S1733 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES—USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELRCfRDCAL Pli ll NO,
BUILDING DIVISION APPLICATION/PERNIIT PLUMB ING-.11KCHANICAL 1733
BUILDING PROJF,CI IDENTIFIcxnON
HUILDINGADDRFS9: SANITARY NO. APPIJCAI'ION SUBMITTAL DATF
c w.r
OWNI!\ NAME: Pf10Nl?;O� -y 00CMACI OR'S NNAMAX ,MI- LIC N(Y
lW� C N/C CONTROLS
• ARCUUHT GINUER I LIC NO: ADDRESS: ❑
L-i tAYN
CONTACB PHONE: BUILDING PERMIT INFO
Q�..�w V _t\ �fj `ab19.73 b7lq ❑ Consultant Fees Paid b}'Appllwnl(initial) BLDG E,L—EC,T/ PLUMB MECH
`Qx `cue Y Til ❑ p ❑ ❑
LICENM!D CONO RAC OR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm ton l aha r erred lacer"'oo,lon,of ChaNer 9(emomencing JOB DESCRIPTION
OgZO with Seenon7dXXBof Division torte Huslnca,vdl Pmfe,daa,Calc,and my]acerae in I'I!RMI'I'ISSUANCE RFNIL� TyNTIAL'
C F In full force and effect. C 0RIUWh 0 KI'PCHI?N REMODIFL
QUU Lmcrw Clu.a hic'0 APPLIANCHS-RHSIUEN'I[Al. ❑ADDITION El PLUMBING RE-PIPF
F a W ONc Contractor
[-DH ARCIIIITCFS DECFRAIION I'ANIHS ❑MULTI-UNIT OSTRUCURAL
Z O L 1 moarannJ my planuhall be u¢d as public tracedv MODIFICATION
OZ^� UP DO21X1 AMPS I [I INTERIOR El CHIMNEY REPAIR
Ladeamd Pmfeciaal 201.1"AX1P5 IMPROVEMFJ.T E]SWIMMING FOOTS
�QyFj OWNER-BUILDIiR DECLARATION OVF;R 1000 AMPS ❑HATH RENIODFJIREPAIR ODFI.IDLITIQN
C 6 1 hafted,affirm Na 1 em exempt fmm be Conrrva«a License Lw for the
3 a U following roam.(,Section loll S,Hmine,and Profession,Ctk:Any city or county SIGNS ELECTRICAL OOTIE/R
a O which y
Permit t to r he pm d< I'sn pi y lr,, u ,
Prig t L '1 ray 'Sc pplr 11 n err It tl 'g du¢narnt 1PI'CIAI.CINCUITMISC.
r�N SvtM1 Ip m t tM.pn . . fah C vuctt 1 ICh gcr9
�Q� (co g lh Sazt IlXXp fU' �s n fIM.B v dl 1 Qddor 'I I.MI'MG'1?RORPEC-HINSI'. COMMP,RCIAL:
a a o Ihul he n exempt therefmn and tiv,ha,k fr r the alleged cxvm v rm.Any v alm'em of 0 NEW BLDG/ADDITION 0 DEMOLITION
Km� Section 7031.5 by any alplicam lin al emant subjects tc alepllnnt m v civil prnalty of IY)WI[R DI!VICI!S C1 TENANT 0FOOD SERVICE
m+more than five hundred dnllvn($5(XB.
H Z} IMPROVFJJENT
=Q ❑LmmvrheroftM pmPcny.mmy empinym with wagca nor Sciraakrnhnprnsvian, iWIS1MINC E'001.ELECIIXIC
�I...� will Jo the,work,and Se,mamrN is nor iineNN«.Real for sale CSec.70OL Hu.ioess COfHFR
Iai1^ and porde,,iers,Code:The Contnctvra Litten Law docs nu apply to an worcr of OUII.I;I'S-SWITCHES-FlKRIRLS
a 3^ pnyrny who bold or improves thereon,and who docs such work hinevelf m thmugn
his own employees,Provided tet such im,aro occt.ora intendedratintendednr offived f« NEW RESIDENTIAL ELEC!R 5
sale.If,hvwavrc the huidlngor impmvcmcm is sold sithinrmu yearot coorction,to SQ.FT.FLOOR ARIA ySQ.FT,
rcr-builccr will hove the burden of proving that he did nx build m impawe lin pur-
.ea,of rale')-
I,u,mvncr of the rmpeny,nnh nxcluxivcly umtmcing wllh lieonurl conitaclnn m 'ILYT IL'.
mmtruel the mood,(See.71FW,Hu,inca,and Pmfesxions-oac:l'Ihe Comracan,L-
s .not apply to an owar 4a m
prPecy who builds imovcx dirtiest.and QTY, PI.UMBING PH:RM[T FEE
who mstoaem for such projects with acomuachi liern:dpo ant to N,ConlrtyINs
Uadtnse Law. PERMIT ISSUANCB
❑ lamcxcm r .H&1'C fm did, ran
e, sUIT:R-DRAIN&VENT-WAIN(F) VALUATION.
17,-11 /
• " M111'IiNSDECLARATIONON DECLARATION HACK HLOW PFt01'F.CT DEVICE!
I
at
KIiR
mmauM RwhyM Pmjury ores of the GalHwing JalNvuon.:
I a,a,andocnmmmma Ccrti Ocmcof he Labor Citriinsum. Warkdx Cnmf do, DRAINS-14,WR.ROOP,AHM,C'QN[)' SIDRII!S
TYPE CONS'IAUCI'ION
nota av povldot for by Stdmn 171X1 of the labor Crx4,lo,Ile IRvllnhwnc of the
wad for which Thi. aintai is'i vanJ. Il%'TIIHIlS-YGR'IRAP
❑ 1 have.nJ will maintain H'nrker'v CanPen.mtion Inmmmc,a rryuircJ by Section
IRMrf do LaborCrdefor the Perfomaance ofthe work for which this lemon is isaacd. GAS-F'v1.SYSIBM-I INC.4011Tt DCC.GROUP AI'N
My Watters Coneniation Insouciance tamer and Policy number ane: P pM
Conic[ Pc iey No.: GAS-EA.S)ST I-OVER 4(F)
CERTIFICATE:OF EaHlvf i`T ON FROM WORKHRti
COMPENSATION INSURANCE GREAS'UINUU,SIRL WASIT INTF;RCEPIOR 11 DF[IS
(Thoweam.need rat he cvmpletN flM rnat pnif a,for ohurdml follarn($lora) GRIA.M;TRAP - - ---
or I—) 1'FNCII ..
Lcenlfy main me perfnmuncatf,M work fair which this puaod,o irmed,Ixlaall SHWHR-SANITARY-SHRMHA.21X117.
rat muploy any fto� any......... m rk u,bcconw-o", ,, be Worker+'Cbmpcm ENI!R' � ,Ui Cl x a lls�
O ,Z radon Laws of Cu10"ordv.DatT WSrFR 1 FATHR W/VFNTnULFCI'R GRADING FTF.
z O Applicant
NO ICO TO APPIJCANLf,after ranking this Certificate of EamMion,you about WAITR SYSH'_M/IRFONG
Fh ? bwac subject to in,Workds Campcnciann povHm,of the Labor Cade,yw must SOILS EER
m
frnhwit comply it such firevWon,athisprnrul shall be deemed revoAN. WAT:R SERVICE
[a] 0
a CONSTRUCTION LUNGING AGF'CY NEW RISID NIIAL Pl-MO. SQ,FT, PAID
U z [)ale Rneiplg
U O Ihacby affirm dust there iaacamsamctiwi lcrdin8 agcrcYfor fine pcHomhvhcc of
0¢work for which this permit k iwucd(Sec.8097,Civ.C.)
LL F' Larder',Name TOTAL:
U 1-coder',AJJrea 'TOTAL:
r� d I curtly that I have real this npplicmian ord maid t1ca Lha oMrvc Intormation I, BUILDING EFF.
F-i V) Ctmat.I ego to comply with ill city and county oNhaarccs and vunc laws relating to QTY. MF-CHANICAI.I'F.RMIT FEC
V hadchm,mnu
, unimNn
.and hcmhyuMne mPreuntntivca of tis city e
y enl,ra,o thSI!ISMIC FEE
aMvumeNiorml pmpcny Gr im,,i am purpac.. PURMI'I ISSUANCEC
(We)agree In save,indemnity and keep harmk.s Se City ofp C. ora agvn,r
I:IJ:LTRIC FEE
liabilide"pati ore...coca enol expenaes Which may its any way xcrveagaimi said City AE-T:R OR ADD TO MECH.
PLUMBING FEE
in canequene of the granting of S6 Permit.
APPLICANT ON E )\ U NO WILL COMPLY WITH ALL NON-PUI.NT AIR HANDLING UNFT(TO HLIXMCIID MECHANICAL FEE
SOURC REG h R
AIR HANDLING UNIT(OVER 10,000CFfd) CONSTRUCTION[AX
Sign, am1Co ter Hum E%IIAUST IIOOD(WNUC) HOUSING MITICA[ION II!li
IIA I Ka118 MAI TRIALS DISCLOSURE
W 1l rhe appliC tan fuwN natio,oc'c'm dare ahoullc lwaallouanattri,l HIAI'INC,UNIT(TO l0tt)(X)11TU)
sox deimd by Jac Culmina Municipal Cuda,Chapter 9.12,toll to Ilmlth and Safety
Code.Section 25512(.)7 IIIATNG UNIT(OVER M.000 It
Ya FjN.
VINDFTON FAN(SINfI.I!RI?SID) PAID [)ale Receipt)
• Will the applicant or future building occulhaN use equipmrnl a devi ds which
emit hvnNous air cmdaminums as Jefir l by do Bay'Ar+Air Quality Marugunem ROILEiR-COMP(1HP OR 1010.00()BTU) TOTAL
- Dlanxt? HOH.F.R-COMP(OVER 100,0001IT))
❑Yea Fl No
I have reed Irk.burnMaa mmcriuls rt eh units,Ch 1.95 Mthe Cah- AIR CONDE'I1ONFR ISSUANCE DAIS
quimncn tical
Iamiu,il &Scu C}' e,ea nece fadi25519andx thifi uoAdryddon ifto NIiW NILSIDI'NTIAL MSCII. SQ.IT. n,-
huidingd adir vcvm tortoixmy cof acranicant, fy the hcivpent �$
an � nn,tm et rata to iaaunma ora crnmcmu
(T aN [)tot TOTAL: ISSUF,D R'S, k7[��7.7a.uCCICI
OFFICE