S 1435 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-F],ECTRICAI. TNn IFNO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL 1435
BUILDING PRf IJE(TIDF.NTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITT�ArL�D,AT
106 D e-lt0Iii
OWNER'S NAME: ION Y)NfRACTOR'S NAME: LIC NO:
QH QVC NIC COM'N/DL x�
ARC'11'H1GI'lieN(i1NiiliH: LIC NO: ADDRESS: ❑ (�
VN � L
CON'I'AM: PHONE'. BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) N IiLECI' PWh M1f EC1l
(A LICENSED CONIRACIOR:S DECLARSHON QTY ELECCRIC PERMIT FE
I bcleby of iren dral 1 am Ikcmd uoc provisions of Chetan 9(mmnercing JOA DESCRIFPION
yR�..II a Z is Srcai..lfl000)or Or iNion i 1 fl rt Birines,aid Prtde.wier,Code,and ivy been..i. RESIDENTIAL:
l f
1-OO in fular and uRaa. PERMIT ISS DANCE
W- ❑SFDWL ❑KUCHENREMODEI,
aW U c.Clues Cm
Class APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBUJGRE-PIPE
lion ARCHITECTS UI!CLARAI]ON ❑MULTI-UNIT ❑SfRUCNRAL
F,D oo PANELS
z O 1�Z I Inxlersuml my Pions shall N,used as Public remi MODIFICATION
Oz-O UPT0200AMPS ❑INI'ERJOR [I CHIMNEY REPAIR
1-�F-ul ijacred Pmfccs 1 201-1000AMPS IMI'ROVF:MFNI' $N'IMMING POOLS
f; OWNER BUILDER DECLARATION OVER IlX0A.N 15 ❑HA'fII RISh10UEllR1?PAI FMMING
' C C Q I berchy affirm that 1 am exempt fmm the Convxtor'x License Law for the
x<O TiON
1 U following rmson.(Sceaim 7031.5.Resines ed ProfexJoxu Cale:Any city or amnlY SIGNS IihF.CIRICAI.
❑(TTI TER
1 ul
C)�+ which requires a prion to c Wrva,miler,imprnn,demolish,or r yvr any slructum
'
C) which
prior to its iswanee,also regaires de aft,icem for such Penni)to fie a sigml thrimenl SPRCIALCIRCUITNISC,
f, yi d.be is liccn.d pcmoan,mllu prsMkimrof the0irtco%k lJcoa.Iuw(Oeper9
W COO (cornaercing xidbSmihn7W mfDiviskn J mt be Buxinaxard Pmfesum Cde)m TEMP METER OR POLE 1NSr, COMMERCIAL
a e a lam Iris exnnp lhnefrvm roil the I,-for the all�gal exumpien.Anpviolwlun of C NEW BLD0ADDITIO.A' [I DEMOLITION
la. Seemi70315 by any app fora lemtit wbj..tleapPlcuileu civil prnalry of POWER DEVICES
=y ❑'I}NANV ❑li]OD SF,RVICE
m Own EvchudrtA d.l m(Semi).
Ih1PROVIih1 F.Y1'
Q 0I.nowarof de poperaY�-mY cmPbyces wile wage,oa deirsalc naG,Busiion. SH'I.NMING I'OOLIJFCIRIC
�'�� viii dame wurk,ad lM1e samarum is nximended ontEcred f-cde(.Sec."ItH4,Buaotcs ❑0'1111?R
C�
63 sal Prolehoans Circle.Theol- lieler's land wflawdoses,not
wokapplyhi 1.norsurerof OITILETS-SW'RCIIFS-FI
himpis own whotr i1Js or nnpmva r .h i pr who dao such mnk binuce or tnrough
,elown awycoyas,providd lNm such mem is sold w are moat inmdd u deom.onal The NEW RESIUFIJ'f1Al.
,sIe.lLhoweveclkne Wingmimpnrvemem is sold within orcyemoDn,ro-hen.the SQ.FT.R.(%)R AREA g/SQ.IT.
-huildn will have the M1urdrn o(pmving that he JiJ nM huiH ax improve f-pur-
paofsale.
❑ un t
1, aw T of the pm1'r'nX am %ine,si vely oat professions
wlta:lamed amlrxnxe In 'fUTghl
rnns La ah Itmjal(Sa.'i(o, Bnainess ro ity k.ans Calc:)The... Ii ldx D-
oclatwdo-raxcplalYmu with
ofPmpunywlm l,ed rrimpnrvcas dumm.ud UTy, PLUMBING T
whoantrects
fear such projccu wish a rnnwcnr(s)Irrnsed purwenl to de Caarctots
Linn.law. 1117RMIIISSUANCE
lameacmpurdn Sas .IIKPCfarihismemn
CosnerMarc
ALTER-DRAINSVEN'I'-WA'IER(EA) VALUATION
ORKER'S CO I'of EnBNSATION DECIARAIION
I M1eraby alRrm umkr en ttv t,me of the fallowing Jedvaiau: BACK II.OW PROTECT.DEVICE.
❑thew orad will meimein a Cmlfichc of Continuo elf-ir.wre for R'nrlaer's Compaq. DRA[NS-FTIIOR,kOOEARHA,COND. STORIES 'TYPE CONSI'HOC]Gr
satiam,as M...de)Go by Salgn 31(X1 of the Lalvx Code,for tae perfommnee of the AI
.,A Lx mi
width Bin tet is issued RXT RIS-PER THAT 4R
Fj I Iwve vel will moimuin Worker's Conolanoccurred!salion Insurance,asoccurred!by Sxelion /�
TIM of theLen-Code.for ale Perfmmance 4l be wM for which lore permit is iswd. GAS-FA.SYSTEM-I INCA OUTLETS -1 rICCGRO PAI-N
My Wudci w Contpunrdlion Insumna cwicr ad I'alicy mumble vc. �.
Cirrol facility phi GAS-1i\.SYSTEM-OVER J(E:G Lf
CERTIFICATEO171; HMlrHON FROM WORKERS'
COMPENSATION INSURANCE GRIAS VINDUSTRL WASTE INTERCIJTOR VISI
to
UTI. (1 ON
�
FF S
IThi,sain n rad col bfcomplcled iflhcpcmtit k!one bundntl dallua f3llXq
- GREASE TRAP
leas,)
Icrnifythar in alae Pcrfonnmrcmdahc wurV:fawhich abix prmtit is iewcQlnM1°Il SEWER-SANITARY-SIURM I!A.2D)F1',
rex employ any person in cry manner so as n become xibxka
t In Ile Woas'Cumpen- F I:RGY FET:
C) z saab lows of Catforda,Dare WATER I[EATER WIVENI/ELIiCTR
Z 0 Applicant :E GRADING I
G NOTICE TO APPLICANT:If,after nuking ahix Cenci Id Exempiow,you should WATER SYSTEM/TREATING
aNcebr ,wy'sa to the Worker:,Gampmsalion prnvixio n of dv War Cala,you nous S011S L '
� ,--, RnAxiah comply with such previsions-this permit shell he skrnicd revoked. WATER SERVICE
=Z)
Z CONSTRUCTION
c,xis LENDING NGAGPJeCY NEW RIiSIDPXfIAL PLAIN. SQ.FT. PA 11 Ilatc Racal,,p
Q Ihereby whdfnnlfw tliloaric ieand(See.mP.Cia,rgcxytor the pehxnwcecaf
fA the wok for.hien an,permit m is.,wt(Sea.JU91.C'rv.C)
iedcfx Nentc 'IYl'IAL:
G I<mlen's Acidness TOTAL
r a 1 sonify that I have bead this rppicrlinn and state the the above inlemwln i, IIILDING FEE
h amat.iaghee maxnPly with all city ard nmmyoadiruuecs and slntc axs beasine to QTY MECHANICAL PER IT FEE
V z Building mnsarvnrvm,and berch,emhnim representative,ofthis eitytorntcrp
uxt the S'SMIC FET,bm
'-' arvc- entimcd pnpcay Lx ine
yce
lion purpoc PERMIT ISSUANCE
id
(We)agse to sale, cmnify and kap harmless ale City of Cupca ino egairet E1J[ FLE
Iabdnie,,jdgmems,cents ud expcneo which may In any wey werre egatna said City ALTER OR ADD TO MECII.
to ataqunee oflM1e growing M this Pemba. %.UAIBIN J
A ITLI CA NT If N DER S'I'A N OS AND WI IA.COMPLY WI'I'II ALL iN
NOs T AIR HANDLING ON IT(1010000 CFM)
SOURCERE UATIONS. A@CHANICA
AIR HANDLING UNIT(OVER 10.000 CFM) CONSIRUC IO TA
Sigauurtc n lwii;iyCanrucicr 1Am E l IAUSf HOOD(W/)UCI) HOUSING MITIG ON FEE
HAZIRDOUS MATERIALS DISCLOSURE
Will theapplieantox Whom brid'vgoaO,moxtomoeforalle Mmrdus materiel HFATING UNIT Tit HVJXX)BI'U)
is defiand by the CoWi ices Mrn'rcapal Calc.Chuper 9.12,anal the Ileelth and Safcry
Cock,Saaion 249200? HEATING UNIT(OVER I IX%(ft 11'N)
E3 y- El No VENTILATION FAN(SINGLE RFSID) PAID -
Will the Ikanl-forme Wildin I oe t or dcvias which Uwe eip X
app go vtheB e.Air
BOILER-COMP SHP OR 100,000 BTU7
cmil hmvhdtus air cmnuninalu ex dcfned by the Bay Ams Air QwlitY Managenenl
TO IAL
Diurial BOILER-GGMP(DVER I(0.0011 BIL)
E3 Y, ❑Nn
I love head the,he:vtlaos mveralx lryuiremnts unkr claii ANA 4the Cali- AIRCONDIIIONER ISSUANCE DATE
Gamia Health A Snlity Calc.&ainn,25505,25533 ud 25534,1 muiaWaxl Gat it the NEW RESIDENTIAL MECII. SQ.FT.
building docs m emendy have o)erns,that is is my mpxuiNiily to notify tk tKR%anl
of the becomblichoN which most lesn l pin to isiarwe oft Cinnirichral Ucophuv.
Owner or author's rl ngcio Ilam TOTAL: ISSUED BY:
OFFICE