26008APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING, ELECTRICAL
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING - MECHANICAL26008
iv::':a8fd. BUILDWG PROJECT' IDENTIFICATION -c: -;-V) •
PERAu r NO,
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BUILDING ADDRESS:
SANG'ARYNO.
APPLICATIONSUBMfITAL`D/ATE
LL 11
GBL[ C�J Y/UNIT# LOT
OW NAME: P ONE: CONTRACTORS NAME: LIC NO:
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CONTROL
.RCHITECT/ENGINEER: LIC NO: ADDRESS:
3 W EL eA M c) M.U•
CONTACT: HO 'i
�S-�L�, _y�O QTY:++,-ktb'EI.ECIRIC PERMTf�.,'os�;; S;'"T,-FEE;
LL_ ...� t`=;++1 M. -Te.. :.u..: +c3:u ss.-.+ 4+',r :c: s.J 1;
6 C. C-� PERMIT ISSUANCE
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., BUILDING PERMIT INFO;.
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ELECT PLUMB MECH
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LICENSED CONTRACT'OR'S DECLARATION APPLIANCES -RESIDENTIAL
Ihembyeffmt that lam liceved underpinvisiomofCTmbo!)(commencinBwilh
Secure 700)).f Division 3.f the Business and Prufmahnis Code. and my license is in PANELS
fad and e8} �/ SrL�t/�� UPTO200AMPS
Liana Class C Lic. N 7
pass 1D—Cantranm G En 201 -TWD AMPS
ARCHITECTS DECLARATION ,` OVER IOODAMPS
I understand my plans shall be used ss public muads.
SIGNS Ft ECfRICAL
JOB DESCRIPTION
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SQ. FT. FLOOR AREA SISQ. IT.
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OWNER -BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
1 hereby a(f dist I un exempt from the Contractors License Taw fm the
fallowing reason.(Srxvon 7031.5, Business sled Profusion Cock: My city cur munry TEMP. METER OR POLE 1NST.
ry rs g II r-,; i
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which requue a Femut m c.mwcl alter, improve, demolish. m mpa'u any swetum
priamiu issuarta.a4omquima the applicant forsuch permit tofi]ea signed smamrnt POWER DEVICES
that h u licanmd Fireman to dim p iviiens of the Conra tracmLicense law(awl'r
91mmmtcing with Section 7tXplofDivision 3 ofthe Business and Professions Cade) SWIMMING POOL ELECTRIC
oribet h iscxempdtme(smn and the boaia fortneall"ad eaonpuon. My violation.(
Section 7a3L5 by any apTlicantfor a permit subjects the applicant to a civil pevlry of OUTLETS - SWITCHES- FIXTURES
m mere than five hmtlmd dollen (5500).
❑ I.mo mrofthepropmy,mmyemploymwithw Mmtheirwlewmpenndm. NEW RESIDENTIAL EIF.CIR _SQ.FT.
DATE
VALUATION
-
'
STORIES
TYPE CONSTRUCTION
=300
wBldodtewark,udthestrwtumisnotinsendedmoffemdfm We(Sm.70M,Busmms
and Product. Cada: The Contrecmis Liana Law dm ata apply to w owntt of
property who builds m improve thereon, sad who dad such work Mmul f m through his
ownemploym,pmvidedthatsuch impmvemrntsem nosintwdedoroRertd (a We. IL
OCC.GROUP
RES. UNITS
Mwevc.the hu0aingarimprwement iss.ld within one ywofcotnpledon, theowm- TOTAL:
builder "I have the buden of paving than he did rot build or improve far ptup. of
❑ -"n.b �hx'na��xA roi...�x.�:r rat .; `.oiy�J�tb' A•r �yYc..:`p
I.sswofthpopnY.mexcluivelymn angwithlicenedmnwmto PLUMBING IiRhDT,�,�,y.Yfir .141-S'
catmsm the pmjeet (Sec. 7004. Business and Professions Cade:) The Cmowtor's
Lic Uwd mtapplytowownerofpmpeny whobuilds mimpmresthttcon,and PERMIT ISSUANCE
FLOOD ZONE
APN
whocmvaccafmsmh projects withacantnctm(s)BamW punumntothe Convector"
U. Law. ALTER - DRAIN & VENT - WATER (EA)',?rrs
FEESIIMMARY„*� r•••'(1?,
❑ I em exempt undo Sec. , B & P C fm thistram.OUTSIDETTET—
BACK FLOW PROTECT. DEVICE
SANITARY YN
'�
ECEIPTa
dOwntt WORKMAN COMPENSATION DECLARATION . DRAINS FLOOR, ROOF, AREA, COND.
p] IhttebY dfvm thulhaveacenifir•.. of canxrntm al( -instant, ma artifiateof N
Warkeri Compensation lmutwaorattnifedcopy thttwf(Sec.]B00. Lab C.)which FIXTURES - PER TRAP
rovers all employee's mail Wer permit- GAS - EA. SYSTEM -1 INC. 4 OUTLETS
Policy M
SCHOOLTAX Y—N—
RECEIPTa
PARK FEE Y N
RELEIPT0
BUILDING DIVISION FEES
Canpwy_-_ 1:5 =A a P/s7 pGAS.EA.SYSTEM-OVER4(EA)
[3Cmified copy is nanny fumishcd.
PLANCHECK FEE
GRADING FEE
Cmifiedcopy is filed with the airy inweauan division. GREASEANDUSTRL WASTE INTERCEPTOR
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP
SOUS FEE
COMPENSATION INSURANCE
ENERGY FEE
(ThismctimneN rot the completed ifthe pmnit is forme hundred dollarsSIM) SEWER - SANITARY - STORM EA. 200FT.
or less.)
I entity that in the perfarmana of the weak far which this peaait is bowed. l slid] WATER HEATER W/VENTIELECD
ata employ my K.. in my roamer so an to became subject in the Worked
PAID ”
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Con,cosadonlawsof Califomi.. Data WATER SYSTEM/TREATING
Data Reccipt0
TOTAL:
Applicant
NOTICE TO APPLLCANT:If. efer making thin Cerdfw.1' Exempuan, you should NEW RESIDENTIAL PLMB. SQ. Fr.
bcane subject to the Wake, Compensation pmvisionn of dm tabor Code. you must
fordwith co nply with such provisions or this pcmut shall be deemed revoked.
BUILDING FEE
SEISMIC FEE
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CONSTRUCTION LENDING AGENCY
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Ihereby affimt that from, is a connvwtim landi.,,unty far the peRomunce of
the work for which this permit is issued (Sec. 3097, Civ. CJ TOTAL:
Lender's Norte wx:. Ne:: --:�.,;t c.-..
ELECTRIC FEE
PLUMBING FEE
ya;.tx.r,ro-:...s^..nr:•.,
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tenders Address QTY. y!sRls MECHANICAL; PERMIT "'..-: 'sy FPB,..
I anifY N¢t I have and this epplicatim wed sore Net the above infmnnum is ---" l
corral. I agree to comply with all city and county ordinances and scale laws telatingui ILL PERMIT ISSUANCE [1l
buildingcmonad M,my(a,ity action Iapmnenutives of thiacirymmtttupm the
above-mentioned popcny for inspection puryoms. ALTER OR ADD TO MECH.
MECHANICAL FEE (,
a
CONSTRUCTION TAX
(We) agree to sive, indemnify and kap harm]en the City of Cupenino against
liabiliuc,'utl enu,coas wed cwcosswhich meycranywaywcrueagainstssid Ciry AIR HANDLING UNIT (TO IO.t]W CFM)
sof the gnntlp8 of thi
�u /_/ AIR HANDLING UNIT(OVER IO.tI()0 CFMI
s/
PAID t z it
S' ApplicwVCmwctor Dem EXHAUSTHOOD (W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IM.OW BTU)
Will the applicant or fumm building occupant store or handle hanrdous material HEATING UNIT(OVER I W.000 BTU)
ss defined by the Cupnino Municiped Cade, Chapel 9.12, and the Health and Safety
Date Rcetpt p
TOTAL:
Coda Section 255I31aR VENTILATION FAN (SINGLE RESID)
❑ Yea ks.
ISSUANC
eardeviceswhichemit BOILER- COW(3HP OR Iffy" BTU)
Will dteaMlictaholut buildingoccupwt userquipmm
w
hawdaus airwnumuun�ua defined by the Bay Amu Air Quality Managemrnt BOILER - COW(OVER 100,000 BTU)
Distinct! 11 Y. ;15(]N.
NEW RESIDENTIAL MECH. SQ. FT.an
Ivj A� IffE
JAN 12 i9g4-
aiMlY
I have d the haa.dous materob, requirements under Chapter 6.95 of the
California Health &Wiry Code. Sections 25505, 25533 and 25530. 1 undanund that
if the building does nm <umntly have a mnanm
t, that is is y responsibi]iry to notify the
Gill' Ur k,I,JrEY.IVU'
occupant of the mquimmrnts which must h met prior to issuance of a Certificate of
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OFFICE