00020069 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 1 2 rXJInCl
CITY OF CUPERTINO BUILDING-ELECTRICALMff NO. I--
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL
I4UILDING I'ROJF:CT IDENTIFICA'IEON
SANITARY
BUILDING ADDRESS
NO. APPLICATION SU13M l'FI'AL DATE
22170 8��K�L� GST Ors AWa-s, 64- 94v24 /2-1Z
OWNER'S NAME: PHON14 CONII��AACfOR'SNAME LIC NO:
�406) _3� p��� /Muwrs�D�/�.�C [' ,f lam ( NIC CONTROL#
ARCHI I EC I'ENGINEER LIC NOOO AJDRITITSS:'"��,YY �f�-I�Y1.Iv . �J Yl'I�IQ3• ❑
CNN o?ki, C-z 58 R o
CONTACT: PHONE'. I1lJILDING PERMIT INFO
'��O ❑ Consultant Fees Paid by Applicant(Initial) RIJIF.- Ii1.P.C'r_, r1.UMH�. MLC
LICENSED CONTRACTOR'S DITCLARAEON O Q,ry ELECTRIC PERMIT FNE rL'yJ(
I hereby at If n,at l ani I rraeH,mds'""""env'It Charter 9(nnnrete al JOB DESCRIPTION
DaX. canto Senlan9000)of DI,kion3aDho Basince,and put ..mn,Code,mdmy accuse 1. RE ;N'IT L:
F a f II lame and eHeru. PCRML'1'ISSUANCE SFDW h ❑KITCHEN REMODHI.
QUU Lirense Cbass hlc.k API'LIANCES-RIES I UENH'IAL ❑ADDI'T'ION El PLUMBING RE-PIPE,
vFiQy Dale ISDECL ❑MUCrLUNIT ❑STRUCFURAL
AItCHITGC'1"S DECLARATION °I S
.7
y ['ANI...
F m I undu."wu1 mY Plate Shull be nsrnl as public rucanls MODIFICATION
rOm 201-E 2011ANT'S
p z..W EINTHIRIOR ❑CHIMNEYREPNR
[ti`3-.W I,imnscd Professional OWNER-BUILDER DCCLARM ION 201-1000AMP5 [MPH REMONI' ❑ELMOIINCPOOL9
Q F
9Yi J OVER 1000AM1'S ❑BATH RI?MODEIJRh;I'AIR ❑DEMQLITIQN
1 hereby airnn Nal 1 nm exnmpl fr m tiro CobVneana,License Law far,ha
a F fallowing notion.(Section]031.5,Businessland Professions Cade Any city or conn'Y SIGNS ELECTRICAL ❑O'I'l ll'R
X
bludi requirespconer ill construch'll p demolish, learn ally.l ct 'e
�.�+ee pr', I n 1' 9 II 111' If 'hp ll inch 8 dsttenon SPECIAL CIRCUbDMTSC.
y .ball periled!p I h p III C I n f Chafer,
W COMMF.RCIAJ_
w�MT tail g itch e 901lid le - r Ili H .' -. fl f .Crde)o' 'LMP MI;fI:It OR POLE INS'1'.
y c ,ilei 1 PI Ncn.f d II h'.':f linalleged own,floor Any - Pin,of ❑NFW 131 DO/ADDITION ❑DEMOLITION
��� Sect n70315 by any rpl mto,eper I Rests theappl n tell civil Parody of POWER DEVICES [I TENANT ❑FOOD SERVICE;
not mare than five hundred dollars IS500p. IMPROVEMENT
y¢� D1,n,owar,(if the uperty,ormyena,10ccs with wagers as lhai,role Compensofan, SWIMMING POOL ELECTRIC
1.. will dethework,and the ouncture,i.s not lnfeadednraffered forade(Sec.7044,Bo,inos ❑OTT II?R
¢�] � and Profession,Code;The Conwcmr's Liccnso Law docs nor apply to un ovine,of (a,1.E'1S-SWITCHES-FIXIURES
C Proper,who hands or Improves Ihacan,and who does such work[allied or II.... h
his own employees,provided that such Improomcr s are nm intended..r ennui for NEW RESIDEN I Al P,LLCTR
sola l[however,the 11111111111i Harrovenarat is sold within sec year ofcomplenfaa.[ho SQ,17I'.FLOOR AREA S/SQ.FT.
builder will have the all of proving lot he did n I build ar Improve fill par salla - 33 o0 O
as..wnrr..I lir pmpeo'nm exmn,evely....,namin"il,u.emsm coahnemrs 1.. 'ro'1'AL: � �� /
enneu [lin r +($ 7014 li sc II f sCr1 )fin C , ter 'le-
d apply to air owner orp p sY who Milds or unproves'lamenn, ul QTY. PLUMPING PEr4,1;,' GC
wlie contracts f such projects with a conlraclor(s)resulted personal 1 111,Cllr It's � � pito
Cru 1 PERMIT ISSUANCE /
I am camp,under Sec. ,B&P C for tills mown
lg�
G I 7 Date 1
'S AI:1131Z-DRAIN A,VENT EIZ IE VALUA'fIUN
WORKERS OMPF,NSATION DLCLARATION HACK FLAW PROTECT DEVICE 011
7
I hereby affirm ander Penalty of prolay one anile fallowing dcClnrvd..n.: �f C) 0 0 y
(]Ibavap vidl mninby Section frramafConsent ill
ei, self-iawmfrn un....Campcn- DRAINS-FLOOR,ROM F,AIZHA,COND- S'I IIItIF_S TYPECONS'fIZUC'I'ICI
sullen,as hick this
fr'mi S.is..n 37000,hc L.bm'Castle,far the pe0hrmance of the
work farwhich Thi,mentalis Issued. FIX'TURE'S-PER TRAP
1 have tad will
hm . lWorker's Compensation Insurance,as unrelated by an
3900ohe LaoCodq fil the perfnnnn.eofrbc work fill
fach fid, bolster],
CAS-P.A.SYST[X-I INC.40U'fhH'IS OCC.G12DGr �� APkN�
My WedeHs Camponsmime Insurance carrier and Policy number nm'. 1//
Cortise Palley No.'. MS-LA.$V$TIiMOVfiR 4II%A) 3
CERT'IFICATF,OFF,XEMITIONI�ROSIWORKERS' CRIASFJINDIISTRL HASTE INLIiRCIiYI'OR
COMPENSATION INSURANCE HUILDINC DIVISION PIPES
TIry,ecro.nmdnnrbeeompleardbilePe,all is In relandeeddollas($100) GREASE'CRAP
m'less.) PLANCIIIAK PILE
lcmlifylhll fame ped'ormenceofNewok farwhich linemcndu isissand,Ixhgll SEWER-SANITARY-STORM IA.200FIL
bill courtly any person in any manner so as r became subject Ill the Workers'Compen- ENERGY DEI:
oz amino Lew,of Culnamin.Dunn WATER I[EATER WNENT/ELFCfR GRADING *EE
Z Applicant
0 NOIICETOAPPLICANH';IL after oinking tills Crsihenle of l?xemp.mn,you should WATER SYS1'13Mf1'REAPING
hcwmc abort m the Workers Cam Ilan f rhe lahnr Code,you mail SOILS FEE
7 Won,or
pmwi,he a
W fonhwilh u.mrly with such pmvisionsonhis pemtil shall be dcemeA revokW. WAFER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RESIDEN'f1A1,PLMN. SQ IH'. PAID
z Dale RereirlM
1 hereby off nn fhanhcm Is n Gmxlmednn lending agency mile,perfnrmancn of
U the
LworkNmuhich,hi,pcnnll is issuul(Sec.309J,Civ.C.)
L>r E•' enders :una 'I'O'CAL:
'y U Lender's Addmss
�y ZI l ceudy had l have mid has a,bar me anal'lan,11.1Om uh.ve'mf"I Tal is BUILDING PER
ir0 correct,l agree to caujily widall city and county ordinances until state lows relining Is QTY. MECHANICAL PERMIT FEE
U z building mn.locurn,and hereby anthem,'Presentness,of till-,.fry To cone,span line SEISMIC FEE
ebovomemlalled pmrerly for inepeeion prposes, PERMIT'ISSUANCE
pate)agnea to save,indemnify Ind keep hornless the City of Cupertino afoot G68CTRIC FEE
hatioli,icn,jadgmenw.......all expenseswhichmay really way name agoras,said City ALTER OR ADO 0MEC,.
rl.unnamc FLr:
ill .ICAN ce of Thu greUNDERSTANDS
SANfIlill pcWI
nto
APPLICAN'P UNDERSTANDS AND WILT,COMPLY WITH ALL NON-POINT' AIR HANDLING UNI'I'fl'O 10,000 CPM)
MECHANICAL FEE
SflU1ZCE 2H4ONS.
AIR HANDLING UNIT(OVER 111,0110 CFM) CONS['RI1CT'ION'fA%
Signaurenf AppHeant/Coolraetar Doc EXHAUST'I IOODOV/DUCT) HOUSING MI'I'ICNI ION PEE
HAZARDOUS MATERIALS DISCLGSUR17
Will line upplicubter fulure huiliin,"Itian,ommnr handle lmzmdn.n nbnend II EATING TWIT(f,101,0001iTU)
as inbred by the Capetian Municipal Cade,Chapter 9.12,ubd lie Health tad Snfcly
Code,Sev ion 255321a)P 1117AI'ING UNIT[OVERUs)ON)HIIl)
VavNn
� VENTILATION FAN($INGLI3 RESIPit PAID
Will,he u Beall or future building aecu V use equipment or devices which Dwc Itcwipr tl
PP d ra. Arco
1301 LEk-COMPf3HP OIt 100,000 BTU)
-coir hamnluus all wnlnininena as def sad by the ILry Areu Air Qbullly Mnnagrne°t 'I CI'AI:
Fishr,�Ve,, No HOILI3R-COME(OVER 100 Flat H'fU) �
AIR CONDITIONER
Ih ul h 1 aI I ,e d Claps 695 of The Ch- ISSUANCE,DATE
film H Ili&S f ly C 1 S t 25505 25533 125514 I 1 h 111 al l lie NI'W RESIDEN'f1AL MECH. SQ.PT.
build' g l , By h n lin t l l y .I 'Illy, I fy til c' P ul
..1'11 qui oro. li.hl ah noPrime,.u.;nmafaC ,Cas of flan pl c,
w •r or omhor'r agcm Oma TOTA[^ ISSDL'D BY:Al
OFFICE