29257 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL, PERMIT NO.
BUILDING DIVISION APPLICATIONMERMIT PLUMBING-NIECHANICAh 29257
BUILDING PROJECT IDENTIFICATION'
BUILDING nI)DRPSS � SANITARY NO. APPLICATION SUBMITTAL DATE
HAI
O NER'SN/Ai/M3 /PHONi- CO' AR 2 1,1 1ROL#
(v 73o
NIC CONTRULN
�ARCHITECT(ENGINEER: LIC NO: ADDRESS:
T PHONL
CONACBUILDING PERMIT INFO
J / 8 ao ❑ Consultant Feeg Paid by Applicant(taller) BO - F.IO PI.0 MOH
LICENSED CONTRACT'OR'S DECIARATON QTY ELECTRIC PERMIT FEE
I nanny aranll ibw 1 all Iica.ud nmmr prl�d�6.�arcnapmr v I�.am�nr�wis JOB DESCRIPTION
WOO dhe6m]Dq).f DiviaimJaid,Bmimeuurd Po,fi,. uCd .and! icrnuu RESIDENTIAL
O Nfull(arcea a—� PERMITISSUM'C'E. ❑SFUWI. ❑ CHEW RFMODEI.
- FFV`j CucnicC tic.11 EZ� APPLIANCES-RESIDENTIAL - ❑ADDI770N U RRE-PIPE
y Dare ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z O n K I wdcnwnd my plan..shall W and as public ravel. MODIFICATION
OZ-0 UP T0200 AMPS ❑INTERIOR [I CHIMNEY REPAIR
Li«nuvl Pn'tex'bnel 2014000AMPS IMPROVElMENT
OWNER-BUILDER DECL.ARAHON
OVER IIp0AMP5 ❑BATH REMODEf/RE AI ❑DEMOf.IT10'
C 6 I lb rtby aft that 12m ucanpl from the Contractor's Lice Law fm IM
K)LL V following rev .(Section]0313,Busi.not Profa.im.Codd Any city or countySIGNS IiLF,CIM1tICAL ❑OTHER
YI which r,,mu..a Pcmrit In cm.wc4 nlwr Impove.dnnnlieh.or mpir army wucwm
(_�•� prior to is issuarce,0.reyuim lbe applicmu r«such permilm filt ugred stunKnr SPECIAL CIRCUIT/MISC.
;!1} IMI W is licond pmFuam to lft,provisiimsorth,Cmnm ore,keens,Iaw(cLuptcr9
aa�0 (commcricing with Stttim"lgkllof Dividm 3ofdr Bwi.sud Profciors C«k)« TEMP METER OR POLE INST. COMMERCIAL
IL6 e K bar he is csemlx d fmm ud the Wsis for the alleged esempion.Any vialruiw of ElNEW BLWADDIT ON ❑DEMOLITION
roy Secure 703 Ll by any npli cent f«a parmn suhjaaslhe opplir mart'a civil NuAly of POWER DEVICES []TENANT � ❑FOODSERVICE
HZ} nor Mort Than Hv,hundrd dollva:550(0. '� IMPROVEMENT '
Q ❑1,as owmof the peapeny,amy employm with w'agn es dlnrsde comrlensvion. SWIMMING POOL ELECTRIC
iii do the wok,and llw suacmm is not imendcd or oRemd for ulc(Sea.7194,Hnssinecs ❑OTHER
3 ad Proreuiom Cade:The Compactors Li«rue law yen not apply to am owmr of OUTLETS-SWITCHES-IIXTURFS .
propmy who builds«im,novis Ihcmm,ad wW does such wrak himself or Ihwgh
his own employees,pnlvidm IMI such intprolcmema mm mr mmmdcd«offered for NEW RESIDENTIAL II,1!CTR SQ FI/ ti
sale.If.Mwever,aleWilding«impeuvenrnt is sold within m,y .fomopledon.the ISQ.,IT FLOOR AREA LSQ.FT.
owner-laudl dI love the W rdem of leovieg Nat la,did ver Wild on mn mve for parr- a'l
pnr of mole.). '
❑ I,u owrmr of Nc SsV.70y,am Business
ine s ady mmm cci. rnurIr- TOTAL \ _
c.La I l pmi,n(S«.]tilt som-of ad P .ho t i Code:)The Comfort,t1ou Lr-
c.
�- 19n
'No contracfur ts
yman ith. ofpmperry who WilJsrrttovcs Con.n,e.d QTY PLUMBING PERMIT FEE S' 19 /•796
xdla,mpa«a r«.Iles Prai«ta x;m.mnpsemrral lie,rced panaant m Ilrt eana.,lnr.
Li.law. PERMIT ISSUANCE LUr L
❑ Irun ,,st tudcr Se, .H&P C Rvtbis mmm rI+I1N
D to ALTER-DRAIN&VENT-WATER IEA) VALUATION
O nn
WORKER(YIN PIWSATI mr DECItfollo ON HACK FLOW PROTECT.DEVICE
I hereby sfr under prndry ofp jury o«of the falbwing d¢lualiom
•❑Ihav<ud will maimaies Cenificue ofCmam mxlbinswe Gp W'mkNs Cnmpm-
DRAINS-FLOOR.RWI'.ARE,S,GOND.
lion,us provitkul for by S«iim 3700 of lo,IaMr Codc,nor(kpcfosrmmc ul mc, STORIES TYPE CONSfRUCI10N
wvtk f«which this pe.t is usueL FIXTURES-PER TRAP
❑I hsv,ad will meinlnin Wukefs Cunpanvtion Insumll,e,not rmulyd by Sectio
37W ofthe labor Cone.ft'Ne psrfmrroa c oftba work for which this p,mlit is issued. GAS-IA.SYSIIJN-I INC.d OUTLETS OCC.GROUP APN
My Workse.Compensation lnsumace carrier ad P.1heynundt ere:
Cart. Palley No.: GAS-FA-SYSTEM-0VERI(PA)
CERTIIICATI'.OF EXEMPTION ION FROM WORKERS'
COMPENSATION INSURANCE GREASEBNDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION FEES
('Thu rction nc4 nal Mmmpind if the perm))is firma hurnbcd dollars(SI00)
or leu) GBEASH'1ltAP PLANCf{ECK FEE
IcrnifYtha imlEC perfomurce ofthewrkfor hicb this pemul is ksu�l shag SEINER-SANITARY-STORM EA.20(1 FE
mr,m,,I,,,Y ymnnar ul}i UNE
Cumpen- ENERGY FEE
z .Z sumo.Isws a i / {O WATER HEATER WNFNI ELECfR
O App:icuu GRADING FEE
ti NOTICE TO APPLICANT.If,ufmr meting thin Cmif¢of laempriom,you should WATER SYSTEM? TING
(•" become subj,cl t.de Workers Cmnpenwlio....inion,of dr tabor Ctde,yw most SOILS FEE
Wfa %iNcxnPlywiN xhprovislau«Nupmnilsb.Ulbcdcrn mvmkd. WATER SI:RVICf! _
0
Uz CONSTRUCTION HON LENUING'.,,MY NEw tiFSIDENTIALPLMB. SQ.FT. PAID .
G O work
when thmrmf i is arnnspuct NYG.Cing .) for lk lrH«nurcsof Dare R_'P`_#
W .. tb,wok(«which this permit in)awed(See.JIM.Liv.C.) r
O F' Lender's N. r TOTAL:
Itrdvl Addrecs A A
Iy I csmfy tum I Use red this applicaim ud Sime,hot the utwvc inhmmliun is BUILDING IEE:
Z rnrtcn.l ega mmmply wish oil city red county omlirurces arta sta¢lewvduingm QTY.. NIECHANICALPERMIT FEE
V Z WBdiry mumrrion,and hneby vudwriu repcscntuivea of this city rt'cnlcr upon the SEISMIC ITS
uWvc mcmi.rlcd pnyeny rm inN.n Rn purprncn. PERMIT ISSUANCE(We)Most to save,mulsou fy ud kcc,harmlens But City aCupcnimo agninsr ELECTRIC FEE
Iiabditimjdgm tru.costs and t,s,st which may in any way accost against said Cly ALTERORADDTOMECH.
in amsequumn of the grumitt his pcmdt. PLUMBING FEB
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.0-0 CF)M) MECHANICAL FEE
SOURCE REGULATIONS. -
AIRHANDLINGUNIT(OVERIq(IOOCFMI CONSTRUCTIONTAX '
Sigvmmor Appli iXor Uredos Due EXHAU.STHOOD(WMUCI)
HAZARIRIUS MA'DIIIAI S DISCLOSURE HOUSING MMGATION FEE
WBIIk spBkam ornmom buildingocoporal sten«handl,1coamims owcrial HEATING UNIT(TO 100.000 BTU)
u Aefrrd by Ne Copnslru Mamlclpal Cub.Chapter 9.12,uta tk HmIIh ad Sarny
Cost,S«da.25512m)7 HEATING UNfr(ovER 0kUlIDBTU)
C3 Yes C]No VENTILATION FAN(SINGLE RF_SID) PAID
Will the a
Date Reccipt 0
ppliam«fumm building«ca Bay Abut
Air Quality
Mc,swhich BOILER-COMP(3HP OR 100,000 BTU)
I buvdau�air maumiruma ea defiml by ale Best Area Air IhlalirY Muugemrnr TOTAL
DlYlrl[L
❑Ys ❑Nu HOILER-COMP(OVER (1),00()(1),00()BTU)
I have read the bersrdow materials requirem N'oder CTaocr 6 95o dr Cali. AIR CONDRIONER ISSUANCE DATE
foMa Haaldl&Sefny Code,S imu 25505.25533 and LIS 1.I udaswd at it ale NEW RESIDENTIAL MECH. SQ.FE
Wildingd noc ly havea smart.dw It is my rnponsibiity b nobly Ne ompary
of Ilsert irtmcnt which must be mct pct«to isw, cc of u Cmifuac of 0Vcu ruy.
Owrrr or uudh«iad ngcm Dal, TOTAL: ISSUED BY:
OFFICE