27153 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
I BUIU01NA.-1'Jm(,IRj1I' PERMITNO.
CITY OF CUPERTINO APPLICATION/PERMIT PLUMBING-MECHANICAL I
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 27153
BUIR DING ADDRESS SANITARY NO, APPLICATION SUHMITI AL DATE
t 6 it LOT
eFt R-�169�,L4J I
UNIT LIC NO tolnj 4�t
IDS N" sION I Kr�ar I
ARCIIIII�C�!NGJNEER: LIC NO:
of I I El
CO IQTY. ELECTRIC P13RMIT FEE I BUILDING PERMIT INFO
r NIECII
PERMIT ISSUANCE
LICENSED CONTRACTOR S DECLARATION
tmiiez 1herelb,iffflon doulma emsed code,prwismasomfCmuid!)(commencing with APPUAN�-RESIDENTIAL 0 PTION
n 3fd the Business and Priffiessunds C.
full f...efordeffiect.
Locn,.Class Lid.# POD,
NCO Seffiforq[t)(MofDoenam de.and my license is in PANELS
UP TO 200 AMPS
,i Dole Comm". 1201-lfaX)AMPS
ARCHITE=S DECLARATION SQ.171. L UR AR12A $1SQ M.
Z8�F I OVER IfgK AMPS
OZ—M I molend,ord my plans slah be madmi publat record, SIGNS ELECTRICAL
Licensed Pofl�.......I
I I
OWNER-BUILDER DECLARATION SPECIAL CIRCUPUMISC.
I hereby wffiods In.,I nin c,imipl for.the Cmalifficat's License Law fordid
on 11,11tosm,ne...a TEMP.METIER OR POLE INST.
-h adi frintax,. .it in frommact.after.ton,ried,denselkh,.,repair any .cl.m
Prior to its issuance.also requires life aMlicart for such Permit to rite a signed sotmem7t POWER DEVICES
a<0 for he t,licensed sur,.......lu�provismers of the Contractors Licens , lCh I,
0 aw ap SWIMMING POOL ELECTRIC
a Crice
9(commencing with Section 700f)ofDo,sion 3 ofithe Business and Profession, a VALUATION
:2� or that he is exempt therefrom and the hanis lot the alleged exemption.Any v I, I
3 a I�.,'rm -SWITCHES i
n a sobcets I c applicant fy of OUTLETS -FIXTURES
I'by Y app"c"u'do peoran "o a civil p"i 0,
Off m ads�1.drf I I a ra
I me n rive '00' NEWRESIDIIIALELE(TPR —SQ FT STRUC,1ION
aw "at off fiff ormay
0 n essenhiscalle'ttithe IRICY TYPECON
a. employ
cr-f
wm'no c immi,mamomal 'it. co" or's "..' .a -s
Van 'Zd ze'froccounds Lm' se Law it_.ans apply to fraform,of
,ur,Inife n
in"c"y who himlil'a'i linowe" comin and"arraw,'indifsor"........rmfioh.�
own employeses,providead thatsuchinipmvements�notinten�oroffemd foraide.If. OCCGROUP RES.UN,,S
however,the builifingrar improvement assoldevillamoneyear of ..fropledbac=id, 0
bail&,will have the handionf,prevout,chat he did.,build in"firprons for
'ide) IQTY.
0 l,asownerofthepn)�ny.amexclusivelycon�gtngwi�licen�contmtomm PLUMBING PERMIT FEE FLOOD ZONE APN
construct the pmject(Sm.7044.Business and Profidsvoines Col Contractors
License Lawdoes not apply loan ovencroff,pro,my who builds or ardidayes themon,mad PERMIT ISSUANCE a,-
�hmexammens forsuch projeems with a exantractorls)licensed pursuant to the Contractors
Lue".Law, ALTER-DRAIN&V13NT-WATER UQO FEESUMMARY
C I am exempt under Sec. B&P C for his re.w. OUTSlI)H ITEI
Owner BACK MOW PROTEM,DHVI SANITARY Y CFIPT# N
DRAINS-FLUOR,ROOF,Aft C�SCGNR RF
WORKMAN COMP�� SATION Dr.CLAR. I SCHOOL TAX Y_N
I hemb,tuffino that I Ifiveitomificiate offmosertm self-moure cxmhl�cwb u�l FIXTURES-PERTRAP RECTIPT'as_.
ed 3,;a PARK FEE Y_N_
0,10 rkeo'Com,ensation Insurance or accifified copy thcmf(S Tax i,
m all employees under this Permit, I? It le
Policy if CAS.P.A.SYSTEM-IINC.401JILETS i BUILDING DIVISION F�
Comfort GAS.EA.SYS PLANCHECK FEE
[D Certified copy is hereby furro,hed. I WA)
GR'TNDUS'I RI_WASTf INTERCEPTOR GRADING FEE
OF EXEMPTION FROM WORKERS' 0 il� TR42:,) SOILS FEE
CERTIFICATE
COMPENSATION INSURANCE V I— I'll
readiddl not ba�completer]ififfie permit is for one hundred dollars SI BY-YORM HA.200FT. ENERGY FEE
or les ) I I
I fecrof,that in iffeeffixormanceidthe weak fier which has .i,,a issued,I MWER ffa4tHR W/4�NTELECTR F
ma employ a,'norm in way...in a.as to Namme PAID
Z Apph-
CfampmembariLavoi.fCalififirma. ER ITIVIMOATING Date R P
z NOTICETDAPPLICAN]`If,diet ranking this Cerrificand. Do"'cold, _,",��ItEsIDIINT14TwIT—SQ.M TOTAL.1
bescomesubject to the Worked's Cond,enceration provisions Ofthe LatuarCorle,
must
> forthwith comply with such provisions or this permit ithedl be dicennexcl revoked! It UILDING FEE
S171SNI IC rE E
CONSTRUCTION L ENDING AGENCY L�'
z I hereby offiroff that them is a construction lending agency for the performance of
IJ the work for which his Permit is ionuctil(Sm.uA7.Cis.C.) ULEMR[CFEE 1�
Lcrdfexsham� I! -
Lenders Arbil QTY. MPCIIANICAI.PERMIT FEB PLUMBING FE i-
0 U I ferity that I have Teral this application and state that the above infirmication's I'P-7 'WI
correct.I agree to comply with all city and county ordlmxra�mad state I , Lung of PERMITIS'UANCE MECHANICAL FEE u JI&V
U baffe-oremainect property for ins,pectuar purposes. ALTER OR ADDI 0 MECII. CONSTRUCTION TAX
71 (We)f,ow ,,save,orderamfy it keep counties,he City of Cameron.
I hit it I AIR HANDLING UNIT(10 10,000 CFM)
"�aarandexpainces which may many way accrue against said City I
AIR HANDLING UNIT(OVER 10,000CFM)
rinat f�Mhmmq7mfhrmom EXHAUST I NOOD W/DUC,) PAID
HA7VUitDOUS MATERIALS DISCLOSURE 11�- TING UNIT G 0 103,000 BTU) _Dald pa#
as derined by the Cammo Municipal Code,Ch.tpier 9.12,and he IIQ,h and Safety I]RATING UNIT(OVER I 0(),00d BTU) TOIALc
Code.Section 25532u)?
0 Yes 0 No VFW]�TIONI-'AN(SINGI.ERI-',SID) nar�w :
Will dicappitctrutor fictumbarldingraccupintuas equipmentiordevicessishich cur, BOILER-COMP(311POR I 00,00i BTU) ISSUANCE DATE
olow,.11 comformanin's.1 defired by hu Bay Area A, A /'t ; 0
trairl BOILER-COMP(OVER 101J,000 BTU)
0 Yea 0 No at NEWRESIDENTIAL MHCIL_SQ.FT OCT 19 1994
1 have mad the hazardous materials requimments under Chapter 6.95 of the
Catifoomit Health&Safety Code,Sections 25505,25533 and 255�1. 1 understand th
it he toolchn,does ma,content ly have nomond,lloiin,,my re,,no,ibi ii,rd dincy the
recursion of the requirements which must be met poor to issuance of a Cerifiente of
Occupancy
Ownit,,omilmor.M tiger, Date OFFICE ISSUED BY