIZS COMPENSATION iderpevlryofperjury aneof Ne nWwne decWuti«a: TION III- UATTIIO.,N r�((�I at `y-yORI, v(�i PACK h10W PROTE ICE DRAINS-P,OQ R(I(IF N D. IWvicendwl0mainminsCcnif CeofCmwnttowlf-immcfm Wmkces ComT - .Pion .s pmvlded For by Satlon 37W of the Lebvx Col, or the, pa famwnee of dr PE CONSTRUCPON far wltich OL, per oil is issued. FIXTURES-PERTR P have wJ wJl ntainmin Workers Compemminn T osomme , as rryuinal by Sesvm .]flairthqef LabICC or Code. the, pelfm�rkumsyrance work for which this permit is iswcd, GAS -FA. SYSIFJA C.iyWor, OCC.GNOUP- APN 7for 1,tam,r. /a OlJ.ir/Ash /Ib- and Policy' PaicY No.: GAS -EASY$ 1OVHRJ(FA) CERTIFICATE Op EXEMPTIONIROM RI -e.S' COMPENSATION INSURANCE phisxmim reed rex tic aornpinWifits, Pemnil in f«smchunJrW Jnllms(Sllxp or least VISION FT -ES PANCHECK FEE 2 OR SRI, CEPTOR OR SHTRAP S - NO RY- R .20014. I renify that in Nc perfnnnawcnfthe writ fur which Nix pertnil in ixxtrs4lshall not employ any parson in any ante., to m bets. w to bbjcn to the WokmCompere- ' Com cation L.wa of Cafifsmia. Dam Applicant ENERGY m GRAVING WATER rex ENTAFLECTR NOTTCETO APPLICANT. If, aflu muting Nix Certificate of f cunNion, you dmuld km become, subject to the Woers Cµcosmion Posisi. or theds laCWa yw muv WATER SYS 'T FA'PIN SOIL WAMRSERVICE fmhwiN comply with such pmv'nimnam this Permit shell W Weaned rtvokcd. CONSTRUCTION LENDING AGENCY I hacby.Oirm than there is. camw tiro imsingagency r«Ne perfanwrea NEW RISIDENTTN. PLMB. SQ. FE PAID Da Receipt# . the wok for which this pmit, is issued Scic 3097, Co, C.) _ La hers Noma TOTAL I<herx AdNas TOTAL: BUILDING E I ccnify Nat I have real Nis nKluraliod and sale that Ik above information is corral.lomg tommplywt .11 ityandmm�tymdimn¢x"micl.w'emleGngm building mn. tructiaand hereby uutdrize alaewnwives a Nis city to enter apoo the QTY. MECHANICAL PERMIT FEE S EISMIC E nO PERMIT ISSUANCE - ELECTRI FEE911. above mando«A pro,smi for im maim purlwsee. (We) 4. to cava inclsonoy ruth keep harmless Ne City of Cia'dino it'ma AI.TERORADDTOMECIL 1'LUMHI G FEE Iubilidnjudgnrnn, cosCsand slrmseswh'Rh navy in any way accrue tandem, said! City in rcmce4att enof the Bourn n, of Ni. pemiil." AIR HANDLING UNIT ri 10.(1(10 CFM) (T MECIIA ICAL ITE APP T UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SO CE GULATTONS AIR HANDLING UNIT (OVER I0.000CFM) CONS ,TION TAX Si aAppitearliEorionamor Dint HAZARDOUS MATERIALS DISCLOSURE EXHAUST HOOD(WIDUCT) HOUSIN MrIlGAT10N FEE HEATING UNIT (TO 100,000 BTU) Will deyrplicara orfuCurt WidioB a[CVpNCarort«heMlc Fazmdvus moored as Jefinmd by Ire Car emum Municipal Code, Chapter 9.12, and tW Health and Safety s Cork, Scctim =2(a)? HEATING UNIT (OVER 100,000 BTU) C:lYn [I No CJ�..•� PAI D Dane Re P # VENTILATION FAS INGIE RFSID) N Will ui applicam mfum i Wilding ut,by the vAapuipmcmit Mara which emir huaNwa en nswndvnta .s herCM by Ih<Bay Ara Air C)uality Mwgemrot District? ❑Yea C] No - BOILER- COMP LHP OR 100,000 BTU) TAU: BOILER - COMP (OVER IW0110 . BTU) AIR CONDITIONER I have Cmd ilia, hvmiWn musarids mydmmeoas uM« Cli 6,95 a Che Cali- ISSUANCE DATE NEW RESIDENTIAL MWIL SQ. E'. fmdn Halt( R SaaY Code. Swims 25505, 25571 and 255th. I unlmound that If Inc Wilding Jots red commonly has# a 1.4 than, it is my rsspp' W ity to reify the «rvpew a 1h re,.. teat he ten Prior to ,.a of. Catifxc of COmpvry. ISSUED BY: TOTAL: Dwn.Yora tbriaN.'ai Due OFFICE