27908.` APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDING-ELFT FRICAL PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL O oO
BUILDING DIVISION BUILDING PR(ydECT IDENTIFICATION
BUILDING ADDRESS: S F-IL SANITARY NO. APPLICATIONSUBMITEALDATE
UNIT# Y LOT# 14—w•- Y�• �
OWNERS NAME: PH Ni !! CONTRACTOR'S NAME: LIC NO: WC CONTROL#
# tt�4D3 DRESS:
1RCHITECT/Fl4 INF.E LI NO: ADDRESS:
ildOrG is IL al sl c
EJ
CONTACT: PHONE: BUILDING PERMIT INFO
416-lew- joy QTY. ELECTRIC PERMIT FEE
l pLpG ELECT P�L�U��I1B MECIi
get. wofPERMIT ISSUANCE I,IE{]I LT
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
Oy.y I hembyaffirm that l nn licaused un&rprovisionsofChapter9(commencingwith
FJ00 Section 7")of Division 3 of the Business and Professions Code,and my license is in PANELS
Kf+l full Immoral effect.
<Z License Class Lw+It UP T02W AMPS
y6a Date Confirm 201-IOW AMPS
F0ce ARCHITECTS DECLARATION SQ.PT.FLOOR AREA f/SQ.FT.
70y3 OVER 1000 AMPS .
O N- I understand my plans shall be used M Public rttorJr.
SIGNS ELECTRICAL
Licensed Pmfessionnl
�Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
R'Op�,U 1 hereby affirm that I am exempt from the Contractors License Law for the
Iraay followingruason.(Smion]OJLS,Business and Professions Cade:Any chymmunly TEMP.METER OR POLE INST.
which mcphas a permit t.constrvcL alcor,improve,demolish,or repair any emetine POWER DEVICES
>� prior to its insuanee,alsorequires the applicant forsuch permino rile u signed naument
s that he is licensed purmanuo the provisions of the Convectors License Low(Chapter
iioLL 9(c pornmeing with Section]000)of Division 3 mine Business and Profeadons Cade) SWIMMING POOL EL E C VALUATION
Wor pat he is exempt herefrom and the basis for alleged exemption.Any violation of
Y Section]03 LSM1 an a ]'cent fora tsuM1 authee 1 u.ecivil telt f OUTLETS-SWITCHFS
-
�Z Q, Y Y red Penni j PP scan pe y o
1 nm more Nw BvehepTOPWY,ormySWL STORIES TYPEC STRUCDON
O NEW RESIDENTIALE ECTR .FT.
yw ❑ L the wrk.and the fpuny,strmyemployedor ofwedfutre,(Sm.compcnsiness
3. and JmhewoIX,Code The
imaense Law
future, Business a.r
end Profassiore CWe:TTe Comaewr:License l.ow rices not apply to an owntt of
pmpeny whobuilds orimprovesthereon,and whodoes such work Nmselforthroughhis OCC.GROUP RES.UNITS
w
onemployms,provided datsuchimprovementse a not]ntanJedoroffered forsale.If, w
however,the building.rimprovement is sold within cote year ofe mpletion,theowner. JN1
builder will have the burden of proving thin he did not build or improve for purpose of L'
s r.)+ . PLUMBING PERMIT FEE FLOOD ZONE APN
C3 1,asowneroftheMNny,amexclusivelycontmaingwithlicemu cmmctomtu QTY - 357-;?.3-(7
construct the project(Sec.7044,Business and Professions Code:)The Cantmcknes
License L.nwdraf apply man.wnerofprorwho bu
peilds m imp rovesthcrcon,and PED
RM 'ISSUANCE
whocantracts forsuch projects with amminawds)licensed pursuanpo the Ciffrom ors ALTER-DRAIN&VENT-WATER(EA)
License Law. FEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT,DEVICE
I SANITARY YN
Owner Date pRAINS-FLOOR.ROOFAREACONDRECEIPT#
WORKMAN COMPENSATION DE , , .TION SCHOOL TAX YN_
`— ❑ Iheicbiffirrnthatlhaveecenificate of coveraoul- urcmil'tmfiems of FIXTURES-PER TRAP RECEIPT#
Workers Compensation lrmumnce oracenifcd copy rt.((Sa. W,Iab CJ which PARK FEE YN
rs all employee's under this permit. GAS-EA.SYSTEM-1 INCA OUTLETS DIVISION
IO#
PnLby# BUILDING DIVISION FEES
Company f GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK ME
❑ CetiferImpykiberebyfumished
ElCenifiedcopyis Bledwiththeci;impeeti division. GREASFflNDUSTRL WASTE INTERCEPTOR GRADING PRE
CERTIFICATE OF/so
FROM WORKERS' GREASETRAP SOILS IEE t�
COMPENURANCE
(This senior remain be c.mpmit is for one hundred dallvn(fi ) SEWER-SANITARY-STORM EA.2WPf. ENERGY FEE
orlexs.)
I certify that in the performancofor which this permit all WATER HEATER WNENTAiLp
not employ any person in any mo become Ne Wr a PAID
C.mpcnseti.n Lews ofCelifomis, a WATER SVSTf?M/IRFATING Data R i N
O 7-+ APPlicnnt
z Q NGT]CETG APPLICANT:IL er rtwking th' Cerin of_ mption,y ushould NEW RPSID[?NTIAL PLMB. SQ.FT. TOTAL:
.�., baome wM1jen m the Worker Compensmion p .abor Cod,you mus
1 fnNtwith comply with suchp visio.....his pe i WQI deemed my ed. BUILDING
W A CONSTRU ON LENDI CY SEISMIC FEE r"r
CTJfV
V Z Lherebyaf5rmthuuhercisac. wetiealconin cyfarth perfmmmaof ELE
O the work far which this Permit is issued c.309],Civ.
L4 Lender's Name
Lenders Address QTY. MECHANICAL PERMIT FEE P N
0 W 1 certify that I have mail tMe app=1ioo state thin the b.ve Info r al.Is .0 CAL FE
Ilr torten.Ingres mcnmply with all city erW co umy dinencese Isete laws rtlaingw PERMIT ISSUANCE
building construction,and hereby eothuriurepram i oaf acilywenterupanthe CO U 10 TAX
V z above-memi.ned property for inspection pmp.scs. v ALTER OR ADD TO MECH.
(We)ague to save,indemnify end keep harmless sty of Cupertino against
liabdines,judgmeats,coxa andexpenes whichmuy in anyway acetneagamst said City AIR HANDLING UNTT(TO 10,000CFM)
crow"ueneeofthegreati afthiI.
yXsQ^r K/1- h6 AIR HANDLING UNIT(OVER IO,(IOO CFM7
SigrammeatziA641ccuoirmcm, I IIS IV Data EXHAUST HOOD HVIDUC11
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING"IT(TO 100,000 DIU) Date Receipt#
Will the applicantorfuture building.ccupsim more or handle barardoua material HEATING UNIT(OVER 100.000 BTU)
as defined by the Catoctin.Municipal Come,Chapter 9.12,and the Health and Safety
CWe,Seni.n25532(a)? VENTILATION FAN(SINGLE RESID) P A a
❑Yes ❑No # U IS ANCE DATE
u
Will theapplicanurfuturcbuildingoccupnnt meaguipmentmdevim which emit BOILER-COMP(JHP OR 100.000 BTU) T )
vNus dr crmaminanls.defined by the Boy Arcu Air Quality Management BOILER-COMP(OVER I 00,000 BTU) y O
hum'? r.
11 Yea 131995
i YNo NEW RESIDENTIAL MECH.—SQ.FT. `/
I have rad the limendous materials reqm
uireents under Chapter 6.95 of me U`�Cfj
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand tha U
if the building does not currently have a afford.that it is my usp0nsibilny to county the
occupant of the requirement which must be met prim to issuance of a Certificate of
Occupancy.
Owner m milimpred agent Data TOTAL: ISSUED BY:
OFFICE