25576APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
OFFICE
CITY OF CUPERTINO Hit -MAIN(. - KLIVU I RICA
If APPLICATION /PERMIT PLUMBING - MECHANICAL
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
PERMIT NO.
25576
BUILDING A OGRESS:
SANITARY NO.
APPLICATION SUBMITTAL DATE
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RCHITLCUENGINEIR: LC NO
ADDRESS:
CONTA PHONE:
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IiLECI'RIC PERMIT
FEE
BUILDING PERMIT INFO
HI.DO ELIiCI� PLUME 'CII
PERMIT ISSUANCE
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LICENSED CONTRACT'OR'S DECLARATION
I llerehymmno that maltecrsed underprovlslnnsofChaptm9 (cammeneingwith
Seminar r/000)of Division 3ofmc Businessand Professiam Cade, and myli,mant in
fullforcoanAe(reet.
APPLIANCES- RES]DENIJAI.
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1400
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JOB DESCRIPTION
PANELS
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license Class Lic it
Dole Cunlmens,
DPTG200AMPS
201.1(100
ARC] IITECI "S DECLARATION
I understand my plans shall be used as public records
-
OVEN 1
SQ. Fr. FLOOR AREA
2ni, 0
V lVV/
$ /SQ. Fr.
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Licensed Professional
OWNER- HUILDER DECLARATION
I hereby affirm Nat l am exempt from the Contractor's License Lew for the
following mason. (Section 7 031.5, Business and Profession& Code: Any city or county
which requires a permit b, cun.ar, er, after. 'u rprove, demolish, or repair any a mt
ero
poor to its issuance, also requires the applicant(orwch permit o file aligned stammer,
one, he is licensed pursuxn to the provisions nl'the Contractor's Licenso Law (Chapter
9(commencing with Settian]IXIO)of DivisionJOf Ne Business and Professions Code)
or he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for apermit subjects the applicamma civil penalty of
o[ ro an five hundred dollars ($500).
as cmfthe properly, ormyemployeeswirhwagesniheirsolecompemalion,
Idol work, and the strucmrt is not inmadmarnrrered forsale(Sce. 1040 Business
S .CIALCTRCUT M
TEMP.
MMI
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POWER
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SWIMMh
GPOOI. ELECTRIC
�� VALUATION'
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OUTLETS .WITCUES- FIXTURES
NEW RESIDPNTIALELECfR _SQ,
STORIES
TY HCONSTRUCTION
nd Prora&sions Code: The Counselors License Law does nor apply to an owner of
property who buildsorimproves thereon. and whodoes such work himselforlhroughhis
OCCGROUP
RES. UNITS
wmm�ploycos, provided lhmruch improvenroms arc notintcndcdoroffored [ar wle. If.
however, the building or improvement is sold within one year of completion, the owner-
hudder will have the burden of proving that In did not build Or improve for purpose of
'
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QTY.
PLUMBING PERMIT
FEE
❑ ], as ownernflhe pro] xny�nmexdusivelycommclingw ]Nlicensed communism
FLOOD 20NE nPN 1
conmracl the project (Sec. 7044, Business and Professions CMe:) The Contractor's
License Lawdoes molapplyrvan ownerofpropeny who builds or impowesrheran ,and
D
PERMIT ISSUANCE
who contracts for mehprojecls with a contmemm,) licensed pursuant mthe Cumanar's
Licenw Law.
pL1ER- DRAIN &VFN'1' -WATER FA
( )
FT:E SUMMARY
❑ I em exempt ender Sec. B & P C far This reason
BACK FLOW PROTECT, DEVICE.
OUT, IDE PEES
SANITARY YN
Owner Data
DRAINS- FLOOR,ROOP, AR1iA,COND.
RECEIPTY
WORKMAN COMPENSATION DECLARATION
❑ I hereby affirm tbml haveacenificaleof consemtoself- inmre,oracenifcmeof
a
Workers' Compendon Immune ora certified copy themof(gee. 3600. Lab C.) which
rovers all employee's under Nis permit
Policy
SCI TOOL TAX YN
RECEIPT#
1'IX'1'URFS- PER'I'RAIs
PARK PER Y N
' #
GAS - EA. SYSTM -1 INC. OUTLETS
UILDIN( DIVISION FEE
Company
GAS - EA. SYSTEM- OVER4EA)
PLANCHECK TE
sit
❑ Candied copy is hereby fumishcd.
❑ Certified copy is filed with the city inspection division.
GREASE /INDUSTRL WASTE INTERCEPTOR
GRADING
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
GREASETRAP
SOILSI
iL'
SEWER- SANITARY -STORM EA. 2(111
ENE G
./'e
(This section need not be, completed ifthe permit is baron, hundred dollars
m (easy
WATER HEATER W/VENT /T:LECI'R
I certify that in the performance ofthe work for which this permit is issued,I shall
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not employ any person in any manner so as to become subject to the Workers
CompeardanLawsaf California. Dale
Applicant
WATER SYSTEIvPTREATING
PAID
6m Receipt#
0
Vi
NOTICE 10 APPLICANT: If, after making'his Cenificamof limmain, you should
becomembjecnorhe Wmker's Compensation pmvisionsob Ne labor Code, you mull
NEW RESIDENTIAL PLMB. SQ. Fl.
TOTAL:
5
fonhwirnannp]y with such pavilions crmis permit shall he deemed revoked.
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L.
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CONSTRUCTION LENDING AGENCY
I hereby affirm than is a construction lending agency for the performance of
the work for which 'his permit is issued (Sea 309], Cis. C.)
Lender's Name
-
PE",
O
TOTAL:
'E
MCONSTRM
Lenders Address
QI'Y.
MECHANICALPERMIT
PER
I cenlfy that I have read NIe it,licmrun and nine Shut he above information is
comet. ] agree m comply with all any and county ONionares and slate laws relating to
building construction, and hereby au'horisa representatives orthis city to enmr upon me
above - mentioned Fault for inspection purposes.
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y CL,
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PERMIT ISSUANCE It
Al. FTC
ALTER OR ADD I'O MIiCII.
'ION 1'AX
�-+
(We) &gam to mm, indem keep harmless the City of Cupertino against
liebil" costs experts wnichmayimao a arromignmetl id City
AIR II ANGLING UNIT pI'010.00 CFM)
in omequence of g mg 'ma
AIR HANDLING UNIT (OVER 10,01X1 CFM)
Si ( ,n of Oat
EXHAUST f100D (Wp)UCI)
PAID
HEATING UNIT (TO IB9,OW BTU)
Dee Ra t#
HA21 RDOIJS ATERIALS DISCLOSURE
WhI the applicant or room building occupant smrc ur handle haardous maoriel
mde0ned hyme Cupenino Municipal Coda,Chap'er9. 12,and the llealNmtd Safety
HEATING UNIT(OVER 100,(XOBI'll)
TOTAL:
Code, Setti 5J2(ap
0 Y
VEM'ELATION RAN (SINGLE: RFSIU)
Will'heapplicamnrfmurebeffinag by
BOILER - COMP(311POR IOB000 BTU)
P A � I UANCEDATE
hazardous air commninanrs`m defined by the Buy Arcs Air Quality Management
the Bay A . AirnQualit Management
D1mritt1
' ❑Y,n 01N.
OCT 25 1993
BOILER - COMP(OVER 100,000 BTU)
NEW RESIDENTIAL MECR, I'I
SQ.'.
-
I have read 'he hazardous Sections 5505, 25533 under Chapter erm id the
1undenond then
miallcanoes Safely alyhave.
I V Ur VUl'CiII IINV
if he har25505,25533 yrer'axi
if Noortotacesno'mnts
whaveastthe etEitismyreapnceofa Certificate of cc
of the requirements which moat be met poor to issuance of n Cenifcme of
Occupancy.
upon
a
ISSUED By
Owner or aulhadmdagenl Date
'r0'
OFFICE