S31007
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL]
BUILDING DIVISION APPLICATIONFI'ERMIT DING PROJECT
BUILDING I'RfIJF.CT IUENTIFICATIUN
PI!R 1'I'NOPLU.
3100
BUILDING ADDRESS: t7 ssr
N9 C4-
SANITARY NO.
API.ICAHON SUBMITrALDAT)!
_ _��
OWNERS NAME I' NI?�UN'RA
1{7
O' /
:ti AM*Appli,.t
NIC
CONTROI,N
ARCHITECI'/FNGINGIR: LICNO:
AD ESSCONTACr:
PHONE
ILDING PERMIT INFO
❑ Consultant Fm Pa
BLIT li ECr PLUMBMF.CH
❑ ❑ ii ❑
LICENSED CONTRACTOR'S DECIARA'IUN
I bereby affirm That I am hce,l:en comer Pronasions of Chapter 9 fcr.renstming
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
PItUT ISSUANCE
withSmion7") M Division 3 oflhe Business and l'rvfessiwm CNc. and my l ittvc is
in full f«a and efll
RFSIDF-NTIAI:
❑SIUWL ❑ KITCHEN REMODEL
APPLIANCES - RESIDENFIAL
Lemsc Glx la°♦
Dale Conal«
❑ADDITION ❑ PLUMBING RF>PIPE
❑MUI.TbUNIT ❑STRUCTURAL
MODIFICATION
❑IMF.RIOR C1 CHIMNEY REPAIR
IMPROVEMENT SWIMMING POOLS
ARCTIITIiCTsS DECIARArIONPANELS
I understand my fibersdull he used! a fehlic nc«ds
UP TO 300 AMPS
Lk:en,ad l4efiba.1
29I-1000AMPS
OWNIR-BUILDER DGCIARAI'(ON
I hereby eTnn Thal 1 em eumpt form the Comrvemr's Licenac Law for the
"nth 70313, opcon,ate. ar,rPMfcssiorn Cods: Any city «county
which m acY stwewrt
sap, w mnsvucs. ilter, impose, dnrenont
❑ BATH RRMODIJIREPAIR ODEMOLITION
❑OTHE �(
to
*o
OVER P" ANUS
SIGNS ELECTRICAL
SPECIAL CIRCURIMISC.
1 ,p pro
i
t e sit
priorM ld isxawtt.ilmrequire the applknm forsuch fermiuO Oleeugrwd sUlenenl
,to, a, is
Mar le is licensed pursuant M the pmvi.s'eam of the Contractor's Liceme law (Chapter Y
COMMERCIAL;
alnnarm Podttsinm Ccdc)or
(coerwing with Sectiot7000oof Divi.5ion 3nftbe Bue
mm
that be is ramp to efrom and the Torsos for ite Mitered emmption. Any viulutim of
TEMMEITA OR POLE INS.
P.
❑ NEW BLDGIADDITION ❑ DI:NOLrr10N
Sectim)031.5 by anyapplicantfee a permit wrRO%the Upplkanun o civil pendry til
POWER DEVICES
[I TENANT ❑ FOOD SERVICE
cot more than five hundml dollars 165001
0 Lasowner'fde pnpcny,urmym,Ioyos with w'agcsan TcovAcarMpamati'n,
will do the xvh, eM, the atmcwM is nm'mlcndnl «offend for sale (See. TOW. Brsi«as
and Profession, Code: The Cuntrai License lacw costs con apply to to est. or
IMPROVF'_MENf
❑ OTHfJa
SWIMMING POOL ELECTRIC
Ou I I, E. -SWITCHES-FI
fk
N RESIDENTIAL IiLECTR
prawn, wpm builds or imprm'es tlrrtve, cold who Ikw-. such voA Movself or tbnmgb
his own en,lo,o es, pnn'irled than such Improrvcorems an mN inmfdd ur offered! For
sale. IL however, the Mildin6 or i noln"Ment is sold wilhln otw,a of emlpletiun.lhe
SQ. hT.Il1M)R AREA
SISIJ.IT.
owner -Wilder u haw the huNcn 01 ToMo, Ihha he did For build', improve to, to,
TOTAL:
E]h Us owner of the progeny, not esdunivdY "'Moncton, with I"cosed oobjeRxs to
n,lruat the pnrjwr (Sec.?(sTT Bns .car and 'nlesxime Cnde:) The C'nlnwnx'e U-
clawdms coca apply loan owmrot pngcnywler Widsor inlpmvs lbcrtno. and
QTY, PLUMBING PE M F
wNr ccooacle Its such pmys'ns wllh a cornowtor(s) 111cowd Ienrwnl m l W C— rKl'r'a
1117 MIT ISSUANCE
Liccasn Lnw.
El I em cle"To oder Sec. ,B&I'Cb«This ne.—
AGILR-DRAIN & Vl M - WAFER (BA)
Owner Ihlle
VALUA'ITUN
WORKERS COMItiNSAIION DFCIARACION
IIACK TLOW I'ROIRCr. DEVICE
1 bcr,b, af0mt Under pcnnlly of perjury me nr Inc f'llov in6 daarutino,
STORIES
'TYPE CONS] 'RUCI'[ON
❑IM1ave and wilHnainminu CeniOculenfCaawronn r<I4lnsum f«Workcr'n CrMrpen-
I)RA1NS-11(%R,ROOF.AREA,COND
,salin, as pmvidd for by SeMlm 37g) TI'the IyWr Code, for the pcniommnte 0 the
which this perron is i,,.d.
1IXT ORIS - PER TRAP
GAS -IA.SYSIl3M-I INC, 40lTNETS
Wve and oll oono, n WaAers COmp"oauim Insumnsc. as scquird by Seclion
(�r
370001 Ex:l� Cada Gx the perLmwr¢e0(Ihe wrA for wM1kh this lgnnit is ovoid.
APN
MY CSM' rsG yvylyp_.w� eotril.+cant l'No Y..k4a1 C4y%T /
LYA il Nujj%) S
GAS - EA. SYST11M-OVER 4 EA)
ZI
GRI!ASI%INDU.STRL WASTE INFER
CE FTCAR! OF IXI!MPfION IROM WORKERS'
COMPENSATION INSURANCE
LS(Thu
tecrinnncd cot Toe compind ifde profit is for orc hudol dollars lS 11X11
ksxJ
ORFASETRAPm
EgBUILDING
tJAVISION
SHWER-SANITARY-SfORMEA._
I cenify ton in the,noteunce fifths wmkIrx'hkh this gamut is toward, l sbell
rpt eno be, any Person in any mamu� to as w h,,om whject M the Worico Cooper-
WATER HF ITER WNFNTIELEM
tion I<xs of California. Dice
Applicant
j NOTICE TO APPLICAN'1: If, after Makin& Thio CeniOcate of 1!semMinn, you slcsuld
WATER S1'SIEMITREDO NG
' hcecirs, wbyTO to the x'orkds Cmryheosarim pmvui«rs orlhe l.ahse Cork. You must
PAID
Dan ri
foMwitbcomply whirwichprovisiones«IbulcmurslWl he Jcemd revolted.
i
CUN..MUCION LENDING AGENCY
Ihereby ,ffirmtb,ban, isa[«uuu[tiun krming age«, for the perf«nwa or
tW weri, for which this ps mlt u loud (.Sac.."". Civ. C)
t<rder'o Name
WATER SERVICG
NEWRESIDENTALPIMB. SQ, FT.
TOTAL_
TO A
1<ndelsA"
BUILDING FEE
I [enify them l hove read this Wical ad state Beat de these infmmarim is
c«re"t.l apes m "'mplY with ml city ed [orunY Winarc[. td wte qx'. rtivirsg to
Wilding rnmuuctirm. and ire hershy surborreryacnulives of this city r0 erosr uom to
QTY. MECHANICAL. PERMIT FEE
SEISMIC ITE
PERMIT ISSUANCE.
ELECTRIC FIJI
' tshro,ornuaredl M pT for ins,fection Turns s.
(we) "gree to .arc, indemnify ed keep harmlm the City of Cupenino agtinw
Iudlities,joe,irend. cots cad cslrnxo which may in any way swervctgaimrstid City
ALT13R OR ADD TO NJIL
PLUMPING IT!I!
in cavn)uace N The granting M this Iemeil.
AIR HANDLING UNIT OO 10.0[1(1 CFM)
MECHANICAL ItiE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURO
AIR HANDLING UNIT(OVER 11),"CFM)
CONSTRUCTION TAX
II
nimceriS
Sigm ofIT mtmct« I/>Me
EXHAUST HOOD(WMUM
HOUSING MITIGATION IIiE.
H RDOUS MAI 'ERIAI S DISCLOSURE
'
HEATING ON] T(FO icily BB'put
Will be e,plicant« forum fuiliingacupan, snve« hardk haraNnuxnw¢nal
as Jctited by the Cupcniro Mun Crdc, Cnapner 9.R and tM ❑r"Ilh and Safety
Code. Section 25,32(u)P
HEATING UNIT (OVER 101.(X10 BTU)
VFNTIIATIONFAN(SINGIERESIDI
❑Ycx o
PAID -
Dare Rcceip♦
I Will the IgRlkanr or future Wilding'ceupant Use ceMrsoem or novices which
e nfsmit harardms air nrmwoinadcbnd by Me Buy Amh Air Qualhy MMlagcintent
BOILER -COMP (LHP OR Iq),IIUI B"ITI)
'IUI'AI,:
-COMP (OVER I!H I tAl,rpfl BTU)
o
DoM,T?
0 Y"BOILER
AI R CONDI' I ONLR
ITv. O want the levardmwM:ucriuly aquirmnan, onder Chapter 6.95 of II¢ Cnl i-
ISSUANCE DATE
NEW RILSIDEN'1'I Al, MITCH, SQ, FT
tsmia llcallh & Slltny Cala Sari ns 255115,15533 uhd 25,S;M. I M(krnl:nvl that II Ile
Wilshogdoc'noieu le hl hs Illy resprlssihilily Irl nh.ily tlx: he"Y"lenl
O
hnulll.lful
se
oflheo,,MoTmaor' ,prior to ilwutnsv rhln CanlE"mu nffkcupuecy.
ISSUED BY: �( _
TOTAL]
Owner«UUth'dad u,e t Dale
uI-FIUE