99110048 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY . -I' ( 10 Q
CITY OF CUPERTINO RUILBINC-ELKCI'RICAL PI!RMI'INO.
BUILDING DIVISION APPLICATION/PERMIT PIAPABING-^IECHAmcAL
BUILDING.PROJECT IDENTIFICATION
BUILUINGADDIt ESS'. SAN I ARY NO. APPLICA'HON SUBMI'PI'AL D61'I?
'7971-/ lot
OWNS \C/DDCI.)tII �o/E p- CO RAFT f w �/�SiNIC CO,VIAOL a
o?�$f��i
ARCIIITECrIENGiNEER: LIC NO: r gglk{5�,.
1
CONTACT: ///111 GONE: /L/fzJJh �t BUILDING PERMIT INTO
❑ Consultant Fccs paid by Applicant(Initial) RLDC FLECI PLUMB MECH
OuLICCENSENS ED CONTkACTORS DECLARATION QTY. ELECTRIC PERMIT FEE ❑
1 bareM1y nlBnn mm n 1 I" auction]ander prnvixiontn lir Chapter 9lcmo;oenems JOB DGSCRIPFION
UO L,1h Sceli y�X1� vun lnfJm Duainccvvnd Proleeninm Cod c.In Jn;yllcv;uc is RESIDF•NTIAI:
Cp ,p , I'i?ItA11'1'ISSIIANCIi
F ;nfull force amlljtit Xt ZJC�.9, ❑$IUWL ❑PLUM IiNG R17 PIPi7.
<. U cnmC , -L[(j ezv 36L -lc.p APPLIANCES-RISIDLSTIAL ❑N)DD'ION ❑PLUNKING RIsPlPli
yah I)' Contractor
A RCIIE"TECCS DECLARATION PANELS ❑MUTbUNIT ❑STRUCTURAL.
MODIFICATION
Z o=K 1 understand my phmv shall be tamd as public records ❑PTO 2110 AMPS
❑EM'IERIOR ❑CHIMNEY REPAIR
�f]Q Luce necd Pmfcaein oil IDI-IIXX)AMPS IMP (WEMVN'I' C]SWIMMING POOLS
Cwt; OWNER-BUILDER DECLAIXA'IION OVER 1000 AME'S ❑KATIE REMODEIAUTAIR ❑DI'I'l fION
C a I herehy o(EIm that I am e1raill fora the Contractors License Law for the
{xq 3 F following reason.(Section 7031.5.Limitless and Professions Code:Any city orcvunp' SIGNS ELECTRICAL �OTHER
which requires a permit to construct,aibnr Improve,demolish,or micur any,vunore
�ON< priors t ': '1. 4 thef inchpc It fl 6 dsttement SPECIAL CIRCUI PM PSC.
P yr• that fi I, t a I. Ira I t t .1 (Chapter') COMMERCIAL:
IV
�a�7 (con su gwithSut 70al tit ?or It 11 I .-' 'I AD)nr TI:MI'MhTI?R()If I'OIJi INST.
A.C.e that he a coca,Ihurefvoln ad tl t basis far the allebcd cxun prima.Ary vbl,t t t of NI?W BLDG/ADDITION CUP MOLI'fION
W Section 7031.5 by any applicant ill permit subjects the applicam too civil penalD of POWER DEVICES ZS .
❑FOOD SERVICE
nm more than five hundred dollars(S500). F
Q I.as owner of the propcny.or lay employees with wages as their wale a aNimtion, SWIMMING POOL EGCrREC will Jo the work,vad the structure ix not intended or oflbred for sale(Se.7OW,kminessWalland P I C Jc ThC t t rx l 1 1 's ml apPIY n an owner nl OU I'LCI'S-SWI"ICI IES FIXTURES
r,p ty M1lkuri p d I ..rah wrdht,Jl lir thrmgM1h,t doy :.pn d I tM1 t h')h;p , nut mended lir otb v i for NIW RLSIDENrl Ah 1;LI CTR SQ I'1'.sale.If.however.the building lir intpmvemcnt issnld withiaora,,amofcn;n,Icnov.the H)H AREA RISA F'1'.
not er-builder will have the burden of,raving than he did nm build or improve for par,
ryxk oLmle). TOTAL
:
1,m owner or the prnpeny,an exclusively cornering with IittmwJ umvucnm m
con ouct the, ,act(Sec.7044.140 ncss and Prnfessi nal Code)The Contractor Ll-
ccn,c law dnev ;ol apply to do owncrof proper,who onaldx or i..T."vcsthcrcea.and QTY. PLUMBING PERMIT FEE
who contruere insuch prujecta with a mmrae a(v)llCeTsed Inrsnvnua the Cnntocnr'x
License law. PFRMIT ISSUANCIE
❑ I am exempt under Sec. ,B A,P C tie this reason
ALTER-DRAIN N:VENT-WATER IEA) %;,%I ONE[ON
Owner Date
WOR KER:S COMET NSATION IIiiCLA R ATION BACK FLOW PROI'HC..DEVICE;
level it
anOintrinuC11allyululall Penof Cuyanvil thcilillnwag do,claWorkrimCo
0In"vu pro provided
for by
3701)of the Labor Code.for therarlooraComtehe DRAINR-IsLQQ1t,ROUT ARIA,CUND. STORMS 'CYT iCONS'I'ItUC'GON
.,,,it far which
thi far by Section?91X1 of the baton Code.for me{scrartnwna of the
work Invwhich this .it is is. 19%'TURES-I'lik'1RAP
1 have and will maintain Workerrkee s Compensation
ance of mien rk hat which
h hisreqperm by Section
37W nIme Luton Cade,4th the perlinntance of the end far which this permit is issued. GAS-PA.SYSI'I!N-I INC.JOUTLEIS OCC GROUT' / �I'N�
My Wndcr's ;Is Jjsny6li;/y{n 'c-' ricraid lbl cy NoY num�ernunmesv�/I� GAS-EA.SYSTI?M"OVF,RJIE!A) (p
Carrier: "Q ll TTAALL 77 6 2—
IFE llsN FION I N TRAM WOItKI?RS GRI'n5)IINDl1S1'Rh WASTE!INTEI{CEPIY)k
COMPIENSA'IION INSURANCE Iil11LUING DIVISION PIiBS
(This scclion nand not lseconlplecJ ifthepcmtll isfnrnnchuu{rcddollun(SIW) GREASETRAP PLANCHECKFE
It"anylhulimmeau,nmmrtt..lbe sued for which oonat 1.the W..tis ersCun,an- SEWER-SANT"1'ARV-STORh1 EA.200 F7,
not employ any peraon in any nwnna so as to became subject m the Wnderv'Cumpcn- ENERGY PCE
Z cation Laws it Cahlormat Une WAIFR III NIFIt W/VI:NTIEI,EC'I'R GRADING FF.E
y NOfICE'11)APPLICANT.It.after"taking this Cenificme of towuni"n,yrs.should WATER Sl'S1'Eh1/1'RF.ATING SOILS FIJI
? hecmne subject it,the Worker,Complaisant—pmviouns of ate labor Code.You most
•� fonhsvim cnlnply witholch provisional orthi,permit shallM deemed revoked WATER SERVICE
0 PAID
CONSTRUCTION LENDING AGENCY NEW RESIDEN'1'USL PLMH. SQ.Pr
D Z Dale Rereipta
U O I bow infirmmwarmixacon(Sea 30 l7,C,v.uguncy��r ns In+rnnnanee lir
'lie work war which mix rDmth ix ix.aDa(set'.?x97,cis.1-.d i Tarn1:
O V lander,No le
Lenders AJdre,s 9Ol'N.:
rLLI 1 comity that 1 have read this application and,abe that the above railroaders i, N 'DING FEE
r
4' s TY MECHANICAL PERM IT
UN corvectl agrecmco,and withaanti and county ofand state.enter
upon
Q CE:ItiMIC-ITF.
U z building unntmctinn,and hereby amhsfize represcmwivcx of this eirymvmer upon the
uhnvaloan llnncd pa),cny loain,yvetion'arnos. PFItMI'I'ISSUANCE Ill !CI'kI 'E'
(We)agree to save Inde"ally and keep hn;nlcsx the Cly d Catania"ugain,t
IiuM1ilities,ludgntenh,costs unJ expen,c,which wavy in any way rennin coal list said City ALIFR OR ADI)TO MECH. KUMIUNG FFA
in consequence of the granting of this permit.
APPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT AIR HANDLING UNIT(TO Karl)CFM) MFCI IANICAL IT2
SOURCE!REGULATIONS. p
AIR HANDLING UNIT(OVER IILIXXI CPM) BY_ CONS'IRU(1TION-TA%—
Signamrenl'Applicata/Cauractnl Dala I7.XIIAGS'1'FOOD i W/UUCD HOUSING 511TIGA'I'ION 19!E
HAZARDOUS MATERIALS DISCLOSURE!
Will lbca,pEcavl or fatale bnildo,oveupamonte lir handle lavadnusnutedal HENING USE'I'(To 100."X)BTU)
as Jelinad by he Captain,Municipal Code Chapter 9.12,and the Ifcabb and Safety IIIEATING UNIT'IOVHR Ipayb(X)BTU)
Coda Section 25532(x)?
p Yes No VI'SHRM ION FAN IS]NGLE RESID) PAID
Dam HeceiPlp
huml
a"m
Will es air calumniator,
or comm heildmgby tale b use e.Air Qu er Aube,emen BOILER-alk CONI ITIONE RIP OR IIXLIllN)ITI'U)
Dist District!
u,air utmuminantn us JclincJ by fhc R;ry Amu Air Quality M;mugcmcm
D I I❑ � E{QiLER-GDMP(11YEER 1100,000 Ill
Y:
' intonations rt r4tt
ial ' d. Chapter 6.95 f theCali-
i,
li- ISSUA^^NC�E IJAI'IE
I hl th
G , 11'10 NCSafety Cd h :2550525511 1255341 under,. dtht it the ,NIW RI;SIDEN'I IAL MECIL SQ.FI'.
bill euur rayl Rngn It . y':I ,hday1 lythm
f rrx` m' na winch s he amt t.or m i von c of a Canl Ste l 0
n! hn La Ia .1 rax j/ q,I—a7
' O rumhorizcd sig t
Oac TOTAL: ISSUED Ely.
OFFICE