S0406 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL Piy rI'NO. 0406
BUILDING DIVISION APPLICATION/IaERNIIT PLUMBING-MECIIANICAh Cv
BUILDING PROJECT D)hNTDICA'MON
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
S. T/��TshG
O RS AME, PHONE y J CONTRACTORS NAME: UC NO
NIC CONTROhN
-�OtCHITECT/PNGINEE L O: DRESS. s1,1- ❑
CONTACT: PHONE BUILDING PERMIT INFO
❑ Cchosulti nt Feet Paid by Applicant(Initial) BLOC; M.I= PLUMB MFCH
❑ X ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT' FEF.
1 E,rtby athrm tlwl 1 am E<enmd nmer proviamtns nlchapnr 9 amm
mncing JOB DESCRIPTION'
O�Z with Sm6cr17 0)cN Division 3 Mlle 9usircosssi PrMeuiom Cdk.und my Neem,i. R SIT NTIAL
I" in PERMIT ISSUANCE
Cwp full fora erd cRm. /N ❑SFl)WL ❑KITCHEN RF:S10Ulil.
FLic.It
a-ZW UI�n¢Clcs l' Cmlumlar APPLIANCES-RESIOEN1lAL ❑ADDITION ❑PLUMBING RE-PIPE
Naw fITECPS DECLA ❑MULTI-UNIT ❑STRUCTURAL
PANELS MODIFICATION
dnK tun mrdm
plaahallheu.duspuhlkmmNi
OZ-0 UPTOnUAMPS ❑INTERION ❑CHIMNEY REPAIR
Licmcd Pufc,iotul 2111-IUMAMPS IMPROVEMENT C]SWIMMING POOS
ad Y z OWNER-BUILDER DECIARATION OVER I WBAMPS ❑BATH REAIODELIREPAIR [-]DEMOLITION
N ❑OTHOG w a 1 Ferthy caftan Nas I em encmpl from the Camrx« aise
ls Lilaw for the 0 y U W owing metro,1Smlion 7031 s,Business and 14ofecdm.s CMm
e:Any city or unry SIGNS ELEC FtICAL
ER
'W� which rtquimf a Peron to Nllstn,4 allcq tmpmvc,denwliab,w mpm'r any mmcturo
F.E00 purl,its iaseans ,dso rmuim Bit ap,1R sus for such pmunitm fk a stlpcd smtcmcm SPECIAL CIRCO RIM ISC.
fyy thin he is licensor purwenlmlhcto—Brom of the Corot'I Liecnse Las,(Cnaplcr9
--�� (mmmencing with Smlian 7004 f Division 3 of Bob Busires oral l'ndmsiom Cole)or TEMP.METER OR POLE INST COMMERCIAL
CH thu m is eaampt tm,noth w1 ths,hasis for the IIIcgm]uaopnm.Any violation a ❑NEW BLDC✓ADDITION ❑DEMOLITION
,-, Section 70311 ny any applictnl Lr apconit nob_ims d,applicmno a civil Penelry of POWER DEVICES ❑TENANT ❑FOODSERVICE
,Z>. nor rot rare Bun five hurdml"I.(5500). IMPROVFMFNT
�=OQ1.aswmdthc pmpmy,amycmpbyccswinhwal;csrts lmirsdc cvmPmaliun, SWIMMTNGPOOL.ELECTRLC ❑OTHER
F- willdotmwtN.wdtm.arnsnuru asst nmmkdtanffmilBrsalc(.F<.]fW,BusinR's
std Professions Coda,The Cmlmclorr License low tk,s nor apply to w u+rcr of OUTLETS-SWI'ICUES-ITS rES
a 3- R9eny w1u Mulds or improve,diamon,and who does such work h;msclf or Ihmugn
his own emploees,
yro,idod ohm such ininvcmroane
cs nor intcnAM or oars fur NEW RESIDEPT IAL BLECIR O IT.
sak.IL however,Ne building oritropmvemem is nd with ,in mYear of ednpinion,Im SO.PI'.FLOW ARIA 5/SU.Fr.
bwlder will base therd
hucn of Proving Than he d'd cal mid or innpmve for por-
�ncrofedeJ p
Fl I,m owner of ne pgctly,em eadunin:
valy ummline with Iicemed nnnrumiss m TIII'AL'. ar
mmtmn ase poAat(Sm.]OW.Hmir,sa and P ofessima Cost The Cmunctats U- ,t q O
casclnwdu,s
not apply wan uwnsrof M,,crywlwhuiltNorimpnno thcrmn and QTY. PLUMBING PERMIT
whoc Laoxv. PsYor such pmysts withacMM1MId(s)lianwslpmuantwd,Cuntnxtun's O�
aas,lawI!RMRISSUANCE.
C
Uc �i
1 eon caampt ural,, ,i, .B IS P C for this mo,um
M�OW
IN&VENT-WATER(EAI UH, AI'ION
Owrcr Date thr/�h
WORKER'S COMPENSATION DECLARATION I'NcIIICCf.DHVICI! VV
I mrthy atTrm uMm Penally of p<'rlsny one of the folbwin,imlarviun,❑Lhasa std will mainuin vCrnifirdenfCmummselhinuae fur Wohtra Comprn- OOR,ROOF.ARIBA.COND. STORIES TYPE CONSTRUCTION
wtioo,us oted for bySetLn 3TCcf tic Ialax Crvk,for lm perfomunec of IlewM fa which this pemut u issued. PIJt'rRAP1 have aryl will meimun Wurccl Compmion Imurence,s<m4uim!by Sm'ion3]011uf the LuMrCock,forlbc perfomnrzeoftm wark4rwhch thisrcmn,asuM. STIN-I INC.4 OUTLRIS OCC,GROUP APN
My Woctm s Cmlpensitium Insunnlre currier aM Policy number am:
Cartim Policy No.: STEM-OVER i(EA)
CERIIIICAIi!OFOFHMMONFROMW'ORKI!RS' GRIiASF%INDUSTNL WASTE INfCHCEPIY)R
COMPENSATION INSURANCE BUILDING DIVISION PETS
(This sa+vt cath not he eumpkled ifdo, mlut is roar hurdml&Bur,(SIW) GRIASF,TRAP
nr 1—jPLANCI IECK FHE
I cmify shat inthe perfornwle<oflha work f«which9, irisl.vorm! Ishdl SEWER-SANITARY-STORM IA.2W IT.
bur Ploy any Pn Y so es n .0 �'.suh tt e, I kp Cdnnpcn- ENERGY FEEmn
z "o"Iz d WATER I[KAI'CK WNENI'll!I.HCPN
O Applin /// GRADING FTE
z i NOTE IC g 1- PI ) ,aud WATIB SYSTEAVLRFATING
SOILS
a ' m<,aaae:mnjmn to Inc wtrkttr cnmPcnmtim pnt�i.idla nom labor cork,rd,q
fmthwiNcumply rith,tich Provisions or this pemut shell be deemed mvukcd. WATER SERVICE
Q
CONSTRUCGUN LENDING AGENCY NEW IESIDENOAL MAIL S0.17. PAID
I mmby dl'um thatnsw
them is a cacdon lc Wing uIencY for Bic Knormuca of Daw R
U O
its,work fa which anis permit is issuai(Scc.3W7,Civ:C.) TOTAL:
Q U I,rali Nmrc
lender's Maes TOTAL
} Iy I unify jr,L boss,Head Bic ,,1 icaninn and Here than c above infurmenim is HULLDING Ill
c,m<'I.l agm to mmaply with all city atd<wnry ntdincoccs andsutu Inas mlalingm QTY. MECHANICAL PERM IT FEE
U7, building conrrucnion.and hneny wthariae rel,l hstlsca or lou city to,ntm upon lm SEISMIC FE
'-' abovc.mentict pmpaty for mycelian o,poscs. FERMITLSSUANCE
IWe)ugnr,..rove,inlcrnif,roil kap heor1r,Im City of CuPmino against IA.I!CfRIC Plea!
liabil'niex.ludgnenu.cavocoal ups,-o which ma yin any woy amma.ti pad City ALTER OR AODTO MECIL NMECHANICAL
G F!E
conscqurnaofil, ranting of this'mon
APPLICANT U S ANDS AND WILL COMPLY WITI ALL NON-PO T AIR HANDLING UNI'I'('TO 10,00OCPM1 EE
SG A
AIR HANDLING UNITIOVER 10,00(HTM) C[IN TAFican muacun )ane EXHAUSTHOOD(WDUCT) KIMGATION Z
HAZARDOUS MATERIALS DISCLOSURE:
Wdltmupplkmnm frommalting omuPwn scare or hodll Istat. conal IUiAI'INGUNITI'I'O1B),IXMIH'1'U)
M deft,,by tic Cupatim Munnicipal Cuda.Chapter 9.12 and a Hcidtb Saftty
Code,Swim 25532(09 HEATING UNIT(OVER 100,00)BTU1
❑Yea ❑No VENTILATION FAN(SINGLE RESIDE PAID Dam RcaipJr
Will the upplicam na foto.&citing malum ure equipn,nt or devices which� NOILGR-C(IMI'p1IP OR IIMI,fX1(111TU)�.!mn hmeNous air conmmiwnnr us,Jelin d by the Buy Amu Air Quality Murou"n cnn TOTAL:
DutrncYf BOILER-COMPIOVER I00.000BTU)
G Yes ON.
I luso n®d the haaudo,s m•m,,cm..,uMa ChW,695 of the Cali- AIR CONDITIONER ISSUANCE DATE
fanw II®lth&Sefay Gds,.Sm+inm USU5.255J3 en12t51d.I uMesnaN that if O, NEW RESIDENTIAL MECIL Sp.Fr
buidingdocs tan anenlly have.bran,thin it iz ruy mPamsibllity Iundi(y a,a<ul ri
d Be n.quimnmms xhich ntusa m mel pia to iasvaae a(e Cvtifeme M(k<,sfan<y.
Ownu ar euNuriism agcm Don, '10TAI,: ISSUED BY:
OFFICE