S3044C,
I
Ata1M Ern NT TO FB 1 IM Iucnwluennu WITHIN RFn I INES - USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDINIG DIVISION APPLICATION/PERMIT PLUMBING-MFICHANICAL
BUILIIING PNOJECT IDENTIFICATION
Mtn NO
v 3044
BUILDING ADDRESS. deg 3 f3:
NO,
APPLICATION SUPMITTALUATIiO1
� E 'S NAME- PHONE:
N 3 r 9i6 �d
CONTS UD)R'S NAME: I,IC Nf)): ��
o N Ne, 6��sAR
jSNITARY
CONI Ro1.G—
\ O
11T-COPNGINEF,R: LION :
ADDRESS:
CONTA� PHONB
E G1+� 9g6 X676
❑ Coluvltanl Ems Paid by Applicant (initial)
BUILDING PERMIT INFO
BLUGi BLF(7 _ PLUMB MBCI
YWJ/
LIC'INSED CONTRACTOR'S DECLARATION
I h relby alnmi that 1 am Hectored soder provelimx of Chnfi 9 Rmm.mming
QT -y ELECIR IC PERM IT FEE
1013 DESCRIPTION
PERMITISSUANCE
with Smtion]BW1oflHvisim Joi the Burincxx wJl4ofeivianx arW my license IS
in fun fxce and effect. 6/�J
)N'I. C3 KITCHEN REMODEL
APPLIANCES-RMIDINDA1.
1.icrn,c Cl CJ
Dat' C'mnroctu
RCIITTECTS DE,CL\RAION
I n.r , mYplena shall be usN as puMk rcc«ds
❑ADDITION ❑PLUMBING RI: -PIPE
❑FIULTI-UNIT ❑STRUCIURAI.
MODIIECATION
[D INTERIOR ❑CHIMNEY RITAIR
IMPROVEMENT QSWIMMING POOLS
PANIJS
UP'I0211H AMPS
Luse') Pmfcasi... I
2l))IdDX))AMYS
OWNERUBUH.DER DECLARATION
I hereby aflimt that I am exempt fmm IM1e Cnnlmcm.'c Llcen.w law for the
following mumu. (.Section 70315. Bosincu and I'mfessials Cndc Any oily a uamy
❑ BATH REVIODELIREPAIR [I DEMOLITION
OTHER
OVER IIXX))AMYS
SIGNS 1iLECI'RICAL
which reeluiras a permil to cooumct alta, improve, dmmlixh, m motor any rtrvcla e
SPECIAL. CIRCU GEM ISC.
-
priortoiuiswence.also 5uirea Heii,licmt fusuch permilm file a Joigncdvaromrnt
mal he iv licenttd punxuam m dt, Pm—i,en, ofthe ComrxnNx Liccnm law (Chalucn')
(emtmcsing with Smbn]EfX))]ufdvinirm3af Ja eminss, cath Pnnersions C.du)m
and be, is cacmp Rodeo. and the hams fm the Mill esemprim. Any vich ion of
Seelon 7031.5 by any applicant for a ,ron't subjects [be applinm In v civil Penalty of
1'EM I'.MEItiN OR POLE INST.
COMMERCIAL
❑ NEN' BLDGIADDITION ❑ DEMOLITION
❑'ITNANT ❑ POOD SERVICE
S
POWER DEVOPERMITFEE
not ntnm than f vc huldrell dollars 1351X8.
�Luaw'neroflR Pmpcny. nr mY employees with w�gnmlheirekaveryen..vim.
will do the wvrrk, and the wsarara is. intended or nReml for Sale (Sec. TBM. normumnos❑
and Pmfccvions CoJc:'fhc Contractors Escrow Low Jucv nor apply m an mvoa. of
property wht boi dl or improve, Ihemun, and wla docs Such wmk himwlfor thmaith
be own emMoyccc prosidd that such imam.<mems ara aw intf�Jsd or offered fm
.care lL how'es'er,lb'huddit,,cimlmvcmcnl is Sold waminoneyeaofutmplmion.Lha
ar-builder will nava the honJ.:n of posing Marl he did nnl FUJd or Inlpnne Grc pun-
IMPROVEMENT
OTHER
SWMMINGIRIC
OVIl.ETS-19%TURES
NEW RESICTR SO FL
SQ FU FLOOR AREA
SISQ. FT
33
TOTAL
Poseofsal�.).
I, u owner of nt pe, 7v)4 am lmesS exclusively caxrsting wish l) Th, C Odn"o, rs toS-a
ions Cnkp the Cammnm. Li --JS
eve mal larey who
msuon theox s not
centt law docs rw applyman owner ofpropny Sohn WdJn or lmlxovex mmem.aal
o at owner
/
� M y�
d� 4ly
'1
6 12
f'1�',I{
QTY, PERMIT FEELienesc
low.P[RMIT
am exempt umkr See , 11.E P C for this ernamALTER-D-
I.I
WA (FA)
VAALLUATION
WOR KERS COMPENSATION DI!CI A RAI'ION
HACK FLOI'.
hereby aflinn aukr pmhy offriary ma of the foll—ingIhave
J"I
STORIES
TYNiCONSI1tUCION
twl will ore inteioe Cmifctne.fConscnl In ue-insure fm N'uhcr' Cnmprn-
DRAINS -PARE .GOND.
swim, es provide) fm loi S kau i]ql of Ile latxrc Cade, for me podnnnase of Ibe
wmkfx which till,apintain ioldeL
S'
PI%'IlJRCS-I'IiR TRAP
m myu ter t i Section
1 bare and will maintain Wukcfs a na dilb v haafor which
3](10 of ga l�bur Cuk, for the prnfmmnlcnf the Souk for which this aconin is ivucd.
GAS-IiA. S\'SILFI-1 INC.a OUTLET,
OCC. Co 1'
APN
GAS-HA.SY\TEM-OVERSEA)
My Wuker'x omp'nxatnm lnvnratac artier and! Policy, mm� r
C. �L I'ollcy Nu:�-
GNIiASPIINUUSTRL W,\STF. INDiRCEI'R:))R
CERTIFEG M E) Ii1ION I N FRObf N'ORKFRS
COMFII:SA1'ION INSURANCE
BUILDING DIVISION I7?BS
GREASE TRAP
PLA P !LE - 2 O
(Tliv.vetinn real not heeontplmcd floc ernit info.... abadrdiinlaa($100)
wIaSJ
Ieeni(Y filar in lhcpMnmleseufthe won fu which min PemJtia iswcd.l shill
not employ any pcau))in any nwnler su us en bceonc Sub,c, ,, Ill, Winters Compum
SEWER - SANITARY -STORM IA. 2111)) FT.
11Jt FEE
WATER HEATER WIVENHF LECI'M
C DING FEE
Sabo Ltwxof'ClUnnia.Dde
1 Applicam
j NOTICE TO APPLICANT: IF, ufm making this Cenilicale of F,xcmpim, Yea dxwd
h4om' SubjL" ,, the Worker', Com""al ,o prem rs of Ila IaMx Cn.k, you amw
fonhwim comply wion such Pmvks or, this permit"I he Jeer invoked.
WA117R SYSTEMfFRIDM INC
SI LS FEE
WATER SERVICE
' CONSIRU(C ION LENDING AGENCY
Ilotted, intent RW them ixecunNmetinn krdingagengf IM1nefvdo neeof
the wort for which this Permit is issud (Sae. 3(9]. Civ. C.)
Leader's Na.
PAID
Uwe Recciplp
TOTAL:
HUlll)ING FT:E
77
NEW RESIDENTIAL PIJAR. SQ, PI',
F'"TA r
1 I -coder', AJdrea
1 cenify that I base rand this ePplicmim and ,Sone that the shove infamt rear to
cures.) eine la etmply Wim ell city mW coarmy odi. and Sole lows: relining to
M1uilding amslme(im,and hemhy nudlorim mptcwnwtivc, of lhls ehy to cmo ulnen theM
ohove-mamtionse pmpeny fm inrPectim purpows.
agree m.,< indemnify and keep borri the City aCupertimegeinsaELECTRIC
QTY. MECHANICAL PERMIT FEE
SI?ISMIC Fl!E O
'"'�
F RMI'1' IJ ��(We)
1?E 2Obdow,.Iudoo.
ALTER OECH.
2,n.wgn
, cow and cxpcowx which may in troy way occme aliment Said City
iiL'cofthegrantingofthislannil.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI, NUN -POINT
AER HANfT0101101))CFFD
ME N ALFEESOURCE
REGULATIONS.
IIAN(OVER I I1dXY1 CPM))
Cl "I' UCIION TAX 40 / 9Sig.
(,fAIR
nfn evmrrctoe 0.m
"ARDOUS MA'fE,RIALS DISCLOSUREVWFI the applicumu Nine, beilding u'copan,turt nr handl' 11-111111-4 molind
EXHAUSUCT)
HOT GMITIGATION FtiiI
HHATINC11,0(X1 BM))
O
un define) by the Cupcn'uw Municipal Coda. Choper 9.12 and Ne, Health end Safety
Code, Smlion'3532(a)^
HEATING UNIT (OVER 101" BTU)
VENF'FLAAK))NIANNINGLERISID))
(]Ve, Cl No
PAID Dane 'iph
' Nill the ysplinn m fumrt building acuPam use cyuiFrrrcm u nk'icca w'hkh
zardous r cinminana refinedby IM1e Eloy Arca Air Quality Marcgetanl
et haaima
mi
B011,1:11 -COMP OHP OR 100.1010 BTU)
B())1 LER- COMI'(OV I?R IW.M))It'ITI)
))imdm'I
❑Yes No
AIR CONTI'HONER
I ISSUANCE DATE
I lwvc.cud na ba,,oc wx ntetmidx ,nir,ncre, under Claptmfi95 of the Cali-
not health & Safety Cud, Sections, 2551))5.255:3 and 25531. 1 uakrwdd that it the
NEW RESIDENTIAL MECH.
handing Ikea na cement, haveatcvnl. Inv it is myncportsbany to ratify the swarm
nflk rtnu whichf�ml-isl�he net priurto'rssuase nfn Ccnifxatc nf(hvpanry.
ISSUF,DBY: r O
L ✓
Ow, IuuBtrccd�o/ Dwc