S 2213 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING..IoLHCIRICA], PE IT No
rLuntnrrvr..nu:cunrvlrnl' 2213
BUILDING DIVISION APPLICATION/PERMIT
ItUlLDI9G PRU.IHCT 11]BN'r14'ICA'CIOy
HUILDINGADDR5.SS: SANITARY NO. APPIJCATIONsTdEVdITALDArE
12S ReCAa C-t �- 7-q7 y
.'Llc'S N Atli:
iG�1gr� 6MYl ( 71RA7TbS NAME
NIC CONTROL on k C
ARCI111'ECT/ENGINP!ERLIC NO: A . a S
❑
CO NTA PHONHi BUILDING PSRMI'r INFO
/� ❑ Consultant Fees Paid by Applicant(Initial) HOG ELECT PLUMB MEGA
II D CON rRACIOHS Di LI ItAI'ION QI'Y. IIaiGIRIC P?RM9' 1•FF
I1 -by Ml t o n I . 1 1 I I f l l l 1)be s J06 DESCRIPTION
OCz wills 7000) m 3 fl1eH¢s . JI f CJv,u dmy ltetec'e 12FSIDhNT1AL:
W o p �p PERMIT ISSUANCE
CUF 'mike Cl�s61: Lic# 'f'Q�332 ❑SIDWL ❑KITCHEN REMODEL
Fz uUl ne Cum I APPLIANCES-RINITHN'1'IAI. El AT)]) 'El PLUMBING It Ii PIPJ:
yG1 ARCHITECTS D[CLARAE 1ON ❑MULTI-UNIT ❑STRUCTURAL.
Zpyr-Z I nndcntand my plans shall he used as public records PANELSLS MODIFICATION
� UP TO 200 AMPS
OZm ❑INTERIOR Ll CHIMNEY REPAIR
F� W Liccnwd Profed"aal 2n1-IfX10AA11'S - IMPROVEMENT SWIh1h11NG IY)OIC
G ,
OWNER BUILDER DECLARATION
OVER 100)AMP'S D I]AI'I I R EMOTEVREAIR [I DEMOLITION
5 C 6 1 hereby affirm thin 1 am emrrtpr&om the Coatmeetrls Licancc Law for the
3 LLF following reason.(Section 70315,Bmines,and Profession,Calc:A,city or county SIGNS ELECT RICn1. ❑OI'I IIiR
y which requires a permit to construct,alter,impmve,Jemnli.sh,or repair any suunure
0�' priurta As issuance,also regnirestheapplieant forsvch Pcnniuo role ucignedetetemem SPECIAL CIRCUIT/MISC. C
spy that he is licensed pumuanuo the'acce,ne, fthe Coloradan,License Law(Chapter 9 RCTA L'
uaia��O (aemmcncing with Section 7000)atDivi.vinn3 of the Huslnmv mW l'rnlesciotu Cade)or TEMP.MH'TER OR POLI I NS I COMME
d y m eL Phut he Is exempt therelmm and the thesis for the alleged esclnpdon.Any viulad a 0 ❑NEW 1LUG/ADDITION 0 DEMOLITION
W V, Socificun 7031.5 by any applicantfor it pernoo,adjecu,the piro I no a ourvd,snal,orPOWER DEVICES
. I 1 IIIb :(15M) ❑IhNANI ❑FOOD SERVICE
I ' I loppin,pert,torn,tuaploy,e,with VuErs al I '' 1. 1 t, SWIMMI 'P 11.MARC'I'RiC IMPROVEMENT
d[..0 will J k 1I t t - tintended 11 II I-(S 7144It e ❑O'llllat
ale, Indlmf swx Calw'I he Uinlmmnrs ku"ale Ldw does aid ""Ay It,uo r of OU 11.111 'CIIBS FIXTURES
RR properly oil...huild-a Ilnpncor,theme,and who due,such wink hi awil or through
his own cmpluyccs,pmvidcd that such impnncments are not intended or offered fur NEW RESIDEN'HAI J.IiCrR SQ CC.
e:delL hnwmxnfhe building or improvement i.s.suld within nuc year of aonipletion.the SQ.14.FLOOR AREA $/SQ.Fr
c
er-bui]dwill have the buNon of proving that he did not build or iniprnve Inar-
n p -
p
er
C]1,ac owner of the pun,",am exclusively emnow ing wilt licensed contcontiguous,lo TOTAL:
instruct the project(Sec.9014,Business and Professions Cale:pbe Contractors Li- ,
rener
l,aw dues nm appho orrowner apmpeny x h,,build,,,,impmve,Ammon.and QTY. •PLUMBINcA'Fk T FF.E
most tnntrcs far such projects with a conmecmgs)Iirrowd Pursuant toche Counselor's
License Law. PERMIT ISSUANCIi
I ant exempt un der Sec. ,Hkl'Clorth'Necaaon
ALTER-URAINffi VENT'-WATI3RI:A) VALUATION
Owner Umc
WORde,p p COMPENSATION IYIi e aL
Ib PION HACK POW I'RtYI'IiC'
II byal'I - trade, 'Pty rpejry IthIM1 rdl hl I olunt, 'A'
W k .Cttpc- DRAINS OR.Ro N .CONI. SOR[HS TYPE CONST RUC IION
s aiou,t.p t sided to,,by Section 3700 of the Labsur C u R.f...a,'ed t-ounce olthc -
v...,to, vind,tld.....ul is lsmusl. ' P1XTURI3' I I R'IBAI'
❑ I havoc and will n.dulam Worker's Cmnpntsatio t msuranm,el reguhcd by,Section
37(Xhrf the Lnbnr Coale,litrlhe perfnrmwcc of the worA forwhieh thix punnit is issued. GAS-Is I IZ14Q PP 4(UI 3'1OCC GROUP AI'N
My Wnr- 'eCnntpirnsation lnsura cecrziunnJ Pnlicytl bit .
Cnrrin�'`n.n/evPolicy Nn.: OI 0
GAS-CA S'[L'M.UVI?H4(EA)
CEIY
COMPENSATION
INSURANCE
N'f1RK13R5'
GDh1PEN$ATIDN INSURANCPi GREASI%I DI1S'I'NI.WASTIi INTERCEPTOR
BUILDING DIVISION FEES
(Thisuainn need not lit,mmplemdifthe ferznif ixlinonc hundred Aullars(Slfq) GREASIi9j
nr Ic",) YIANCHIiCK ITE
I cenify that in the pctformme w
ndest work go
which this Permit is issued,I shall SEWER-SANITARY-S'IORM EA.200 FI'.
nnom
m employ any Rn in any anner so as to become subject to)(he Workers'Courtlier- ENE ENERGY ME
2 z cation Laws of Cottonton.Dam WATER PITATER WIVE UELIiCI'R
Applicmn t GRADING FEE
NGHCG:10 APPLICANT:If.after makingthis Cenificanuf EXamprion,y.0 should WATER SYSTEMnIU7RIIN(1
a , heanne nLd ject to the Wonder s Compensation provisions ut the Luhur Calc,you nmu SOILS THE
fnnhwith comply with such pr,kmnin,thl.v pcout shall hedernmdrevuked. WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW IYIkSID13N'I'IAI.PLMD. SQ.ITC PAID
VIhcl'ehy nllirm Jtm them isuronstructimt lending agency fur the perlul'nuntrw of Us c cipt#
LA the wok Rn'whleh this permit is isxred ser.3097,Civ.C.)
O U old,',
N L
TOTA
1,cander,Addru, IOTAI.:
Fa fu'r'y tl't 11 read lti:appli'( d malc that l ( t i is - t - I{UILUING II.
r
N courrel.lagree er conply withal]city and county ordinance,and.,ac Loss remf gm QTY. MECIIANICALPERMIT FEE
L) 7i alswengerld oedlomund hercbyouthoda mprcsanmtivec nl this city In cnmr upon the SEISMIC PER
aMtvcntamioncJ Pntpcny for inspution Pugxtscs. /'
(N'e)agree tit save,indemnify and keep harmless the City of Cupenine a6mnst PERMIT ISSUANCE RIC FIJI
liahilitlas.juctgmcros.construct expenses which may in any x;ry accuse ngainsf said City ALTER OR AUDI O MECH.
in annwr nfthe gmmin thus permit PLUMBING Plili
APP ANT l VDERSTA DS AND LL COMPLY WITH ALL NON-POINT
RCE REAIR HANDLING UNIT(TO II10,000I CFM)G LA W. MECHANICAL FEE
AIR HANDLING ON IT(OV ER I od")CFM) CONS TRUCE[ON TAX
enl'Applkam/Contntu r Date MEALS'I'IIOOU(W/DUCT) HOUSING MITIGATION FF.E
HA9.ARDOUS MATERIALS DISCLOSURE,
Will hunppli, to,,future building rcapant.vmmnr hunAlu haanconsnanatull BEAT INC,UNIT('10 00,000 111 U)
tc dcl incd 1,the Culwnlno Municipal Cale,Clu:pmr 9.12,i I the Luah and Safety
Col Suainn 25592¢07 - HEATING UNIT'IOV,1E I do(M),R',U)
❑Yu Na❑ PAID
- VENI ILA]ION PAN(SINGLE RESP D) Dole Hce ipl#
Will ldcapphcant nor future building urcupunt use egulpmenl or devices which BOILER COMP TIM'OR IPAl,llq)If'I'U)
emit harnrdous air eonmminants as defined by the Buy Arca Air Quality Managemen -
t _.r
IJisniml
0l'cs ❑No BOILFR-CON P(OV 17R 100,001)IT
]bait rcalthe lotallesitre¢rials rcquinememc under Chapter 695u the Cali- AIR CONDI I'IONIIR D1 ISSUANCE DATE
lirmit 1{eahhk SafetyCale.Sections25505.25533.an125534.1 undennndthus ifthe NEW RGSIDIiNTInh MECH. SQ.17. (� 1 /�g
bulWing Jucv noaurrcntly havcamnaot,rhm it is my rc.pmsihilitym no.lfyal.necupant ( l `�
ofihemgniretnenfswhichnt¢stMmetpriortoissuanceufa Cenilicamof(kcupancy.
Oxmcr or uwhnirN ugmt Dam ISSUEDBI': rT ter o �✓
.OFFICE