24825 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUILD ...L PIiRMI'I'NO.
CITY OF CUPERTINO PLUMBIrc-MECI.ICAI L
BUILDING DIVISION APPLICATION/PERMIT
P„77 gBU1LDING PROIRCIIDENTIFICATION.. 24825
BUILDING ADDRESS:` I1�\\ lP`� SANITARY NO. APIX-ICATION SUBMITTAL DME
I 'D 1 4': , �a� JC. �"`�NIT0 LOTN �I
O RRSNAME:, (� PHONE: +)'RACTOB:S AME: LLC NO: N/C CONI'NOLp
Y. 7JFJ �Pf1 Ci 1 ( 11 (�� �SM.SV-J`X ('.WjrV'\
.\ 1
AUI)p(
IT[?—A 1 .^o t rs_ice LIC NO:
i contract: a�1T l• 'S$ PII�nrf, =, QTYVI"dNrT 'ELECTRIC PERMIT,'ir,: *r "II•��'EB+; ' BUILDING PERMIT INFO
` BLUO PLUMB MliCll
V 1,
'77_�_ )3a 110 PERMIT ISSUANCE '.E
El El
LICENSED CON TRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL TOB IfFSCRIPI ION
afy I hereby affimnhat l am licensed malerpavlsionsof Chepler9(commencing with
00 Sectimtl(XX))of OividPr
«5 of the Bu,inew,md of<ulma Cade,and my license is in PANELS
a�alC full force vad effect - UPTO20UAMPS ,
I.ZCy( Licence Clare Lic.I
y1-=y Data Contractor 201-I”AMPS SQ.F1'.FLOOR AREA S)SQ.I'1'.
ZOrNiv Z' ARCHITECTS DECLARATION OVER INC AMPS
OZ2pppppp l undeaund my plena shall bused ee public recants.
FQyt SIGNS ELECTRICAL
E Licensed Pmrusionel
E OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC.
oto 1 hereby affirm that 1 am exempt rmm the Common's License Law fm the
a W l; following reason.(Section 7051.5,Business and Professions Csvle:Any city or county EMP.METER OR POLE INST.
Egg which mquires a permino commar,then,Improve,domolish,or repair any strucwrc
;!lye prion,its ivmeuce.ala requime,he applicant fmmch Perot
no file•signed atnet«m POWER DEVICES
a<Q that he is licena<d paramour to the Provisions of the Commucto's License Lew Chapter
O y,LxW Ww SWIMMING POOL ELECTRIC
q(commencingwith Section Division rheBusiness and ProlaCMo ✓tVALUAYl
or he is exemptheermmandthe basis for the alleged exemprinn.Anyviolation of Cs—
OUILMS-SWITCBES-111ITURES
�3y
r'�O .1 rom e hall five
ehnuyMePrepdlicdollars(SSW).
xuhjeavhe applicamroadvil pnelry of
NF.W RFSIDFNIIAI.[LIiCIR _SQ.f•T. STORIES l'YYI:CONSIRUCI'ION
C ❑ I,aow«roflhe Praperry.«myemploymwithwaguestheirmlecompenaelinn,
3� will dnthesiva.ende:nomuiaor iv Lielmue Law mdforulapplyi an owner
of
vnd Pmfraiorcv Ctvla:The Conuemoi.a rad whau Law uchdmcor apply tf an r ugh of
ownenywhob.M)virimpsvasthemms,atd nisd s in,co iorralfortfmuie'his OCC.GROUI' NfS.UNITS
employees,p building
or improvement that such implov ld wit arcne yearo c moffered the ow.Ir,
buucvrwitir. hauildhe moelamlde did one year orimproveifmpuCause of
builder will have he burden of Proving that he did rot build or improve for pugxae of _
xale.L QTY.'14ie'-" PLUMBINGPERMI'f�''+^�` I '";I`.d.PEE�`n.: FLOOD ZONE APN
[I1.owmrofthepopny,a xclusivelyconlnclingwilhlicenaedeomracmnlo -vva M.,r
<onabuft the Project(Sec.7044,Business and Profeltsims Cwle:)ne Contractor's
Lic<cU
PERMIT
PeeALTER
fmsuch projects with a emmutor(s)licensed pursuant the C«trumia -IDSSRUN^NIECAEV
FEESUMMARY�
whomtreu
-- License law.
❑ I ore exempt under Sec. ,B A PC for this reason BACK FLOW PR 'I. P.�'ICEJ s r/ '-' -
N 'DRY Y N
Owner Date - DRAINS-FLOOR,ROOry ARFd,COND. RECEIPT#
_ WORKMAN COMPENSATION DECLARATION S LT X Y_N
❑ Ihembyalfirmthetlhavee«Bir.c.leolcenusnroself-inasm,m.ct,iftcauar FIXTURES-PE TRAP RECEIPTM
Wmkerw Compnsminn lnmranrean certified copy lhetmf(Sec.5RW.Lah C.)which R Y N
covers all sund,ee',under this petll. GAS-EA.SYSTIA-I INC.4 OUTLETS DIVISION
M
m
Policy N BUILDINGDIVISION RSFS
Company GAS-G.SYSTEM OVER 4(EA) PLANCBECK HE
❑ Cearif¢Jcapyisheaebyfumisbed.
❑ Cenined copy is filed with theclry inspection Jivisism. GREASrONDUSTRL WASTE INTERCEPTOR (TRADING FRE
CERTIFICATE 01:EXEMPTION FROM WORKERS' URBASE]RAP SOILS FEE
COMPENSATION INSURANCE
IThis auction need not he completed Drive prmit is faros,humlmd dollars($100) SEWER-SANITARY-STORM EA.2(X117. ENERGY FER
m lean)
I ratify that in the performance ofthe work for which this permit is Issued,l shall WATER BEATER W/VENTAILECTR
not employ any parson in any m rears,so as to becmne subject or me WorkerPAID
Cmmpnuri«Iewr of Celifomie. Date WATER SYSTEMITREATINO Date Recd,,#
z Applicant
O NOT ICE TO APPLICANT:IL ober looking this Curinam of Exemption,you abuuld NEW RESIDENTIAL PLMIL SQ.FT. TOTAL:
V) beam¢mhjecnu tire Wmker'v Compensation Prevision,of the Labor Coda you mart,, BUILDING IEE
rormwim cmnPly with such Provisions.,his permit.hell he deemed.,.kW.
L6CONSTRUCTION LENDING AGENCY SEISMIC IFF.
I hereby affirm that there is A construction lending agency for the performance of
J 0 'TOTAL: ELECTRIC ITR
the work fm which,,hh iu
Permit is fled(Sec.7097.Co.CJ
mss... lender,Name - ,t'�
Eeahes Address QTY. '.i� MECIIAMCAL PERMIT ,- y?�,. PEg'r' PLUMBING ETF.
W I cenify that I have reed this IrPPlicaelse information ix MECHANICAL ITE
orretion end oam that the
a
correct l agree m comply with all city end county ordinances and sure laws mining to PERMIT ISSUANCE
y buildingmnsuuction.utdiumby vuthnri sentetivennfild'etymrmeaupvn the CONSTRUCTION TA%
cnKmirved property for inspuf n puryn ALTER OR ADD TO MECII.
(We)agree m nm,in ntrn/yv k«p Ire the City of Cupsino against
liahi 'n.judgmems,emu desPrnw id ay In enywryuccruc ngsinat miJ Gq AFR HANDLING UNIT(TO IO,pp CPM)
an yu cenr,,hr Frlsing th�r _ /s
l 1.Y .a !` 7 AIR HANDLING UNIT(0V1iR 10,(X1(1 CEM)
Sig or r ties «tnd« J `Dat ( EXHAUST BOOD/WATUC) PAID
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO 100,0t00TU) Dare Rneip#
Wil the applicant m fnm a building«cupvm Concur hvuAlc hmnrdou,mvmrinl IIPATINO 11Nl'T IDYE!R IIXI,IXX)IIl'tq IAL
m d me Fy the Cupnino Munidpel CMG.LTeper 9.12.enA rhe lkdtlt nnJ Svfny
f C . dion25512(q] VENTILATION FAN(SINGLE.RISID)
❑Ycx ❑No ISSUANCE DATE•
1 Wllltbmpplicanlmfumre hnllding«cupemuaeequipmemmAevicanwMch soil BOILER-COMPISBPOR 10.0001181)
keaantom Air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100.000 BTU)
°"dn]
❑ 1D
Yen ❑No NEW RfSIDf:NTIAI.MECII. SQ.FT. FA
1 have read.11h he f tyCa materials requir25533 under Chapter 695 of the e.
if the mil ilydth A Sn(cur CMy have ore 35500.t it Is y M534.nponi I ity t nand rho,, MAR
if the ant oft Area nor cunt,w have must
he that it Is my rteance oility m testify the
occupant of the mryirrnrms which must he ata,,pilo m issuance of a Certificate of
Occupancy.
Owner or omborix<dagcat Data TOTAL: ISSUED BY: �1.J '/ /' Ilj INU
OFFICE.