S0462 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELEC'OUCAl, 1' IIT NO
BUILDING DIVLCION APPLICATION/PEIN1IT PLUMBINr,.MECHANICAL 0462
BUILDING PROJECT IDF.\rIFICATION
HULLOING ADDRESS: SANRARY NO. APPLICATION SUBMITTAL UA
clx-
OWNF IOT—
/40 I'IIONE: , C 'R'S NA LIC NIT. NIC LM
t/ re i r/ b / S^O •
ITE. /FNGINEEJL EJC NU: ADDRESS ❑
es F"
I/.e /2 ZO' Siq0./ ,, AQ
eONTACf PHONE BUILDING PERMIT INFO
I� oltwltant Fees Paid by Applicant(Initial)K � PLUAIH Fuicx siii�
LICENSED cc RAC RS DECLARATION QTY ELECTRIC PERMIT hTE
1 hccby a1Hrm Nat I= an.ed amkr i5mvisianx of Cham
Chapter 9(commencing 10B DFSCRIPTION
Oi'Z with Sc,fiar7(XXBofDmyoo3ot'mcBnaln�ss end lmdcasir ns Gdu.uM myl'lanwta IIAL
D10 3701 yq I'1!RMI'r ISSUANCE
Fenn In full force oN eflnt. KWh ❑KITCHIiN HIA10UI?L
NQS n�cnsc Clis QF
Con�mna AI'I'LIANCIS-RF_SIDIiNfIAL ADDITION ❑PLUMHIN'G RIiVIPIi
F=N RAI
ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑MODIFI AT16
Z IuNvstnrtl myplam shall hath 1u Public rmxJx MODIFlCATION
OZ-'� UP TO RID AFIPS ❑INTERIOR ❑CHININEY REPAIR
F-.yFu1 Liao.iPmirm ioovl NI-IDp AMIRS IMPROVEMENT (DSWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IW)AMPS ❑BATH REMODEIJREPAIR E)DEMOLITION
y IX Q 1 hereby e0irm That I ant esempt from the Cnntmcu,'1-hecoae Law for the
X O a U following renown.(.Saclpm 70315tsxs mil P
.HusirofusnMv.ioCAny city m coumy SIGNS ELECTRICAL [I OTHER
W 3 W which myulrcx a pemnit m uxialmel,.ler.'Intyrovo.dentol kh.m ret,air any swetum
F.IiO Printto its issuance,eksoo RimSit,v stRitcont Torquer l,,nriun fknnigrcdsmtcmen( SI'IiCIN.CIRCUITIMISC.
ythat he is lieensed punuanln,lSoPovisionoftla,culoacisr'S l'cenxc I"(Clurfrr9
�00 (Ommeening wish Section 70W)of Disision 3 oLo,,Halt v aM l'mfoskrx Crate)or THMR M EIER OR POLI!INS'1'. Comm
,c a IY that m is n.N th oefmm anal tic basis for the aOagol excmptirn.Any violation of ❑N LWADDITION ❑DEMOLITION
Sectiot7031.5 by any mEttlicant for a Mrrwt saii the applicant to a civil p,mItYto POWER DEVICES 22nn DrDa�F00D SERVICE
my muethan Rve hundrtd dollars(SWI P EFIPM
F=Q ❑I.uawrler of the propcny.mmYetmJrryees with wages as thcirwk romPxnsatiay SWIMMING POOL.ELECTRIC
fF0 will in the wmk.aN the sweturt is wtimcNrd o,ofiercd fm sale(Sev.7( .Busircss DTl{�q
uM Profeol.enlc:Th,Crmtt�mr's Liecnsc Law dm nm.,1,to an women of ()VEI.Efs-SWITCIIES-FIX'NNFS II Vr �UNEH([�
pmlrny wins,hoilds on improves tlterem,and wM does Such work himself rr t ,h
Fie own enWbryw,1'mviti 1 th,soeh imPmwomentx are not imemWd ar offend Ion NHW RESIDE- IAL 1:1.1:01k SQ ET
Safe.If,I.wcvcr.the nuilding or lmMovencnt is wld wilnlnmw your ofurmplction.the SQ.F[ FLOOR ARI\ VSQ.PI'.
rof oiWcr will harc(M+1mNrn of proving thv he Jid nm Nild rr Impnr.e for pun- /�
p�dwe). `J
❑ Las rmvmr of Its Prolsny,em cadusivdy cmtmcting with IiansN cmtrmnon to �ti
ars,Laos,
(5«.ono owner
andny whoiom Cuk:)Thr Cwranars al .�y� /I,
me law Joel arepplYmen nwrltt of pmleny who huiWsrcimpmvea tlsman.urd QTY, PLUMBING PERMIT FEE 'f.�7Nlc 7V1
who contra c,for such pmjecu with.cuam onO I ianrN lauaoam to the Cronsweun'a
Lice am law. 1'ERMOISSUANCE.
0Iwt cacmptuMcr Sec. ,Bh PCfrc this rcvwn
ALOaR-DRAIN&VENT-WATI!R(EA VALUATION
Ihvncr talc
WORKERSCUM of"'j.'or UfCefoilo LGN HACK ROW PRGIF,CI'.UI!VI(Ji � o
aa—
I hsrehyll rtrmmates pchaHy of Perjuryreteof nifimme ingwerrk tC.
�0 INvcmM will malntnln eCmif mnfCmunnn.alf-inure Rr Workers Conytcn- DRAINS-BOOR.R(K)h,ARIS.CUNU. SIURII•_S TYPE CONSTNUCf10N
.1 or which
es Rs by tiectim 3'!1X1 of the Isbor CNC,far the perfnrnoehuc of the
ich mNie s Escort,is iswN. IlATU
- RFS-PFR TRAP
w 1 tuh<mM will meiwin Wu4Ya Cmnlsmasion Ewhmrce.u rtquited by Smion
(p of the Labor Csatc.Im th aHom arae wukfw which thix permit is isysJ. GAS-Iw.S1'STESEI INC.JUVIIRTS OCC.GR AI'N
MY Worker ��/1 1 n Ertl Polity number Im:
Curricc, Palley Nn.: GAS-Flo.SYSIEM.OVER J(ls)
CERTIFIC OMPE SATE N I N FROM WUNKCHS' GRHASFANDUN1 RE.WASTI!INT CEp40R
COMPENSATION INSURANCE HIl .DING DIVISION FEES
(lhieudion haul ort hcmntpleicd iflhc Noon lsfosmohuhd,cd Jollma($rx)) GRLASH'fRAP
I amymat in meprdoorumca(tls woh Grzwhich this 1.1h is iasucd.I shall SF,WER-SANOARY-SIUNM HA.20f 1"T. ENERG J! h
nut employ any pnsc n in any menet so as to become reinject to the WhenCmonert-
z scion Ino ts'Cnlifmnin.late WATER HEATER WNUGU!I.ECHI GRADING F,
z ° AW.
N NOTICE,TO APPLICAM:If,titre,rmki,this Cmifcue M Escmption.you should WATER SYSTI M/TREATING
F' ^ henme infli to the Wort,&,Compemano r proviums of the 1� Calc,you must SOILS FEF.
WfoMwiNcomply with mrh,00skitme ar this lsrmit stand be-dceatN rs okM. WATER SERVICE
as CONSTRUCTION LENDING ACI!NCl' NEW RESIDENTIAL NAB. SQ,Ti. PAID
u 0 Phereby an!.tbaumen,is.von4medon kding.gency Gr the pcifoinance of Data R ip
tor:work nor whim Ibis Icmth i.iuueJ(.Ste.wet.ci.'.c.1
O F"' Lamers Nabs TOTAL:
Isrdals,5ddrtss
y1 anify tau I irev,this application suralscw Nat the above informion is BUILDING FI
Vl enrrect!agree to amply wiN till city nod many sxdivrcneN state lays reWingm QTY.- MECHANICAL PERMIT TEE
f) z haikling romaucfion.and tlttehy uuhorire repmenmtisv ofmbcitYmemer upon tic SIJSMICR
move-mentimed progeny fm inspcnion 1tuPm'a PERMIT ISSUANCE
(W.).9..'eve,imkmnify W keep brumless the City of Cupmim apfc,o ELECTRIC FEL!
I'nhilitin.judgmnats.nom ad cxMnw%which may in anyway accrue aeoint.said City AMER ORADDTGMECH.
IX.UMBING ITIn.
in nvyuena of the granting of this Psmtit.
APPLICA UNDERSTANDS AND W .CO PLY WITH ALL NON-POINT AIR HANDIANG UNI' fill IgtXXf CPM)
SOUR EGULAl10 - MECH,\NICAI.II!I!
APR I IANDLINGUNIT(OVER 10.000CPH CONSfRUCI]ON TAX
:igoaua of Apel aurenrc
' Due I!KIE
HAUSTHOOD(WMUCT) HOUSING MITIGATION E
RDOUSl,ATER DISCLOSURE
Will fromA.or front,hailding svluM.ore err hawk,hanNous meterinl I(EATING UNIT(TO I WAX)BTU)
no CMTs d by the Cupeniro Munkipl CME,CMger 9.12.uW The x®Ith anal Safety
CMC.Section 25532(.)^ IIPATING UNIT(OVER IDI,IXI()BTU)
❑Yes ❑Nn PAID
VI',MILA'fIONFAN(SIN(ihF xE_SID) _Wle NtteipM
will ties c,Eliohttr in borhongrcuryun esu qu'mmmlrr t1c �icc,which IIOIhIiH-CpMPinure borho,gtcuryun ose Wrunnarltr t1ccicc,which PIOPLIiHCOMPIIIII'DH I(X).(XX)ll'IV)
lii,hm.Nrus sir commninmtu n dcGrN by me Bay Arca Air QuAa,Ma cma,ht '(TYPAL:
D,omT7 BOILER-COME'(OVER I(X).(X)J BLJ)
E]Y,, ❑No
I base ted ma bamnkus mar rials rryuiacnsmx uMcrC Wor 695 date Cali- AIR CONDRIONER ISSUANCE DATE:
fames Ifdin&Sfcty Code.Saviour 25505.25533 aM 25534.1 uMcnluat then if es NEW RESIDENTIAL MF.CH. SQ.bT.
Funding does ret curacmly have a knank chat it is my ocsfe,n ility to notify Ric n'^,pm
d t!r r;airserms,which must he met prion to issiwsac d e Certificate of(kmyvvrcy. -
r7 LA
(Tuner or authmimd agent Dem ISSUED BY:
OFFICE