99120141 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY O
CITY OF CUPERTINO
BullDINGPERMIT NO.
BOLLDING DIVISION APPLICATION)TERMIT 1'LU\iBING-51F,CHANICAI. 1
BUILDING PROJECT IDF.NrIFICATIUN 1
BUILDING ADDRESS: GON Aa� GaG� O8 SANITARY NO. APPLICATION SUBMITTAL DATE
/O So/ �• TA�ITi4J /� 1 J79
OWNER'S NASE PHONE: CO�+{�ACTORS NAME CNO: N� CONTROL
M
CONJ1.4 Co,.ii✓� K. Haid-W., MBcH i67Yo
R ITECf/INGINUA LIC No ADDRESS: SArTA F-1 Riac /NG. G /S90 3 13of L elLA41*004 4
CONTACT: PHONE BUILDING PERSITT INFO
❑ Consallenl Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑
LICENSED CONTRACTORS DECIARATION QTY ELECTRIC PERMIT FEE JOB DESCRIPTION
I hcrehy affirm don 1 turn licensed umk povkion,of Chuptu 9(ammeaing
Mwz with Secfi.n lflW)ofDivision]ofthe Busirc.as and Nufeniom Cak.and mylicrn,eu RESIDENTIAL
Ii]C PERMIT ISSUANCP
aFW,F in full nice wJ eRe ZD 780 ❑SPUWL O PLUMPKITCHING
kEMODEL
at U po, � Ctmvazrw APPLIANCES-RFSIDFXDAh OAUDTfION OPLUNBING RE-PIPE
In ARCIIITIiCI'S DHCIA ANON PANELS ❑MULTI-UNIT ❑$'IRUCIl1RAl,
Z O n Z l usdeaend my PE.Dull W evil as puNic rtcerd MODIFICATION
OZ-� UPT02MANIN OINTERIOR OCHININEY REPAIR
W Liccnctl Profmiawl - 201-1IXMAMPS IMYftOVEMf3NT ❑SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER I.AMPS O BATH REMODE11REPAIR 0DEMOLITION
yyx
M=7 1 Ecmhy andn mat I am evemp from iW Cnmmmvr's License law for the
W O a U{ fallowing re]um.(Scclion 11315,But.turd Pm.ism,Cul,:Any city.,umn% SIGNS ELECTRICAL O GTI Uik
3 LL ry. which rry]im a penmil to cmwcl,dirr,init.o.<.demomb.a repand any wunmo
�.µ•.�Q pric,u, ,ci.uuamq uLvu,muva the i,rAicanl f.r.,li l romit In fn,a sigrcd,tutenent SPECIAL CIRCUITIMISC.
�n`oJ that he is licemN pu.'m the lnovi.mm of the C.m,ector's license",,(Chpirc 9 COMMERCIAL
Wp1¢t0a (..in,with Ssnum,7")a Division 3 of the Busitcu mid Pi.fedmss Co&)m TEMPMEfER OR POLF,INST.
G E:G C ihnt he is uempi ihcrefwm wd the kola for the dicgml.domino.Any vidimon of O NEW BLUC./ADDITION O DEMOLITION
km Minn 10315 by my epplic-omfit a permit wbjrcu the applicant toecivil petwhy a( MDEVIC� k
T [01 FOOD SERVICE.
IW-Z> ,.snore than five huidmlJollvrs 03500). VKSIINT
psQ ❑ La,.wrcnn me prapmy.tx my cniplvyce,wiU wngcsm lWir u�lc uimTCnwti.q P]]iCfklCfldcte xrxland the svucture is nut ddctulcdord m,,1 Ocr.fi(Stt.1UD.Bmiress L3and Profs,i Code:The Contrstols Liccme Jaw da,m apply to en msmrr ofCHES-FIA-NRF_SNprocny who Wilds or impro.tWmm,and who dxv such etxk himself m Ihmm,hL EL[ SQhis nam c,.pinyee,,provided that such improvemenu—m imended m offered fol IT.FLOOR AREA SrsQlefc yearpMtinomr-builder will hae Jic huNen.fProvng than he did mx build o,iinpOt 1'tirpme M uk.k OTA❑ L as mmer of te Momy,am exclusively onus ing with limiued cohlos,( .ei
.hm,l Oil ioy-c't(Sao 1IIW,Busircar eml Ihv(earitxu Can::)TW Comercio(,Li-
BING PERMIT
wM uoniruts for such pngats with a cnli eoms)licenscd pun,unm it)lo,Commnm's
Lice.law. PERMIT ISSUANCE
1 tumexempt under Sat. .R&P C fm this rco.nn
ALTER-DRAIN&VENT-WATER(PM VALUATION
Ovow, Dw
WORKER'S COMPCNSATION DECLARATION BACK FLOW PROTECT,DEVICE d
I loran union under PsWlyof perjnrynrieof dol follt-ing&imation,; V V
I have and will maintain.Cenlfiemeof Cortmiuto,df-inwm for Workcfs Conn rn DRAINS-FLe%)R.ROOF,AREA,NND. STORIES TYPE CONSTRUCTION
sainm,c,providsd for by Section 37M of do laiirc CuJc,fro the Perfomn mce of the
w'al six which ill,'mut le is.mld. 19KTURLS-i'llR TRAP
1 ha,e and will maintain Workef,Cmnpcmmiam fmarrarce w mgoircd by Sauon /
POO Olds,labor CuJc.for IIIc performance of the worA fm which disp,,Orm is i.,S]. GAS-LEA.SYSTBM-I INC.4 OUfLICIS OCC.GROUP
MyW«tcr'r Ami,c i,adict Inmmm' uml Puliuy u filer ort GASB-I?A.SYSTEN OVERJ(EA7 �f
C= �d.s7'i.��/�slt t'.Ld Pony N.. 3
CERIIFICATEOFS%IIMPf1ON FROM WORKERS' GRFASlJNDUNFRI.WASTEINIF,RCI:PTOR
COMPENSATION INSURANCE BUILDNG DIVISION FE 5 _
(Thi,rccrimn timl rs be rnragmMif tic permii 1,fa ac humlmJ ddlai,(Sion GRFASETRAP
u Iescl PIANCIfECK FEE
I codify that,.the pmGxnumofihe wxk Tor which fin,permit is issued,l shall SEWER-SANITARY-STORM EA.200 FT.
rut c,.pby amy pe*som in any maws tai as in bcetxrc subject in ibe Workee'Ctxripen- ENERGY FEB
7, onion laws of C.Efnmin Dam WADSR HEATER WNE: MIXCTR GRADING FEE
Z O Applicant 1
H
NOTICE TO APPLIC,%W.If,tate making this Ct mficiuc of Elvdimiicm,y.o shuud WATER SYSTESMEATING SOILS FEE
a 5 bccnnio,uon,y t WichMviswn, rsion Ixovidnm oo dr labrn Ctdc,you must
fmhwith amply with:ah provisi.m nr Ni.primii:hall be tlremcJ ievokN. w'ATI:R SERVICE
0 PAID
z CONSI'RUCGON LENDING AGENCY Nlll'HE9NENI'IA1.I'LMB. SQ.fT. pale Raeip M
I hereby eR Not lhert is arm+wcdun flding agcaytM the Pcrncmmrc of
Lt — tic workIt which ibis permit i,i.uuN l5ec.3091.Civ.C.) TOTAL.:
0 U 1<ndr's Nwc —
❑J leiidea's Ah , TQGL:
0.t I coni!,that I hive iced this illicdtitm and auie URI(bit lhove inf«mali.m i, BUILDING
h caral.l agnc to<oinply with ell<hy umlcwnly nNiwnm wJ.ta¢laws relating,. QTY. MECHANICAL PERMIT 'IEE I IJ 11
I..J Z building cmrhecti.n.mW hereby authacixe mpre,cmativa d this city 1r ems uqm the SEISMIC FtE 1
aMve-memioiid Iminco,four in,pccrxn puHaoes. PERMITISSUANCE
(We)aT,icc to save,in&dmdy and k,,bro oks.the Clly M Cupfcm.agelmn 13LEC1'RIC Il3E
IimWlities.judgncnu,rotas end capenses which Only in mty way.nc eguw said Chy Z ALMR OR ADD TO MECTL PLUMBING IO�6.
imequrrce a the graaming of ihisl rmu,
APPLICANT UNDERSTANDS AND WILT.COMPLY WITH ALL NON-POINT AIR HANDLING UNI'CTO 111.1100 CFM) MECIIANICAI�FEE
SOURCE REGULATION. •
AIR IANDLINGUNI'TIOVER 10.1011CPM) CONSIRUCf!ttr!
S Zm. Duc NOTAL
/DUC10 HO SING Ff
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant s fmuie Wilding mca,anl start s haMle harurilous mte ON IT I tlu,tlUl IT U)
x deBncd by i�CuPcrurm Municipal Cal,.Churl-9.12,aid the Hedih aid Sefcly
Code,Scetion 25532(.)1 ER 111 LOX)B'N)
E]Y,,, ON. ISINGLE RFSLD) PAID Omc Ra<ilx♦
Will the 0pplkam w futua huiding octuNut use Nuipmmn or nevirea which BOILER-COMP DHP OR 100.1100 BTU) ^
i h arallro ov cvnurtdnaas as dclioM by Ne Bey Aiem Air Gaudily Martagernam TOTAL:. V
mrictl BOILER-COMP(OVER 1"),Ol0 B'TO)
L
Ya ❑N.
AIR CONDITIONER ISSUANCE DATE
W sc mJ tW hawokw,malnals mtluimmcnis undo C haNcr 6 95 of Je Cali-
lth&Safciy Calc,Sectitxu 255!13,25533 oN 25331.1 uideruwd slut i(the NEW RESIDI!NTIAL MECII. SQ,FT. �� 9oe on,cmrrmly have a temp.Jut n is my orvionodhiliry to mtify�«apam Guitenenis whichmoa emxu prior,.issmxc of.Cnifwmc of(k'Pruc vmMriral agent Wm TOTAL: ISSUIiD BY:
OFFICE