S0767 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
RII I LDING-ELECTRICAL PERMIT NO.
CITY OF CUPERTINO PLUMBING-MKCHANICAL S 0767
BUILDING DIVISION APPLICATIONMERMIT V
BUILDING PROJECT BYEVrrIF'1CATlON
BUILDING ADDRESS
,�pp SANITANY NO. APPLICATION SUBMITTAL DATEDATED7/ SS �2 (_Du/Z T Lott -3 rill
HONE. C)NBACTOR:I NAME: LIC NO'.
OW N NA] CONBOI-♦
r ��� o2Cb�N - - ❑
RCHHF.Cr (NEER: LIC NO: ADDRESS:
C)NTACT PRONE: BUILDING PERMIT INFO
❑ CoasWlanl Ems Paid by Applicant(Inifial) I Ix' F.LECI PLUMB
/-
F .
cu
/I,iN C'e�C S6Gr-s7� 8 '(gam\
LICENSED CO CTOR:S DECLARATION QTY ELECTRIC PERMIT FEE JOB DESCRIPTION
1 hereby affirm dant 1 an licensd under I o,Ssiaru of ClePcr 9lcomromcing
O=Z nh Stttinn 111007 nfLx,i, Sof the Hu,ircx,valPmfeeinmu Q.Le,end mYliccnse ix RESIDENTIAL
WOO wi / PERMIT ISSUANCE � WI ❑KITCHEN RIT/ODHI,
1-ly
in WE fora hot OEM.
�F.UZ�j Licrnm Clx IJc# N'%.IANCIB-HESIUF.NIIAL )I'I'ION [I PLUMBING HGI'll'li
N6� lym Cow.,... MUUrbUNH ❑SI'RUCfURAI,
'1 ARCHITECTS DECLARATION PANELS '' MODIFICATION
I-DOZnZ londn,eal my pl�ts'hdl be uncd a,phblk n,cm� UPTO200ANIN �jTER1OR ❑CHIMNEVREPAIR
pj Licemad Pmfeaimmal 201-100( 5 Ih pVPA11iM' ❑SN'Ip1AlING PO(11S
Y
OWNER-BUILDER DECLARATION OVER HO)AMPS e�BATll RI1.IODEUREPAIR ❑DENIOLTT[ON
Ra a 1 thereby of io not l ip f nn C tma I c Low for the ❑OTHER
CaU fnll a .NeG ]IRIS tl .in Iltf:o s Code.Any city or,Orp S NS EE.CDOCAL -
31L whith try Nonni to Cori r1e,imtno,t,&0or OCIIIy NrvOur{
F u'O pbrt e' x of-acqui.,me opplilionl uch to file o. fined mmcnmcm S CIALCIRCUIT/MISC.
f' 'neer tae- ace scl po.to the pr -summ ttheC for Liot.lisw(Clitlur9 COMMERCIAL:
W�pO Icommrcmng wmthSmnn]000) fDi ivald'hc Bu md14Of Cons Cock)« TEMP METER ON POLE INST.
a L y then be i,cacmpt t,,Cfmm end the basin for'W alleged exemption.Any violation Of ❑NEW BLDG/ADDITION E]DE110Ln10N
X5LL SCmm70313 byvny eppliam fnr a permin suhjuts the applicm m v civil leuehy Of POWER DEVICES ❑TENANT ❑FOOD SERVICER
non mmwrt'hxn five hmdred dm 1.($5010)
IMPROVEMENT
C Q I,mmwrcr of nM1epmprtty,err my en'pinyu:lwl'h wagax u.'hcir Cole mmpea,vnior, SWIMMINGI'OOLELECTRIC
$a ❑OTHI?R
ill doth,worh.:mdmC,macmmi,not nrmCdoroffcrtd rrx wI (Se 11114.Bminos,
W P
I� mf oimv Calc:The Comm"", am m"",LiInw date of apply no an
rwrcr of cl T rrS-SWHatfS-FIXTURES
a 3- pmill wb Wilds or im Woo.ft.,and who docs wch wmmrk himself. nhmuSn NEW RESIDENTIAL ELECTR SQ ET'
hi,.Graf"..pmvdm that,beth impm,errcnu art na in'ctdul a o(fertd Imx SQ.FT.FLOOR AREA YSQ.IT.
.ole.If,woe„cr,mtr bW Idin,or impm,.i,told wid'in nrme,w Mmmpkrimm,dmc
w-Wilticr will hese nhre bunlcn Mm,,in,Par tr did au Wild or imllore for per- P d l h
1
[ ,z {A
❑ I.a„>wrcrof the pee.704 am onnC.Cony cnmmcung wi01 fi Due Ceommcen i.
chnVmcl the p Ox (See.o an t ,wro„hid Itnf4c,i boi Cde:]'liw Cm tha mon''Li. DEC 8 DrillY
cense lswdm ant apMYmwowrcrof pnmpeny who huilmL,orimpnne,Cnoom,uW QTY. PLUMBING PERMIT -EE (� ,p�,{U
w W egth io,.lmx wch pojcns w'inn v emmntMa(O liccved Wr,uant m the ComlVlenn/' �S't1r t 1
Liamec I�w. MIT ISSUANCE
CITY
yr VVr
1 ern c,cmlm'ur,lcr Ser. .B k P C fOr this rt
ALTER-DRAIN K VENT-WALIiN(la) -VACUA
QoinU Ihm
• WORKER'S COM PIN SAO ON DECLARATION n n BACK FLOW PROFECr.DEVICE
110 by torn m pc 1y Of p-U ry of'M frill-11
me dal
IM1 cal 'll nmm n CrfBrn¢ fC tnm calf-i fir Wn C DRAINS FLOOR.ROOF,AREA,CONO. STORIES 'TYPE CONSTRUCT ION
yion pm WN h by J]00 f the Lobar CMe.f the Pcrf of the
wmrkf 'hien N,pe 1 -wed. FlX-HIRES-E'ER TRAP
❑1 ba,,,end in mer min Worker,C r enae ti 1. o by Section
}]00of Nc l�bm Cuk.far oldme work for M.nh 'ti i.,uGAS C\.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
My Worker 1h roc m[rard PnT n : GAS-1'A.SYSTIiM OVER4(IiA)
Cvrricr: P v POI I,N
CERHRCATE OF EXEMP PION PIR. ORKERS' GRLASI'IINIJUSIItL WASTIiIMIiHCIB'R)H
COMPENSATION INSURANCIi BUIL INC.DIV ION
(Thi„mien reedmbc complctN if thr p[nmdn i,f-.humboddolme(SIM) GREA,SF,TRAP PLANCHECK FEE
Lcrnify that imhe perfomexcnthe workfor whkhthis prrmit i,is.wcLlshall SENER-SANITARY-SILLRAt EA.200 17, ENERGY Pili
nor employ any per,00 in an,nal sO it,1a bccmme wbjm to nh<N'mhm'Compen
O Z .Corton Laws of Cnllbunia.Dee _
WATER IIEA11iN WNENTIELECIR GRADING FEE
Z 2 Appl''ant `
NOTICE 10 APPLICANT:If,M,n'vkln8'hi'CcnlflcdC of H,cmption,y,u should WATER SYS I'LM(I'HEATING solus P;E
a > Feenme,ubjeet to the Whiter:Coml'enwfon provision,Of the Lulwr Corin.yin mutt
fo,,a,mE ComplywRin suchp o,oicro,or this pmnit,hell W dared rtvOkcI WATER SERVICE
6 Q
CONSTRUCTION LN'ENDING AGENCY NERI51DIlti'IAL PLS1B. SQ.FL PAID m RecciN
1 Wr,,y e1Em mhm BOO,i,,.coreaucriun knding agency f«the Per—M
V 0 be wak for which bit,Permit 1,IVird(XC.3091.Co.C.) TOTAL
C) Lender,Lenderor
',We TOTAL.
:
{Uhl Lender',AMO,. BUILDING IHI
6. 1 emir,men I nave rxm'ni'ii, icelhn and oram'ba1 the uWve mromeaon 11
.. (n Co.l'oCno Comply with dL city aml enemy Ordimrce,otd'note law rtmaing n,, QTY. MECHANICAL PERMIT FTE SELSMICF!E
V Z huihmor commotion.and hereby auNarin mprt,enmtive,of OO;city no crier upon the
i horc-n'entiored prpeny for io diva on pmposc,. PERMIT ISSUANCE: ELECTRIC IF-
(W'e)thp.m,aro,Calera fv and keeP hermks,me Cy of Cupmim"unit m
li,bilinie,.jud8"em,,rw,er'dc.a,en,nwhith may in vny ureYeeco'e agaitun raid City ALTER OR ADD TO MECH. PLUMBING LIN
'n mnrrgm'ena of the gmndng Of thi,permit.
APPLICAUNDERSTANDS AND WILL C t� VITH ALI,N N-POI AIR HANDLING UNFF(TO 10.1M)1CFM) MECHANICALITH
SOUR -ULA
T10N� g
/a. AIH HANDLING UNIT(OVER 111,gM)CII,1) CONSI'RUCfION TAX
ligation,Cd Applicant nm D. EXHAUST HOOD(W/DUC17 HOUSING MITIGATION IE
If DOUS MAT:RIAM D CLOSURE
W 1l mhcoppl tent Or to,.WiNing m .,mivote or Mtdle M1vaNmmuw material HEATING UNIT LTO 100.000 BTU)
az defrNd by lo,,Copcnitn Munkilal Cdc,Chapter 9.12 rod rhe llcdth nal Solely HEATING UNIT(OVER If DXA)HTU)
Cdc.Swnirm 255721x)”
El YO,, -1 NO VENTILATION FAN CSI NGI.B RESIDE PAID
Ihm Hv ''Ian M
W'dl the applieam Or It Wildingm eoprn h,c aryiptrcit or devices"hith BOILER-COMP(JHPOR I0I.00(1BTU)
•emir Iua ndrxa,an cora oioanu a,mklircd by thmc Bey Arta Air Quality Merugemem TOTAL:
Di.t] BOILER-COMP(OVER 100.1100 R'UU)
❑Yes Fl No
AIR CONDITIONER ISSUANCE DATE
hath Cowl that bm ice nwn 259C5.
5 rtyxirtonme umke 1 ono t"C of IenI th
Wild Health or re Code.0 ittOn,2-5.4X,4on, and25.S.L1,I no—iflyd'hum ilnMe NEW HLSIUIiM'IAI.MECIL SQ FL
WRidingrbc,Cotu"a W,'c he mOl piM1m'n i'my of
Clliyceaofyo uIeoCy.
of rte rtgmirtnv'H which mut W met prior um i,wamma of o Cerfcate of Occuparny.
Ow'rcrmmr walumad agent Date TOTAL ISSUED BY:
OFFICE