B 0195 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILOINC-ELECTRICAL PERMIT N11`_ 0 19 5
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL SOOOI � yy
BUILDING PROJECT IDENTIFICATION
BUILDING AfIDRF_SS: ' n�, SANITARY NO. APPIJCATION SUBMITTAL DATE.
6— 2_
OW 'S NAME PHONECONTRACTOR'S NAME: LIC NO:
NIC CONTROL N
ARCH ECTAENGINPPJL LIC NO: ADDRESS: ❑
CONTACT: PHONE BUILDING PERMIT INTO
/�jy,y,x/ ! .. &�,F ❑ Coflsvltant Foes Paid by Applicant(Initial) Hhlxl ELECT I`LUMx MPCU
✓v„YV •���J G ❑ [aa ❑ ❑
LICENSED CON9'RACTOR'S DECLARATION QTY ELECTRIC PERMIT ITE
1 hmeby ends,that I son lian,el maker ,rVsn on,of Chai 9 teammesing JOB DESCRIPTION
O�Z with Sectinvn7")M DiGicion 3afore Busircv vd Pnrru.inrw Code,ud my liceme is RESIDENTIAL
41 O O PERMIT ISSUANCIi
F-�F full lircx vnJ cRal ❑SFDWL El KITCHEN REMODEL
yZ IDori se Cl°ac Co'�Im APPLIANCES-RESIDENTIAL ❑ADDDION [I PLUMBING RE-PIPS
AHCHII'IiLTS DECLARATION PANUS ❑MULI'1-UNIT ❑STRUCTURAL
Z O,`�Z 1 conanstmd my Plana shall he mai av public revnB MODIFICATION
DPTO200AMPS El INTERIOR El CHIMNEY REPAIR
�'/�I� Ucenud lTnfcuiural 201.1000AMPS IMPROVEMENT C3 SWIMMING PMS
OWNy�
%=,JJ1 hereby a0imt Par I an carrot front DECLARATION m's Licane Lew for the OVER 1000AM1'.S ❑HATH REJMODFLl EPAIR 0 DEMOLITION
p(0�W U following anwn.(Section]11313,Ha nvass erd Proa,,our,Code:Any city or county SIGNS ELECTRICAL DOME
LLLLII LL O-1 which its a penNt m comuucl.slur.m forst Parrot
1 ar repo, ed
v� primbimiaon r.mrcpuim'thc nEElicom for Commi^^inu fill. La,(Cnremrnl SPECIAL CBCUITIMLSC.
y)Y� that he is licensor puAuenl to the provisions of lheCmtrsldxliceme Lew lCM1ugm9
W p(p0 (ex nm muingwith Scat-i and of Diviaian3 afdleBcd cs,o dm, An,violoicsof
CoJe)a TEMP.SIFTER OR POLE INST COMMERCIAL
a a Ss be is 31 J b tan,a pIt and ds,anis forub cs than c,flaaa o AnY vi Motion of ❑NEW BLI%✓ADDII'ION ❑DEMOLITION
�'g�'N Sadun]0315 by nny appl'Ianl fore permil eubjsulhC applicam to ecivil perdty of POWER DEVICES [I TENANT ❑FWD SERVICE
F-Z
not tate than five hundred dollars($5110).> IMPROVEMENT
�SpQ 01.¢v'rcutx+nrlhc pnryrcny,ow my emPloyce wish wngcemdx�ir urlc monpen,mion, SWIMMINGPOO1.ELECTRIC 0OTHER
d.F. roll Jo the wort,erd the structure is no,rmand,d or fileted Par sale(S .]tlki,Busiruv
W $ erd Pofersims Cole:TM Cantracmf,Liccrne U.Jac,not apply to an m oat M OUTLETS-SWITCHES-FIXTURES
pry 1 ry who huddc or improve thmaro,and who ds,',ach wart himself m b,so,h,
hie own enplmav, moiJN dur,ach impnavemems are on imenJed or offend tat NEW RESIDENTIAL ELECTR SV FI'.
Of rale.If,how ,the building or imm pnrvenri,sold within as Y.ac'mn4clitc,the .IT FLOOR AREA $/SQ Ff.
ever
cr-MrilJcr wall hasc Js burden of Povio,Ihet M did.build or imprmo lar pun
mvn rM,ak.1.
I,v,ow.,M the Progeny,em adu.dsdy cooraclin,wish Ikon: cminacmry or TOTAL M
nmmm the Pro,,.(Sec.7041,Bunincc,and Prole sio r,Cra4::)The Contractor's L,
ca.LawJasnotepplyta son m,om MPrupcn,whobuilds or impnrve,drmerr4 and QTY. PLUMBING PERMIT FEE
whocomrae,fawchp,ojncl.witbo ormcool,)Ilct, se al"tonuothecomraclae
Lt.law. PERMIT ISSUANCE
❑Tam trace turdm .PAIL
E3 x ALTER-DRAIN AVI3NI'-WATERTA) VALUATION
sf
WO . COMPENSATION I ARA Ot I BACK FLOW PROTECT.DHVICH
1 rthy nllirmtain a penilkane of Conm¢oflhcfnsomfor dalareti Co
IR eo willforbynt tion 000 of Con.unuoCork.forea, Wrrkefe Campm- DRAINS-FLOOR.ROOF,AREA.GOND. STORIES TYPIi CONSTRUCTION
cation,,pmvidel for by i, of c!. of the Wr Calc.for Js perfmmvsc of Ih<
workfor which Niep'maI is arkm 11%lVRFS-I'ER TRAP
1 m.<anst or nuimwn Wa4er'r Cmnprnswion Inuaxnce,h liva 1 by Section
My of tha on,an cfmthep.,rc,octof and work fawh,aara: Pmmit is iutsJ. GAS-1'A.SYSTEM-I INC.40lIlLTS (XC.GR( APN
My Wurkefn Comperemim Inrmarcc comer and Policy number e2:
Carrier. Policy No.: GAS-EA.SYSTEM-OVFJt 4(EA) J
CERTIFICATE.OF HXFMPION FROM WORKERS' GRGSEIINUUSTRI.WASTE INTEHCEPBIH AA
COMPENSA'T'ION INSURANCE BUILDING DIVISION FEES
(Thio aeeim rcNmbc campkted if the permit ufmmshurdrmldollm,HIM) OREASETRAP V ,-
m Ams.) PANCHECK FEE
I ccnity lhatlnlhn pafatmn.ofthc wort for which no,pcmin,i,.N.1,hall SEWER-SANITARY-STORM EA.200 ET.
rot emWoy tory Pawn in any morass sa u to bccomc sabjat to III,Wmic rs'Com,an. J ENERGY FEE -
Oz -,.on Lew,of CaGforma Data WATER HEADER WNBN1i-
GECI'H
O Applicant G�\ GRADINGP2
z
NOTICE TO APPLICANT.If,afar making tbi,Canificare of Esam,irn.you.Mould WATER SYS7MMG`R2ATING SOH-S FEE,
IF
a ? hamne suhia't m Abe Wo-1s,,Cano,armtinn Povi,irns of 1M Labor Code, on maul
foMwiN comply with such movisiom m this pmmn shall M Jatmcd avokcd WATER SERVICE
P 0
7 z CONSTRUCTION LENDING AGENCY NEW RESII3L A1,111-MI{, SQ FT, PAIR Union, ai Y
1hmbye(flmW theleisarnnurvctionkMingageuyf«du IsUmwrmeM
U O the work ror.wmrn ton pmmil is ixwred(see.vat.tri.'.c.)
CU Icwkr'c Name TOTAL
'TOTAL:
} 41 LarvalAddras BUILDING IEE
1 cartily that 1 hove rad this epplicotitm atd star nw the shove infommtim is
.�., V0.] cnmxt.Legh)comply w ih all city uM nnnly ordirwna,aml,rale laws relm ing to QTY MECHANICAL PERMIT FF.E
U z WiMing constracdon.end lsmby authorize sPe,emuives d thin troy to ever upon the SEISMIC FEE
shova.1ioncd pnrpeny for in,fcctitn parplwu,. PERMIT ISSUANCE
(We)agree to ma,indemlynify anal kap hum la,,the Ciof Caperimr vgwn,t ELECTRIC P?L'
It
hunalitia,justgmvne,cmt,mdc,pmun wli+may in anY way scree against quid City ALTER OR ADD TO MECH.
in anseyoerce of the granting of this pc,lil. _ PLUMPING ItE
APPLICANT UNDERSTANDS AND WILL COMPLY WITIN
H ALI.NON-POT AIR HANDLING UNIT(TO 111.000 CFM)
SOURCE REGULATIONS. MECHANICAL FEU
AIR HANIALING UNIT 10VER 10.000 CIM) CONSTRUCTION TAX
Sigwtuu of Applicenl/Conaamm Data EXHAUST HOOD(W/DUCTI
HOUSING FIITIGAI ION FEE
I IAYARDOUS MATERIALS DISCLIRE
IR
W 1l the npplicwtmfuma huilJivg acvpenl entre mhaMlc haurdmu mvtcrid HEAPING UNIT TV)100.010 BTU)
E rlcfired by cls CuPeninm Municipal Cale.Cheptcr 9.12,and not,Hc'arib mal Safety
Coak,Saninn 255321sT! HEATING UNIT(OVER IMiss)BTU)
0y C]No TIPAID
VENTILATION FAN IS RESID) Date Rcai,is
Will IhC apPliaanl or lulua badJing occupant u,c ar At, a on Monona which
DiithvarJous:u caunvdnem,u Jctirld by the PeY Aro At,Quality Flvugerocnt BOILER-COMP(3HP OR 100.1%10 BTU)
TOT 1_
Diuria!El YAM rl No BOILER-COMP OV 17R 11p 111111 HTU)
1 hove rod the hvallona maleidv rryuirntrna umkr Ouptm 6.95 of theAIR CONDITIONER Cali- ISSUANCE DATE
fuoia HealthA Safe,Cole.Smimn 255115.25539 anal 25534.L wJerstonJ that d TIC NEW RESIDFN ,L MECIL SQ.F-L —2—'q ��(J
bamngfirs,w commdy havca.,that it u my aspauihilny w stay dsa ,sea, a
of the raryirenson,which mun Na mm Prior m i...tda Camfiom of Oceulm sy.
O nmoraolhoriaM'arm Dea TOTAL: ISSUED BY:
OFFICE