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29591 APPLICANT TO FILL IN INFORMATION WITHIN REO,LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-F,LF,COUCAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT ' PLUMBING-MECHANICAL 29591 BUILIIINC PROJECT IDENTIFICATION BUILDINGADDRFSS: SANITARYNO. APPIJCATIONSUBMITTALDAJ ' /03 /5 T61ZR /✓ 1-9 6 ✓� OWNER'S NAME: PHONE CONTRA . OR'S NAME_ LIC NO: NIC CONTROLN GH6� ARCHITECT/ENGINII±R: LIC NO ADDRt S: ❑ � //9� F6AI VVV «<rtVJJ CONTACT rxon'E .4AI7; J CL BUILDING PERMIT INFO ❑-Cansallanl Fee.Paid by Applicant(Initial) B� M ` PLUMB MECH LIL'BNSPD CITNTRACfOR:S Il1:MRATION QTY ELECTRIC PERMIT FEE OneZ 1I by. imnmu lam Ikemcdwaif Inmvisia wCl Vi 9(ctmanereing JOB DESCRIPTION Ih Srctioe-I()0o)ofUivisim Jofde BevreesarW Rofaaivns Codc.rd myliccmcis RESIDENTIAL fr�0 mr _ By �.� `�{ PERMTTISSUANCE <U� Kearse Clam�3 e 315" ❑SFDWL [I KITCHEN REMODEL Z APPIJANCES-RESIDENTIAL �DDTHON ❑PLUMBINGRE-PIPE baa Dele�ly/lp�TIDECr RAL FvZ lundnvimd m' ARshall he eaNuC M'Ic rcTImU PANELS ON ❑MULTI-UNIT ❑QDIFlCATION zoy_ yW^¢a w pZ-0 UPTO 2W AMPS (I INTERIOR CI CHIMNEY REPAIR F1,,1,• Liecomed ProfaaionW WI-If100AMPS IMPROVEMENT gyf_l OWNER-BUILDER DECLARATION OVER 1000 AMPS 1:1BATH REMODEUREPAIR [I DEMOLITION IY IY Q 1 hertby.ffirm that l.m exempt from the Cmimtu's License Lew fur the K�LU following rtaral.(Section 70313,Busmen"Pmfessiou Cute:Any city or county SIGNS ELECTRICAL ❑OTHER F LLO whieh res lire a permit to corno.t,alter,impmrc,dcmolide,or rcPilr.ny&vucuve prior to its inuuwe,utso rtgDim the appli,oll fmmch pennitro flee sillier! SPECIAL CIRCUUMISC. _ �j that he is licersnl pursuant or the provuisru of the Connector's License Law(Chapter 9 p(p0 (rommcneing wiN Sxtiaa 70001 of DivivunJ of U«Busire.a end Pmfenian.CoJe)m TEMP.METER OR POLE INS'L COMMERCIAL a yy thtu he is exempt tlertfrom and the Wi,fur the Wkg d e.aemptimn.Any vi.1.&m of ❑NBW BLDG/ADDNION ❑DFMOLfHON 4'LL Saliun 90313 by any gpplknmfaapermit whjauthe applicantroecivil pewlTy of POWER DEVICES �V' rerrlm.c Won Bee howldrellan($5W). ❑TENANT [I FOOD SERVICE FZ6 ❑I,es owrlerNile propertY,amy employees with wvgauthcir.wlc rompemwtiw, SWIMMING POOL ELECTRIC IMPROVEMENT ft p will do the cour,aoW lheswclurt is no,inteMN oroRc«J for sale(See7(W4,Bilines& [I OTHER W atd Profession Code:The Conlndor's License law dee noi'upply to w owner of OUTLETS-SWITCHES-FIXTURES property who builds m itrynuses tMrron,cal who Ike.such work himself ser Ihmugh his own employ.,proteiJal thus such Impnwementx ve not inlenae d ui UBcosi for NEW RESIDENTIAL ELECTR SQ PT. We.If,however,nee Wilding or impluvemcnt is wld wohinnlleycnrofecnpklion.do SQ.FT.FLOORAREA S/SQ.FT. mxr-builder will have tie hoolso of pnrvintl IMI M dW Ila WiW ar improve for wr- nf �) 3 ❑ I,ss owner of the property,am exclusisely conlowline with I'Isien.J commelo s In 0 �'�O ./ L O m und the proN,1(,See.9()0.4,Bualncaa lost Plofunlons Cale:)TM1e Cnnnannr's Li- I . ° c Law Jacs not apply m an ownerol pri,eny who blo sor improsot bent.,tall QTY. PL MB GPERMI'T FEE who conwclz f s men pr.jeco,with a atutmdorts)liren.sed wrsunnt m the Cuntuctor's License law. PERMIT ISSU V f�s9 ❑ I nem exempt coder Sec. .If&p C Lr « l,his aw9 Owner Date ALTI!R—DRAIN&V — AT R(• ) g 1x. VALUATION / I'Vf ` WORKER'S COMPENSATION I(EC1AHATION MACK FLOW PROTE D G,�1 ©r 1 Ir«bY aRum seniles penalty a(perjury oro o `f the following dttauntiacc ❑IhaveaM will nuuinwin xCcnil-wa¢nf Con.semlosdl-in.wmlin Wnrkcr's Cnmpcn- DRAINS-ILOOR.R SIORI'LS "Y it CONSTRUCTION nlion,u Irovided for by Sn71on 3700 ofTe IaMr Code,for IM wrfrnwnce of tW work far which this pcmuil is is,ced. - FIXTURES-PER TRAP• - PC base unit will msinmin Worker'.Gupenwtion Imumree,as reclined by Section 37M oftle Lobar Cole.for the prnirmoncc oflhe work for which lhispennit is issued. GAS-fA.SYSTEM-I INC.JO OCC GROUP APN My Wo.1",C 'tion lnwnnce haler old Policy umM1er are: GAS-EA.SYSTEM OVERi1BA) Currier W/VL /rfMK Policy Na. 1,9 CERTIFICATE 0P EX I- PTI ON IlR0M WORXE S COMPENSATION INSURANCE GREASMNDU.STRL WASTE INTERCEPTOR BUILDING DIVISION EYES (This action need tel M1e cemplclN ifft fermi)is(arse,hundred doll.(SUsH a lcv.) GREASE TRAP PIANCHECK FEE 2 I certify IM1ar in the perfomurre of IM1c wink for which this permit is issued.I shall nor employ xny Per*'u in any rmnner w as to bean.subject to the Waken'Cmpen SEWER-SANfTARY-STORM EA,200 FT ENERGY ME zZ s,,tien lass of C.lifael..Lhte WATER HEATER WNENT E m O Applicnn GRADING FEE Vl NOTICE TO APPLICANT.If..BcT making This Ceaifc.te of Excau ion.you should WATER SYSTEMTREATING I" ^ become subject to Ne Workers C provimons u soils Fee 3 smpcmacinn of Labor Calc.you must fanhwith canplYwith such pmvisitmaathis pxmdl shall WdeemN«soked, WATER SERVICE CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PI-MB. SQ.FL PAID U O Ibe«by ltfflrtn lhntUertis.smestnutisn lrnling.gcneyfm Tk perfwnlance rd Dace Receipt. LL. the work for wTkb this permit m inued(See 3097.Ci,C.) C) Utrcks's Name TOTAL Lenegs's A11d«n Va I cenify thm I have least this rtwicotiuo.al vie that the.hove mfort is BUILDING FEE l mrrrel.l.grtc to comply with ell city.rd rnunty wduurres Wstdc uw&rtlacinSm QTY. MECHANICAL PERMIT FEE -r U eZ building cortshuetion.sM be«br adhurise repretemsuvesofthiscity loeverupon the SEISMIC FEE Nqa ^ anewc-newomllrePcroy fee inspection purpose. PERMIT ISSUANCE (We)egre Tosevc,iakmnifY old kttp husrnkas Ole Cily MCupeninu.6vrut ELECTRIC FEE � IuNbti=jW�mcmuac cxpcm hichmayin.nywwyucme.gai mw City ALTER OR ADD TO MECH. inml. a of the mount,ofthis pemtil. PLUMBING FEE7747 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO U),IIDO CFM) A SOURCE REGULATIONS. MECHANICAL PER qK itV AIR HANDLING UNIT(OVER 10.(10n CFM) CONSTRUCTIONTAX Si,mou«ofApplicenV onbsclor Ihte EXHAUST GOOD(W)DUM HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will lhcspplicontar future Willing aiulwll.slnrt urhatWlctewvJuus matemil HFATNG UNIT TO 100,000 BTU) its defined by the Cupsainu Municipal Core.Chapter 9.12,aril one,Health surd Safety Cade,Section 21572(.)? HEATING UNIT(OVER HIT"BTU) ❑Yex orla VENTILATION FAN(SINGLE REMD) PAID Will the Ilcom or noun,huildin t use i or lesices which 'Date Receipt N app gacupw eyuiplen BOILER—COMP(JHPOR HSLN0 BTU) nNl M1 nodous air conmmitlanta¢a defircJ by the)ley Alen Air Q.111,Merwgnlem TOTAIs DlurkR ❑Yes BOILER—COST(OVER 10),W)BTU) .�GMa . Ilwvc sold d.:bavuJlwe nwmnal&myuirnnunls utWer Cmpterfi45 of the Calb AIR CONDMONPR - ISSUANCE DATE Bmia Health&Safely Cl.k,ticditmv 25515.25577 not 2,15.14 I understand ihsi Vthe NEW RFSIUENTIAL MECH. SQ.F-L ' _ Wildingtbcs nM earrentlyhu.'ca lcwnt,that 11 is my n,sponaihiliIy lonnify theteivlwnl of dx rcyui«mcm&whinM1 muse be nr no inn IEcam of upuney. pwnttagmhoriral agent « ISSUED BY: OFFICE