S0694 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL P IIT NO
BUR.DING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL 0694
BUILDING PROJECT IDENUFICATION
SANITARY NO. APPLICATION SUBMITTAL DATE
BUILD]NO ADDRESS:
a—is �✓ess[2✓ n.-r � �b �4'�
OW R'S ME.' OY 90 PHONE''O AICI LIC NO: No- CONTROL
�'v til�� !�'l "" ❑
RCHITECT IRSEF.R: LIC NO: ADD 'SS:
CONTACT. bs PHONE BUILDING PERMIT INFO
ScQ� 6 1/ �jr.- ❑ ConsWtenl Fees Paid by Applicant(Initial) SLUG ELECT PLUMB MECH_
LICENSED CONIxA R:S DEQT ELECTRIC PERMIT FEE JOB DBSCRIIPTTII`O"N
I h«cbY amort]hot I am IiremN u Jm Prot ion,of CnNnm 9(commencing
Z with Secli.7")of Ut,oao 3 of the BusimottaJ Professi«u Code,fad my license i. E RESIDENTIAL--
W p O PERMIT ISSUANCE wt. [I KITCHEN REMODEL
WU_ in full fact and cRctt
aUDole Cls¢ licEN
e APPLIANCES-R[SIDTIAL ADDITION El PLUMBING RE-PIPIT
F 7-�6 Detc CarTS DE m f'I
Vt¢
ARCH]'1'IiCTS DECLARATION I`ANEIS MULTI-UNIT � '4ySFRUCNRAL
~=Z 1 urdmtard mY pWns shill he usd u Puhlic rtart, MODIFICATION
Oz--' UPT020()AMPS ❑INTERIOR ❑CHIMNEY REPAIR
0 IMPROVE 1 SWIMMING POOLS
F^�~J Licensed Rofcuiatul 2111-IOfIf1AMl'S -�
OWNER-BUILDER DF,CLIRATION OVER HXXIAMPS ❑BATH RI' F,I'A IT10N
L I Immhy oDmn Not I un caempl from't he 6eint,C a Licenx Law fur tM ❑OTHER
x U % ad,ny rojes a LSecflsn 70313,Bmitler.onA ve,de ions Cnoe'.Ally city ocaamy SIGNS ELECENICAL
3 4.In 'ca'rt"irs .pdmil to c«uafle ante,Tornow,dcmdi,1.«mp"gany omorma
5 "'i Ioiarto,lim suna..lwrt1.the fae arplic of be Comramdltn file."grand Law(sutcrrcm SPECIAL CIRCUIT/AILSC.
,x. tLat he is liccn.iPur.uenl to Nelmovision,of the CoNracmr's l.ittnse tomo lCnaPtcr9 COMMERCIAL
alC (mmtuncingmoilh Satitn 9")of Di vieiun Jof the lfusis ,owl Prufc,-iona Clxk)'a THMP.METERORPOI.El .
ayx c p{ Nut its,exempt tlwrermm and Ne basis f«the alleged!esempinn.Any violal of ❑NEW BIDGIADDITION ❑DEMOLI HON
W^ Smtion7O3i5hy.nyapf4 entf«Rp�twbjmL,thepplicwtto.civil Pnwhyuf POWER DEVICES ❑TENANT ❑FOOD SERVICE
y nal nsore then five hublool"I.I$500f IMPROVEMENT
Q I,uowrler of the{mPeny,«my cmrluym with wagesulnrir wk mmpcv«im. SWIMMING POOL ELECTRIC
0022GG,'{.T', will dotlmwM.add ,,,00emre isnot inleldN«offend for wle(Se,7044, u
Beon , BOTHER
L 3 and Pmfc„i�vu Cole:The Contractor,Lied.Inw Jtxs not apply to en tw-I of f111'RETS-tiN'ITCHLS-FI%'ILRLS
pmreny wind builds or improves themam end who dm.oath work himself«Nwgh
his mvn cmrlmtm,pmvirlt that s«h improvement,de sot imcIIJM«olfeteci for NEW RFSIDENTAL ELE:C R SQ FT SQ,FE FLOOR AREA Ssq FT.
stile.IL however,the building asimlmvenscnt i,urM within ole yewofcvmplcl,..the �\
rwwr-h�uilder will have he boder of pnwing thm he did not build a improve fm Por- �� V
rync ieIE.J.
to 'ROAL,Er : c
1,u mwocr ,of tl,,p ,mr ma exclusively ventroeting with tsnt
lee !corulon
cawmcl the paject(See 7041.Besitcss sed Professions Code:)The Contramm'.LO- -L
redoo,law does rndlarPl,1. owrcr mfpmrmy who buids or impmves thertan.and QTY. PLUMBING PERMIT FEE
who vnnlr«I,fm wch fxnjttl with nconlncmrls)lians 1purwannntM Conlrlgnr's
Lecnm Law. PIJtMII'ISSUANCE
Iamcacmplarukr --— - &PCfwAho mown
// ALTER-DRAIN&VENT-WATER(EA) VALUATION
Ow rear 1>.tc 9 3
• / WORKER'Sndlyof.NSA,on Dfdref1ATION� y � BAC )W PRQGECT:DEVICE
I netrts amort ander penadr..r 1e11aM arc ar IhC rNhwing Acdamdmla:
IhvvenNl willnwintnlo.Cmiftcate ofCmscNmelf-insure hrWMcrS Gnnpen- DN -1.(x)0.RWEARFA.NND STORIES l'YI'I[C(INSI'RUCIION
otiaa,m rmvd,d f«by Sati�m 37110 of the Labor Cade,for be reA'mmn<
'«kf«which Nis otos«d. 1X"URFS-PER TRAP
❑ Ihavemld will t Wtrtkds Cartmenotir In,nfQ, lion GAS-ITA.SYSTEM- INC.]OUTLETS
3700ol lbe a,, the perOmn)rtcc ftl 0f1�h\n L Pcnnll hiv,vl. OCC GROUP AI'N
! arc
My Worker's •1 niml ln,vana cutin a« sl'o number GAS-EA.SYSTEM-OVLRJ(EA)
Candor Policy
:RTIFICATE OF EXEMPTION FROM WORKERS' GRE.ASI IINDUSTRI.W'ASIP.INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION IIJS
(Phi,sccii(n mN not he )n1pklcd if the pemnit i,fur one hu«I ddrA lar,151110) GREASE'FRAI'
I'LANCHECK FF.F.
mk )
l armyshot in the my
of,twork f«which Nis the Wo,uwe4lshill SEWER-SANRARY-STORM EA.2111IT.
not employ�nY Pd„^'In mly nxntla w es to Isdotne wbjm to the W«leti Compcn- ENERGY FI:E
Z motion laws of Cnlif«nia.Dae WAGER HEATER W/VINTIIH.ECfR GRADING FEE
Z O Applicant I
NMICE TO APPLICANT:If,alter making thio Certificate of Ei Iolpiieo,P'o,huuld WAGER SYSTEhVIREAEING SOILS FEE
hecome object to be Waists',Campemation pmvi,mru M the lobar CNe.)ru mow
WfmhviN comply with wch pmvi,km or Nie permit DullMdeertred nevsA:cd. WATER SERVICE
0 PAID
CONSTRUCIGON LEbID1NG AGENCY NEN'RESIDENTIAL PIAN. SQ.FT. ate RcvciNe
U O 1 knot,aftort Nat dwo, ,a cdn,tmcdsn lc«lin6 egcrcy for the l esfomnarco of
� IhC woh for which Nis pcmdt i,i,wed(Sec.31H7.Co.C.) TUTAI:
UI<rdef,N.D� Lemklx Addax, TOTAL
0. 1 mnify Nal I have rend this awleatioa std state that the ahavc infortordon is BUILDING IIJi
h Co.,.lagme m nntply with all city an it only«dinulcc.and uNe laws relating to QTY. MECHANICAL PERMIT FEF, SEISMIC 11414 3
V Z Widiteomsmu'lion,vol hereby amhvdac tcPrnrnwives of this city to enter up)o the
ad,vcrrcniarlM frno,ody f«impretion Ptulr„es. jff�MITISSUANCE ELECTRIC EmlIiuFJllie,,judgrrcnl,,eu,ua«Icapemcsw0icnnwyInany„'"Y"co'n'eagainst,uidCityR UH AIIII TG MT:CIL I'LUMHI �ITIiAPPLIC/SD:F NDERSTANDS AND WILL COMPLY WITH ALL NON-POINTANDLING UNIT(T(l 10,000 CFM) MECHA ICALFEE ISOUR ULA`�pNS. ANDLINGUNR(OVER IBAfl1CFMf CONSMN]'DON TA%
g"om�pplicunOConlacx Dutc UST'l OOD(WIDUCI) HOUSINGMI �A'CIONII!E
HAZARDOUS MATERIALS IIISCLOSUREWie,oturt huilding occupant store«handle bvardaus mterialING UNIT(TO Iro.00i HTU)
u dcfrled by the Cupmirn MuniriM Cade.Chaper 9.12,and the Hen]th rw1 Safety
Cork.Section 255921.1^ HEATING]]NIT(OVER IIXIJI(I(1 BOTH
❑Ya C]N,, V F.NTILA'1'[ON CAN IS I NGLE RLSI U) PAID Daty eceiN0
Will ON,ep Aie m m future budding«toper,ux oWiprrcN or drives which BOILER-COMP(3HP OR 100.000 BTU]
emit lu:udous ah ttxYantirunlx a defrlN by the Bay Arca Air Quality Nbosimrrcnt TOTAL_
Di,triafl BOILER-COMP(OVER H)0,000 BTU)
E3 Yes [:1 No
Iheverd the hvvdau,tromm+dstryll'uctrcnls undo Cham 6.Y5 M ON,Cali- AIR CONDITIONER ISSUANCE DATE
,mat Hm]N&Sefdy Code.Section,25505.25513 food 25511.I wdemuntJ dw if 0e NEW RESIDENTIAL MECH. SQ.FT.
buihdng dee,not currently love a Irnwt,Nal it is my aspn inility m toffy fatapnn
e oit
of the lianaenl,which maw IV ncl prior to i,a-ar,d of o Cenidenm M(kcuponry.
(Twirler«vuthmiacJ.{cot Dae TOTAL ISSUED HY.
OFFICE