S1995 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL Pr; I'r NO
BMI,DING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 1995
BUILDING PROJECT IDENTIFICATION
ItUl1.lY IMG ADDNISSI ����� SANI'p1RV N0. AI'I'hI 11N SUBMII'ITL DAII[
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ARCHITECIENGINI2R: LIC NO: UHE,S.S: S nD ❑
CONTACT: PHONE CJ,YYII�IJJ 1" BUILDING PERMIT INt"
TOi / !off ❑ Coacnitant Fcec Paid by Applicant(Initial) RLDG ILLI T PLUMB MliCll
N� sqS o / ❑ EN" ❑ ❑
LICFIJSHD CONTRACTOR DECLARATION i1h
ELECTRIC PERMIT FF,F,
I n.mny animt dint I lull lieenenl mukr I,ndNimw.n Chap u,9 arwne - 1013 DESCRIPTION
WOZ with Scctim 90110)of Divixirm 3 ofdieJlusims an] fes tw xk,",for,l'xeRESIDFNTIAL
F�� in full force aro cited - PERMIT ISSUANCE
3 S ❑SFTJWI. ❑KITCHFIJ HI1.10DEL
QUV hiccnxc Clay-T�_A��IicX N'PLIANMi-RESIDENI'IAI, ❑ADD]T]ON ❑PLUMBING HE PIPE
C'tnlmdul
o.
ARCHITECTS DECLARATION ❑MULTI-UNTT ❑STRUCTURAI,
F w f urdcrxtand my plus.shill he uwd n public reaads PANELS MODIFICATION
ZOZ � UP10200 AMTS [I INTERIOR [I CHIMNEY REPAIR
IScroscd Prowesimal 201-1001AMM Ih1PROVFhfEM' 6SWIMMINGI'OOIS
CY OWNPR-BUILDER DECLARATION OVER I"AMPS ❑BATH HFADDEIBEPIR ❑DP,IdourioN
IY C Q I hcrch ]Edit Thal I rm ntariff front the Cnnlmcmr'x Liccnw law
ya ❑OTHER CIOZU D FoZ
c.U hdlnwing vmr.(Scetinn 7031.5,Rusin.,utd ItaRxeims Calc:Any city,a atwnry SIGNS BI,I!CI'RICAL
W 3 Uuh which retuim To permit to crm4ruct,alter,inlpmve,demo]i.h,a return was,..Core (2 r 1 u3z e.ES A r
priorm rex ixwwart.alm myuiiesnerpplicam Rrsoeh pnmiuo file.xignMd nunsd SPECIAL CIRCUITMISC.
yIbm he i,llccnvxl pu,narun Ili:pmviwmd of the Cunlr;Iantrx Liccnv low lChaplrr 9
(cmlfnnx'ing wish m
S.di700(dof]Tvism l� 3nf the B.inecr wall Pmfessiom CaL:)a TEMP..MG11i14 OR POLE INST. COMMERCIAL
d a e that he is camPl Ihcrefmm ad the WG%for the dkgd csemryion.Any viMaun M ❑NEW BLDG/ADDITION ❑DEMOLITION
-dim]0315Ayeny eppllcw far.11mi1 canto's O,rppluanl In.civil Prlalry of POWER DEVICES ❑'rPNr1NT ❑FIX)U SERVICE
W,nxxc diad rive Cordo,JUllwx l55fx01. IMPROV EMEM
?O nI.suwnu of Nc pmpeny,amY'empin,ccswilh wegcsas deirsdecmtp,mwion, SWIMMING 14 MI.ELECTRIC a �O1NER
I.+ Il da lM work.vWlheswdure is nut inleMed ufuffml fix sale Pit, 0,1'4,Buxiness
IPI-� mxl YadL,,,aa,Cid,nv QmINCtorN Liccnm law dotes not.I,P, ,,w ownu,of 11)'I-$WI'rCfIES-FlX'I'I1HIS
a 3- prupeny wM Wilds a inflators,dicrnn,aIle whn dues w.h work hireelf for Ihmugh
his mien enytbyms,pmvnkd[hal wch imprmerlenl.arc mM inteMN m offend fur IDINTIAI,FLI:CTR W IT.
sale 11.Wwe.cc de M1nldia,a, mpnrrnnent is sold wilhintneyearolbanpknbn,the Sp.FT.Fl.(%)KARBA 5/SO.FT
mo-dlil,.r
will haw We huNen of pnrving Ihm W did mot Wild or improve fur Ixu-
pee o -k.)
I,es nwter of the 1„i'ertY�vm c.adusivGy mmraung wish Iicensd rm—lusts In ',DTA
dawn IM1c pntjat(Sea 911W.Huwircv and Pmfu'xims etde:)The Cunlmdurx Li-
sense Low Jodiout uOdytoanowner ofPors Y whist Wilda,imPruves lhneon.and QTY, PLUMBING PERMIT FEE
who cone-acts fa ouch ryoje t,wish v turslMO Iicervvl pu—m Ne CCIatMtU l
Licenw,law. SSUANCEIvnc,arynual]erSet, .B&I-CbrdiiNrtuxnDRAIN A VENT-WATER TTA) VALUATION
Wf1RK[R'tiC(1M1'INSA'1ION UHCIARA'rIDN DW PH[TIIiCI'.UP.VICHFl�H)R.BOOP.ARBA.CO ND. SORIIS TItylion,as pmvid.d fns bySeim 3700 of the Indra Cd,,,hr the Isef'.nce M the
wph for width Ibis pcnnil ie is,wd. 5-PER TRAPhere and will maimein W'a,,,,Cumenwim Inw.amc,m ceyund by Seen.
L,d rCode,falhc perfamanceufthc w,A for which Illi,pnmil is iawel. .SYSTEM-I INC.4(IURE-I'S DCC.GROUT' APN
MyWvk�rs�� lion n,aynpr�yrJrjynif. GAS
Camp Sl 1 1111 O,.� L�
CERI'IFlC O E SAI TON
NYINS FRONT WORKF,HS GREASFANDUS I L W'ASTF,INHiRCIJHDR
COME an,jAc]itfic cariANCI! BUILDING DIVISION IlAS
(This sttliim Nom M1u amylldd if lM pcmtil is funtrohudlmJ thdlrrrlSlllfry GRRASETRAP _ —
m1anJ 1 C iCK FFY,
Icu,y land in lhcpMotmarec of the wvA Lr w'hkh this pcmill is icw,d.i shall SEWER-SANITARY-SfORh1EA.MITI.
nut cntpiny uny pc IN,any a riu,ret:.to Crani,xuh L,to the W..kcal'Cnlnpun_ IiNGY
0 Z rasion law,of Caldomin.Date WA'IP,R HIAMR WNINTIELEC R GRADING FEE
Z Applirem
NOTICE TO APPLICANT:If,nflcr making Ihiv Cenifi.e of f:.cmpmn,you slxmW WATER SYS'ITAIGNUAIING -
F' ; hcaome suh0
jeci it) Work es Cumwm In
penGtrvi.itxls of IIx:lalan Codm n
e,ymst S IIS hili
I0. .. fadiwith ntmply with witch pruv'usiats ar his pera it sball he deterred!mounted. WATER SERVICE V\
UZ CONSTRUCTION is a IONLENDING ng ncaY NEW HESIUHNTIAI,III-MIL tiQ.EI'. LAID Dom aeiplX
I herehy affirm lhel then ixacumuuclion lrnding age yf«IM'pcUarmtnee of�- the wa,k fur which lhislrnnit to ivucJ(S,v.3091.Ci,C.) TOTAL:
OF' 1<alkr's Nan,
U lender's AJ,rcu TOTAL'
F EV
d '1 cmify that I have fluid this atupliruinn wall data that,,above infmmalim i. BUILDING P
to nmcd.l egrtemntmlxy aim a]I chy.rd cmnlY'^Bina^ra vtd nue lows rtluin8m QTY MECHANICAL PERMIT FEE
U n ddingnnslr.ctr.,..nd Mrthy..11xxinc mprt.mnla,ivu nfl ll,ily to enter ulxn lhC SIi15MIC Illi
uM se wrlinned pruptty I'us inxp.lion prtrytxcx. PERMIT ISSUANCE, ELECTRIC PEE
(We)ag_rel.ave,indcnmify am]kap IlaradvT,We Cil,of Cupcnw folim4
Iinbilaic, which tray in eny son,xa.e alainvl and City ALI 17R OR ADD TO M ECIL
PLUMPING FEE
in
cnn[CAST Ndt.RSTA g S AN pcnnil.
APPLICANT UNDERSTANDS AND WILL CONI PLY W'I'fH ALL NON-P(11Nr AIR IIANUfJNG UNIT(TO 10.010 CFM) MECHANICALFEA
SOURCE REGULATIONS.
AIR HANDLING UNI'I'(OVER IB.nXI CIM) CONSfHUCI'ION'IA%
SignatweNApplicanVConnecmr Doc EXHAUST HOOD OVDUC) IIOUSINGMITIGAIIGN FEF.
HAZARDOUS MAliJt1AIS DISCLOSURE
WIIthea"Boum or future budding r,cugml ammaI wdlc ha'mNous..Lochial TAPING ON IT'(TO I E,off)11 IU)
as dell,,,by Inc Cn,aEr.Municipal Caddo.Clager 9.13,was!d,11Wth wad Sticty
Cde.Salim 25531(a)^ HEATING UNIT(OVER 100.0110 H DD
❑Yes :1 Not VT N[I IA[ION IAN(SINGLE RES]D) PAID
Far, Recoil,#
Will Ne a,,lcanl m future Wildn,a cumin l one egaipnrm for devices which HOILER-COME CHP OR 100,1XX1 RTU)
crNl Warden,a,ruframircon,a defined by IM Bay Area Air Quality Mwgement KI
ntdncfl BOILER-COMP(OVER 1mirm H'TO)
❑Ya ❑No
I If
1 fruit,01:x]the huvankwx mmcti.lx r - IN diol.,Chinn,M1 95 of Inc Cul' AIR CONDTDONER ISSUANCE DATE n
ymmlen /1 Z O
Imdi,dco,A surely fink.o,G 15.505.25533 aha 2abdi.1 ualknwrld,hal r de NI:W RESIDINTIAI,hf I:CH. SO.FT.
,A the,a,te51m1Moliwb or"ho, M1911.1 ar...ior no,ImT, f.
0,
11K t%CYI®II
tx 0,mryimmenu which,hint k mel pn�,In iwaae of e C'nifleem td(k.vparuy,
Oester maNhonzd egenl Data TOTAL: ISSUED BY: 1 Q
OFFICE