S 1963 — -APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECIIUCAI. 1 9 6 3
>W-11
TNG DIVISION APPLICe\TIONMERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
GILDING ADDRESS: SANITAR\'NO. APPLICATION SUPMITLLL U TE
Z -ro C� pan vti 'J-2Sl'Y�
O NER'$NAM1tI° PHON1 CON IHAL9UNS NAME'. LIC NO;
2-- N/C COVTROI.M
C�I ARCHITECT/ENGINEER LLC NO ADDRESS.
CONTACT. PHONE: HUILDING PERMIT INFO
❑ Consultant Ftts Pad by Applicant(Initial) UIDc ELECT PLUMB n11iCx
❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hero\),alrr,n thm 1 am heen.<J under 1wilion,of Cbdjl v lcommendng JOB D RIPI'I(
W O
OC'L sith Scelim 7aXt of Division 3 of the Buximi Pmf<nions G.Ietd PERMIT ISSUANCE
.amy licctut 1% R SIIF SIS;
F W 2 in full fora and cRnt. z ❑SFl)W'L ❑KITCHEN RIi,10D1i1.
L�L.UU Littnsc Class Line APPLIANCES-RESIDENIAL ❑ADDITION ❑PLUMBING RE-PIPE
NQa 11Lc ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STRUCNRAI.
, Om PANELS MODIFICATION
Z0174Llunrt:rseud my Pham sut W used as public records UPTO ZW ,I
APS
❑ NTE
OZ- IRIOR ❑CHININEY REPAIR
F--o,F[O,
111 Licensed Pous-li Xtal 201_1000AMPS IMI' VIMENT 0 SWIMMING POOLS'
�1'C Q rt
OWNER.HUILDLR DL'CIARAIION OVER IOOU Ah1 PS ❑B ERE\10DEUREPAIR ODFNJOLIT10N
I hchy affnn tat 1 an tom"fmm the c
Cumosn(s Loiasis lorw fa the
x�x 6IUF.. fuhhwing unarm.(See, n]1131 S,Businessunm@
xs J Pnsionn Cold,Any city m county SIGNS ELLCI'RICAI.
HER
W 5 U.y which quirts v Tumid to cons me,ah..,imlruvt,inti or m,air say suucmrc
prim to us iwit dsomi irdshie epPlicent hm souM1 push In flkasi,mod dacme lSPECIAL CIRCUO/M LSC
u(Iy,,shccnsNpurdi m do ro,monsof die Commscnx's Lccnsa saw(Ch l 9
ai�aGO Ieuntmercing wiN Sectimt]g10)nr Division Sof the buttons,Bird PmfesvmsCnd<1 yr 'TEMP.,Mhh;R ORI INST. COMMERCIAL'
a a C that he is essai Ihmfonso and de,Laois fm the alleged cxctnptim.Any videsion of ❑NhW BLDGIADDITIO LJ I';MO
� LL Sermon 7031.5 li upphicvm bit. mutmhjcxa the applicant toad oil p..ulty.f POWER DEVIR ❑TENAN DSERVICE
r-^y n+mo bso floc hoodrm dolon($!i00L IMPROVEMEN
EZaOLas nwncroflltc pnrpcny,nrnry cntploym with wugc"vsdwirmlc,Osu,n,uoof, SWINISH1 IsOOLIILECTRIC []OTHER
�F. wllldu Hylwmr awdysdruoV is sat intcrrSdoroRmd for sale lSe.]f1U.Husircss
0.3$ and Pof<sXirrn Code:Thi,Conlranurs L.icettsi,law dues rind apply to rn mvrter of OV .;IS-SWRCIIES-IlNUR15
pnrymny sada W IIJx nr impnrvrs thartrm,and sada Boca such wort htmrclf a tLrough
his sem to Ployed,pmvidmi tat such impovemrnts con notEmended or olcred fa W RESIDENTIAL ELEC SQ FT.
-1c,If.howaa.tW WJJing or imPmscowmtomldw'ithin ace year nfcumplcllnn.He
- SQ.F1'.FLOOR AREA 5/SO.IT
ow ner-W Eder will ave la W nlen of pm,ing dua a did not hal Id-improve fill Im-
1sr ofvls,f
❑ L is mvosrofthe prolxny,am exclusively col mning with hcenwl contrmactor OTAL: �N
conumct to pilmi LSce.7014.Busittas and OMcvsions CnJml Tbc Contraclnr's L-
cense Lw Jtcs a.applymowrcr Mprend,sand Wilds or impruvnlhcrcm,.nd QTY, PLUMBING PERMIT FEE
who Ommicla for such pmjata with a amtmcmys)hmosrsl peduunl m tIm Comnmtals
license law. PE10,IIT ISSUANCE; SEP2 819,18
❑ I cmryunder See. ,HAPCfonhis rewm
ALTER-GRAIN A VIM-WATER(EA) VALUATION
Deal
)R . 'S COMPENSATION DECLARATION HACK rlI-I.OW PROTECT.DEVICE D
r<by a on untr pewlty of perjury arc of the lollowing d<clmmions B
❑11 end willtminanaCmifieecnfCarcnno slf-itswrera Wnttrr's Ctmprm" DRAINS-FLOOR,HOLE.ARIA.CORD. CHOLA
satin , ,Uovirbd for by tectum 1710 of bit,W Wr Code.ra tlit,prg oloal of tod
work her which this Truth is io tod IINURES-PFR TRAP
C1 I haus and will nstintain Water's Compensation Insurance,is'
requund by Senian
J70UafIly,Lahr CldC,fa the pafnntwac of Inc wort fur which thlspemul is iswN. GAS OCC.SYSTEM-1 INC.J OUI'LL'I'S OCC.GROUP APN
My Wardn's Cordimssumn las ,,murim.dl Polity mtmbc art: GAS-I?A.SYSfEMd)VERd(PA) ��
Currier: PUI'tey No.:
CER I'IFICATE OI;R)EMPTION FROST WORKERS' GR[ASFJINUUSTRI.WASH?INTERCEPfUR
COMPENSATION INSURANCE! BUILDING DIVISION FEES
(1ltlaxdion ncedtxttWcotnplccl if m,p'mtltu Lx and full tMIDun G1 bit GRFASGTRAP � - -- -
a IasJ NANCTIECK IEE
Icrn ifythal in bepmmalmtceofthe wad forwhich this,crmt sisalteJ.I dull SEWER-SANI'T'ARY-STORM IA.21X1 p1'.
nm....As,any pcwm in tiny mond,sow m
to hece-byev nt the W rte,'Can,lu- ENERGY FEE
0Z satirm U.,of C.lifmmie.Ih¢ IHt WATHEOER WNENTiELECTR GRADING FEE
z o Applicant
fn NOTICE 11)APPLICANT:IL after ons ing this Cmitiem<M Haempion,you should WATER SYSI'F.M TREATING
a ; bilsel subject lethe Wodeh Curn,icttsatiorr,pmvisted,of Thi,LMr Code,you must
SOILS IEE
form oh com,ly with such pmvtntn is or this pcmth Doll W deenull ruoolnd. WAGER SERVICE
CL,
CONSTRUCTION I.EADING AGENCY NEW RISIDENIAI,I'LMB. SQ.ET. PAID
UOIWt<hye0inn tl>vthertinamngmetitxllcdlingagcttcy fa the p<rfomunwof Dan Reccipt4
F the wort fust which this Lerma is iodised(Sec.3D1],Civ.C.)
I orders Name 'IT)I'A L:
U4 lcndds Addo,sx '1 DOTAL:
6. I mcify Had 1 arc nrorl this epplilsono an ant,that the almvc infmntation is BUILDING FEE
.�. m ..rrat.Ingtwmcot.ply with Wl dly and crusty oNlnuncmamdeletc lew,v<lulil,la QTY. MECHANICAL PERMIT FEE
U Z building mouraction,u.l hcrtby authorize massetuwive M tax city ld ever u1sm lfc ''1 SEISMIC FEE
eWvcmcntiorcJ prnprny(a irryccoma' Hmscs. PERMIT ISSUANCE (ELECTRIC FEE
(Wel fi In mon,indemnity and lacy bumdexs Ilse City of C.,nuo aglumt
liabilitusjedltmtnt><mtsedl e,pemeuwhich may in any wavy a<crtt<egaimtsaW City ALTER OR ADD TO MECH. 12-2,0
PLUM HING 1113
n.seyucna N Wgranting of Thin permit.
APPLIC UNUIiRSTA ' `1ND WILT.COMPLY WRIT ALL NON-POEN AIR HANDLING UNR(TO 10.00)CFM)
SOU'" RB UTAf10N5, ) M1IF.CHANICAhILE r
AIR I IANDLINGUNI1'(OVER lo.actiOTM) CONST RUCTION TAX
Z=,�,,,,
,fic' actor Ddo EXHAUST HOOD(W/DUC) HOUSING MITIGATION FEE
RDOUS MATERIALS DISCLOSURE
aepplicam a faun Wimi,a<vltism unit or hani baza.bm metctid HEALING UNIT ao E00.00d BTU)
the Cu,moo Municipal Code,Chulstr 9.12,and tW Henhh and Siam,
25512(alo HEATING UNIT(OVER 100.000 BTU) O7lQ
El No VENfIIATIUN PAN(SINGh13 RP_SIO) 1'A -
Uam Rn'eip N
/
Will the applicad ur drum building'rceg nt tae cyuipmtnt a dcsym,;which
t cmil hw.vduus air comlvnmand ns Mf ad]by the 11vy
it.Air Quality Mem,col BOILER-COMP CHIP OR HloTi 1 m)
LI
OIAL:
UiarkB
❑Y E]NO HOILER-COMP(OVER 110.000 BTU)
Ilovet<Wtlr hvaNrus matnwHto clociamts untr Chapel 6.95 N the Cali- AIR CONDITIONER S UANCED 'r-
fania Health A Sefny Code.Sm' s'3N15.25533 fund]25534.I urdd Thathis if NEW RESIDENTIAI.MECH, SQ.IT
buildin lm
not-rreolly va 14atlittesty osryusihility to wxlryla austrit
a rcm w'ni<n mexr tai.wattta.rocmirtat<nrLrcelattr.
c B<n Dme TOTAL ISSUED BY it
OFFICE