S 0048 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPS RTINO IIUMBING-MSCHAICALCAl rERMR N- L V V V
BUILDING DIVISION APPLICATION/PERMIT PING PRNIBC7IDIANICAI.
BUILDING PRfIJF,CT IDGMI'IiICAT1US Scott
DILDING ADDRESS'. SANITARYNO. APPLICATIONSUBMITTALDATE
NF 'S NAM(_ HUNG CUNTRACfOR'S NAME: LIC NO,0 n NIC CONTROL
It A 1.471
IMF
LIC NO: ADDRESS: ❑
C(INI'AGE IYIONE: Bl11LDING PERMIT TNI°O
❑ Consultant Fees Paid by Applicant(Initial) [LOG ELECT UMN MECO
❑ ❑ ❑
LIChNSHU CONTRACTOR'S DECLARATION QTY FLECTRIC PERMIT ITE
1 oT 71 of f oaf I mm Ilac-Ru amJMh and
Prol m oris Com 9 fammmeeheg JOB DGSCRII'TION
{P{yCZ. with Smitm"Ilgfll of lEvisionJnf the Husinca and PndaitmsCdu.trot my littrvcia RESIDENTIAL:
F00 in full forcead cRm. PERMITISSUANCB
W� ❑SFDWL ❑KITCHEN RFMODI:h.
aUU Liccn¢Cluv IJaX APPLIANCES-RESI CKTIAL ❑ADDITION ❑PLUMBING RF-PIPE
F+Za
Date—Contret«
VViIQv ARCHITFCPS DECLARATION ❑MULTI-UNff El STRUCTURAL
ZpvJ'NZ lunMrermd my Alam shall be mcd ns PuNic remdx PANELS MODIFICATION'
CZ UP UP'TO 200 AMPS ❑INTERIOR ❑CHIMN'EYRIPA[R
I,i,e,,d l'rcfaltmnl 201-1000AMPS IMPROWNIFNr C]SWIMMING POOH
y J OWNBR-IIUILDIR DECLARATION OVER I"AMPS ❑BATH RFMODF1A PAIR O DEMOLITION
C Q 1 hereby anion"I am eacetN from Ne Comnluors Lirmw Lew for the�❑OaU followingrmmn.ISeclion]OSId,Busmcsaead Profa,iom Cods:Aey city a camry SIGNS F,LHCTRICAL [I OTHER
fA 3 W� which require,v P,it In c nnomicl ohne improve.Jv-I ish.or reser ar Nnscwm
t 1=-0� prior to[is issuaec.also requires the epplicmt for such Permit to rile a signed mmcmcnt SPFCIA L Cl RCU I'f/MISC.
fly dm he is liermet! ..t to the PmrixlaY of IN C«I la's Liana Lane(CTuNn9
�
C�� (commencing wit Smtion]fMMry of Divisiem Jo(the❑wires,vol Pmfasion,Calc)« THMP.MFMR OR FOLEIN COMMERCIAL
dy C that he is eeemN thasfrom and the boss f«the ullegal useinjAina.Any violation at ❑NEW BLDGIADDIION ❑DEMOLITION
x N Sclitm 70311 by sey.ppllant fora Eli subjeclsdc elplicam to.civil pera of POWER DEVICES El TiLNAN-r ❑FOOD SERVICE
W not more Nan rive hundred Jdlar,(S.R)0).
F Z_T OTHER FJrfIl.T
CxQ D I,a+owner of the prnpcny.a my cmpinyen with wugcutheir u�le Lumpenwtlao.
SWIMMING POOL ELECTRIC
W p..� will do f.i.Code
minorum.soOl Unit
apply.n an oemI,'If ❑OTHER
6 Z� and sem, he
b Calc:The Cvnaacur. ".1,do arca m apply m lf nwna of OUfLEfs-SWRCHIiS-FlXTI)RES
his own wbn built,,or isided a d such iaero who does such wmk himxlf a Inaalgh
his own cmpUrymg ImindcJ that Mo eIoI vwid w not not iatcald a d&rd for NEW RISIUEN'1'IAL i?LLECI'R SUP[
.ak.11 hawneuhc WiWingwimPnwemem is mW within Oteycm of complctiat.Nc SQ.FC FIOORA A SISU.fT.
a.eT-huilJn suint na.e Inc ImJem or Novfeg met h<die ora mild«imNo.e ra wT.
porter sale.). TOTAL NO 28 �
El 1,ax ovner of the Pnycrty,mt caclanoaly comrmting wit IlcImad contractors et
comma IM pmjm IS,904al,Bunol.0 end Professions Code,Thc Con isemr'v Li- �x T�'
nselsw JontutPPly Inenowrefof Po my N'hobuildsorimpfovothreon.and QTY. PLUMBING PERMIT FFE yll r (Jf- �Ur
wMr Ivntrmllx for such soject%wit.conuacmf(s)Iiccmed Penu It toIh Ctmormd Cf{�'ry
of
U.law. PERMIT ISSUANCE
❑lune under See .Bk PC for thin rcwmn
ALMR-DRAIN k VENT-WAMR(IA) VALUATION
InT Uate
WORKHR'S COMPENSATION DECLARATION HACK FLOW PROTECT.DEVICE
I hneby affirm under Fernley d'entuy res,el 011e following declam aI
'D Ihovc afro will nuitminuCeniliufe ofComrnl mself-im«e.fa WMe/s ComPen� DRAINS-FLOOR,ROOF.ARRA,COED. STORIES I TYPE CONSTRUCr10N
wtitm,u,pnovidul for by Smarm B)Ofl of the labor COM.f«Ne Peff.i,or the
work fer which This Fit is ismd. FIXTUR13-PER THAT
p 1 hose mil will maintain Waters Coal a lion Imwnec,n tcquiml by Scclion
37n0 of me LM1tx Code.for 0e periomuus of tK wM for which It puma is issued. GAS-FA.SYSTEM-I INC.i OUTUBT'S UCC.GROUT' APN
My ii Compcmmion Immrance c ,ism and Policy number mc:
Carrier: Policy No.: GAS-RA.SYST?M{OVER G IEA)
CERTFICATE OF F%BMITION FROM WORKERS
COMPINSAI'[ON INSURANCE GRI AM%INDUSfRL WASTE INTFRCEPDOR
BUILDING DIVISION FEES _
is,canon need not III nanpledd IT the Permit is for not dollan(SIFEE GREASEETRAP
a less.)(ThPfANCI1ECK FEE
Icedify Nar inme,elfmmaeeofiewaTk forwhich dii.,Pcrrml isies".I shall SEWER-SANITARY-STORM FA.20l)FT
not employ any Person in any nwnmr son to become subject to Ne Workers'Comps ENERGY FEE
CZ nation laws of CaJifxniu Date swi HEATER WNHI N`P LECfR
Z Applicant \ GRADING tEl!
rn NOTICE!TO APPLICANT':If,after making Nu Cernfrade of Fsmrwom.you sMUW WATER S1:SILM/RCATING
F ; hccnnle nbjccl m the Worker'.Comp titre Provi.iom of IK Usher Code,yah ono SOUS FEE
forthwith comply with such Novi,....nr his fit shall be darned Tcs'Zi WATER SERVICE
Q
5 Z CONSTRUCTION i—IIDN ItIJDING r,AGFNCY
errs, NIiN'RIkSIDENI'IAL PCMB, SQ.FT. PAID
U (for whillimi til Nem is and CSactim .Cis. .) For Ht,lFerfxnancc of Dare ciNN
IN,work for which mss Nmnit ie sued(Sec.J(M.Civ.CJ
u Leadt Mare TOTAL
y CFAMfx emy T
L�, I ccmify IM1vf 1 M1uvc rmJ tis upplicvtiom wJ roam troll IhC ahtvc information is BUILDING PF
L Eie) c«rtct.I agmc I,comply wit.B Illy mal avwty mdiamea ted sato lawn rclatingm QTY, MECHANICAL PERMIT FEE
U Z building conVrvclion.end herebyeuthMm rtpmnuirn ofthis city meater upon the SEISMIC PEI:
aMwe-trcmioxmJ Property for impRlion letrP^se'. PFRMIT ISSUANCE
(We)agora m save,inJnnnify and keep hams Par City of Cupema,agwtssu ELECITtIC FEE
Iiabil111cs,jdgmi colts wd eMpmi which may in any way amine ageiotsaid City AL'IERORADDTOMECIL
in romsequcorc of Nc grunting d Ibis pant. PLUMBING TEF.
AI-PLICA NT ON DE RS PAN DS AN D W ILL COM PLY W(I'll ALL NON-POINT Al R HANDLING UNIT TO 10,000 CFM)
SOURCH REGULATIONS. AIECHANICALP E
AIR HANDLING UNIT 10VLR 10JMCFM) CONSTRUCIO TAX
Signdmcof ApplicmtiC«(rector Darc EXHAUST HOOD OVIDUCT)
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITI[ 'PION FEE
Will de.pNicml nT Rate.bulldingoccowl more«nentlkhvarJnus msterid HEATING UNIT ITO 100,MM)BTU)
III Mfed by Ne Cupertino Municipal Cat.Chapin 9.12,old the Ilca dh.d Safely
Calc,Section 25532(.)? [HEATING UNIT(OVER 10(L"FITH
DY, C1 No VI?hTLATION CAN(SINGLE RESID) PAID
WiII rile licam or furore buildin t rix 1 a rondo which Date Receipt N
aPP 8h,far
rytprrcn BOILER-COMPQHPOR 100,00B9TU)
Emil h:nardur air ummmimnf.ea-MftuW by de Buy Arta At,Quality Maeagctnent
AL'.
Digrwt? BOILER-COMP(OVER 100.00011TH
❑Ya ❑Nv
I have reed he hivmtkmenwenols fs anw,Chapter 0.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
m.255
!arose Hes,k Sm(my Cale,s.naso 25505,255Ji wJ 255.1].I unJvsmud Nal if esu NEW REgIDENTIAL M11[CH. SQ.Fri.
huihe madnn ora,maternallywhich nave a Ream Ohm it n my se 4 a Celily to nasty de tNeacy.
rel the rquimnxmfs which mmfMmel prior In iumea d.Cenifrme ofpzuprry.
Ower mr autnrvnl agent Dam 'DOTAL: ISSUED BY:
OFFICE