2238 CI'T'Y OF CUPERTINO - R -- - - - - - PLUMBING——MECHANICAL -f i� rERMIi Nv
APPLICATION/PERMIT PING PROJECTIDENTIFIC
BUILDING DIVISION �-„ ,'+ BUILDING PROJECI'IDENTIFICATION ^..'_ I _
BUILDINGADORESS. �� ��� �� �� , I aw vu m� Al M.'aWNS15BMfITAh
2�G�0 UNIT# LOT. I
OWNERS NAME: Pf10NE: CON'I RACTOR'S NAME LIC NO �+
„7n{{ r\J l7 Fj'�.h A 1 j A'0 7 23-f'L8o 1'}D-Xn£a-V A." L_ I we colvTROL n
..RC i TEC NGINEER. LIC NO: ADDRESS ❑
• CONTACT: PIIONE. 2 - �. - '• - i �•` -. -._."
1E .. D YLDING PER_IT INFO.?f I_s-
Q'I'1'. -•;,ELECTRIC PERMIT ."ate " . FEE• _ a _
` BLDG IICF PLUMB � MECH
l PERMIT ISSUANCE
LICEN SEDCONTRACTOR'SDF.CLARATION I APPLIANCES-RESIDENTIAL I IOBD NCRIPDON
OxZ ih7W).Onnthmi ant l rove Riaucaroutvisione errC Code.and with
X00 Section ceredol Drviumnl aRhe Bunssesx amlProfessom Cede.and my Lana nor I PANELS
full lm,CI,v efPoet.
�U� UP TO 200 AMPS ✓Lie.N
riFi<� Datenu Clus Cosumctor
ON 11N10.\NIPS S .FT.FLOOR AREA S/SQ.FT,
zOy?
ARCHITECTS DECLARATION I OVER 1000 AMPS Q
C Z—O I understand my plans shall he used,ss public records.
i, F m SIGNS ELECTRICAL
<y7q Licensed Pmiessmnal
ccxa OWNER-BUILDE"R DECLARATION (SPECIAL CIRCUIT/ ISC.
KO U 1 herehy affirm Chef i am exempt team the Contractors Llaens< La.for the
following reason(Section 7031.5,Business and Professions Cole.Any city or county I TEMP.NETER OR POLE INST /
which requires a Permit to conswm,alter,improve,demolish,or repair troy structure
�L3Y� poor to hinintance, bur,uquocx the applsant(orsuch perm,sidle a ugaed suemens I POWER DEVICES
�YO0 that he is licensed pursuanno the proasums of the Contractor's License Law(Chaper SWIMMING POOL ELECTRIC ) e
eio�z 9(commenang wolf Section70(gl of Dmumn 3oldm Business ane Promsxmns Cole) J VALUATION
—m omhatheuesempuhcrtfromand the baau(or the alkgNexemgson.AnyvnAcionof
FZQ Section 70315 by:my applicant fora permit sublecrs the applmannma nnl pcnWry of OUTLETS-SWITCHES-FIXTURES
i mom than dve hundred dollars(S500). NEW RESIDENTIAL ELECTR S
KE.2 ❑ I,mownerofthe Properry,ormYemPloYCeswMwages axtherrsokcompemabon, I -- Q. STORIES I TYPE CONSTR L'CTO
a3,., wJl do the work,and the xtmcrom is not intended oroffered forsale(Sec.7 a.Business I v/
and professions Code.The Contractors License Law does not apply m an owner of /'
propcnywM buddsorimpmves thereon,undwfwdocsxucM1workhimulfordmoagtihu I / OCC,GROUP RU.UNITS
however due ilding rimpr versenpmvemwithin one ieendcdo plienturforsale.IL J
mulder oillhav building burden of Imemnsn fur,di in build year;,compleufor the owner- I TOTAL:
bmlJcr will have'he burden of pmamg that he did twt Wad improve for perpmu of
sale.) it'L}0.`.,F .. .. .S, ,. - - - _ _
❑ Las owner of the pmpeny,.me.adustvelyconmenngwnh bcenue contractors DING_ PERMIT-E¢.'14' I.r:FEE. ,�I FLOOD ZON[ - APN
construct the pmten(Sec 704,Himmcss and Ro(essmnx Code.?The Contrctors PERMIT ISSUANCE
License Lawdoes oorapply m anawner,t property who builds or improves thereon,ane
won mnsraesxforsuchprojec¢whoa rnmracmgs)licensed pursoder.the Conueclsrs I ALTER-DRAIN&VENT-WATER TEA) ',.,;.igyp;yLfP'EE SUMMARY ;
ecnx Law.
"•-
❑ 1 me eumm under lice. B&P C for this rtason I BACK ROW PROTECT DEVICE s OI v E FEES — — —
SANITARY N
Owner ante I DRAINS-FLUOR,ROOF,AREA,COND. ISCHOOLTAX YfCE tr N
WORKMAN COMPENSATION DECLARATION
❑ iheuby affirm thatlhav<acempcam o f<nnmmto selhmsurc.ore cemficnm of -f RF EIPT♦
FIXTURES-PER TRAP
. Workers'ComP,com's nderditrsceoeacenifedeWYNneof(Sec 3800,l.abC)wMCh (PARK FEE N
coven all employee's undenhis pemt GAS-EA SYSTEM. INC,a OUTLET'S f SEy�Es_�_
Case,g Bub �. DI �Slq
Coro Cers I (GAS-EA.SYSTEM OVERalEA7 IPL\NCHEC ,ar.
❑ Cemfied copy is hereby famished.
❑ Cemped copy h Cited with the city inspection division GRLASEANDUSTRL WASTE INTERCEPTOR GRADIN`��
CERTIFICATE OF EXEMPTION FROM WORKERS' I GREASETRAP SOILS FCB /
COMPENSATION INSURANCE
(This sedum wood.bo<ompinN d1be permn is Foronehundred dollars IS 1011) SEWER-SANITARY-STORM FA.200FT. ENEfs\ssy1.'[ ,
or less.) �_f`/I
I cerdf der,mine perfommnceoflhe work for which Nn permit uissued,Idall WATER((EATER WNENTRiLECTR
not employ any pe..n any manner ea.to become sub)cct w the Workcti I PAID
z ComleOullonlowscf Cahfomia Date WATER SYSTEM!(REATING D e Receipt is
Appikim
NOTICE TO APPLICANT,If.after emil this Cempcme of Esem t / T AI,.
Z g p ton,you should I NF.1V RESIDENTIAL PLMB. SQ FT.
� (q become sub)ttnothe Worker's Comprnsauon pmnsiam of the Wbor Cak.you mud I BUILOINGJFE
� fonhwhh comply wnh such promnons onhts pennn shall be deemed revoked.
4 (] CONSTRUCTION LENDING AGENCY I SEISMIC�iT
z Ihereby.ffirm that themua con.wmmm lending agency intense ohmormnce of 'TOTAL: ELECT FEE
J O she work(or which rms person a suucd ISce.3097,Cis.C) f_ �
Lenders Nam• ",T' y
U. F Isndre,Add— QTY O-q' a,v aMECHANICAL,PERMIIT :".y FEE.4 PLUMING FEE t
V I<cndy that 1 have mad iMs ePPlmauun and xiate that the above mform9imn m ' a:.:.u.:. gym,+ a a ✓, ".t\%- k{, <
come]. l agree mcomply with all city and county oneiimnces and dam laws mlumgto PERMIT ISSUANCE n e (MECH ICAL FEE
budding construction.and hereby atinmen ormionutivemfthis city former upon the �'1 CONSTRL ON TAX
V Z aMvcmerman<d Import,for 'pectin It swev _ IA`OR ADD TO MECH,
f Wet a rte m save.mdcmnify e J ccP harmless sh Gry d
hanhues.t m rsandexpc x hush may many wayu ry .gas f JOry AIR HANDLING UNIT(TO 10.1100 CFM)
m iaauyu c thews unB of s n -
\` AIR�I ANDLING UNIT iOV 00.10,000 CFMI
Sigmm�m o-AppbcanVCnmmcsar D.to I EXHAUST HOOD(WM(1Cq
PAID
HAZARDOUS MATERIALS DISCLOSURE I HEATING UNIT(TO 100.000 BTU) Dam Rscespt I
Wdlde ofidcans m Forum buJJmgaccupam score err handle hazatom mmferwl HIb1TING UNIT(OVER IW/qO BTU) I IOTA
n deduced wire CLpcmno Mi mctpal Cale,Chapter 9.12.and the Hcat xnJ Safety
Code.Section 255321x)' I❑No Yes VENTILATION FAN(SINGLE RESID)
❑
I I ISSUVCf DATE, v�
Wdhheipplicemnrfnare building occupant use<gpmem ordevecs whehcmu 901LER-COMPJfP UR IN1,000 BTU) ✓.,
harm tin,air contaminants as defined by the Bey Aria Air QLalry Management I BOILER-COMP(OVER I W O(M B FU) ��
Dnmrr. 4 �'
Q Ycs ❑
No I NEW RESIDENTIAL MECH. SQ,FT. I J/. 1+9996.
I hnvc read the havaNnax mmena6 rcgmumcros umler Chapter 695 of pr, I I •J�tT"�
7�C'�,Lbcmr duo"a Heahb&Sat ery CadeSmarms 25505,25533 and 25534 I undersund that ldmg does nor wncntly Lave a mnam,(het n u my resp,nstbihry fo nnuly the
pain of the rcyuneu which muss Fo mn perm fe Issuance oa CemOCam of up ncwnensr amhnn<W agcos par, I TOLL I ISSUED 117
OFFICE