29084 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO . BUILDING-ELECTRICAL PERMIT NO. 29084
�9 0 8 4
BUILDING DIVISION APPLICATION)PERMIT PLUMBING-MECHANICAL L
BUILDING PROJECT IDENTIFICATION
BUT [I A DBS
�I1S� /-� c SANITARY NO. APPLICATION SUBMITTAL DATE
OWNER$TfAM)V� . IW/& _ T CO 'S NAME LICK
,l\J aI'�Vbl/UW/AI/� PUI•I fJ N/C CONTROL
%RCHDECMEIRGINEER: I LIC NO: pp _ /'/ ❑
ACT PHONE BUILDING PERMIT INFO
n/5k7 yl�� El Consultant Paid by Applicant(Iniflsp BLDG �U� PLUMB MEC
LICIFINSED CONTRA.COR:SDECLARATION , QTY ELECTRIC PERMIT FEE
1 hemby.fr thin I ae hcennl unkr Muvisium or ClalBm 9(commerciog El PV CD
JOB DESCRIPTION
woz wl],Smim17000) h Tana ami. r n a mylkrnacu RESIDENTIAL-
1—
W__ mfWlfmcc H PIikMRISSUANCE
Usrnse Uc.♦ ❑SEDWL ❑KTfCHENREMODEL
��W Due Co.INCI« APPLIANCES-RESIDI IAL DDITION ❑MUMBINGRE-PIPE
[F-..7y c ARCHOPECTSUI:CLARA MULTI-UNIT ❑STRUCTURAL
ZO K I ur omrwl my piens shell W tors]o pudic ra«da PANELS. - MODIFICATION
JJUP'ro:. AMPS
r,4 F� Licemed Pmfeui«ml El INTERIOR [ICHIMNEYREPAIR
m7_l OWNER-BUILDER DECLARATION 2014"AMPS IMPROVEMENT
C�Q I hereby affirm that I am exempt fmm 1k Consommes Licensew dR
Isfor o OVER IWAMPS ❑BATH EMODEUREPAIR C1DEMOLITION
L 36th following muco.(Saint 7031.3.Business anciwr lee. ledoeu Code:Any city«ccunry SIGNS ELECIRICAI. El OTHER
LL which ox oz' .x'al.,to conumet,ldttt,impntve,]emdish.«repair end meawat
LLp pral1wi.x,erowdc,ro m to me thespplixenIf«suchpa"L'cem.1'.(ChaXenl SPECIAL CIRCUfI/MI,SC.
IhalW illi wit pamaant mule.f DislnnvnfiNe6mVoclrcxlican,Ww(LTupm9
a Qp O� (enrru«x easta ilhisretecr n7q the
DboL,m3 of dox eJ exemption
An irmts m4s a of TEMP.METER OR POLE INST. DNl MBL ISA-:
d 6 a Nat os is exempt drrtfmm vtl rhe burs it hf trice a escmpion.Any vidndw al
LL. ❑NEW BLDG/ADURION [I DEMOLITION
St,c�y . thoor by any vppli"I.(Iipemdl rubjacstk gglkanttoacivil penalty of I'OWFR DEVICES ❑TENANT ❑FOODSERVICE
n«more thvl ave lmlbred ddlers fssao>.
❑ Lod,, oftld pets.,«mymoployax crofferMfr dk(Sec.c0al.Braman. SWIMMING POOL ELECTRIC IMPROVEMENT
will dothcwoh.mdtk xeNC n.-mLio.1 Rer ,an,k,I, ttan owner
1:1 OTHER
ad Pmfvs i b Cdo:Ile wes theeor'x I.iccnsc lawx nm v hi In if twat of flVfI.EI'S-SWITCHLrS-PI%TURES
MaprnY wha build,«impeovex strwm,a«I who thu.,eb work Mauer o through
aMfor A '
his awn employes,,pruvi]g thv leach rnint ureawithin
ort oa ineemle],r offered for NEW RESIDENTIAL ELECTR SQ TT.
WalLtwwevmBlotle the boa impmvemem i,soldwind notWiM or immplaionptr SQ.FT.FLOOR AREA 55Q.FT.
pmrer-W Bdcr will Nve the bueden of MovinY that lie did m Wild«impmsx f«qv-
eafule,. TOTAL: MAY 10 1996
❑
em,
ritun otwkxprroojfathet Spneerpc)nfyi,t,t,Buconexxx vWery Pmmmfemomi«inuB Cwoitdhe:))cTantheeCd mmos,,I laxrs to
Li-
cense Law dmnot aWlywmowner ofpngcoywho build improves memom,am QTY, PLUMBING PERMIT FEE C�(1' Vi VVf[TII IIVV
who canvecu for such ponjab with a comon,o ds)liccnscd pursuant to rFe Cnnuaclalr
Liceme Law. PERMIT ISSUANCE
F F-1 Iem exempt u«kr Sm. H&P C fm Nin rmrvn
Owner Dae ALTER-DRAIN&VENT-WATER(EA) VALLLNTION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hexchy arW
arm ua pcnWly of perjury are of de following dalar.tkm: '2,•✓
�FlIhevc and wEl maiotninaCmifiacofCmrent roself-insure f«Waheh Cvmpcm DRAINS-FLOOR.RODE.AREA.BOND. STORIES TYPECONSPRUCIION
,lion,u provide)for by.a 3700 of the W
lar Cade,f«the Teoiara«e of the
work f«which thio pend,is issue). FIXTURES-PER TNAP
O In II l WuheVr Cnmpcnvti«t In,urs«x,m reyuird by Saloon
3]W of sde, c fthc wart f« ihu l GAS-EA.SYSTEM-1 INC.aOUTLETS OCC.GROUP APN
MYw
Gorier. Pdicj No.: OAS-EA.SYSTEh1-0VER J(EA)
CEKTIIBCATE OP
COMPENSATION I EMPfINSURANCE N FROM WORKERS' GREASIVINDUSHII.WASTE INTERCEPTOR
BUILDING DIVISION FE}S
(Thin seniem rcpt n«be eompind lithe pefrt]r is for arc hands]slnlWs(5100) GREASE TRAY
or
les") YIANCHLCK FEE
Toy way der in lie any maareenf ho as
o«subjeato the Wis erti C,lsWl1 SEWER-SANITARY-STORM EA.21X1 FT.
not employ sty pavan in any r,nler x u In haeme subjal w de Wuhan'Compen- ENERGY FEE
Oz utionlswsof CWifamia.Omc WATER HEATER WNG',tELECI?
Z O Applicant GRADING FEF,
N NOTICE TOAPo the Work r,C."cdnor kistions s Cerdf m of are,1 Exemption,yaa shtCW WATER STSTEWfRFATNG
F' ^' beemre h romp y the w«herrn C«opeweiix ryoviuona of th Ichor Cde.Ymr muss SOILS FIE
W � lorlhwith comply with such Maviaim,«thia penldl]leB 4decmd revoked. WATER SERVICE
Q
0.
CONSTRUCTION
o,nom INGAGENCY NEW RESIDENTIAL PhMB. SQ.FT. PAID
I huebY oOinntMl them isoaruwcllnn ledit8 age«Yf«1M1CpM'omtvmeof Uatc kcccipM
ick.+ Ile"oh"f«which Ihix pern]l is usual 3197,Civ.C.)
d
p >, I< ehame NTOTAL
V Ern Ad s TOTAL
0.
1 cxnify that I have read Box gjEcoion ad..e that the etu.x infomwim is BUILDING FEE
V1 cmcc7.l agra lu mmply bxreby Ntyad awry ordiraten ed sets lawnmlainglo Qry, MECHANICAL PERMIT FEE
C„) ,'Z .I iloingmmtnwtin.eny trrebyeutiort prepteteeltativesof this city tomler upon Ole SEISMIC FEE
eMve.mmliored poop von«myecti«l parl•ur.
(W me m wv<,indemnify ad k«p hnnnkvs the City of Cupenino ayalnsl PERMIT ISSUANCE ., EIF.CBIC FEE
Imbilili l bne,coxaadcxpcns,,sh'eh may many way rtcme or.aid City ALTERORADDTQMECH. PLUMBING FEE
M cvrt a flhegrmaingof Ulla permit.
APPLI 1R ANDS AND WILL COMPLY WITH ALL VO POINT AIR HANDLING UNIT ITO 10,000 CFM) MECHANICAL FEE
SOUR ( < NS.
/Jl AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TA%
Sipnetum Appb HAZARDOUS
t 1 n E%HAUSTHOOD(W/UUCI HOUSING MITIGATION FEE
HAZARDOUS ildn1iRIA'a DISCLOSURE
Willyeepplierano turchuildmga,Chani nt«e«handlehurLrrLmxmntaial HEATING UNIT('IY)IIU.IXMI tlTU) ,
Cork.
Se, o the 32(a)?nn hlunicipW Cade,Cnepta 9.1;end the Ha+IN nd Sefery
Cafe,Sadon 25512(gP HEATING UNIT(OVER I W,BOo BTU)
pYu ❑No VP LATION FAN(SINGLE RESID) PAID
Win the lic,t m for=Wildon Date Receipt N
app g«she li Cvc.Air Q l«]wises which BOILER-COMP QHP OR 1 ccal BTU)
.nth hauNws air mnlnmiwnu es dcfnW by the e.y Arra Air tAtelity Managcmmt TOTAL'.
Dialein7 BOILM-COMP(OVER I W.000 BTU)
❑Ycx C1 No ,
I have nand the huuetlau materials requirements Coder Chapter 6,93 of the Cali- AIR CONDITIONER O
forrounSSUA DATE
both Huld1&Safay Code.e. 2SS05,:.553)ed 2553).1 t odvuetd Thu if tW
building does eu cunenly havealerwl.thuhis myrcapvlLplirymtaifY Ncoavpmlt NEW RESIDENTIAL MECH. SO.PT.
oftie rec mone,nu which rIW 4 rat prior to uwmac of.CadBcatc ofoa ..
Owner«authorird ogcnt Dmc TOTAL: ISSUF,D tlY:
OFFICE