S1310 APPLICAI JTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF:�UPERTINO BUD.DING-FT,ECP((((al" PE IT NO.
PUII,DIN.I DIVISION APPLICATION/PERNUT
PLUMBING PROJECT[BEST
IFIC �J 1310
IIUILI)IW:PNUIt:CI IURNI'IFICATII)N
BUILDING ADORESK / rL SAN]DRY NO. APPLICATION SUHMfITALUATE
U
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Cof0 CT M_ i1CN(�
ER•yNAM PIRNli
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A .(;prFNGINP' LICN(y i 1 ADDRESS.
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CONTACT PIIONId BUILDING PERMIT INFO
`� I Do ❑ Consultant Fees Paid by Applicant(initial) .1 ILJiCr PLUMB SHECH
.CJI Boa 24�- El 1-1 El
ILR(JSF.D pCfON'S DecLANnnoN ELECTRIC PERMIT FEE
I hereby aH.m dw 1 ren roamed under pmvi%mn%(of Rw('Ier .win, JOB DESCRIPTION
1CPyy=Zth Section7lltlB5f Uivisiab3of the Husincu and Pmfeusi ,ydmy it PERMIT ISSUANCE RFSIDENTIAL
t 00 n'full In.veal edt". ❑SIl)WI, ❑KITCHEN REMODEL
�UU L:amc ateIJ' ,r- pPl'LIANCI!ti-NfSIDF1Jl'IAI. ❑AUDD'ION ❑PLUMBINGRC-PIPE!
��W Uwc "nl1°cl"r ❑MULTI-UNIT [I STRUCTURAL
ID. I HITECI'SI A PANIUS MODIFICATION
:Orobt
Z��'� . >'llan%shat 11PT02(In AMPS
❑INUERIOR ❑CHIMNF.YRFPAIR
Z1-1000AMPS IMI'ROVEMENr []SWIMMING%)UIS
OWNER-BUILDER DECLARATION OVER_1(000 AMPS ❑BATH RFMODFWRBPAIR L1 DEMOLITION
W 6 1 h:mhy drann that I am excmin linm mhc Comtme nr'x Lice—1nw far the
d U fcllowar,re an.ISeclio 19031 5,BLNlwxx unit 1'ndc..amn Code:Any clly'r nwnty SIGNS FLECRICAL El UII IFR
3 LL wh.h require a gerund an ca ariond,eller,improve,demolish,or mluir any s0ucume
FLLUs primm ih ixwerce.rd.mamru the a(b Aicetm(match permit.flee sill aulemenl SPECIAL CIRCUIT(MISC.
fy Pyr that lc is Bernd]location to the Provision%of Ile Caron d%Uomw l,tw(Chapter 9 COMMERCIAL:
41 00 Icommeneingwibh S«Pim--M Division 3 of the Business uxl%ufnsiom Codel"r TIMI'.METER OR POLE INST,
a a that M is earnyr Belefvn and the hmia IM ole alleged eacm%'xw.Any violation nT ❑NEW RLMADDITION El DEMOLITION
Seclian7031b by any applleanbfor a Permit wbjecu the apMicam toe civil p mallyof POWER DEVICES ❑'TENANT ❑FOOD SIiRVICF,
irx a—m nen live hundred d'Ilaa($A#II.
� I,assowrw+af the prolrny.or my cmptlecn with wages�lair radecmllenxvlial, SWIMMIN61NMLF.LECIRIC OTHFR EMh:N9'
��+� will G'Ihe work,Cd :The,C isax1Lke . ,oerM fnrsalc(Scc.1.an B ulf ❑D'1111:R
C
aC� aed Pmfe ba CW e:The rat t ancrea I.ierna Low...It apply to w r bro of UVI1J'r5-tiWITCHLS-Il%'IURfS
33 hi,..wM ei cr,m do th kcin, ire wow docs%uch t ime himself a t ed far
hi,own cmlhyce,Pm%idd du(%wh impm%%old arc.nn incur of a allcml Eat NEW RRSIDIN'r1A1.ELECfR
sale.IL hawevcr.0e huildine orimpmvcnwnl i%.'d wiNin one yar of compktia4 the SV.FL FLOORARE.1 LSV.I'1'.
nabuii will have ae,bander of treating that he did rep build a improve for Pur-
pose or.Iad.
1.m,owner m IN 1'n'lany.am exdmivdy cr'a Pim;with rcclnN adorn to 'rDTn L:
coniat kne Pro}l(4c 7641.Bmmtcv and Pmfe%ium CnJe:)'De Contmcara 1j-
crn Law acesnot apply to an owner or pm
oapy who mildape%
%c imovURma ,y:d QTY, PITUMBING PERMIT RFT-
wina
ourant to for such P'mjee0,with a connown Hs)hxmed lamunin 10 the Contrxrofa
Barrer La, PERMIT ISSUANCE!
P am e.",ureic Sic. .B R P C for this rteam
ALTER-DRAIN k VENT-WATER VA) VALUATION
Owner Date
WORKERS COM%iNSATION DECe roUn ing HACK FLOW I'HUfIiCI'.UIiVICI!
lemon ill oninat uMcr Penaltyofane of the fo oJo declErnWc"efi'm%:
�Ih.e aunt wile maimvna CeniB4ae WCarenno alf-imumf«Wdcr%Campcn- DRAINS_FLOOR.ROOF,ARRA.GOND. P:STY%iCONSO(UCIION
w kom m povidcd or by Section 3700 M de I�bm Code,for Ibe PeHn^^ana M the
work for which thi%Mnnit is uw'ed. _ %%TUNIS-PER TRAP
0 1 hate a-I will maintain Wndeh C mq'anmlien Imulumc,m rtquird by Serino
37b0oflhe WMr Cody Gr the fe,fortuamcofthe work for which(hit Permit is i..ec! GAS-FA SYSTEM-1 INC.a OUTLET'S (�.GROUI' AI'N
MyWo Canlren.lp lnxumnaemmer and Policy9 mb4/lr �^�
CyrPak,Na.: -1.r ge CAS-B.A.SYS IVA-OVER 4IVA)
CI! FICATF.OF ESIJ111'fIUN'FROM WORKERS GRP,ASENINVORL WASE INUTICEPTOR
COMPENSATION INSURANCE. BUILDING DIVISION FEES
(Thi%vxti'm nml ax h aaly'leeA iflle pomit is In,arc baabcd"bn 1510 8) CREASE RAP
or 1h,.) PIANCIIECK FEE
I cmify that in the perfomunce of the wm1 for which nut Permit is i&VkA l dmI SEWI7R-SANITARY-STORM QA.200 FT
nm employ anY Iw"N'^in onY'nanwr m:u to hxro'rc nub'Jecl In the WuRrn'ComPcm ENI!RGY Il!T.
OZ .lion Lateof CaI1hnia.Dore WAIPR H EN]IN W/VENTn;l_1VI'R' GRADING FEB. O
Z O Alplicenl
fn NOTICE TO APPLICANT:If.afar nuking bit Cerifrate of Evi mpbian.you nhwW WATER SYNIbvVrREAT1NO
F — haome.bjen In the Worker%ComPcn.uian pmvivms of be Isbm CLdc.yma mon SODS FEE
14 .�,x fordwith comply wif Nch mvisi.or 0mi,pera t%h 11 he dsmcJ rt%okcd. WATER SI!RVICI: 4 An
Q
CONSTRUCTION LENDING A617NCY '1 F IAL PLMB, SQ.FT. PAID
UO h:mbynnimm tl'enlamita,o,,o.nlnn lendingasamy lir me l'tTimianee of ate Nnxiltp
1
IL F^': the work for whi,hmi,le mal a i..cdl(,Scc.3047,Civ.CJ A
ll
0U Isaacs N.. AN TOTAL
} infa
WBUILUIN'FEE
6. I raritythan1 have atIhi%a%Rlm canue
vtild that hi,shove vlahw is `�
V) cortcc4.Ii'me to comply with,A[city and n'umy adinanac ard.hws retuning. 4'''Y. ' VWMgCE1r1N(0ALPERMIT FEE
U Z buildarg,morwtiom.and hereby authorimrgrmenaaiveofthis city w eranupan the SEISMIC E
ah'vonsminad lm,eny for ico c lian porod,en. PERMITISSUANCE
(Wc)a,num.ate,i nkmnil aid keen hmmlc%x Dia City of CUI'mIre'ag:dnxt ELECTRIC TRH
Babililiex,jodgmenls,cmi anti en(cn%u which may in any way accrue agaiml.id Cly ALTER OR ADD TO MECH,
PLUMBING IRE
in iim�ucdkc if he iman.,of Ea, muL
K`PART UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIN HANDLING UNIT(f0❑I,III#I CFM)
MECHANICAL ITE
C(�GRCURCG NEGUTATIONS.
( , AIR HANDLING UNIT LOVER 10.000 CFM) CONSTRUCTION TAX
Srgnam, nfApplicaaV owtlwlar Detc EXHAUST I IOOD(W/DUCI) I IODRIN(i MITIGATION FEU:
HAZ RIXWS MAI'FRIALS DISCLOSURE
Wll the applicant or future naiding rcculant mama lwndle hmardw%:manul HEATING UNI'I'(TO 100.00)It IV)
is dcfnd by the Copm4iao Municipal Code.Chapter 9.12,and tic Health mad Safety r,
Cndc.Samoa 25532(,)^ HCATING UNIT'(OVER I00JKX0 BTU)
❑Ye ❑ ENfI
No PAID
1 VLATi(IN FAN(SINGLE RISIU) Date Reecipl I 1
Will the applicam or comm building occup of me alu lfci an dcvia%which '
emit haradnox nir cnmamimnty ax lkGmfi by lhr Puy Arca Air Quality Manuy'cmm�t ROILI!R-COMP UHP OR g ditoo 111U)
% TOTAL: /t J
Dimiu? BOILER-C'OMP(OVER 100001 H'I'U)
❑Ye No
IM,mad lie hamdae m,,mki rcgwecncbv%under Cl,.6.95 of 11e Cali- APR CONDITIONER �-4ISSUANCE DATE
forma Ile,hb&Snfny Code,SMiae 25505,25533 reit 25534.I undnvanl them,if Ile NEW RISIUENIIAL MECIL SQ.ET. 2. / �,- 4 ry
hoiWrult ace,not NfTxly have a bacon,shat it is my bep'xeibilily la notify E,ect,am I� O
or dw rtyuvcmmt%whwh must he ren lda w isswwx M a C'ytifcvlc of(kx'uµu'cy. T
pwmcrw amhim cd agent [)We TOTAL: ISSUED By L156(5A f
OFFICE