S 0036 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUIIDIN<:-ELECTRICAL PERMIT NO, r� /�
BUILDING DIVISION APPLICATION/PERMIT 1'LUM1IRING-MECIIAMFIC � y') � _I_L-ty
BUILDING PROJECT IDEM9F'ICATIUN �1{Jy1(� ��J V
BUILDINGADDRESS: SANITARY NO. APPLICATIONSUBMITTALDATE
0 q l 27
OW ES INA PHONE: CVNTRACI'OLR'S NAME' + / JC NO:
/�
rV �30 ✓11 _'k, ioNl /NG �b6 q/- SIC CONTROLS
ARCHn'ECTruKGINER: LICNO: ADDRESS: ❑
I va D� d�dti �
CONTACT I'HONE: BUILDING PERMIT INFO
.FE t,f r'' 1 '^ ,r'�- /}�� ❑ Cnruvltant Fars Paid by Applicant(initial) n.nG 'LOM❑
JrI,ICR<SEDCONIRACTOR:SD:SDIiCFLACG1ON� Q'Fy ELECTRIC PERMIT FEE
1 hereby anitin thin 1 am licen.m under p isiona of Cbspo r 9(cumtnifi J DESCRIPTION
oat with Sacniiio]nlNllnl Uivisim JnfJia Busitess aril l'nifcssinns Cede.aril my licntse i. RFSIDEN'UAL
Li W= PERh1R ISSUANCE
_ in full face anJ/� o ❑SFDWL ❑KITCHEN REMODEL
aU�j liavmse Clas e^' Lic.x fKVlir APPLIANCES-RFSIDENTAL [I ADDITION ❑PLUMBINGR&PIPE
�i,aa Ilam Contra•, ti _.IOAIe /JC.
F Dh ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT El STRUCTURAL
I my msdnoarid pans shall be used as puhfr rtc«ds MODIFICATION
OZ`---0 UPT0200AMPS El INTERIOR ❑CHIMNI!Y REPAIR
F-,~ LicrnsW YmRoslonal 201-1010AMPS IMPROVEMENT []SW[MMNGPDOIS
g'Yf ' OWNER BUILDER DECLARATION OVER 100f1AMl'S L]BATH REFIODF.VRIiPAIR ❑DP.A101,ITION
a a 6 I nemhy afrm anal 1 am cxeinp from the Contmetnr'.License 1,0w Gx the
xxaOiU foUnwing mann.LSnclion7031 S.9minss and Prnfcadons Code:Any city or county SIGNS ELECTRICAL. C3 OTHER
W 31+-y which"arm,a from,m cunaruck rater,impnwa,otmolish,of repair any strtsewm
P'�Og prior to its issuance.also rt90im the vliplicanl fm.such pemul to file a signal formosol SPECIALCIRCUIT/MISC.
"7t that he is Eiccnsod pm.dn,mthr pmvlriomvif Jc Conaacmr's License 1sw(CUNcr9
ZOO ( "cing withSmion]00(Ilnrllirisim Jof the Husiriesa mtJ Pmfcisiona Cule)ar TFMPMEIER ORPOLEINSIC
Q..y o y that he is earn,thcrcfran and the hv0.s f«mut allc6ud c.mnpion.Any Aolmion of NEW BI.DG/ADDRION ❑DEMOLIHON
uX1 tr. SRyxq]03"by any.,innt f«a permit subjects the applicant to a ccilirndty of POWER DP.VICF_S 'IP.I:MT ❑FOOU SERVICE
F.ZY noinxsm than Bvc hanlind doll.(INM)). IMPROVEMENT
O �I.ea iiwnerof the popeny.«m}cmpkryees with wagcunthriruslc campcnxatiiin. SWIMMING POOL ELELTRIC
�5 will du the work,aril lbcismbtmm is noluictif uroffertd for sale(S .)014,Busines ❑OTTIER • ✓ -
a 3 and Pmfnti«n Code:Tic(antroclnh Bernie law,does tw appy 1u an awnr or lNlI1,ITS,=SW'ITCIIIS-Fll"NRES
properly who hums or tmpovex lhetcun,aid wbo thins.such wont lonoxi «thnsti '
his own employees,pmvidi nonsuch impmvemmas art nn intend 1«offirmd for NEW RFSIDFNTAL FT FCIR SQ FT.
aak.If.Mruevcr.tlr building or lmpmvcnem issoidwlthinoricyimofcemplanloo,0e SQ,17 Fl,.(�%IR AREA 55Q.FT.
tic loonslQ will have the burden of proving tIN1 he did not hiW«impure but pan- P A D
oficati
El Lan mier of 16c p9seny,am esdueively cosseting with li.d ront.is,to TOTAL:
n
mnoruct the frojat(.Sec.7011.Business and Pruress'i«cs Inchni Toa Cmamct«s AsLi- �AY 27 �,0
e laoe
w ds nn aplR3 mon uwtsr of pntperty suns builds Or m
tov-forin.and (QTY. PLUMBING PERMIT FEE
w1w cnna«a�f«such pojms with a mnrmct«(u)liansN ry,y�to the Cootracturs
Li.law. PERMIT ISSUANCE CITY OF UUt��HfIN
❑I ran<semp uMcr Sm. .B&P C f«Jus rtasan
ALTER-DRAIN&VENIT-WATII OW VALUATION
Owner Doc
WORKERS COMPENSATION DECLARATION BACK FLOW PRIYECT.GLVICE
1 hereby aRum roan penalty o(peti ore of the infusing aeelaations:
❑I lmwmb will maintainaCenihoumd Cnnsan In self-in.mm Rm Wmker'a Cninpcn- DRAINS-11.00R,ROOF.ARBA.COND. STORIES TYPIiCONSTRUCIION
union,u pm.ika for by Seeuun 3700 of the lunade,r Cafm the perfiinrurice or the
w fnrwhichmsp_nnitis iumd. FIKTURES-PERTRAP
1 hoson and will r0inlaln Worker's Compensstion Imuinrce,a mroirM by Section
l] lnofrtlyro�Whir Cnk.�ftumrJw perf«nisei Mthe w«4fm which thL permit isissucd. GAS-LA,SYSTEM-I INC.4 OUTLFIS iJCC.GROi APN
Carr•/CCuttptlL/ I mruice l Pmol Pol;cNgytnbewc.. �,.y/
N' t"[� 7Y7 J]S GAS-HA.SYSTILN-OVCRJ(BA)
CERP'IFl UMPENS( TION FROM1I WORKERS' GREASMNDUSTRL WASTE INTERCEPTOR
COMI4:NSAHON INSURANCE' 11 INC )1 VISION FEES;
or esJ PfANCI '
(iiia rectionl oast be tie compklW ifthe pmdt is fm«ehordrM doll s(5100) GREASE TRAP -�
l
Icrnifylhel in Lie pcHoimancc ofJc w«k forwhim thispermit is iuieJ,leMll il
SUER-SANITARY-STOkMUA.2(OFT.
not employ any penin in any mantic m as to bout«wb3ean to the r4en
Wo 'Compen- ENERGY
OZsaiom laws of Cabfornia.Ilam WATER ITIfMR WIVENIOULECfR GRAVING
Z O Applicant
y FEJ
NOTICE TO APPLICANT if,after making this Crtnificae M EsempOin.You stnmld WATIiR SYSTEAU BEdsxiNG
F beanie wbjW m the work"Compom
cnstpoiisions of tort lum bCode.you must SOILS FEE
forthwith comply with such provisions or IN.Pmorct shall be dibi tcvukcd. WATER SERVICE:
0
CONSTis 2i ONLP.NDWGAGENCY NIiW RIIIIUCNI'IAL 1'LA1N. SQ,FT. PAPA Dem lbreb,0
U O IhetNnotiY oRrm JBete is conulrn
suctianlintngereY fm lhC perfmua'
ve of
dcc wod:0th which this pamnt is i—ed(Scc.]IN],Clv.CJ
N. TOTAL
Wi L<ndcfsMaros TOTAL:
eF^ 1 crnify that I h l'it mad this epplicaion and swe that the nbove infori mtitm is BUILDING FT;I:
hcorm".i ogrcu n.m.nply with all city and county umitwmcn arta smm Ww.rcledng til QTY. MECHANICAL PERMIT FEE
U z buik4ngcmwisction.and hereby wth«vc rtprtsetumivn d Jus city In eacr spm tle SEISMIC FEE
nbrvo mentionsd pnspeny Rif ins,s,iom purpuscs. PIRAIIT ISSUANCE
(Wit)agr¢to save,itdnmrlry ad l p harmless rob City of Cupcnirio against EfICIR1C FEET
whilitic,judgmnnts.cicd and espc.which cony in any way eccru .,lift sad City ATM OR ADD TO MECH. PLUMBING FEE
in evnse9ience of the gnome of this permit.
APPLICANT UNDIiKSTANDS AND WILL COMPLY WITH ALL N N-POINT AIR HANDLING UNIT(TO 10.000 CFM)
SOU I'F]�RF U�I/JAT10'S AtEO3nNICAL
/7��H LATIO AIR HANDLING UNIT LOVER IO.IW CFM) CONSTRUCTION
Sign(ort of Applicant/Contnct« Date EKHAUST HOOD(WiDUC) ROUSING MCDGATI VFEE
HAZARDOUS MATERIALS DISCLOSURE,
Will theappknmtar Timm boldin,cs,iicim mnm or hardk Purvdwarnwcrial HEATING UNIT(TO 110.000 BTU)
as defnvil by the Cnpmitc Municipal Chile,CTnptc 9.12,aid the Healon ad Safety
C«It.S«tinn 25532(0? HEATING UNIT(OVER 100.007 BTU)
❑Yes ONO PAID
VENTlLAT10N FAN(SINGLE RISID) Dae RmcipY
Win the applivam or filum building occupant u¢equipment«dedeLY which
emit ha "1i-,air cOmmu mus as defi1 by lbe Bay Area Air Quality Maougertca BOILER-COMP OHP OR 100.010 BT U) TOTAL
Damc" BOILER-COMP(OVIJf 100.111]IIBTU)
❑Ya E3 No
Iluvc frail ole harmduas maenah rtgntcttrnaudc Chrism 6.95Mthc Coli- AIR CONUT'IONER ISSU TE
fomin IIsulth&Surly Cud,Snnioms 259fi 15533 roil 23500.1 umkngmd four if the NNW RESIDENTIAL MECI I. SQ.Fr..
W idirigdoxs riot cnnmtly have a rerun,that 11 is my repms Billy in ossify the oamisva
of 1M requirements which owl nc and pion to issuutcc ora Cer ilicae of Occuparuy.
Owncraraullmdzcdagent Dam TOTAL I ISSUED BY:
OFFICE
wj
..q
� Q
� io
CLa
UL C6
tt9
F7.
SM
Z C J
4 i T
SS s
ol
® Qri
C � ® Q L
10
LL
— — — "IT
�,
. . � ` O
Q
� � ��
_ �
0
� � a n-,�, �zN�t�c�
•
a
� _ I
�.�P�kt•.�••�--�-_ . :. r, ®19iiGPa�iilt��9l_
11110
Is
INIS
'ili�
■ �:
Is
WE - /_1111■Y �1COR11t,7��0��� _ ®O■ �I
— li, rl ��-� -7� �r•�c
I
!tel I®u� '�I � ■ ;�
as I I :n u
� �. '� 0 � --'moi= �_ - j� ,°■i .
� .� .�� , ....� _ '.___ilk:.■ -
r■ .
•
logo