29134 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERhfff NO. w
BUILDING DR9SION APPLICATION/PERMIT PLUMBING-MECHANICAL {`Jl
BUILDING PROJECT IDENTIFICATION of
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMIITALDATE
a-fl q . -
OWNC&A pIG: PHONE CONTRACTOR'S NAME: LIC NO: i NIC CONTROL Or
RCHITECLINIGINEER: LIC NO: ADDRESS:
QAMEr� uTTak14 +-1 Sqe .
CONTACT. 4� PHONE: \� BUILDING PERMIT INFO
I1m SSS 736yC�C� ICoflwlten[Feec Paid by Appllcent(INr Bk EIFCr' PLUMB MEC,
V UCENSIDCON RACfOR'SODECLARATION QTY ELECTRIC PERMIT FEE
1 homhy err than I oro fmnsed ower provu;«u a Grapter 9(comn,a,cing �aa JOB DESCRIPTION
�a'z wih Smior70MM)of DMoor.1 ofrhe Businm and l4nfecsion,CMe.otwm licerue is PERMIT ISSUANCE Sv F_LAIC
00 y PG RFSID NT
F full force ot.d affect.aFUU ,lkena0m L.icg ❑"FOWL ❑KITCHEN REMODEL
y<a D. C«nfamor APPLWNCES-RESIDENMAL ADDITION El PLUMBING RE-PEEP.
f-O y ARCHITECTS DECLARATIONEMs' c ULTI-UNIT ❑STRUCTIMAL
z O'on TJ. I micarsmml my planar shill b<uN as public records MODIFICATION
oz-, UPT02W AMPS
� Llcavai Prdcorimml ❑INTERIOR ❑CHIMNEY REPAIR
DE cacmpt
OWNERBUNTERIMPROVEMENT
I
sss exempt fro
dt DECLARATION OVER IMOAMPS
y�� hereby aRrm Thu 1 ern from the Commcm/x I.icenw,Law for the ❑BATH REMODEI/RFPAIR 0 DEMOLITION
5): Cod following rcum.(Secd®]OJI.S.BWrcss and Professions Code:Any ailywarumY SIGNS ELECTRICAL C)�FR
LLl LL, which rryulm is permit w mmvun,eller,improve,demolish,of rcpeir any u pure
0 prior w iu iwmac,.lso require,the appl.","'far such Perrault to Ble a signed uuement
w0y SPECIAL.CIRL'UIl'/hI1SC.
} hmhc is liacmed punuenuo he pmviswms of the Cnnwcmh tinme law(Ch.Ixer9
0 rcamrtrrcing vim scatiiw]IMnlof Divirion3nf the Uusircss utd Pmfadoru code)« TEMIR.METER OR POLE INST. COMMERCIAL
d C mer k pt is exemhcrtfrom viol ilr bads frr he allcgui mean,iva.Any mlstim of NEW BLDG/ADDITION El DEMOLITION
h
Section 7031.5 by say lmlicarn fora lrmi
rt wbjenthe e
s pplramnr a civil penalty of POWER DEVICES TENANT ❑FOOD SERVICE
QZ Y ^m mine bun five bunked dollars 155001.I,ns oxmcr ofine prgeny,«my empoyera with wagesheir sole compuuahm, SWIMMING M)OL ELECTRIC � IMPROVEMENT
will oto me wmk,.M thedum
Iure u Id ineaded orofferad for aeric ]f N4
(Sec. ,Rosins., ❑OTHER
L3 end 1'wfasim.Code:The Commmaf's Lican.s,taw Jan trot apply rot w owner N OUTLETS-SWITCHES-FIXTURES
pmpeny who builds or impmvn thmecn,and wFn dee wmh work himself or hwugh
hi%own emploYco,f widecl that wch impn smixats arc not rattail or offered for NEW RESIDENTIAL ELL'CTR SO ET.
oak.If.however.the building a improvement is sold within nnc yemof completion,me) SO.F'T,ELOOR AR _7
w -Wiµder will have he dvdcn of posing thu he em ver build«improve rot pw- 0 I '� 3 11
rf.sale.l. � y f,
rof ft, prop(,a..H lino cod cimmichmIrsaling Cat The Ccomr.mon to O Z'Z �/ Y
Of d ,r not
(.Sec.]Bw,Bminw'and mowvims Code:)The Cantrsmis tel
c ro mamodtranm apply hnnowrrrufroccuny w,mrsho oddxmimgoves Contrq.d QTY, PLUMBING PERMIT FEE JUL 15 1996
who convtna f«such pmjemx with n mmrecux(c)feemw pursuant m Ina ConuvclWs
4ceew Lew. PERMIT ISSUANCE
❑ loo ore der See. ,B&PCfm hurcaam CITY ur 1:1 H-1 _
ALTER-DRAIN&VIM-WATER EV)
m. h• VALUATION
WORKE 's MMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE ® I O �r
I hereby aMmi under pinalty of perjury naw of he A}-- S following Jederndams: V Q ` "
(have amt will rtuinaina Cenifrnm of Content m.self�in,um f«Wxkcr's Canpcn- DRAINS-FLOORROOF,AREA,COND. STORIES TYPECONSTRUCTION
som Frau f«by Seetion 311X)of the la «bCode,far the pmt mimre of me
work fa which this permit is turned. FIXTURES-PER TRAP
F1 I beve and will m orm tin Worlsto Conµmaation Imtvnrre,u neutrino by Semim
37IM.Fibe labor CMc,f«Je Nifomunceofine work mrwhich dais perWt i,iuucd. GAS-EA.SYSTEM-I INC.4 OUTLETS
My WM,'e CnmPnxue
mmtinn lwrearner aryl Policy oumbrt:ef oOCC.GROUP AI'N
Carti¢ Policy No.: GAS-'IA.SYSTEM-OVER 4(EA)
CERTIFICATE.OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFANDUSTRL WASTE INTERCEPTOR
BULLDWG DIVISION FEES
(This acmioa rmJ not be mmpklN if Ire lemtit is fame huwrtd drllan(SIM) ORGASBTRAP
or leas.) - PIANCHECK FEE �•
I emir,IMt in m,Irff«merce ores work forwhichroti the W u err Cr l rWll g
nm employ any frrvin in wig tmnwrw¢�ur herons aub' Imine W«km'Ca _ SIiW1iR-SANITARY-STORM IiA 20D PT.
rZ sadm laws of Coliforms.Dina lac ^Rem ENERGY 12G �.
zO Applicant WATER HEATER WNEM'/ELECTR GRADING FTE
H NOTICE TO APPLICANT.IL other making this Cerdfnm of Exemption,you obmld WATER SYSTEM,`Ut ATING s
H I subjat to the Wardes Campnuetian pmri,lans of the labor Cede.you must SOILS FEE
mnhwih comply wdh aah pm isam,a his pemdt shill he dammed revokM.
O WATER SERVICE
� z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID
p IMWy effrm hathert isv minvmction lading egcaY f«tMPerlomturreof Dete ReceiNOr
L)
U F the work fm which Nis fmnit is owed(Ser.309].Civ.C.7
V Tender"Name TOTAL:
U.l Iewcr's Adders 8,.
y 1 cenify het 1 mast real his applica.and uue thin the shove itdormaunn ix BUILDING FEE �•
to cntrtm.I agree m comply with all city aw co my ordiwrxes arW uuc lawn telvmg m QTY. MECHANICAL PERMIT FEE 2.
U Ivildingcanvrumnn,mtdhcmhy imnrve re{xcsctadvcs of this city w artm upon rho, SEISMIC FEE
Wove-venOmed pmP,ny f«impcctim purpoaw
(We)araen,er,iMemnify and trop bmmleos the City of Cupenino ugaim, PERMIT ISSUANCE ELECTRIC FEE
Osb;litica.jWgmcd,,cmu ourill u,which army in anyway accrucegoinu said City ALTER ORADDTO MECH. /�^R 1,
in avnse,um.of m,"fing of mi,permit. PLUMBINGFL'G t
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO ld,000 CFM) ^
SOURCE REGULATIONS. MECHANICALFEE f.
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TAX
Sigainmeof Appliam/Canummr Dine EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE,
Will he ti,ricaru or future building a<uPvdst«e or handle hnasromu,armorial HEATING UNIT('IT)I OO,(Ko BTU)
no defnel by the Cupcnw Munich al Coda.Chapter 9.12,sural the Health aed Safety r
Cod,,Sona 25532(a)? HEATING UNIT(OVER 11W."BTU)
F1 Yea [:1 No
VENTILATION FAN SINGLE RISID) PAD
Will the appl;wn m franc building acupam use aluipment ort devices which 1). Receipt
arrail hunrdaus air conamlrans its defnW ny the Bey Am Air QSm ity Menagcmrnt BOILER-COMP(3HP OR IM,fMM BTU)
District? - TOT
L]Yes C)No
BOILER-COMP(OVER W/pO BTU)- a
I love mad the n.,..d,rus armorialsAIR CONDITIONER
rtymmurm.ander Llmpter h.93 of the Celi- ISSUAN TE
famiot Halm&Safety Cade.Smiom 25505,25513 Erol 255X.1 unlcruatd bust if Irk NEW REUDENTIAL MECH. S0.FE
buJdingdon ria mvrernlYamed e¢tum,IMIhis mY rea.Colitycaramifytic Imary. t
err hr reywrenm.wnhn intro Ire ma prier w iasnatre err e cenir�m ata<apara:y.
(lwneraauhwved.,m Dem ISSUED BY:
OFFICE