29936 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY,
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. ^ ^^�S
BUILDING DIVISION APPLICATIONXERMIT PLUMBING-MECIIANICAL - 9 9 3 6
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE
�ncom
OWNER'S NAME PHONE: CO, ACIT)R'S NAM1fI° ^ �T EJC NO:
1`�_nV, L NAC CONTROL A
•A GINE' LICNO:nff AOpITFSS: _
L(OS
(20
CONTACT: PHO. L✓_,�-_/�J BUILDING PERMIT INFO
511�/yQs /yw `r e � I ConSulfenf Fees Paid by Appllwnl(Inid d) LDG ELECT PLUMB MECH
`-,J"� CLIICENENSEDD CONTRAC OR'S DECLARATION QTLY` ELECTRIC PERMIT FEE
I banality aR-arh than I.m licarucd ander prnvi.ia,.of Chi orr 9(awueacing JOB DESCRIPTION
o�z with,seniar7BHB)nfDividon3ofHeBadrauWPmrevimt,cMe. amrhaeraei.
rWoO ' PER MIT ISSUANCE RESIDENTIAL
in full f dale _
aU(F�' Lic.X ❑SFUWL ❑KITCHEN REMODEL
NzI Dem Comvemr APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING R&PIPE
ARCHITECTS DECLARATIONPANELS ❑MULTI-UNIT^ /'R ❑STRUCTURAL
z O t2Z 1 uNavvd my plans shall h weal v public muds !•a �' V MODIFICATION
CZ—M UPTO200AMP5 �� El INTERIOR ❑CHIMNEY REPAIR
F�F4) LiccnsW Pmfanirmd 2014000AM1IPS IMPROVEMENT
�Y ,_l OWNER HUILDER UECLARATON OVER IW)AMPS ❑BA"D{J TOO P},I�DEMOLTTION
y Q I hereby affirm that I am exampa from the Contreaa(s License Lew f c the 0,11_f���yN�LL
x a L UUF following reason.(S Ieaa 7031.5,Busiras and Nofosions Crile:Any city or county SIGNS ELECTRICAL ❑
F C ya which Not,. pe )t rt t R , p d h h tai any nmewm
y.] pnoc is erocc al: y ah pplc If lh n fl gad start S PECTA L Cl RCUITAI ISC. / L<II f VI `a
qq5 y that he I ,ed pis. ti th p s l b C a SL Lo (Chyrta9 COMMERCIAL w•
t� OO (°ore ecrgw)h Section700(rot hvnu 3 tithe Noeoe„ IIT f airm Code)or TAMP.M EILR OR POLE INST.
a e C that he k cxengn dcrefnmo end the basis for the alleged exemption.Any violation o1. EW BLDGIADDITION El DEMOLITION
^;m Snake 7031.5 by any applicant tin a permit,.bjaa the applicant toe civil Nasky of IsOWHR DEVICES ANT ❑FOOD SERVICE
I„Zyy nut mire than Bre hunkad!dollara(S5(X0. PROVEMENT
Fq (] I,uowrcraf Oe pmpeny,nnny empinycaa with wugdutheir wlccomprmation. SWIMMING POOL ELECTRIC
will mthe work.and the stmaaa is nor mtemted usoffcred for We tsee.7w ,Business ❑ ER
— .m Prores,ian.Cove:The Conant Llama Us,does not apply to an nwrcr or Lars-SWITCHES-FIXTURE
popcny who builds u impruvcs thamn,aid who docs such wok himself or through
his own empinyas,prodded Nat such ian,...cmenH art not imerdN or ofeml for NEW RFSTDF IAT.ELECTR SQ FT.
ale.If.however.the buildirt,an vuvemmi i,sold within use yueefcnmpletion.the Q. FL AREA $NQ,IT.
err-builder will have Na burden of Proving wt be did wt build ser improve for par-
qcc of sok,. 23 29
❑1,m owver of the poPantY•am a scludvdy caursting with liccruM m uroxh.m TOTAL.
comuuca the Irtojm(Sec.70NR.But.eM Proubc si.Cale:)The Cnna.csor's Li-
rose1..v dues ore.pplY m>e nwrur of popenY who buildsoimpw.es dercua sold QTY M RMIT FEE
who cwtran.fa such nojecu with.corse cauls)liansert pursuant to the Comractofs
License,Lsw' P SUANCE
O 1 w comp ander Sa. .B R P C forthis rreroo
Ower Dere "AL � URAINA VENT- :R(EA) VALUATION
WORK[R:S COMPENSATION DECLARATION BACK OTECI'.DEVICE" ��/l
lhe�eby�adaperufty of perjury ane of the lollowine dcclm.tim: (Vc l/1,/t1
❑Ifuve end will m.iwine Cenifcue of Camenam self-imwefu Wahv's Compen- DRAINS-FLOG (30F,AREAXOND.
sat u provided for by Satim 371X1 a the lobar Code.for ttr perfamorce of the STORIES TYPE CONSTRUCf10N
work for which this pemut is issued XTURES-PGR T G
❑1 have and will anoint WorLae,Crmpanwiun frau .ss rryufd by Section
3700 of Lubar Code,far the patarnurec of hew or which thhiiss premia is round. GAS-EA.SYSTEM-I INC. CTS OCC GROUP APN
Color I �� T C I��R' OAS-EA.SYS EM-OVER4(p
CHRTIFICATE OF ENINPTION MOM WORKERS'
COMPENSN'ION INSURANCE GREASMNDUSTRL WASTE IM'ERC
phis rection aced ern he cimpleasd iftlu t is for one hundred dully (SIM) G )IVISION FEES
perml GREASETRAP
or lass.) \ PLANCHFL
IcertifythalintInt, afthe amt ac,an which that permitixirsuel,ldodl SEWER-SANITARY-STORM IA.20017T.. '
no,employ any pawn in any inanrcr w an nr bavuw suhja�a m the Wxkai Comprn- IiNERCY 1
O z setion Wwud CdiNath.Due WATER HEATER WNIiNG1i1,EC1'R O
z O Apf icent ORAUWG r.
y NOTICE TO APPLICANT:If,after naking this CenTeahe of Esta ion,you should. WATER SYSTIiM/1'REATING
a > h:emrc-whjm to Its,Worked,Co'npavaaion Iaroso,.,M tba Lalra Code.you must SOILS PER
W '" forthwith comply with such Provisions or this p roi shall M dc<nscJ rcvokM. WATER SERVICE
CONSTRUCTION LENDING AGENCY NEWRESEDENILILPLMB, SQ.FT. PAID
I hcreLy sfRrm thio there is.construction landing ogcrcY fm tk performorce of Racip p
ly eche wart ra wnian Inial permit is i.,aed Lsca.3(197,civ.c.)
IeMef.No. TOTAL:
LenhYs Addre.x LI
1 I certify that 1 lora read Nis spoliation and oats this the bova iaformvian is BUILDIN O
V) arida.l.gash.complywith.11 city county odEumcs W sum law.relmi". QTY, MECHANICAL PERMIT FEE
1.) ,z building constmction,and hereby aurhuia repnsamuiv6 of this drym enrar upon the SEISMIC
" .hove-mmuorer)proputy for inspection purpmes.
(we)'ra to ova,hdanrmify and hannalea,Hoe City of Clolmirm ageinu PERMIT ISSUANCE EI.0
IinbiBties,l�Pn�'4 emu Weaperacs wh' mayinanywayxcrue.geiasts.id City ALTER OR ADD TO MECIT
in nal of —ingofthis PLUMBING FE
AP r ANT ON STANDS r L COMPLY WITH VON 'DINT AIR HANDLING UNIT M)10.OW CIN) h1ECHANICAL
URL .GU ONS.
ATR HANDLING UNIT(OVER 10,0)0CI-M) CONSTRUCTT NTAX
gnuua of C ra< EXHAUST HOOD(W/DUCT)
HAZARDOUS MA iR1AL5 DISCLOSU _ HOUSING EON FEE
Will the - ru m let.bsiun acctryaot voauha hnwdous reared HEATING UNITlT0100.0HO PTU)
as,dc0nd by alta Curt Municipel Cuae.Cn.Pran 9.12 end the Health and Safcry
Cock.Sauon 25534(.)7 HEATING UNIT(OVER 100,000 BTU)
❑Yet ❑No VENTILATION FAN(SINGLE RESID) �� PAID
D e R aiPr
Will eche apprwona err fns a building by t1he B use ,a AiroQu m devices which TOILER-COMP(LEP OR 1(0,(0X1 RTU)
emit huardws air conmmiruma,us Jefrcd by the Hoy Atw Air Quality Mersgenuiu
•DLsr,an? TOTAL:
❑YaXNo, BOILER-COMP(OVER 100,W)BTU).
I have tee Hoe Iuvudr a,nmmnals aqui mu aorkr Chatter 6V5 of abs Ceti- AIR CONUIIIONER ISSUANCE DATE
Hnith A. Say Caxk,Nechen � h,. 5 3md 25$33.1 uidcna Hat'fthe NEW RISmEwrlAI,MHCIL' SQ.Fn
tui cost". ocaHy leave s yraynndniliiymnoaify a For
of the Icon whit Fe 1 Tri
,cat )ate - ISSUED BY:
OFFICE 111