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S 3353 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-FI,KCI'RICAL ITt IT NO.
BUILDING DIVISION APPLICATIONAIERMITPLUMBING-MICIIANICAL 3353
BUILD ING.i`koxur[DON I'I kICATION
BUILDING ADDRCSS: SANITARY NO. AVVIACATONSORMl'I'I'AL DAT
OWNEk'S NA. E: PHONE: COST RACIO 'S NAMIi: LIC No)
D I q� SG�111C �L`L ^ N/Cp///, CONTROL/a1
qw, C.HITIiCI'/li GINEER: LIC NO: C. M
ZC.L DR ❑ / / /
CA to/C N"IAC'F. I'IION'L" y BUILDING PERMETINFU
Z, CO SUII2OfF2CSP ldnyAllllcd III 1(1311 [it DO 111.13 PLUMB LTJ/- ul�/dL'CII'
"TpcM�
� , .1 3&g.
gL��{
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT PEE
O a'Z
1 bcrchy minim mat I min fiaemen abler mommaas lir Chapter 9 0amourencing JOB DESCRIPTION
with SsaiuI70mbri Division 3slob e Naslnasnnd l'mfessbinm Cale,anA.,ry license is RESIDENTIAL:
won 1'1:1tM11'ISSUANCii
F-�� mlull force ands I. ❑SI'DWI, ❑KITCHEN RI?MODEL
C U F- license Clxvs hie.p
6 U AI'1'LIANCES-RUSH)IIJ'I'IAL ❑ADDITION El PLUMBING kI:-PINh
F Z W Dote Cummnr
ro<a - � 'ARCUirEi:CCS DECARAI'ION~W�J�`LA�I3ec__'' ❑MUCfI-UNIT ❑STRUCfURAi,
F-m 7 I understand my plans shall be amid as public rcnrtJs r�oo IANEIS MODIFICATION
OZ�O 11PT0210 Ah1R5 ❑IMfIiRIOR ❑CHIMNIiY k13VA1R
Licensed l•ndcsmiannl 21114 IXXlAMPS 0 IMI'ROVIiMI?NT E)SWIMMING POOLS
a OWNFR-II1111,DFR DECLARAD
' ON UVI3R 1(XXIAMPS ❑IIAI'I I RI3MOIl1dUkEPAIR ❑DEMOLLFRIN
E C 36C Q I hereby affirm that I acue frothe CoinracmrOI HhR
s License Law far the
X7 following Mammun, m ni
Mastic. 7031.5.Business and Profcons Cale:Any city nr county SIGNS ELFICTRICAL ❑
W 1+,vFi which requires a permit to construct,alter,im,n ver demolish or repair any sructme �,.,
p� prion 'I. 4 IX 37371 tf bps It TI 6 J.nt mcnlJ SPhCIAL CIRCUIT/MISC.
uI
gyp- man 1 i t. m p nn C n .L 1 ILn pmu COMMFRCIAI,
N 0 cOm n mS v lh Section]1x1111 111 11 f tour Ito R ML713R I lk PULE INS'I'.
a a
than,he is oacmpt thcrcfrom and Ihe Noi, or the,dlegsl exe npl on.Any v r Lnom of ❑III W BLDG/ADUI'UON ❑IlRM01,1'IION
x= Section A015 hyany applicant Error permitsubjeas the opEbbi' o a civil penally of POWER DEVICIiS O Ia'fI:NANT ❑FOOD SI:RV10E
Sy m marc than five hundred dollars($500),SG Las owner Of the try,or employees with i aslf.ole compensation. SWIMMING MHIL ELFCIRIC IMI'ROVIiM13NT
❑ prop% Y P Y p I o ❑Q11111µ
~m ill dotht,work,and themot is tool intended or, r.sole(set.90.W,Rusines 7e
63 bdP f Come the C I n Lic not pplyt ,wnerO OPI'Lf7S SWITC1nS FIXTURFS
1a,prty hailds or ,,all Imakn ll I,, I m
N:W hSIDEN'I'ALPIµ I
III, mitintended thence fT
,.It.If,l J.g pct an y a pl l' n the SQ.17.FLOOR n12HA SISQ.FT.
e hu ld _ hbrde fp JJ Id p f par
po
se ( ) p
❑has—act of lice 70,1vincs .�'Jmorn to Lm
,Hamm be prof"1.+ce.vua4,'i:^I. n e IeJ a 'onn:rtu,:a Li-
esxw
rme Uwdaes, cly munonl'; r who t prove.thereon.and QTY. PLUMBING PERMIT' FF.E
who mntmctm' PmjucL r(n11'I p nnlnc Crs
License Luw. I'EHM1IIT ISSI NCI:
E31 I thi,dais.,all
1 kl Con
e AI:IER-URA k .M \VATER(HA) VALUATION
Own
W l6 I N 1 DI CI, ION IIA CK FLOW I DEVICl3 1
Ih by ll .�rJ J ll �nsu 16J Ik iGmmpen 7J' DRAINS-FLOOR. RLA,Co
] Inuvu,dwll n armin u Ce ., s,IC n S'1'OItII3S 'I'YIIII 5'IR UC 110
.s:nion,as provldcd far by Sco.o„i)t' a the labor OSI,. 0 the perfonnamc of the
work for wbicb this permit is issued. FIX'I ORES-f11µ'1 RAI'
❑1 have and will maimnin Workers COmpemation Insurance,ns required by Section GAS-En.SYS'T'EM I INCA UI FES 3700 ofthe Lahr Code,for the perfmmonceofthe work far which 0a peark is issued. TMC GROUT' %/ Zt�N ogtl
My III 's Can Ov`a�tis Insulin,`ccatrrr."and Look i , �/� ,^_ b S
Came � np�� ILOSVnlicy Nn, � T/— (IAS-P,A.SYSTEM"OVER4Us I IYJ7
\ Cl2l4l'I17]CA'fE0I7EXliMPPIONI�ROMWOIZKERS' GRHAS[%INDUS'1'kh WASTE IN'll?RCI31'l()k
COM1`pNSAIIONINSUItANCti BU )INGDIVISIONPIiIiS
(T'bomationn,rsl not hemmplemcl iflhepem,it int Rvanchuodreddollafs(SI00) GRCASETRAP
or ksc) 1'hANCIIIiC
I,%city lhal in the perfnnnanceaflbe work for which this permit is issued.l shall SF'WER-SANITA RY-STORM His.2(X117.
QZ ,femploy any psson in any manner so as to became wbject to the Workers'Compen- GRAI GY /)
n I'lo f(:antmrl iu.DNe WAICR H13NIHR W/V13NT/ELLCI'R '3 3 �o GIIAUI ( it 3
o Applinmt
z (n N(IrICE'10 AI'I'LIGNI':II king XMeCE cats of Exe pliom You mbauld WATEk SYSTFM/I'RIiAI'ING SUITS I'
PPI
(•' ? ketone subject w er's 411 �m tion poll alI,of mhryr f Cala,you mus
d's forthwith comply Ishprvis m I spermit Ill he d�F� revoked. WATER SERVICE
Z r I ST'HUCTION LENDING AGI7NC 1 I NI2W RFSIDIiN11AL PLMB. SQ.FT 1`AID
UO Incrchymrrir Ilhere kSnp.a� tit fim gLgrte ;r penarmanecar Lae Rcceipta
mcoso ""In'lm0 miltays:fd Tse.3rXlz iT`L"J J / rnrnla
Ulender's Nlnne �Tp�p ( O
} Lenders AddressLLJ Ve IfUll.ill 'EE
G Lenity that 1 a read this application and sate thm Ihc ala, inlona tion is
F to cornea,l agrees can IYYy��wvv all city and count rdl rlemt uwsrclatinga QTY. MECHANICAL PERMIT PEE SFISM E '
U Z buildings nar,tion, n}d##eh m r rs city mo enter the l
uhols-onemioncd pro .....lion pu.� 1.17RMIT ISSIJANCF 13LIi .[[:I, w lam©
(We)agree la snot,indvunlly unit much aan ie,,Ibe City it Cticial n ngnlnst
Imbilhics.judgmcuta casts and ex Pcnsus which may inany way scenic-,III"'said City r ALTER OR ADD'IU MHCH. r PLO ING FEE
n consequence of the graining of this permit.
ICAN'I'UYDERSTANDS AND WILL COMPLY WITH ALL NIINd'OINT AIR HANDLING UNIT(TO IO,000 CFM) MEC NICAL FcE
OUI CIi RI' )1 Yr10;SS. — �qQ
AIR HANDLING IINI'1'(OVER IU,(XXI CPM) CONS'rNUGT10N TAX
igmalme ulAT1.1anVCn umor Dolt, HXI RUST 11001) W/DUCI) IIOUMNG MITIGA'I'IUN ITH
HA, DOGS MAI FRIALS DISCLOSURE
Will[Ile applicant iaure building occupant more or handle hoeunlous maraca IIHATING ON I'I'(10100.000 R'I1/)
as defined by the Cupeninn Municipal Code.Chapter 9.12,and the health and Safiay
CWe,Scotian 25532my? (� 1]HATING UNIT(OVER 1µ0,11µ013'1'U) n
❑Yes 9-191, VFNTILATION FAN(SING RI?SIU) IAID pas Rttcipla
WIIIIhc uppllcanl nr l sun,hoildingoccupant not,cqulpmcm lir devices which HURLER-COME'(31 IT OR 00,000 It'I U)
.it huaanlous on,comm amara"ns defined try Ile Huy Are.Air Quulily Management it a
DivficC BOILBR-COMP(OVIibi 100,000µ'1'U)
❑Ycs is
I have read the hmaNum,nmterials co uirenmemv under Chapter n').Sol the Cali- AIR CONDITIONER ISSUANCE DATE
loris Health k Salify CnJc.Scolloo 25505.25511 and 25534.1 under mind thin If'he N13W RFSIDHN'I']At,MI3CH. S 17.
It dae h
really aa tsw
ve nl,IIl:c-1 is Illy rexpnasibiliq la nm «aipm
ifydmea ( V
Ilemmir
who,h roam he Incl prion.l"tral"of a Ccer or " ate of Uccu
am tri JOR Date T AL: O ISSupi)IIY:
OFFICE
