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S 2709APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CIBLUV OFCUPRTINO BUILDING - ELECTRICAL PHRMIT NO. ILDINAPPLICATION/PERMIT PLUMfUNG-MECuANICAL 1) VISION C 7 xlilll)1Vl:l'nlllitiC.' fulo V'1'Hal'Al'IGN 2709 / os- M NN 2 3 /1 I? ME: ` 1111ONE: CON"IkACIORS NAME: LIC NO: /17cICi e0 I!>a iI'1 M RC w sir/ J -'7 NAC CONTROL# ENGINEER: LIC NO: I ADDRESS: a -- _ ❑ SNymaiure IdAppucaMCnmaeol Data HAZARDOUS MATERIALS DISCLOSURE WIII the applmunt or future build'mg 0,uupanl storeor handle harard0us material as defined by the Cupertino Municipal Cwlc Chapter 9.12, and he Ilealth and Safety Calc, Section 2553201' Ys. Vel Will the applicant or future building occupant use equipment or devices which t homahan, air cunumtial7efined by the Bay Area Air Quality Management ,.grin? E3 Yrs I have read the h:vnrdonss mutcriuds mryimments under Chapter 499 of the Cali. fsmio I lttdth Ar Safety Code, Sections 25505.25533 And 25534. 1 unJcmenJ drat II the huild'a.�1.� al coarsely have a mnunl.mal it is my responsibility to notify the rcculuml plod,. c4kt yire m%which must be mel prior o issuance of a Cetificata of Occupancy. EXHAUST HOOD (W/DUCT) I(EATING UNIT (10100.000 Is I' U) IIEATING UNIT (OVER 11X1,00 BTU) VRNTI I.ATION FAN (SINGLE RES] D) BOILER -COMP (3HP OR IOLM)11'1'U) BOILIIR - COM(' (OVER 11xf(m 11'I Go AIR CONDITIONER NEW R ICSIDIEN'1'[A]. MSCI I. SQ 19, HOUSING MITIGATION FEE PAID ILvc Bit it CON'I'ACI': PHONE: TIItLvll". Po.avu t t ! /f CI IO ( El Consultant Fecs Paid by Applicant (Initial) BLDG ELECT PLUMB MECII ❑ ❑ ❑ Ozz W00 F-� QUU F Z W LICENSED CONTRACTORS DECLARATION I homby:dfirmt mar 1 an. hcen.ed under prmi..... old chapter 9 (,aan+endng to Sce:inn 700(4 of oivi.im+ 3 of the Bistros, A I Proc�.i..n. Cotla.:,u1nn, ccn.c i. with in lull Base and elfal �j Liccnx a Lien ,['JR ^� Tatc as Cbnnwy 4 QTY (ELECTRIC PERMIT FEE JOB DGSCRIPFION RESIDENTIAL ❑SFDWI. El KITCHEN kEMU1J1E1. ❑ADDITION [I PLUMBING RE -PITT: ❑MULTI -UNIT ❑S'i'kUCTl1RAl. CHIMNENIOD[FIY TION REPAIR ❑INTISRIOR ❑CHIh1NEY REPAIk IMPROVEMENT SWIMMING POOLS I'Iikh11T ISSUANCIi _APPLIANCES AL m6y 0 o, z m Z Zy� AH"I-01 T'S TEChARAI'ION 1 undemm�J my plana.hall he uxd as public records I'ANCIS UP T0201AMPS t3�AA Lienacd 11 cost oil 201-1000AMPS Y�= at Q OdO i LLO NQ �y C0c) y c 5 XmLLSection =Q i 0 F- Ad 3 m OWNER -BUILDER DLCEARAI'[ON I hereby affirm that 1 am exempt from the Comracmr'. License law, far the following rwrtr n.(.i,clion 70.31.5, hooness and Protection, Code: Ally et, or,oumy which require, a permit to on.Ime, alter, imprn e. ch nudish, or ,,At, any amc,ure prior to itsissuance. I. W the ppli t for such fiction tfile A siguradmatermall matt f Ip tt 'be pill"I'llas atTh Contractor s I' L' (Chapter9 (cannon"+g will, Swan 90X0ol lomkio. SalIl,+. B"ire".,II nI c—no,Ud,pr that he i, exempt therefrom and the basis for the alleged exemption. Any violation of ll13L5 by any applicant for a Permit%objects me taplicantto a civil penally of 1101 pare than live hundreddullac.($51X). Lesawnendthe storm to cm with wa thcirsnle cum ❑ prose) Yams Y fill.B.eue,s will do thewna, Cors, he Conteare ractor', Livens Lawdosrtot e (SeeApply town weer of and Pndcoions C+dc: The Cnmmnnd hittmx Law acs not apply m an owner of prt+pcny who huddN or improves lhcmon, and who does such work hinsself or thruugb his own employees, provided that each impmvcments an or intended or offered for sale. If. however, the building or improvement i% sold within one Yew of complelinn.the ❑RATH REMODEI/1 PAIR ❑DEMOL]'1']ON ❑OTHI?R oVIiH p000AMPS SIGNS ELECTRICAL M'LCIALCIRCUTUMISC. IEMP.ME". I' ER OR IDLE INS' 1'. - R IA ❑ NI?W BL)G/ADD1"f10N ❑ DFMOLI'1ION ❑TENANT POOR SERVICE IMPROVEMENT ❑O'fIIIER POWER DEVICES SWIMMING IOOLFILECI,HIC OUTLETS - SWITCIIGS-FlXTURES NEW RESIDENTIAL ELECTN SQ SQ. F'1'. FLOOR AREA &SQ. 1'f. owner-hW dcr will have the harden of proving that he did not huilJ or improv, lie pnr- TOTAL: pnse of sated. EIL w more, of the progeny,m aa dudv,ly culan g with licensed commemn m QTY. PLUMPING PERMIT FR. instruct the project (Sec 91W, Business and Professions GdeI it. Contmmors Li- st. Low aces nntappdy to on owner of property who nuldsor improves In.reon.and who contracts for such pn9ecls with a contmemr(s) licensed personal o the Comowein,. fill License Law. PERMIT ISSUANCE ❑ I An, exempt loader Seo , B.@ I' C for this rcuwn ACIER- TRAIN A VENT- WATER IIIA) VALUATION Date 6 2! Oxmcr WORK(?RS COMPENSAf10N DECLARATION herenY nflirm ands penally of perjury un, of Il,, following do,0—diml.'. Ihavc and will maintain uCenificam of Conanno hdFinwrcfur Worker's Compen- BACK FLOW PH(YDiCT. DEVICES DRAINS- ELOOR. ROOF.ANEA. CON.. S'IORIF' 'I'YPECONSTRUCI'ION ,A, n, no provided for by Section 37X1 of ,be labor Code, fur me performance of the work tar which this permit is Issued. IIXTURBS- PER *1'RAP GAS - EA. SYSTEM -1 INC. 4 OUTI.EIS ❑ I hove and x'111 ma cion Worker'. Cumpcn.atinn holance, as repaired by Section 3700oflhe Labor Cade, for the perampance ofthe work for which dispemtit is issued. OCC GHOUL' APN GAS -P.A.s .. EhLOV 'A) My Workgij)}�mp.n Zinn ln.mmnce carrier and Policy n abet am: Policy Na.:�/K !j2`1/i. Collier: 1,= Policy GREASHA IRLW .TCL 'RCIiI I CERTIFICATE OFCXEMMION MOM WORKERS cOMPEN56rQN INSURANCE BUILDING DIVISION ItiI!S GkF.Aodil P 7 S SEWER-. 1'IAR -S ORMEA.201 (Thl.,ceian need not be cnn+plumd iflhe pemlit is bran, hundred dollam(S I(XB or less,) 1 ceaify that in Ire perfomance ofthe work fnruhich this permit n isa red. [,hall not men to manner no as In become subject 1. he Weden'Co.,.- p ram rerun many 1 PhANCIIECK PEI3 ENERGYFEC WATER 111 NIER W/VEN'PHI.1ECTR xenon L."O Cad iia Tam GRATING iIi . Z,Q +� F-r5 L Up1 U. 0. CA Uz Applicant NOTICE TO APPIACANT: If, alter looking this Certificate of Exemption, you should Core, u masa fwenmeh wail vwit Worker's Corns or this slant steal a l' me deemed forthwith romply with such pmol.ion.. or this pcnnn shall be JeemcJ revoked. CONSTRUCT ION LCNDI NG AGIENCY herenyoffirm lhuuhera iv Acoalual;onlendingagency furtl,peformaareof the work for whichthis permit is issued foss. 3091. Civ. C.1 NameU WATER St .y WATER SERVICE Receipt# NEW RESIDENTIAL PLM D. SQ. IT. tPAID TOTALC)ULenJa'. Lcnitnl, AJJlce.T(YIAL'� 1 cenily Ina, 1 have wad,hdnpplicntinn laid sem IM1at the above iulimnation is cones. I agme m comply with all city and county ordinances and state laws relating to huilding comrmeliva, and herchy authorize representatives of this city to enter upon the ,movo11wnot ned property Icor moliectiun pugnnes (We) agree to save, indemnily and keep hairless the City of Cupsnino.g.las, Mobibles.judgmiall,c fmdexpcnss. whichmayinanywayaccmcagains,said City QTY. MECHANICAL PERMIT FSC O ELLCI'RIC P,li PLUMBINGPti I'LRMD ISSUANCE ALTER OR ADD TO h1ECH. ' ...+rven,colm. grunlns tthis serail, APPLICANT UNDh I'ANDS AND WILT. COMPLY WITH ALT, NON-I'OIN'I' 501 L"RCGUTAl) �ON /• A 1 MECHANICAL PCE CONSIRUCfIONTAX AIR HANDLING ON[ (' 01Win) CFM) AIR HANDLING UNIT(OVBR 10.001 CFA) SNymaiure IdAppucaMCnmaeol Data HAZARDOUS MATERIALS DISCLOSURE WIII the applmunt or future build'mg 0,uupanl storeor handle harard0us material as defined by the Cupertino Municipal Cwlc Chapter 9.12, and he Ilealth and Safety Calc, Section 2553201' Ys. Vel Will the applicant or future building occupant use equipment or devices which t homahan, air cunumtial7efined by the Bay Area Air Quality Management ,.grin? E3 Yrs I have read the h:vnrdonss mutcriuds mryimments under Chapter 499 of the Cali. fsmio I lttdth Ar Safety Code, Sections 25505.25533 And 25534. 1 unJcmenJ drat II the huild'a.�1.� al coarsely have a mnunl.mal it is my responsibility to notify the rcculuml plod,. c4kt yire m%which must be mel prior o issuance of a Cetificata of Occupancy. EXHAUST HOOD (W/DUCT) I(EATING UNIT (10100.000 Is I' U) IIEATING UNIT (OVER 11X1,00 BTU) VRNTI I.ATION FAN (SINGLE RES] D) BOILER -COMP (3HP OR IOLM)11'1'U) BOILIIR - COM(' (OVER 11xf(m 11'I Go AIR CONDITIONER NEW R ICSIDIEN'1'[A]. MSCI I. SQ 19, HOUSING MITIGATION FEE PAID ILvc Bit it 0 .l 0 ]QI of CUp.ut:Cn maaam a Cs I -- -1. 4_i Vf. ..i r,,:J_r, LQ3 1Woi 1'errY Avu Noe, C•Y Na,•Vlo�, CA, 91OL4 NCOY YY24NY waYs�wearsrexw�.Ycr� s.ajM._-��i�DM:�••.,.. _..�s.�. _ �. _-- ... (DATE) PA,iC .11 y!;rJ7 P•= i atn an adjoining property own\� owner of L- t�b c.k �iG�t�1C (NAME) Whose proporry 1s 16c:afed a[j�S,Anipr=�W�'•_________� l approve (as per Grdimmce Nc. 686„Section 16.26.1kt() of the Ccpercinu Mtmicip t1 Code} the aUcrwanCt (if a foot high fence faci:•:g my (8 MAX MUM) proprrty. AMPMS; MS:xcz _ .�s?�L ✓':.. � mac:' � 1 fis is r i APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CIBLUV OFCUPRTINO BUILDING - ELECTRICAL PHRMIT NO. ILDINAPPLICATION/PERMIT PLUMfUNG-MECuANICAL 1) VISION C 7 xlilll)1Vl:l'nlllitiC.' fulo V'1'Hal'Al'IGN 2709 / os- M NN 2 3 /1 I? ME: ` 1111ONE: CON"IkACIORS NAME: LIC NO: /17cICi e0 I!>a iI'1 M RC w sir/ J -'7 NAC CONTROL# ENGINEER: LIC NO: I ADDRESS: a -- _ ❑ SNymaiure IdAppucaMCnmaeol Data HAZARDOUS MATERIALS DISCLOSURE WIII the applmunt or future build'mg 0,uupanl storeor handle harard0us material as defined by the Cupertino Municipal Cwlc Chapter 9.12, and he Ilealth and Safety Calc, Section 2553201' Ys. Vel Will the applicant or future building occupant use equipment or devices which t homahan, air cunumtial7efined by the Bay Area Air Quality Management ,.grin? E3 Yrs I have read the h:vnrdonss mutcriuds mryimments under Chapter 499 of the Cali. fsmio I lttdth Ar Safety Code, Sections 25505.25533 And 25534. 1 unJcmenJ drat II the huild'a.�1.� al coarsely have a mnunl.mal it is my responsibility to notify the rcculuml plod,. c4kt yire m%which must be mel prior o issuance of a Cetificata of Occupancy. EXHAUST HOOD (W/DUCT) I(EATING UNIT (10100.000 Is I' U) IIEATING UNIT (OVER 11X1,00 BTU) VRNTI I.ATION FAN (SINGLE RES] D) BOILER -COMP (3HP OR IOLM)11'1'U) BOILIIR - COM(' (OVER 11xf(m 11'I Go AIR CONDITIONER NEW R ICSIDIEN'1'[A]. MSCI I. SQ 19, HOUSING MITIGATION FEE PAID ILvc Bit it CON'I'ACI': PHONE: TIItLvll". Po.avu t t ! /f CI IO ( El Consultant Fecs Paid by Applicant (Initial) BLDG ELECT PLUMB MECII ❑ ❑ ❑ Ozz W00 F-� QUU F Z W LICENSED CONTRACTORS DECLARATION I homby:dfirmt mar 1 an. hcen.ed under prmi..... old chapter 9 (,aan+endng to Sce:inn 700(4 of oivi.im+ 3 of the Bistros, A I Proc�.i..n. Cotla.:,u1nn, ccn.c i. with in lull Base and elfal �j Liccnx a Lien ,['JR ^� Tatc as Cbnnwy 4 QTY (ELECTRIC PERMIT FEE JOB DGSCRIPFION RESIDENTIAL ❑SFDWI. El KITCHEN kEMU1J1E1. ❑ADDITION [I PLUMBING RE -PITT: ❑MULTI -UNIT ❑S'i'kUCTl1RAl. CHIMNENIOD[FIY TION REPAIR ❑INTISRIOR ❑CHIh1NEY REPAIk IMPROVEMENT SWIMMING POOLS I'Iikh11T ISSUANCIi _APPLIANCES AL m6y 0 o, z m Z Zy� AH"I-01 T'S TEChARAI'ION 1 undemm�J my plana.hall he uxd as public records I'ANCIS UP T0201AMPS t3�AA Lienacd 11 cost oil 201-1000AMPS Y�= at Q OdO i LLO NQ �y C0c) y c 5 XmLLSection =Q i 0 F- Ad 3 m OWNER -BUILDER DLCEARAI'[ON I hereby affirm that 1 am exempt from the Comracmr'. License law, far the following rwrtr n.(.i,clion 70.31.5, hooness and Protection, Code: Ally et, or,oumy which require, a permit to on.Ime, alter, imprn e. ch nudish, or ,,At, any amc,ure prior to itsissuance. I. W the ppli t for such fiction tfile A siguradmatermall matt f Ip tt 'be pill"I'llas atTh Contractor s I' L' (Chapter9 (cannon"+g will, Swan 90X0ol lomkio. SalIl,+. B"ire".,II nI c—no,Ud,pr that he i, exempt therefrom and the basis for the alleged exemption. Any violation of ll13L5 by any applicant for a Permit%objects me taplicantto a civil penally of 1101 pare than live hundreddullac.($51X). Lesawnendthe storm to cm with wa thcirsnle cum ❑ prose) Yams Y fill.B.eue,s will do thewna, Cors, he Conteare ractor', Livens Lawdosrtot e (SeeApply town weer of and Pndcoions C+dc: The Cnmmnnd hittmx Law acs not apply m an owner of prt+pcny who huddN or improves lhcmon, and who does such work hinsself or thruugb his own employees, provided that each impmvcments an or intended or offered for sale. If. however, the building or improvement i% sold within one Yew of complelinn.the ❑RATH REMODEI/1 PAIR ❑DEMOL]'1']ON ❑OTHI?R oVIiH p000AMPS SIGNS ELECTRICAL M'LCIALCIRCUTUMISC. IEMP.ME". I' ER OR IDLE INS' 1'. - R IA ❑ NI?W BL)G/ADD1"f10N ❑ DFMOLI'1ION ❑TENANT POOR SERVICE IMPROVEMENT ❑O'fIIIER POWER DEVICES SWIMMING IOOLFILECI,HIC OUTLETS - SWITCIIGS-FlXTURES NEW RESIDENTIAL ELECTN SQ SQ. F'1'. FLOOR AREA &SQ. 1'f. owner-hW dcr will have the harden of proving that he did not huilJ or improv, lie pnr- TOTAL: pnse of sated. EIL w more, of the progeny,m aa dudv,ly culan g with licensed commemn m QTY. PLUMPING PERMIT FR. instruct the project (Sec 91W, Business and Professions GdeI it. Contmmors Li- st. Low aces nntappdy to on owner of property who nuldsor improves In.reon.and who contracts for such pn9ecls with a contmemr(s) licensed personal o the Comowein,. fill License Law. PERMIT ISSUANCE ❑ I An, exempt loader Seo , B.@ I' C for this rcuwn ACIER- TRAIN A VENT- WATER IIIA) VALUATION Date 6 2! Oxmcr WORK(?RS COMPENSAf10N DECLARATION herenY nflirm ands penally of perjury un, of Il,, following do,0—diml.'. Ihavc and will maintain uCenificam of Conanno hdFinwrcfur Worker's Compen- BACK FLOW PH(YDiCT. DEVICES DRAINS- ELOOR. ROOF.ANEA. CON.. S'IORIF' 'I'YPECONSTRUCI'ION ,A, n, no provided for by Section 37X1 of ,be labor Code, fur me performance of the work tar which this permit is Issued. IIXTURBS- PER *1'RAP GAS - EA. SYSTEM -1 INC. 4 OUTI.EIS ❑ I hove and x'111 ma cion Worker'. Cumpcn.atinn holance, as repaired by Section 3700oflhe Labor Cade, for the perampance ofthe work for which dispemtit is issued. OCC GHOUL' APN GAS -P.A.s .. EhLOV 'A) My Workgij)}�mp.n Zinn ln.mmnce carrier and Policy n abet am: Policy Na.:�/K !j2`1/i. Collier: 1,= Policy GREASHA IRLW .TCL 'RCIiI I CERTIFICATE OFCXEMMION MOM WORKERS cOMPEN56rQN INSURANCE BUILDING DIVISION ItiI!S GkF.Aodil P 7 S SEWER-. 1'IAR -S ORMEA.201 (Thl.,ceian need not be cnn+plumd iflhe pemlit is bran, hundred dollam(S I(XB or less,) 1 ceaify that in Ire perfomance ofthe work fnruhich this permit n isa red. [,hall not men to manner no as In become subject 1. he Weden'Co.,.- p ram rerun many 1 PhANCIIECK PEI3 ENERGYFEC WATER 111 NIER W/VEN'PHI.1ECTR xenon L."O Cad iia Tam GRATING iIi . Z,Q +� F-r5 L Up1 U. 0. CA Uz Applicant NOTICE TO APPIACANT: If, alter looking this Certificate of Exemption, you should Core, u masa fwenmeh wail vwit Worker's Corns or this slant steal a l' me deemed forthwith romply with such pmol.ion.. or this pcnnn shall be JeemcJ revoked. CONSTRUCT ION LCNDI NG AGIENCY herenyoffirm lhuuhera iv Acoalual;onlendingagency furtl,peformaareof the work for whichthis permit is issued foss. 3091. Civ. C.1 NameU WATER St .y WATER SERVICE Receipt# NEW RESIDENTIAL PLM D. SQ. IT. tPAID TOTALC)ULenJa'. Lcnitnl, AJJlce.T(YIAL'� 1 cenily Ina, 1 have wad,hdnpplicntinn laid sem IM1at the above iulimnation is cones. I agme m comply with all city and county ordinances and state laws relating to huilding comrmeliva, and herchy authorize representatives of this city to enter upon the ,movo11wnot ned property Icor moliectiun pugnnes (We) agree to save, indemnily and keep hairless the City of Cupsnino.g.las, Mobibles.judgmiall,c fmdexpcnss. whichmayinanywayaccmcagains,said City QTY. MECHANICAL PERMIT FSC O ELLCI'RIC P,li PLUMBINGPti I'LRMD ISSUANCE ALTER OR ADD TO h1ECH. ' ...+rven,colm. grunlns tthis serail, APPLICANT UNDh I'ANDS AND WILT. COMPLY WITH ALT, NON-I'OIN'I' 501 L"RCGUTAl) �ON /• A 1 MECHANICAL PCE CONSIRUCfIONTAX AIR HANDLING ON[ (' 01Win) CFM) AIR HANDLING UNIT(OVBR 10.001 CFA) SNymaiure IdAppucaMCnmaeol Data HAZARDOUS MATERIALS DISCLOSURE WIII the applmunt or future build'mg 0,uupanl storeor handle harard0us material as defined by the Cupertino Municipal Cwlc Chapter 9.12, and he Ilealth and Safety Calc, Section 2553201' Ys. Vel Will the applicant or future building occupant use equipment or devices which t homahan, air cunumtial7efined by the Bay Area Air Quality Management ,.grin? E3 Yrs I have read the h:vnrdonss mutcriuds mryimments under Chapter 499 of the Cali. fsmio I lttdth Ar Safety Code, Sections 25505.25533 And 25534. 1 unJcmenJ drat II the huild'a.�1.� al coarsely have a mnunl.mal it is my responsibility to notify the rcculuml plod,. c4kt yire m%which must be mel prior o issuance of a Cetificata of Occupancy. EXHAUST HOOD (W/DUCT) I(EATING UNIT (10100.000 Is I' U) IIEATING UNIT (OVER 11X1,00 BTU) VRNTI I.ATION FAN (SINGLE RES] D) BOILER -COMP (3HP OR IOLM)11'1'U) BOILIIR - COM(' (OVER 11xf(m 11'I Go AIR CONDITIONER NEW R ICSIDIEN'1'[A]. MSCI I. SQ 19, HOUSING MITIGATION FEE PAID ILvc Bit it 0 .l 0 ]QI of CUp.ut:Cn maaam a Cs I -- -1. 4_i Vf. ..i r,,:J_r, LQ3 1Woi 1'errY Avu Noe, C•Y Na,•Vlo�, CA, 91OL4 NCOY YY24NY waYs�wearsrexw�.Ycr� s.ajM._-��i�DM:�••.,.. _..�s.�. _ �. _-- ... (DATE) PA,iC .11 y!;rJ7 P•= i atn an adjoining property own\� owner of L- t�b c.k �iG�t�1C (NAME) Whose proporry 1s 16c:afed a[j�S,Anipr=�W�'•_________� l approve (as per Grdimmce Nc. 686„Section 16.26.1kt() of the Ccpercinu Mtmicip t1 Code} the aUcrwanCt (if a foot high fence faci:•:g my (8 MAX MUM) proprrty. AMPMS; MS:xcz _ .�s?�L ✓':.. � mac:' � 1 fis is r i