S0540 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL lTgIIT NO, 0540
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROIECP IDENTIFICATION
SANITARY NO. APPLICATION SUBMHTAL DATE
RUILUING ADUHESS:
�L9 �'t 77
0 'R'S NAME H L': CONE RAC vR.S N M" LIC NO N� CONTROL M
IJa�Onv✓T5 w�r,�e� t < 7y�
ARCM II L '/bio /. //I 5�-/J I n l /A ❑
/2/c,a[' � -f`f (/v COs!' /� /ra- /5/�
CONTACT ^ PHONEy P� BUILDING PERMIT IRFO
G£ —v..JLsQ
9_3 19-,3 ? {, 0 ElConwltan[Fees Paid by Applicant(Initial) HLDG ELFM PLUMB MPCH
❑ ❑ ❑
LICENSEDCONTRACILIR'S DECLARATION QTY ELECTRIC PERMIT FEE JOB DESCRIPTION
1 fact all.,ttil I w,luawad under provisiMw ar Chapter 9('--at
nizzwith Sec'dm]ap)of Dlvixku3uftha Busiw,,smd Pwf1aiu sCode andmYlumsell RESIDENTIAL:
PERMIT ISSUANCE
U- in fit
fortxmdc 93DOLae, ficN - -/ -X 4 Zr - CNhDWI, [D KITCHEN HEMOUEI.
inQL Uam Contra T APPLIANCES-RESIDENTIAL CADDUION CPIAMflING RE PIPE
DECLARATION PANELS MODIFICATION STRUCTURAL
E.h Z 1 undalvund My plan.•hall he used an public mcanis MOUII KATION
ZOZ^Q UlIT02MAMN ❑INTERIOR ❑Cl i NINEY REPAIR
r4w Licenml Pmfas'r MI-1000AMPS IMPROVEMENT ❑SWIMMING POOLS
�SeOWNLR-BUILDFR DECLARATION OVER I" PS ❑BATH REMODFIAEPAIR ElDEMOUTON
C W st I hereby andiron that 1 for,excut from drt Cmuactors I.ic"w Law fm Ibc
Gtllawing rtman.(S¢linn]Iq 15,Business and Pndecvinnn Gdu:Any airy«must) SIGNS EiI.ECTRICAL IJI'HER
CLU
3 LL which rcgaira an P,,ma to co,oacei near,irnpawa,dcmnlixh,or rtpa,any awchaw
F'!' priarm itsivaawa.alssualm.the drPhicait f«achfaonit la ER nsignedsatelneon SPECIAL CIRCUMMISC.
y that is is hismsm purnumn to thatoo,isions.1 the Commnors License Law(Chvpter9
W COMMERCIAL:
Q. ffic,be
N saaircon dthDiai'n3oftheensircuanption.eainsCNe)M TEMP.Mt-f1;R OR Pl1IJ:INST.
Q. e oC Ihvt he ix esvmM Ihertfrum wJ the Nsix f«the allepcJ enoinpinn.Any vinWti«I of C NIiW HLDG/ADDD'ION C DPh101.IT10N
Smion]0315ba,any applicant for apturner sed*sJc-PlilinM to a civil Paredly of POWER DEVICES El'DiNANP ❑FOOD SERVICE
FZi act nuc than fvc humetd do1Ws 11508). IMPROVEMENT `
Q ❑I,ea nwlnrof me pnryuny.nr mycmpinycL.wish rages vs lhCirsale camper.won, SWIMMINGPOOLELECIRIC
will nd the wort and the structae is lis iluendN«uRcled f«ale(,Sm.]OW.nosiness [I OTHER
^ awl Pmfexsions Code:Ta Comr war's Limnsc Law IIoP not apply in an ess cr of OUTJTfS-SW IPCH15-Il%TURLB
,L may who WjU,u,imFrva thcrron and whom dm such wool,hin,alf or thrwgh ;DRAINS
IUFNI'IAL FLECITt SV FT
his own cmployme,Frontad duce such imp.wmaaw.van not Innewlsel or tHTcicd f« SQ.Ef.IT.00R ARE N LSO.IT
sale.If,hwara,IM building or impwo mem is.seld within one Yeac ofeompleiion,the
1lerauihlcr will mrt the Wardto M proving thin he did end build or ionpm.t for par-
Face of sele.). TOTAL
C I,as user M tha Fopeny,aon aaclusively roMrecting with licaosed antro.to PA
rawamct the pmjal(.Sm.71W1,Buainus and Pooch siom C dcq Tic Camracads Li-
,m,,law daces ru applyw an o acrMFrnr'rty w'nd builds«impruvastMeon.atd PLUMBING PERMIT IcEE O
wehomMraWfafsuch pa*cw withvcontmclo l)licavadpulvwM toan C«arancmfs Lr1
Lkcn.¢�1�ee ' ISSUANCE (� 1
Izempt under Sm. .Rh PC f«this rtasnn a
DRAIN&VENT-WATER MGI �: \'A , ON
Owner s Iatc
WORKEN'S COMPENSATION DECLARATION OW PROTECT.DEVICE UV~rj{jjNU
' Thereby vlRml under penully M perjury maofaw follwing deel.dom:
❑IbveWeill vuiltuinvCmi&mcof CamenunselGimurt f«N'mknl Compcm -FLWR.ROOF.ARIiA.❑OND. STORMS 'TYI'G CONS'IRUCTIOP
wain,r F ,detl for by Smww 3]ro of the lab«Ede,for d¢perfumw¢e of the
wrlk for which this permit is issued. !lK-NRIS-PLR TRAP
1 hove and will unsound.WMker's Conlpcnsm:n[..more,as rtqulml by Swim
3]00 ofthu labor C«Ic.fonh 'srhorw«c of the woN far which thin pmwil i,,iissued. CAti-IiA.SYSfI',M-I INC. OUfl.1!TS OC'C.GR( APN
si„ My WaheYs Can lllanntt aarricr and PWirypi/`a ^^
Camcc Cb/(_E/_ IPnIkYN�..L ✓ Z� ! GAS-EA.SYS'D-:M.WAS
Ai IJ INT (, J
CERTIFICATEOMPE EX SATION I N FROM ORKERS CNHASELNDUSI'RI.W'AN'I'E INTERCEPTOR
'
COMPENSATION INSURANCE 'll. NODI
.f
Mi, action sad Ma nd utmplaal fifth:permit is f«unc hundred d,Ila,(S 100) GREASGTRAP PIANCII :G
Voy my that in the imy wntnnccofuw,tacc for whiehthis pWWarlcmCclshdl SL'WER-SANITARY-STORM fuss,24)FT.
u,l empMY unY pclwnin anYnl^^ner aamlr hea,nte suhjmlto the Workeri Compcn-. F1.'I;R l:E
Z in.Lows a'Cdiwsram late WATIER HEslTER WNEN TLEC R
Z 2 Applicant ' GRAD 1 Il i
NOTICE TO APPLICANT:If,afro making this Canifwxtc of Eaagnioo,you should WATER SY.l'PFJsf/IRLATNG
V1 NUIIS MFG
afttnme subject at tic Worker's Cmupenemiis escol shun b lbs Wlor sake,you must
� �..� ImM1wiNnmplywith sucM1 Fr.isimn Mthisprnnit shush be decmcJ rcvakN. WATER SF.NVICL
6. Q PAID
CONSTRUCTION LENDING AGENCY NEW RISIDIWIlAL P1.MB. SQ.III-. Date RaaiFY
1 b aaby nf(uon that thaa I'.rmsvm+:,n aiding agency f«the pmwwanm of
U C the wI"for which tbie peril is i.suvl(.See 31N7,Civ.C) TOTAL:
01" Larder's Name
WL<ndcrs AJdms ITD'AL
r a I cmify that I lava and this appliomion and,are that the aMm
va InR ,alitm is BUILUI G FPH
F sol corrmt.Iafam to comply with dl city mal county ordinannctn and mine lags rtlning to QTY. MECHANICAL PERMIT FEE SHISMI IIT
U 4Wilding arnstrvcdn.unJ Mrtby vuthtns mpmscntmivsw of lhls city e.cnmruFntM
ebovc-Ilemitnal Pmpeny fair impaHon propos,, PERSIDISSUANCE, ELEiCI RIC
(Wel agree to nave Indannouty and kcal,hmwn ,the City of CUPmi a agniltn
habllltimpedgonmw,costs and expense which may in any way acerao against aid City ALT ER LIR ADD 60 MECI I. PLUMBING Ilii
I. «ncgacncc M the granullg of this gamut
APP" A UNDERSTANDS AND WILL . LY WITH ALI.NON-POINT AIR HANDLING ON['I'(TO It),("CFM) MLCHANICALFFE
SODRC. EGULATIONS.
AIR HANDLING UNH(OVER IU,IMIH CI]f) CONSTRUCTION T,\S
Sig cof Applkm tenor DocHOOD HOUSING MITIGATION IT
DAZARDOUS MATiRIAI S DLSCLOSURF
W II Nc epplicnntorf«wc building occupant stwc or Aandkhaw6ws material "'TNG UNIT(TO IB0.000 BTIH
m dc0ad by Lha C.I ince Manicipal Cade,Chapter 9,14 old Ibe Health and Safety HEATING UNIT(OVER IM."BrutCndc.Sttrinn 25532h.)?
[D Yet 0N VPNDLATION PAN(SINGLE RESID) PAID Dam RmdFn
Will d,applkmu or futwc Wilding omich t use cquipnow«chic x hich BOILER-COME'(3XP OR 1000X)HTU)
• TOTAL
crit humd w;air conwm o nts as deR d by Pat,Pat,Bq Ata Air Quality Malm
tageenl
Distinct? BOILER-COMP(OVIiR 111(Lleg1 HTV)
CYcx C]No
I have mnd tha ha=vdous llmtmals otechuma undo Chola 6.95 of the Cdi- AL R CON DI'I'ION ER ISSUANCE DAT17
broth Herdlh dt Safety Cade.$arbour 253115.25531 and 25531.1 utdclsurd that if the NEW RESIDENTIAL MF.CH. SQ.FT.
building duce tel mnrtmly hast a manor,thin it is my lcspsunNlily to"ify tN,aminmu ' /�
d'del,Nuirtromw,hirb mlm he Pic'prior m isstawm M o Cartifrwc of Occupanrcy. 11!:]( 1/
(TaT[fM WlhOniie-0agCM
IMa TOTAL' ISSUED BY:
OFFICE