26949 AYYLIUANI 1 V FILL IM IMFVMMAIIr,/M WIIMIM MCV LIMC.I-VaC GALL YVIMI FCM VMLT
-CITY Gr'CUPERTINO - � FERMI No. j
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION G
^aka 9s'It�C•W BUILDING B DENTUDCATIOpi .ry.FDSAty
BUILDING ADDRESS: _ 56"
SAN)I'ARY NO, A111.ICATION SUB
UNITN LOT# Y qI s
OW C S E: PIIONI NA L NO SY• VVV
i KCIIITEC(ENGINEER• CIC NO: . ADD - �L N/C CONTROL#
S\ / E
corrrncr:
PHONE; a�•4,k.`HUILDINO OHRMRINPO
rj nl i^DWs ,�4!::ar�i'$'i EsDjA-"re. tp y Xu, BILDO ELECT PLUMB MECH
PERMITISSUANCE El ❑ 0
LICENSED CONTRACTOR'SDECLARATION APPLIANCES-RESIDENHAL 'na MION
CZ Ihreby affirm CENSE licensed visDECL RAT( 9(commancing with 1 ''"Js11D
opo Section 7CM)of Division 3 ofthe Business and Professions Code,and my license is in PANELS
y� full farce note sS
FZ Ilem lu — -L LIc.N UP TO 200 AMPS
,as Dem 1 ConVapor 201-IOW AMPS
kF..y Z ARCHITECTS DECLARATION SQ.FT.FLOOR AREA SISQ.FT.
Zpy OVER 1000 AMPS
O Z� 1 undenmml my plans shell h used u public raards.
F4 w SIGNS ELECTRICAL
hLicensed professional
�$ that
OWNER-BUILDER the CoATION SPECIAL CR2CUR/M
3LLU I following
affirm thm 1 am exempt from rise CantradsCh License law for the
fallowing season.(Section 1831.5.Business and profusions Cade:Any city or county TEMP.METER9146LE(NST.
which requires aFormil e,.htotdrs thmalter.improve,demolish,111 repairanystructure
mu
!gat pfiarmiuicensedpursont to the
Nevisiosofar the Co pomitta Liease Law meman PoWE0.DE CES
''FF''SS11 ap that he is licensed pursuant to the provisions of the Conrradora License Lew(Chapter V7
�je 9(commaming with Salion l001paf Division 3 ofthe Businessand Prafoolons Code) SWIM GPOOL ELECTRIC o lA(JU(7�y�
Myr or that he is exempt therefrom and the basis for the alleged ex<mgion.Any violation of O S-SWITCIIES-FI%TGRES -�
Za Section 7031.5 by any applicant two Permit mbjecd the applicant m e civil penalty of
am are than five hmtdrcJ dollars($5013).
❑ I.aeownerofth<propety,ormyemploye<s with waguastheirsolecompenation, NEWRESIDENTIALELECTR _SQ.FT. SIONIIiS I'YPECONSTRUCIION
will do the work,and thstormare bran intended oroffered formula(Sm.1044,B.A.a
and Professions Code:The Convector'»Limme Law does not apply to an owner of
NoMywhobaildsorimpraves thereon,and whodoeuuch workhimselforthroughhim eI
ownemlaees,provided thetsuch int OCCGROUP RFS.UNITS
p Y tIs mid within
not lnteMed dofftired theowno-
huweventheavet the burden
ishathwithinoneyear or improve
theaox,.&
builJer will have the burden of proving that he did not buildoeimpr�ve for puryone of cm FLOOD ZONE pPN
�'`';p�'UM.LfA1�
(")I,asawnerofthpmRay,amexeluasvelywncBngwBM1license cmn ctomt mstlPEji :F"., s��
[Im
onnmd the project(Sec.7044,Business and Profession,Carl Th<Contractors
Licrnne Lewdoemnt apply manown<rof progeny whobuildsmimprnva thercon,arM PF
whommotem far much projects with a commetot(e)licensed pum—m--......Ix ALTER-D NA l 11 !(•µrat P885UMMAHY'A'"1
License Law. ) h"IcS''ly5`,.r
❑ 1 am exemq under Sec. ,B A P C for this reeabn BACKFLOW OTECT.DEVICE SANITARY Y OFEES
N
(honer Une DRAINS-FLOOR, , AREA.COND. RF.CIBPTM
WORKMAN COMPENSATION DECLARATION . SCHOOLTAX Y N
t ❑ Iherehy eflirm thulbveattrtiBum of connenHo selginaurc,arecenificam of FIXTURES-PER TRAO RLCLIPTN
_ Wmken.'CmmpenaaBm in,urumemattnified copy thereof(Sm.38W,Lab C.)which
PARKFEE Y N
orvere silent e' n e hi er GAS-EA.SYSTEM-I INC.40ITIL RECEIPT#
Policy# BUILDING DIVISION FEES
El CyscGAS-EASYSTEM-OVER 4(EA) PLANCHECK FEF.
❑ NR<d copy I,hereby um aced. .
stifled copy is filed wiN the city inapec0on division. GREASFJINDUSTRL WASTE INTERCEPTOR 011ADING FEF.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need nosh completed ifthe Permit is foronehundrcd dollars($100) SEWER-SANITARY-STORM EA.200FT. ZNERGY ME
or less.)
I certify that In the performance ofthe work for which this permit is issued,Ishall WAT ER HEATER WIVEWIELECHI
nm employ any penton in any manner ao m to become mbjeet m the Wmktr: A6
Compensallonlawsor Celifernia. Date WAT BR SYS'I'L'M/fREATINC Irate Receipt as
O z Applicant
NOTICE TO APPLICANT:If.after making this Certificate o'Exemunion,you should NEW RESIDENTIAL FILMS, SQ.Ff. TOTAL:
T-• V2 am...esuhjmt to the Workers Cmmpenaadon provkhmmafthe Labor Code....mum
forthwith comply with such pravhlonmar this 1.11 shall h dammed revoked. BUILDING THE
{S( A CONSTRUCTION LENDING AGENCY SEISMIC IIF.
z I hereby affirm that them is a construction lending agency far the performance of
V O the work far which this Permit is based(Sec.3091,Cl,.CJ TOTAL: T:LLCIRIC FF,L
Qt..t lenders Nam. a PLUMBING FEF.
[C-.-1r Lenders Address ( fY � 1'� 9CIIA�'7 .'ALP t I'�4ds Irtr' 1}'."r4 ?.
I certify that 1 hovers"list»ePPlicalion and amte that the above information is tr "r v.ntav ass* I ,1;
Lk1 cooled.l agree to comply with all city end county ordinances and state laws mlating to PERMrr ISSUANCE MECHANICAL PLP.
yr h building construction,and hereby saltation representatives of this city to enter upon the
dCONSTRUCTION TAX
V 7
dove-mentionedroryo.v
pperty for inspection puee. ALTERORADDTOMECH.
C7 (We)egom m neve,hMemnify and kttp h.la.o tee City of Cupertino against
Iiebilitica,jndgments,costa andexpenseawhich may in any wayaccme against said City AIR IIANDLING UNIT(TO IO,I#p CFM)
in consequence of the granting of this permit.
AIR HANDLING UNIT(OVER IB.O(IB CFM)
Signature of ApplicarOContractor Dam I EXHAUST HOOD OVIDUCT PAID
HAZARDOUS MATERIALS DISCLOSURE MATING UNIT(TO IW," U) Date RemiptN
Will the applicamarfuture building occupant state or handle hacrodouh material HEATING UNIT(OV ,qpu) TTM
as def ned by tis Cupcnlne Manic' Code,Chapter 9.12,and the Health and Safety
Code.Section 23332(e)1 VC•NTILATION FA SINGLE RFSID)
❑Yea No
(SSU C T
at
Will he epplicantofmure M1ulldingoecupantuseequipmemardevitts which emit BOILER-COM (311P OR IW,UW BTU)
di.,air ranmonhmmu w de cd by the Bey Area Air Quality Management BOILER- P(OVER IW,gp PN) JAN 11 1995
.ie ❑Yes NEW RESsfyIENTIAL MECH. SQ.FT.
1 have read the hvarrksm material,requirements under Chapter 6.95 of the CITY I VI
California Il.alth A Sank Cod..Section,25505,25533 and 25534. 1 unsl.ommnd that V
NP
f the huilJing dtc 1c mall haveamn..t,that itta my responsibilhy to ratify the -
oecupent oft vi rte rot h met prier m issuance of a Cenificate of
(kcu /may
Owner or aulhorimd age !{•a Use TOTAL: ISSUED BY:
OFFICE �.