29040 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BU IXING-ELEcrRICAL - PERMR NO. '//�Q /N�'
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL - 2 9 O T O
BUILDING PROJECT IDFNTIPICATION -
BUILDINGADDRF_SS: - I 'SANITARY NO. APPLICATION SUBMITTAL DATE
OWNER'S NAME: /�1// PI N ' •l _ CONTR R'SN E: LIC NO:
Mp
ARCIIRECt'/IrvvGINH'R: - LICNO: AUURFSS: ❑ �781 l.J
III CONTACT. N PHO.NF
El �I INFO
COiu;siI nt Fees Paid by.Appllesnt(Initial) _ .. BUILDING PERMIT01
IT
LICENSED CONTRACTORS DECLARATION QTY ELECfRIC PERMIT EEE
T hereby alfam th o I am r e ander pmvisima of CV o r 9(mtmuntciag JOB DESCRIPTION
,Orco with Sa(ion]000)of UiviumJof Ole Busircu erd Profes.iass Code,eM my licrnre is RFCIIIFNTIAI�
00 in full lora ottd cRul. PERMIT'ISSUANCE
p:�C ❑S WL ❑KITCHEN REMODEL
QF V Lia.Clms Lia 0
NQa Due Con.. APPLIANCES-RMIDEN'IAL Df HON [I PLUMBING RE-PIPE
ARCHITECTS DECLARATION MUL TUNIF ❑STRUCTURAL
ZOv�K IuMmivldmypl...shall be uxMupublic mrNe PANELS MODIFICATION
OZ�JQ UP Ii120U AMPS ❑INTERIOR' OCIUMNEYREPAIR
�,N.F'Gq LiccmN I'ndusimvl 201-10(X)AMPS IMPROVEMENT
OWNER-BUILDER m tin RATION OVER I"AMPS O BATH REMODELIREPAIR ❑DEMOLITION
C�Q I Irrtby eff rm Thu I 1 eeemp from t4 Contra C License Lew fa We
X 3 a V whichfollini Rnson.(S rim].tru I,site, m, Pofes.si�m Calc:Any city or couuy SIGNS ELECTRICAL ` OTHER -
F LLO which teyuim.permit m ewwn,ilter,impove.Jemulish,or mpeir any nvucmm - -
priorluiniuuerce.atm mywma lltc applicoo fmmch#erode to file u slga stalctanl SPECIAL CIRCUIT/MISE.
�y thulrinliacnw thSnumt to the pmvuinuofacCB.,i. Liccnw Wwls Cool)as
MIL W tr"R1C1ciremith funs cowl IN,
Iilfo J o(rte1,J otasedamfAm,ori Cadc)a TEMP.METER OR MILE IN I` \ COMMERCIAL-
MIL
OMMERCIAL
6 6 IY thu he h eactrtpt therefmn erd the basis for the WIegM eaempion.AnY vidatim of
LITION
Srion 703"by my epplicent(or a comil eubjrs the ePPIhC& to a civil pemJty of POWER DEVICES ONENAINT G]ADDffIDN ❑FOOJOSERVI
.. \ \ ❑TENANT C1 FOOD service
C�Qnd1.mom t n fi�ofc pft)hundred mye(NR. IMPROVEMENT
I,vx owrur of the propertY amY employees with wages ur their role compen.wtim. SWIMMING POOL ELECTRIC'
pS� will do the work an0 the stnuctureunm intoMed aolferd for sok(Sn.]Ui4,Buiau ❑OTHER
01
IY ettJ Pro(essiaa Code The Connor's License Lane does pa ly to ro ownerof OUTLETS-SWRCHFS-FlX1QR -�
ti 3 papeay who bwlds m impoves Octan,ano Gas d who, such woappA him.xlf a through
his own employees,pmvidM that such impmvemots ue nm imctld d or oRerM fur NEW RESIDENTIAL.ELECI'R SQ
sokif,however,the hm1dingaimpV,e.tads Boldwithin ooe yarofmopletion,the SQ.FT DDR AREA a/SQ.I.1
c�Knwldcr will have the Wsden of pmving that he"not Wild or improve fa pm- tb ,
1 ar tete y,ma eadtwvdr emvaeOng with Iianrm emtanam m
11,eproject(aa.ce,7](/4d,Bu.ims asd Pmfasium Cade:)The Cmvxrar's IJ-
la rbcs not apply to on owner��r pnipeny wn�Wiw.orimprnves thereon,and QTY. PLUMBING PERMIT FEE
who,GAlmett for such pmjeets with a ennlolows)liernsd puewnntto On Cmtmeur'n -
Uauelaw' PERMIT ISSUANCE
0 1 em eaentpt under Sec. &P C far IN,re�wn
ALTER-DRAIN A VEENT-WATER(EA) VALUATION
Dam Dole
WOR KEH'a LbMl'ENS/DEC1CI ATION RACK FLOW PRO11iCf.DEVICE ILAr'sW olmwm,do emlimn: 1 LeDlhevc eedwJl mainnina Cer4fua4 uf -inswcfmWar r"Cmtpm- DRAINS-FLOOR.ROOF,AREA,COND.Wioe,u pmviAed for bysc a J'!00 fsdc,fmthepert ofOle STO TYPECONSTRUCTIONwak fm which this Parmm E iuucd. FXTURES-PER1 have aM will mommoa Workers Cam . ,av re,lired t too3]U)of the labor Cde.for theeeformetvfor which thi.#roil' oas . GAS-EA.SYSTESI-IINC401TII.EISAPN
MyWandsCompenmdonlnsuran carricy numberCerd¢ ry .: GAS-IA.SYSTEM OVER 4(EA) /�t
CERIIFlCATEOFE%' Pf10N FROM WORKERS' LILY h
COMPFA TON INSURANCE ORIi SFANDUSTRL WASTE INTERCEPTOR
flhis scdion and nth he 1plvlcd if thepmnil is fatme hundmddillarn(gIIMI —'-'BUILD WG DIVISION PEES
a ku) GREASE TRAP PLANCHECK FEE
Ic rythin perfamexxafthc wort(awhichthupmnit uiewd.islull
to enrybysm nary rtaaar n ss to beeatrw ' W«tcn'Caro m- SEINEN-SANRARY-STORM EA.200 FT. ENERGY FEF.
O Z ssim laws o ilifomia.Date WAFT HEATER WNF.NT/ELECTB
z 0 Applicant - GRADING FRE
!A NOTICE TOA LICANT:I(.after making mi. a of Eaempion, ushmld ,y WATER SYSTEM/1'REATLNG sa�
F Carona subjr to Workers Compcmalim of the labor C .ym moot SOILS FEE
forNwith eomplYw hweh ormu ms as is lbe t,.- -.m WATER SERVICE
N.STRUCIIONI G.,,enY NEW RLSIDEMIAh PLMB. SQ.fT. PAID
0. -
IhercM1y�rml them isou V to 'n8 ugencY fa eperRmnnm of Dale N M
O 5 the work for which NLs it u issud(ace.]09], 1 CI
1<nders Neme L
lenders Addscu
Q. I certify Out 1 have r thio appliWiun and.tme thin fie abave mfimm m n is BUILDING FEE ^�
In cared I agrce o comply with I dry old nanny oo inwc utl smm lows mlmiag h., QTy, MECHANICAL PERMIT FEE
U Z Wildingcmm�ticl ,oad Mab tbo, me taOves fthin city menmr upon the SEISMICF
" above-rnmOmNlroPCRY fa in im purposn.
(We).grteto.sevc.iMcarm .stJ keep hartnl th,Cityof Cupnitw agvw PERMFISSUANCE ELECTRIC E
Iiebiliti ,jWgmrnu,terra emf ex whichmeyin ywayxcrvcegeimau City ALTER OR ADD TO MECH.
coosryuenee of the grvnlingofthie it PLUMBING FEE t
APPLICANT UNDI7RSTANDS AND LL CO PLY WITH ALL NON-POINT AIR HANDLING UNIT(TO I0.00RCFM) MECHANIGL E
SOURCE REG UfATONS.
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIONT
Signal=of Appharmt/Cmtrnmr De¢ EXHAUST HOOD(WNUCT) HOUSING MITIGATION
HAZARDOUS MATERIALS DISCLOSURE -
Willthe,aMliuntu fimum Wildingoaca wt vurcorludk hvuNtstu material HP.ATTNGUNIT(T0I00,000BTU),
u deflsrd by the Cupenirxs Municipal Cnk,Chapter 9.12,and tic liedth este Sefery
Code,Srim 23332(a)T HEATING UNff(OVER 100.000 BTU)
OYa [I No VPNHVGON FANS INGLE REST D) PAID
Date Race t
Will the isir dmaTroon M1leminI by rho,Bay Are.
Air Q orJMo.which BOILIiR-COMP(JHPOR 100.000 BTU)
t harastgsui av cmumiwnu u hinted by the Bay Area Air Quality Mvttegemmt T AL
Distrin
DYa Otho
BOIMR-COMP(OVER IBLBB1 BTU)
oc Ota hvmJnm macriolr mquirenem,anter Ch la 693 of the Cali- AIR CONDITIONER
ap - ISSUANCE DATE
fascia Heneth&Safety
d dte reyWrtrpmu whicCh tkre,y h rtsnaa 25me1233JfI Mtii[Or
NEW RF_SIOEYIAL MECH. SQ.FTWihfig Joey d wly ha,e.aeounatu'smy tonodry the cecvpwP,., mCrnrimeav (`C\)
Oma,orvothmci Dcrc O ISSUED 11. �N�
OFFICE