99090136 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.FJFCrRICAL PER
H DII.DINIi HI VISION APPLICATION/PERMIT PLUhIBING-MECHANIC9L
BUILDING PROJECT IDENTIFICATION
BUILUING ADDRESS: SANITARY NO. APPLICATION SUBM DATE
FELTU.A) /ti '7 -u /y
OWNER'S NAME PHONE 'ZS9''11 CONTRACTOR'S NAME_' LIC NO:
BE HZ sre AJIFW Fsr7.lZ. e)wN(5ML n(c coNTRtxY
ARCIETEC- NGINyi�R: LIC N'O'. ADDRESS: ❑
awe Az6KAS Cl4
CONrACr PHONE: BlijILDING PERMIT INFO
❑ Cauvltant Fes Paid by Applicant(Initial) BLDG 1ilt'Cr i mums MECH
El
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
M1 1 lcahy anion hat lam licenced tn.ler pmvivau of Cha pr 9(cmerecoe tg _ JOB DESCRIPTION
Z
��O in fall e(ariicautj0)aaf oivi,ioolof Jc susircu and ProfessiorsCme,wd mrlicemx i. PERMIT ISSUANCE RESIDENTIAL
❑SFDWL ❑KITCHEN REMODEL
aFVW Liar Oav Conamehor APFLIANCIS-RESIDEONAL ❑ADDIT]ON ❑PLUMBING RE-PIPE
ARCHUNQi Daa C'SDEC1
F.nv, pl.
EC TS DECI.\RATION PANELS El MULTI-UNIT El STRUCTURAL
Z On Z I anJcnwnl my plans sha11 M u 1 m public rtcmJa MODIFICATION
OZ-O UPTO2ftOAMP5i ❑INTERIOR ❑CHIMNEY REPAIR
ar-'F(y I.icenv Prue"..] 201.1000AMPS IMPROVEMENT SWIMMING POOLS
1 C Q NFaemEhICRnTON
I arcby affirm that mexmptfroDECLARATION
License law for the OVER 1000AMPS ❑BATH REMODEL REPAIR ❑DEMOLITION
K L V following fawn(Sectim 70313,Busimew arW 1'rufcuinns CnM:!Any city or county SIGNS ELECIItICAL ❑OTHER _
41 W WO< whivh rqulrcr,i Iwfin In cunetrud,ahco...prove,Jcnwllsh,nr repair any a ructum �r��
prirrmils ioum,r,almreyuh
ireecappl ,,te,fasucbperninafdtitai, edfinm
seetif SIECIALCIRCUIT/mLSC.
W } flit he lecmcJ pmorem,tn The po,,i,inn,afthe Cammetor,I.icemc 1aw(Chapfer9
-00 (unmtscrcin6 with Schram 7000)of Division 3ntthe hla,man and Pmfee ions Code)or TEMP.MF.I ROR POLE IN . COMMERCIAL:
RN a a C that be:is csemo thaefmm and the Nasi,far the.IlegcJ ettraimun.Any violation of ❑NEW BLD(HADDITION ❑DEMOLITION
a'
Section 7031.5 uTo
by any.,,Art rim
prit lairier.the applicant mpa
.civil nty of POWER DEVICES
=y
C1 TENANT ❑FOODSERVICE
e more bar Bat huNrcd dol4rz(SS(10).
❑1.aownaoflhc properly.or myefnployeea with w.gea es UbeirwkcvmpcnsuiaS, SWIh1MING POOL ELECTR OTHEIIMPROVEMENT
will do Ik xsrk,aW t he saum
ma is na itueodal aoffemf for aidSc
( .IDhi.Haiti.. ❑ R
THE
W F .d PfnfebsiaSs Cede:The Coov W%Liana law Jtcs fan., to se war of OUD.ETS-SWITCHES- R
pmpeny who hood,or improve,Heron,aftd wlw tlocrusch work himself or da a yla -4 ill
bar.emp"cea, frovicierfleal,ach inapmvemcm,art to intended a oEl fat NEW RESIDENTIAL ELECIR
We.If.haeeva.the holthe'or impmvefrcm is"dwithm ycv of ocmpliecm.,fSQ.FT FLOOR AREA 5/SQ.FT.
rcoFuilticr will ba-f1 buNon ofproving that fix,that not,uildaimprovefor
pur-
Precy�wlc.).
L,sri rorthe Ice,re,eni,TH wB exclusitelyLod cnnvoctln6 wish Ikon,cd rtareemrs to AL:
nsuuet t hiopn jecf(.See.o Or owner
nalrtywe,mntikoroIbaCmfrena'sl;-
nwWwAtwsnonvpPlywwownarafpngcnywM1ohuJJ,orlirmtcsthctmn.vtd QTY, PLUMBINsist
IT
.ho coniracta thr,mh pro s'1 ontractor(O lirenzJ pursumtto he C000-acfod
Liana:law. PERMIT ISSUANCE
❑ l am eeegarl r B h PC radii,realm
LC . A
ALTER-DRAIN& (EA) VALUATION
Owrcr D
4'ORither OSIPENSATION UECLARAIION BACK FLOW PROTECT D ICE
I Many aLrtrm either crafty perjury one of lf-in loving tkclttes Co: O
[]Iluve vdwill mainstin.Ccninrere ofCwsrntto ulf-inatrrt fm WahcYS Cortsprn- DRAINS-FLOOR ROOF AREA,CO.' STORIES TYPE CONSTRUCDON
sari-,as ryovidd for by Section 37W of be,L0,or Cade,for tha BETE.of the
.mil,I-which Ibi,permit u usual. FlKTIIRES-PER TRAP
❑ 1 heoc efd will maim.io WnrAcr,canpenan irn Inanreaa..s requirM by S«tim
370(roffhe"Irr Ctdc.for theK.c,,fhc wort.for whkh tda tib i—e& GAS-EA.SYSHISF I INC.i OUTLETS
R Pe^m OCC.GROUP
My 'a Coprnvfim lnurccaertierand
' policy
. numcea ^ APN
Career. Policy No: y�f
GAS-IA.SYSTFLM-OVF.Rd(EA) I V
CERTHICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE GREASIMNDUSTRL WASTE INTERCEPTOR -
('mh xedun mxA irx Ne cvmplmal iftbe pemtit h hx me bundnd Jullvrs fs1011 BUILDING DIVISION FEF$
or las.) GRFASB'TRAP PLANCHECK HE
I terrify hat in do performarce of he work fa*hien this Nanot is i,weQ I all
me employ any petwta
n in any ffmer ao es to bcome whject to ten '
the WrCtmpen- SEWIDt-SANITARY-STORM IIA. Irl'. ENERGY FEE
O Z wfwn I-w.s of California.One WATER HEATER WAIENr/ELECHt
Z O Applicant GRADING FEF
N NOTICE TO APPLICANT:If,after making this Cienif a of Laetnl.mn.you sboold WATER SYSTENIORF TING
F" become aubjeet to the Workat Co eforow im prrAwata of be Cribof Care').must SOLUS FEE
fonhoph comply with such pmvi,ions or this feet shall be domed tevokcC. WATER SERVICE
a0
z CONSTRUCTION LENDING AGENCY NIs.W'RESIDENfIAL PLN B. SQ.FT. PAID
V O IMrthy.ffirm that dart isemnsfructim lcnJing egcrcyfa tic pcKtrmtnrceuf -RraiptY--. -F-
he work for which h1,Perim,i,loex09
d(Sec. 7.civ.C.) i
0 U Umlcr's Name
114en to AJJtc, TOTAL:
ly I ttm y mm I have teed his vppbcmim uwtat
l se that tic ubmf
ova mfoufim DIN i, BUILPlia II
rq .oao,cl.I ugrce fo c ofily wih oil coy tort aunty v diranaa and arae law,rclnor,nt QTY. MECHANICAL PERMIT FEE .�
V Z huiding amM
nstction.ahereby mifhtrim teprewnmtives ofthis city nh
s eSterepon e Se CFEE�f SEP G 4 IJ`JO
^' imove-rcntitned Pmpeny for IB,pction putpo,c'.
(We)agree to.wa,imic rrify and keep harmaline the City of Cupcniro WarrantPI?RMTIISSUANCE EL A1C BE4 ) LJ
Iiabiit16^fcnu 6 a.tdcspms�wM1icM1 may in any way moue against sail City ALTER OR ADD TO MECH. PLUMBG 1 B41 1
in convocit. W ofthu rmn. o
APPIJCA UNDERS NDS AND WILL CO.$QI.Y WITH ALL NONPOINTAIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL FEB
SOURCE EO'1.5TIO
AIR I IANDLINGUNI(OVER 10.000CFM) CONSTRUCTION TAX
tgremlLof Appy onttear Date EXHAUST FOOD(W/DUCT) HOUSING Mt1lGATON HE
HAlAnRDOUS MATERIALS DISCLOSURE
Will the applicant ur future bolldir,occutami mtrc or hardle b-ar kram mammon HEATING UNIT(TO 100,000 BTU)
as&rimd by Of Cuperlino Municipal Cant,Char Ver 9.12,aid the Health aM Safety
Core.Scion H932(a)P HEATING UNIT(OVER 100.(00 BTU)
❑Yob ❑No VI!NI'I I.A'I'ION FAN(SINGLE RISA)) PAID
Will the applicant or(arum n moue, oa fent ht dwhich
LBJDate Recta
1. 11
emit Mrm it nmmninana m rictial by the Bay Area AirQuuLty Marmgmnl BOIN-COMP( HP OR IW,M)[BTU)
VT L'
Uistni]Ycs ❑No
m'! BOILER-COMP(OVER IOfI.(100 BTU)
Ihave it the Vela wquitatmu maer Chanter E95 of the Cali- AIR CONDITIONER ISSUANCE TE
ftmie I{mlh 8 Sofa Ctde,Sc' 255D5.25573 and 2554.1 unclematd hes if tie NEW RESIDENTIAL MECH. SQ,Er. Y� L[//�`((//(( /
btuldingtloe cot cu yM1.4cee t.tbtif is mYtcapreibilhywtwtilY de orcupan
r girt mm own mwi.sauvtaaoca irtaw oraaWnrY.
Ownerav9t txisNag Dae TOTAL: ISSUED BY:
OFFICE