30199 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO.
BUILDING DIVISION APPLICATION/PERNIIT PLUMBING-MECHANICAL 30199
BUILDING PROJF. IDENTIFICATION
BUILDINGADDRE.SS: _ SANITARY NO APPLICATION SUBMITTAL DATE
0 6� o e gad � t Cup"-,1 rJ ISGr96
OWNER'S NAME LL YIIONE: CONTRA R;S NAME: LIC NO:
r L Sat ki` r NIC CONTROL
ARCIU1tiC N( N'+R: LIC NO: - ADDRESS ❑
L ' :31 i S e 55- 14ong
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Ft Paid by Applicant(Initial) yLIIG •E}LE�CT a.uM MECH
flSo �
SEDC
LICI1.' RACIOR'SDHCLARATION QTY ELECTRIC PERMIT FEE
1 heahy affirm,that 1 am Iicenud miler movisinne a Chapter 9(commence., JOB DESCRIPTION
�00 with Satim]O00)nf UivislonJof the Busiass ami Profcudm Cock,and mylittmeu PERMIT ISSUANCE RESIDENTIAL: -
in full force aril cf(,-clsl
IF V Lamle Chis C.- Licr ❑SFDWL [I KITCHEN REMODEL
�Z, Dam Comracmc APPLI ANCIS-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
ARCHITECTS DECLARATION - INNEfS [-I MULTI-UNIT ❑STRUCTURAL
Zp�2Z l uncicrvnrvl my plugs shdl be use m
vv public rcrSv MODIFICATION
OZ—� UPT020TIAMPS 0INTERIOR [I CHIMNEY REPAIR
��~W� 13censW lamfeesimW 201-1000AMPS IMPROVEMENT OWNErn scter"fr.DECLARATION OVER 1000 AMPS ❑BATH REMODE1BEPAIR ❑DEMOLITION _
1 hereby•f!trootOW 1 R-cUII.D Tran CL RATI Contractors Licrnse law f«the
1X 0.V following meawr.(Section 7031.3,Bo,ie.urd ItofeNe.Code:Any city,or roomy SIGNS ELECTRICAL ��
which regmrs,a pent w wham,slier,improve,drep
enudish,or s,any si.cec �^
pd«mill l.cswuw ,eLw require the applicant fur such pcmtiLmlleasgrme YdlernLht SPECIAL ORCUITIMLSC. '
tA That bcu licrosdpursuenuodn pwnaxru nfmc Contnatols Liccnx Law(0bepmr9 - --
C�� fcormmaWg wmSaYian](1f10)of DivisionJof the Busireas artl Pn�fessiom Codc)m TEMP.METER OR POLE INST. COMMERCIAL
6 q real he i•escmp Ihererrnm and IM Iasis for the WIegM exemption.Any loAarmn of ❑NEW BLDG/ADDITION ❑DEMOLITION
W ou Satiw]OJISMany applicenL f«apcnNt sub}ccra cite sPNimnt tnecivil pcalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
t m«c tun Ovc huwlml dollar($500). -
FZN °O IMPROVEMENT
C ❑I,othe.efofndche ourchur i,oNimondecimhwager ns thcirsulecnmpe�mtitw, SWIMMING POOL ELECTRIC
witi do diework,wulthe cCoais,tatinmm)eor..do f«sale ISec]Ofi.Busma ❑OTHER
arilemfe.csims C,Id,male Cmnrcmlr I,iNI whlawdux vv apply slf owner of ONLITS-SWITCIIFS-FIX
prapeny alio builds m bolaoree thereon,aril who noes such ash himself«erred.
M1i.own etnployeex,pmvidN tMt such impovetnrnts oR Tut ivemdad«o,B f« NHW RFSIDEN'IAL F1 m:CTR aQ FT.
We.lf.ha.'eva.dre building«inynovemrcmie wd within one yblo c pltoon, he
• SQ.FF.FLOOR AREA SISQ.IT
weer-builder will have the bmdcn ofMving that he did m build«impwve for per_
1..elcJ. - T A ! D
❑.ni thrcr of the Sec.property,em eve lwsively mwnete.g with license ctmtmctm w
o La dp,not (Sec.oan Hu.of and ywhormxd,depThcCo
estheetor'sLi-
whocool I,ko,t,h Y ,,wither MlmlcnY wlnbuilds«int that,Commu•end QTY. PLUMBING PERMIT IC
who
wnncmn,wt.r«wen prmjrctn wnnacmmrractnnx)Seemed pvrstuntmme c«mtrecrm'• JUL
License PERMIT ISSUANCE 10 1996
❑Tam cacmpL under See ,B&PCfarfais n -
Ower Dam
ALTER=DRAW&VENT-WATER(EA) ill ! Vr i jot VALUATION
WORKER'S COMPIiNSAI']ON DECLARATION ^CETT°gV
BACK FLOW PROTEGE DEVICE \`
1 hereby sir uncles,lenalty of perjury oea of the frfloworsure i er Worker,Crimper-
ri ' G•-
❑Ibevc and will forbineCervi YtOO of co Uttar salt-dtunar«Wrkcra Comp the DRAINS-FLOOR,RWP,AREA,COND.
cation,as pmsvltl f«by Section l'M of the IgM Cadc,for me performance of the STORIES TYPI?CONSTRUCTION
wak for which Nis permit ie iwue. FIXTURES-PER TRAP
❑I have and will maintain Wndeels compensation Imus«e,a ayml,cd by ScOinn
3700mfine LaborCoda.fm use pofmrnrce of the work for which this permit is issued. GAS-EA.SYSI M-I1NC.40U LFDi
My Wrket's Tan onl nsumnm courier and l'oI Tiler on,. GROUP- ANN
% Gorier: t Policy No.: GAS-FA.SYS7EM-0VF.R4(FA) -
CER'IIFICA11iOFEXEMPTION FROM W RKERS'C.610 5W
COMPENSATION INSURANCE �+ GREASMNDUSfRL WASTE INTERCDPIDR
(]tris section need not be cornplwd Bute penal is f««re M1umdad dela,,(SIIXB BUILDING DIVISION FEES
or ret,,) GREASETRAP PLANCHECK FEECNLf)tV(D
I certify Char inme perch raeof ire we,k f«which this permit is issue.)shall
nmemploy tiny per,n in vrymamnr m us m ncc,noe.ubatin the Wrloc 'Crm 'SEWER-SANITARY-S]ORM E5.2W F1'.
Z sati°a laws of Califomu.Dem ) pen- ENERGY FEfi
Z WATER HFA'IY,N WNENyELEC1R
Z O Applicant GRADING PP2
NOTICE TO APPLICANT.If.Compensation m roiling thio Ccnifinef of EacmprCe syou should WAIYR SYSfEM?RGTING
Wf•' became suM1Jat,it W«lcmo Ikcrno,iom of circtabor Code,you must SOILS FEE AA V
� f«d,aim comply with such movi.itms or Ink permit s'hull be deme)revo4eW. WATER SERVICE•
D G
w7Z CONS [ON LENDING AOENCNEW RESTDENf1ALPLMB. SQ.FT. PAID
U O IbertbY•Rrm Out there
re I,isa mnmrunim keine egrrc,fnrda perfu,manc<of Dm eeiptx
� mcw«tr«wnicn mix arndtuiss«dlSec.3091,c..c.)
OU
I--' IaMc/s Name
TOTAL-
TOTAL
OTAL
Irecr'sA n.... TOTAL:
y I anify that I have A his upplic sun and mut,mai dm aMvc information is BUILDING PER
v) cmosL.l ape to cvrnply with aH city aril county«dime,and state lawn relatingm QTY, MECHANICAL PERMIT FEE
C„J ,7� buildimg cau'uucLion,enJ he+ehy aurhnriau rcpaxntativice of Ibis cityromter upon time f!
SEISMIC FEE
shove-rentioncd pmpeny f«in.spcction purryncs. PERMIT ISSUANCE
(we)agree to save,intcroody end kap footnotes'the City of Colton.egaimL - ELECTRIC FEE
liabiluics,judgmmu,costs roil eapcnsa which may In any wuy accruagvnY said City ALTER OR ADD TO MECH.
in cumegteaa n!dr granting mf Jou permit. PLUMBING FEF,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM)
SOURCE REGULATIONS. MECHANICALREF, .
,I AIR HANDLING UNIT(OVER 10.00()CFM) CONS]RUCHONTAX
SigaLwcof ApplianuC... T— Ilam EXHAUST HOOD(WA)UCO HOUSING MITIGATION FEE
HAZARDOUS MATT IS DISCLOSURE
Will rlteepplkwL«ftutue Wilding occulum Yore«hardk mucriol HEATING UNIT(TO 100,000 BTI)
as&fired by the,Cary-+lino Mtoneq el Cede,Coupe,9.12,aril the Helm ere Safety
Code.Senime 25532(•1] HEATING UNIT(OVER I W.00a)BTU)
❑Ya ❑No
- VENIIATION FAN(SINGLE RESID) PAID Dem® Rceci
WII ttc applicant m fntsa WiL we M
g«cupm equipmem«devices which - HOLLER-CUMP(1HP OR I(p,(xlll H'HH ci1N hvvduul air contaminants act dcfnfim e by the Bay Area Air Orality MuagcnanL TOTAL
District? BOILER-COMP(OVER 100,000 BU)T
❑Yes ❑No .
I have mend me hs000 normals aquircmme,wader Cltager 6.95 of th Cali- AIR CONDITIONER -
ISSUANCE DATE
forme HWM&Safety Cee,Sations 255(6,11533 on, tad 255th.I mnothf th that it da: NEW RESIDENTIAL MECH. SQ.FT.
W idimtg dm rte s which mare th tmvu,mm h ie ea rn or
Cali fi Lo emif)'de aavlvn
M the mryuiamrcnLs which num W met prier ro i.ewaree of e CMifcme d llavparcy. I '
Ownerv aothoriaed wont Doc TOTAL:
ISSUED HY:
a OFFICE C