26548 APPLIGAN 1 I U FILL IN IINFUHMA I IUN WI I HIM HCU LIINCA-U't CALL YUIN 1 PGI'1 U1NLI
CITY ONCUI'ERTINO UUrLUlNG-ELMIKILAL I PIANO rNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 26548
C
BUILDING DIVISION ly,,,r •n,i,xd- -BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS. ph I SANITARY NO AI/TLLICA ITOON suBMI I'm.DATE.
/U/ y 4D2 11-1-4 ✓E- UNIT LOT I 0 P.,t9 (.
W 17RS NAMR. PIIONIR CONTRACIOR'S NAME LIC NO: NC L CON I ROLa
�F Mf'AE�a- 4o3�-3y9,Y.2u L_, gala/&R
RCIII❑[Cl/ENGINIiIiR LIC NO: ADDRESS: ❑
CONI'AL9'. PHONE. QTY, "�:�t'"`ELECTRIC PBRMIT"', 'i ' t°'(�:l PE8 4: - BUILDINOPERMITINPO
-f(`z' '• = I `S"'°" B UO ELECT PLUMB NIT: If
PERMIT ISSUANCE LL I I] 0
LICENSED CONTRACTOR'S UECIARA'I IUN I APPLIANCES-RESIDENT IAI, I JOR DL'SCRIPI ION
Ma;Z I hereby affinn That l am licensed under provisions arChopler 9(uonntaoingwith
X00 Sect6ncemd)ofDosmn J of the Businessland Prefcannm Cale,and my license is in I PANELS
Q Liunm Clan L,,a UP TO 21X1 AMPS O 1
tiI-DN Dale
Contractor 201-IIXMIAMPS l SO ter.FLOOR AREA srsQ FT.
ZOyz ARCImTCTS DECLARATION I OVER I"AMPS
O p Ilmdertanot my Plant shall he used.,Public records
Fy W I SIGNS 17LECIRICAL
���dd .JJ..4I LmenaJ Pndntionnl
edej'6 OWNER BUILDER ;heCRAIION I SPECIAL CIRCUIT/MISC.
ttpaU I hereby.ffimi that I em emmpt Tema IM1e Canlrermri License law far the
3o.1 which oapirc . ISe,om commo,iinemmd POfeat]om.Cato piti,iymcoomyI IIMP MIE EROft OLEINS
��
tEt Per tocondore ,lonnpmva,h pecon 1 mminimany soucmu
don he is hssnnree nko rOn min lhe.p.....of tire Ca ,...bar a LieaseI. (Canon I POWER Df:V 141: ` V
_gip IM1vl he it licnrsnl pnrsusm mine provmom of lbe Cmm�nnr'n License Law(Chapter SWIM��({��(�1.CLECIRIC
p� 9lamnendngwith Seclion7(M)of Divisim3ofiMBusinesnnd Nofeamnsl,I I ? Y I VALUATION
_o, onhat he is nemplherefrnm and the bssis fonhe alleged evenaplion.Any v...mmaf UTLETS-SWCIIPS PIXl11RES JOW
Z.Q Senann O II
lU115M1y.ny applicant Wrepermil nuhjmslM1e epplicnnuo ncivll penally of I I
,5
(� $ nor ril, hmi five hundred dolun IS5o0
11
I NEWRESIDENTALELECI SUIT I tifORlliS IYI'C CUNSIHUC-IIfJN
lu will Jnlhewnrk.anA lhetw(mfe land lmendW moflertJ foetal,(.See.lIN4,11minea
and Professions Cole The Contractors License Law doer nor apply m an awns u! I I
prnpcny who builds or inmrovcstarcon,and whodac.such work himarlfarthrough Ios
aiipinyee..prrviAN @abuch inipmvnnnntumnor intnidedmnlfereA far t�le.IL OCC.GROUP RES UNITS
however,the huddingor Improvement is said within one year meornpit,lion,he owner-
,yam
bmlde,..If have the hurden of proving that he did nor build a improve fur I—-
of
,+^
a of IM1e pro }fi
perly amaclwivelyaimt racing with licensed commomon, QTY. •r.�PLUMBINO -
, FI noD 9UNI A1114•y
•hn,t-
ntllUnl Il eniinoleel(Sec.7(1 Rm]ness anal Plofe"ka"Cle:)Te Contractors \Ji 1ERMII'ISSUANCi Lacnu lawdoes no(apply man ownerofpmpeny who bull sormprov sthaem and NEEi whommraat fm such projects with a contractor(s)licensed formation to the Contractor's
License law. I[A) FEE SUMMARY Alaiift-DRAINA VENT.WATER '
�f.}"I iYi.d.��.[' .t
❑ I con exentpl under Sec. R&PC Earth is r...nn I OUf5IUh I LES
BACK MOW PROTECT DEVICE I SANITARY Y N
Ownm Dale RECEIPTEI
WORKMAN COMPENSATION DECLARATION DRAINS-19.WR,ROOR ARfA.COND
SCHOOL TAX Y N
❑ rrsrC. ,as,.M1at lM1aveaannirncauofconsennoof(S_sum.or acenificem of I RECF:IIeIa
, fR%I'URES-PER TRAP a
. Wnrkeri Cnmpenealion lnsurnnre orewnifieA copy Thermf(Sec JAIXl.LnhC lwhieh PARK IRai YN
covert all employee s under his permit GAS-FA SYSTEM-1 INC. 0UTLETS RECIBPI'a
Canny a I PUILOING DIVISION fLh�
El Certified GAS EA.SYSIEM OVF.R4(PA) PLANCIIECK ET:C
❑ Codified copy is hereby fumatM1Cd
❑ Cenifed copy is filed wid,the city im,ectinn division. I GREASIVINDUS'1 RL WAS'III 1WERCEPTOR GRADING PETE
CERTIFICATE 01:EXEMPTION FROM WORKERS' I GREASETRAP SOILS FEE
COMPENSATION INSURANCE
('Ild....I nneed nor becnmplered if the permit is four,hundraldmImsSIIXII I SEWER-SANITARY-STORM PA.20X11?. ENFRGY FEE
or less)
Icenifythal"',he perfoonaneeuf the work for which this plaral issued,l shall I WAI.R It PIER W/VENT117LECfR
nor employ any perwo an any morns,so u m become subject m the Workers' PAID
Contrenuhantinwsrf C.Romia Do. I WATER SYSTEM/TREATING Date Recnpa
Oz^•� Q NOT Applicant 70 APPLICANT If,apes mekinglhis Certificate of Eaemplion,yon should I NEW REST DEN'IIAI,PLMB. SQ.FT TO TAI.
t"
ketone e ith)<cr ui de Worker',Gnnpenmim pmvismru of the labor Code.Two cowl ^
FFa" � fanhw ilh comply with such pmvi siom or this Permit he deemed revoked I BUILDING ME In
ITT C4 CONSI RUCI ION LENDING AGENCY SEISMIC FEE
Vz I hereby affirm thann hen is a convmuion lending agency for the perfnrmance a TOTAL ELECIR IC ITS
Q he work for which this pemin is killed(Sec 7097,Civ.C)
0 � 1,adds Nunn
].ender.Add— QTY. ,M ECIIANICAVPER�SIITa•'p„i,I�'.^ K,�FEe i!, PLUMBING err:
W I crony Iho I have mad Iles apphca min and sore IM1m IM1e aMve infnmmlion is ,i MECIIANICAI.F[E
,omen )agree.monply with all city end county adin.ien and sum lawa rdabng io PIRMIf ISSUANCT: I I
Vy huilJmgemnvucann,and herchy andante mpresenmoves of this alymemerupnn the CONSIR(ICIIONTAX
U above.menooand pmpcny for intpeetmn pumnus. I ALTER OR ADD TO NIECE
(We)agree bi cove,indemnify and keep barn]en the City of Cupertino against
Inhilhies,jo reas.coasmdet s wh¢hmaylnanywoyeccruengaintlmid Cily AIR TANDLING UNIT(TO 10.MXICFM) I
in con r.,of the olumin of ' permit q AIR HANDLING UNIT(OVER I0,001)CENT I
L lam- /
5 insure ofA phe Contra,,n Unte E%IIAIIST IIOOD(W/DUCp I
PAID
IIA]ARDOUS MATERIALS DISCLOSURE I DIiATING UNIT(TO 1011,0(0 BTU) _ I Dam RnciN p
Will the npplicanl or futon,building occupant store or hamile hazardous material I
.1d1F Id by the Cupenii.Mmiicipal Cale Chapter 9.12,and the Ilcnith and SafelyI GRAIINC,UNIT I'(OVER 1010.0011,0011 BTU) I UT
Cafe,Section 255120.17 VENT ELATION FAN(SINGLE RESIDE
11 Yes ❑No I
s_ISSUANCE1)A'ILn' -
WIIltheepplmvmorTmurehuildingacupamuxequipmenlnrdeviceawhiehem]I I BOILER-COMP(TOP OR Thai BTU) I ,�
hmnnlous air contaminants as defined by the Bay Area Air Quality Management I ROILER-COMP(OVER 1100,11fiX1 IYU1 I )��I fj
District? S
❑Yes ❑No NEW Rf•SIUEMIALMECII. SQ FT I 8
I have read the limitations materials requirements under Chapter 695 of the 99q
California licallh&SnE y Code.Sections 25505,25131 and 25574. 1 understand That (�/• f
iftaforatoft Jaequiremrrennyhavealt hemetm it issuance hilny TernobfytheI I '/��'h,l{//n
aapom of the reynamrnemt wliiaM1 most Fe met prim m ivunna nf.Cenifieate of
Occupancy v Vr
lixne of.ulhnalreJ ngcnl Date TOTAL IISSUED IIY
OFFICE