S 4218 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PI!RMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL C ^ n'I O
BUILDING PROJECT'IDENTIFICATION J 4 L 10
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAT
N Ar#CIC I. s a u Kt a r g. aaixow 4oAs7z 7_24 99
OWNERS NA Er PHONE: CONTRACTOR'S NAME: LIC NO:
�ou� S- a NIC CONE'Rol.a
ARCI It IP,CT/ENGINEER: LIC NO: ADDRESS', ❑ Q
h1(UAfAv VX u rAa, ct 9 5-3D
CONTACpC ate.. PHONE:: BUILUINC PERMIT INFO
RE( VW Iz�1 A. b .7 e7 ❑ Consul and Fe n Paid by Applicant(initial) Ba-0"
DG i ELECT_ PLUMB - h1E❑CH
LICENSED CONTRACTORS DECLARATION O QTY. ELECTRIC PERMIT FEF, rClf/ LN
I hereby affirm that I ani licensed under movisitar,of Chapter 9(commencing JOB DESCRIPTION
a f;'Z wish Scnino7ohino tDivlsion3nflhc ltuxiness and Profcssinm Calc.unJ mylicemeis '"7RESIDENTIAL
WOO TERMTr ISSUANCE, e�
C W i- n lidl force and eRed c SPDWL ❑KITCHEN RF'.MODEI.
Q,UyU Licmuc Clas Lica gpPLIANCES—RESNIiNTIAI. []ADDITION ❑PLUMBING REPIPE
yQL Uwe CunTmmor
0m A CIUI'CCI'S DF,CL RATIO PANIiIS [I MULTI-UNIT ❑STRUCTURAL
F H Z 1 understand mnsy plashill Mused as public owls", MODIFICATION
czUPTO200AMPS ❑INTERIOR El CHIMNEY REPAIR
W Licensed Pmfessiowl 201-1003AMPS IMPROVEMENT SWIMMING POOLS
K C Q 1 hereby affirm
OWNER
am leanmDEfromEN Con DECLARATION
License Law for The OVER IBBO AMPS ❑BATH REMOUEVREPAIR DEMOLITION
El OTHER
1ay.F following reason.(Section]031.5.Business and Professions Cale:Any city or county SIGNS ELECTRICAL _
which requires pornt)construct,aIT p e demolish,or reP ny stricture
F u'0 prior in itsalso mq 'th pploa Tloultachpc 'u fila it signed.tt ent SPECIAL CIRCUIT/MISC.
tIran he is I d ptioneanT tire To fth Contractors LLow,(Chapters)
W25 COMMERCIAL Seenou' )(M)dtoltkon duflhI Boinosand lralcssinto Code) FIDIE METER OR POLI I NS I'. COMMERCIAL:
2 X n a that he is exempt Therefrom and the basis for the alleged exemption.Any violation of [I NEW BLDG/ADDITION ElIT
DEMOLION
—w Section 0031.5 by any applicant for a Permit subjects the applicant to a civil penalty of POWER DEVICES 0TENANT [I FOOD SERVICE
F Z y not more than Five hundred dollars($501). IMPROVEMENT
ESC (] I,as owner of the propny.or my cmploYees with sages as Their salt mmfRnxaion, SWIMMING POOL ELECTRIC ❑OTHER
p. will do the work.and Thexlrcture is not intended or offered for mle(See.7Osa,Business
W 3 m and Profcsslmns Code:The Crounwh is License Law does not apply to an owner of OUT LETS do.
_
prolixity who builds improves themon.and who doxx such work hiniselfor th u' ;,-%, �� —`'-
his aw PI Y : p J J di,it h p t- I intended offered for NEW RESID IAL ELF.CTR SQ Pf.
vle fl 1 th buildb t Id :tti y SQ,FI'!FLOOR AREA/ ISO EL.
c.h m llh Ib h J I1
M1.r. I ) / � " JUL 1 9
❑ 1. f theprolixity,W4exclusivelyandcontracting Th l I contractors - tly 1999
construct the project(lee OIHJ,Bus news and Profnsi v Gale)IIx Comrunt r s Li � i t!
e a Law does not apply to an owner of property,who builds or impravex thereon,and QTY. ZA.I FEE
who contracts for such projects with a cnmrai licensed pursuer m the Cnmmnoh
License Lw. PERMIT ISSUAN O
1 am exempt under Sec. .B&P C far this mason
ALTER-DRAIN&VE T-WATER(EA) %
Owner Date
WORKERS COMPENSATION DECLARATION RACK FLOW PROTECT.DEVICC
I hcrcby affirm under penally of perjury one of The lidlowing Aedarwians'. (/
❑ Ihavcuniwillmuimaina Ccnilicamnl Comemnnsell-insuref rWodcr's Compen- DRAINS-FLOOR,ROOF,AREA.CONU STORIES TYPE CONS,RUCTUT
sauna,as p elided far by Section 3700of the Labor Code,for The pe nassio a,of The
work for which this pecon is issued FIXTURES-PER TRAP O2
1 have and will maintain Worker's Compensation Insurance,n"mmed by Section G/
37M ofthe labor CMe,for The parfommnce offs,work for which This permit is issued. GAS-EA.SYSTEM-1 INC.J OUTLETS ICC.GROUP AI'N
I/ CMy ame.rAc(/.I�ep��Inhion y..Iw,yrCorPoliicyNo: X7nln _9 /J 3
J In'/Cw 1••1.L/✓:/ GAS ✓,/�
CERTIFICATE OIt EXEMPTION FROM WORKRS CHIiASFJINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
CI'hi,wainn need not be enmplend tome pamduf one hundred doll...(SIW) GREASE TRAP or less.) PI.ANCHECK IT31i
I ccnify matin no,wd'nrmaneenf nowonkforwhieh Thixpcnnit isiswod,lshwl SEWER-SANITARY_Sr IDRM BA.2W Ff,
not employ any person in any manner so us m become subject To Ne WorkersCont ENERGY FEE
OZ sulinn laws of California.Dam WATER HEATER WNENT/1iLECTR GRADING FEE
Z O Applicant
= NOI'ICETO APPLICANT:IL after making this Ciamfi are of liscreption.you should WATER SYSTEMOT EATING
� ' became'O'ceT m the Worker's Compensation Provisions of the Labor Cade,you must SOILS FEE
Omhwith comply with such provisions or his permitsholl be deemed revoked WATER SERVICE
Q
Z CONSTRUCTION LENDING AGENCY NIiW RESIDEN7IALPLMB, SQ.ET. PAID
I hereby affirm NUT there is a construction lending agency lir The performance of 97 )' � Receipt
{L O Ihn work lin which this permit is Iastmd(See.3097,Clv.CJ
O U Lender's Nano, TOTAL:
T Ai,:
r IJ.I Lenin.Address
1 1 rectify That 1 have read this application and.state That the aMrve infarmalion ix BUILD[ FEE
F y c rran.la,.,.comply with all city and county oNinanccs ani state lawsmlatingm QTY. MECHANICALP13RMIT FEE
building ronsmniun.and hcmhy uumborim represenmtives of this ciDmemer upon The SEISMI FEE
U Z
aMwcmentioned property for inspection purposes. PBRAirr ISSUANCE
(We)agree m save,indemnify and keep harmless the City of Cupsnino againxt ELECT IC FEE
liabil'nics.jqUNDI
and expenses which may in anyway accom against mid City ATTER OR ADD TO MECH. PLUM GFEE
nseyuong of this permit. T
APPLICAANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(11)10.0X)CFM) MECHAIC Will
SOURCES,
AIR HANDLING UNI'I'(OVER IB,(Nx)CFM) CONSTRUCT ION
. gnamre of pphe nVContreemr
Data EXHAUST HOOD(W/DUCT') HOUSING MITIGATION PER
HAZARDOUS MATERIALS DISCLOSURE
Will icapplicant or future Wilding occupant store or handle hamNoux material HEA'I'INGUNITCE010 M)BTU)
as defined T the Cupeninn Municipal Cods.Chapter 9.12,and the Health and Safety
Code.Seen I25532(np HEATING UNIT(OVER 10ROW BTU)
E]Y,,, ❑No VENTI LATION FANS INGERESIDE PAID
Date ReceiPta
Will the appllwm nr fuune bnilJing occupant c,aA t:,Air col or devices which
it bu'r.uNons air uneanununw ns dctinNb the 13a'Aru Air Ii1 Maw cmenT BOILER-COMP{3fiP OR IIXI,(pU IIID)
Y Y Quu Y 6 TOTAL:
D'o(1iof/ BOILER-COMP TOV ER It 0s)(lf)BTU)
❑Yes F7 No
Ihavereah oadou.osaariws ayuirnnems under Chapter A 95 of the Cali- AIR CONDI"fIONER ISSUA CE AT
Inmiu Ilcallb&S .SIXlinnx 25505.25533 and 255JJ.1 understand Nat now NEW RESIDENTIAL MECH. SQ.FT. /'N
buildingdcesnot 'hit conLdenoismyms7n.libila,,,ustifytheoccupam '7^ (�� r 7'
of the reyuiamenaM tenprimmissualaeofaCertificateofOccupmay. ( �j1 m raulhuriat Date TOTAL: ISSUED BY: L `
OFFICE