99110038 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-F,LECI'RICAL MIT NNS_
BUu,DINf;DIVISION APPLICATIONIPF,RNIIT PLUMBING-Mh:CHAMCAI.
BUILDING PROJECT IDENTIFICATION
BC<LDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
//09t? r/ow)enh Pelta - cam.
OWN,! SHAME: PHONE:1.1911k -O CO A R'SN 13: LIC NO. O
Uk)A7 NAA CONPROLN
1FRCHFUEC7D`ENGINEER: ENO'. AD RFSS'. r'W / g' ❑
CONLQCI' PHONE.. - � BUILDING PERMIT INFO
{�✓/A7G—Ga � (µ�V :52,r-:52,r-9Z8 /'7 ❑ Coaenitaat Fees Paid by Applicant(Initial) BLDG ELECT PLUUMII B MEC
❑ ❑ LY ❑
lelfhICHNSI3CONnRDECLARA'T'ION QTY ELECTRIC PERMIT PEE
I n'by arm at th1 a von licensedd underprovisianpmrnei
a of Chucr 9(cmng JOB DESCRIPTION
Z with Secu.7000Iof Division loft ,Busirtux ud Rofcaviass code.and mYlinmcisRFLIDENTIAL
FOO - full force W effect PERMIT ISSUANCE
K — '" —J TX11 ❑KITCHEN REMODEL
Q,U�j Liccmc Clw Li<.N APPLIANCES-RI!SIDF,NTIAh ADDITION [I PLUMBING RE-PIPE
W
L.
Ctm o
' SI:CLARAON ❑MULTI-UNIT [-]STRUCTURALF>y PANELS
Zp�2Z
MODIFICATION
OZ—G, UPTO200AMPS C1 INTERIOR E)CHIMNEY REPAIR
Licensed Pmfesdon.l 201-H)OVAMPS IMPROVEMENT E)SWIMMINGPOOLS
�dq OWNER-BUILDER OECLARATION OVER 1000AMPS ❑BATH REMODELIREPAIR ❑DEMOLITION
C C Q 1 hcmby oDlrm that 1 om cxcmpt from the Col.,-,'s Lice Law for the
ny'3 L U fallowing re�sar.(Section 703".Business end Pr"furian Cole: :city or ttunty SIGNS ELECTRICAL OTHER
ti.
LL which tttlunes.p[nnn m cpXINCI,a11R,rmtplow,dertoilh, enY NnKlurt
C�' primmae iswence,ulvt requires the ageicum for wch permit fleexignalswtement SPECIALCIRCUITMISC. �l
F�`y that hcte licensed pim"mmme puvinun.of o Contract .License law(Chaptrr9 COMMERCIAL
W�GCO (cannrncingwM.cc mWM)ofl)ivisirm 3nfee B esmd Pwfesoccl Codc)m TTMP.MEMRORPO INST.
c.a e� ew he is cscmpg therefrom vW ee Iasis for ee d cd exemption.Am swWion of ❑NEW BLDGRADDTI'ION ❑DEMOLITION
Section NJLS by any applicem f«apcmtit whj s No aWicam to.civil Penalty of POWER DEVICES
=o, ❑Tll.'ANT BfYSF�tVICf:
no more than Five bwdrtd dale,,($500).
Sp ❑ Lu,owner nl the pnrpan or my cmpl0 cwith wugnwtheir wle eempenwti0n. SWIMMING A.ELECTRIC
IMPROVEMENT
F_
will&the work.mdthcwucmrt is nmi oronecolmeralc(Soe.IOW.Businesa ❑OTHER
6 3 ro s m whom Code:The Ctntraca r mil*1 Ides dm my ric If to.n oweer M OfIH.lT SK'RCHFS-FlXT ES
prrrpenY who buika m improves t ..N wiser Mas...h woh him,elf or though
hi.mwn cmpinyca,pr"idcd t s.in im......te em Fix intended Fir offcme fo, NBW : IDENTIAL ELECIR IT.
wk.lf.hrnever,the hui Wln impnwement is old within me year of cmnpldinn.the SQ.t1'.RWRAREA 3/SQ.FI'.
rcr-builder will have buNen of ryoving thw he did ort build or improve for pur-
pwe of sale).
❑1,ax owner of t porpvty,em exclusively amtracting with licemal conuvnurs to TOTA
11
answer the phi I(,Sec.](Wt,leaixcsandl'mfusitn�Ctde:)ThoComnwomelJ-
Wnsclaw nm apply to an owner of pnaenywM huilde m improves thereon.and QTY PLUMBING I FEE
n c"n rm wan pmiect,w;thac"ntraermfxlfaa:<d panaantta the c"ntraatarr
I'ce""c PERMIT ISSUANCE
❑ Ian mop uMcr See, ,B&P C for this rayson
AUTER-DRAIN&VENT-WATER(EA) VALUATION
.wncr Due
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE /„T� .�
1F=rd affirm urrdcr penaltyof bl'Conoleortheinamehgde A"',oru ((/L/
❑ IMve urcwillforhiS Crnifcme of Ovmwhno Costa.for
Wurkds Com pen- DRAINS-FLWR,RWEARIiA,COND. STORIES TYPE CONSTRUCTION
sminn,a,provides r by seatir.a J"!IXl of ur worn exk,fir tn� am«toner onnc
Y�for which thi,permit is issuad. Et URE,-PER rMAP
NQ 1 have and will mama n W«kera Compensation Ira a.u rtge'ueJ by Section / �I
ofthc labor CaY,for the perf.a of Bc wcrk fm which out permit is usual. GAS-EA.SYSTEM-1 INC.J OUTLETS OCC GROUP APN
My Wortrr'�x Cam,J'��n`�{p }µnn pqP' Policyls � —h
Carries: y`�, t Li//SL fU L12 GAS 32 �y3O
CERTIFICATE OI'EXEMPTION FROM 4TV RS
COMPENSATION INSURANCE GRI:SSFIINDUSTRL WASTE;INTERCEPTOR
BUILDING DIVISION FEES
flnisau�tin Itoat benmrylerMifRe pmoir it Tones,nuiatrerldWl.rt(Sim) GRIASE TRAP
tt Is..)MIS
THE '
Icenifythet in mcperoinnoceofthe.,A furwhidt this —I,,%ie.utd,ldsill SEWER-SANITARY-STORM EA. FT.
mtcmployarypets manymannerso tobecomewbjectmoNe Wml<rs'Compern- ENERGY FEE
Zz. awir'n laws of Cdifomie.D e WATER HEATER WNENT/FlECTR
C) Applicata / GRADING FFR
y NOTIC13 PO APPLICANT:If.locr akin Thi,Camf..c of F cmptlon,you Should WATER SYS HM/IREATINO
become lbcal ,,the Workers Cumpcnwriun provisions til the Wlwr Code,yes must I SOILS FEE
fordwith comply with such Provisions or this pmmit small be deemN revoked. WATER SERVICE
n.
CONSTRUCTION LENDING AGENCY ane, NEIN RESIDEV11A1.NAB. SQ,FT. PAID
V Ther which this Knhere isaco (Se,ionlcheingCgercylot Oe pufnmmtwe of Dme ReceipN
O the wrnV:for which Ni,permit IS iw (Sec JIM.Civ.C.)
Lank, None TOTAL:
Lerxler'r:Ahiresr TOTAL
0. 1 certify that I Its,mad it, licntxn mrd state that one enure imormvtien is x BUILDING FEE
m ctnr�ia.1 esron II r.onen ply wrel city wd county omirrance.aad,wm mw,mlwing m FE
QTY. MECHANICAL PERMIT E
V z bui W'mg conswction,wd heresy vwMrim reprcmnmtiro of this my menta upon one SEISMIC FEE
abovcrtentiard pol acry for inspection pnpnses. PERMIT ISSUANCE
(Wb)agrcc to sawm +"d k
.iodcnifyccp hn"d0,o
css Ilia Gf Culenino agamn z ELECTRIC Flip?
Flip?
oras and cxpcucs which may in any waywcwcagainu to City ALTERORADDTOMBCH.
in nutluenec of thgra
Inc nting of this ParnOit PLUMBING ITB
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO to."CFFt1
SWtt///yyy��,ERBGUI 4TIO S. /^/ 151 M ECHANICA--L�F'� M
`a �JN• AIR HANDLING UNIT(OVER IO. CFM) CON 40ON TA% �
t grew pkn thea, / YYYpp,V` Win EXI IAUST HWU(W/DU
11 HWUN FIATF,RIAIS DISCI(SURE HOUSI MITIGATIONFEE
Mill the.pplicentafumrt hui Wing acupansrae«haMlc hualloun matviW HEATING UNIT(TO I 94BN) 1-jj III
u defrhel by the Cup:nim Fluhicipel Code.Chapter 9.12,oral tic Hmlth and Safety
Crdc,Sccuom 25532(e)" HGATING UNIT( ER I00,L XI BTU)
EDYes I'ND .-
VEYIlLAT1 FANISINGLF.RPSID)
Will the applicant or fumm buioling occupant ur oWipment or de'viocai which C3 ave—Raerp N--
.mit harardous Ili,c,m.rnirwnts as defimM by the Bay Area Air(Ardity Nluug,ment BOILER COMP(3HP OR 1(10.000 Bill)
Orion,,?
TOTAL;
BOI !R-GDMP(OVER IIX)fXXI PTU)
the hertut rtmvinls R CONDITIONER
mryirtmvns urvlcr Chapter 6.95 Nth C.li- ISSUANCE DATE
for "' Code,Ncnir.0 25505.25533 and 2553x.I mderuand flet if the NEW RESIDENTIAL.MECH. SU.17
wrn havicerne"orthin iti,my mcpnriMl illwar lfOncu npFituw chmu, a nnpriortois les ufe lityto il(ken teav f TOTAL I ISSUED BY:
OFFICE