25598 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOLDING--ELLUrRICAL PERMITNO.
BUILDING,.DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 25598
BUILDING PROJECT IDENTIFICATION
B LNG ADDRESS: SANITARY NO. APPI.ICATIONSUBMITTALDAM
LQ,'»
O FRS NAMIi: � O 'Cl0 NAME EJC NO: NtC CONTROL♦
SS /
ARCF ILCT EIN [i eLIPIIONEGCNO: ADDRESS:
1'&/AJ470 AI -N93 ❑
CONTACT: PHONE
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
L ELECT PLUMB MECH
PERMITISSUANCH ❑ ❑ ❑
LICENSED CONTRACTOR'S DL'CIARATION APPLIANCES-RESIDENTIAL
pnZ I hcrcby affirm that l am licenserl urJ Voviv'ions ofClarnal(cmunerring wish 1 IPII N
00 Sauon]000)nf Uv'uimJaf thefludrcv end Prafeviov Code.enl mY lwxrt¢iain PANS
Vfull fora sM eRaL
6Z Urensc Cuai Lic.N UP TO 200 AMPS
♦rr 6 aDun, Connector2(t1-IM AMPS
20yZ ARCHITECTLA
S DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA VSQ.FG,.
p/— l undemand my Plan:shell lx ascd as Public rtcads.
FSIGNS FCIIU L /
LicrnN PeofmicrW
d'Q OWNER-BUILDER DECLARATION SPECIAL Cl
4XX'Oacp. 1 hereby,aHbm this,1 son exempt Ivo Be,Contmcte/s Lictrut Lew for the /
W 3 to fo icomirtp reaaoa.(Section 7031.5,Business ud Pmfmiou Code:My my a county OR POLE IN
C�'�� which trywas a Paenit m cansimw,alter,improve,JnnrlisM1,or repab eny mm�urt /
fi< pee,bm,its isesoodi ursorequuestheeppliant(a,Cdn n01F'leaxigecdatattmentrEVIC�-
S—Op INTI ht is li
evueA puewmtto Ne povisimn of theCmmnaLireuc lawlCTtaWeL �' 9(amrttcncing with Serino](pU)ofDivisionJof the Business and Rofesions Calc) G IC/ VALUATIO
to or dwthci.exciii.t cmfmmwdt�ebesisfortlrtelLgNexemp4im.Myvio =of -SW I FDLT)ftFS
CZQ Smion703lS by enyapplierttfeespermit subjala tlz aPplkvu to•civil perWty.f
m mare than flue lb d dollar($50(1).
Sa�O ❑ I,uowturnlde PmP ,oemytmployetwlNwaguuWirsokcanlensauem. NEW RFSIDETTIAI,ELECEN SQ.tT. STORIES TYPECONSTRUCTION
y3� wi0 doth.worn.,Code he CoueiartninRstlMoroaw does We(See.0 aa,Bwinexs
nrk Pmfevionn Code The Contevwm's Llanse I..w dm_a not apply to an vwec of
prupeny whnbuildaa imtrove thetmt,urn who Joessorh watl0etuelfa Wwghhf. /
Pu,e,,J,e.a Pmvior tlw sucM1impmveneeuve rwt,or.fdv,lelio ,foe We.lf. OCC.O UP RES.UNITS
however it Ihavl tinyrcien of roavingsur he aninoneyea or in,rt .for theawner- / TOTAL.
huildcr will have 0a burden o(Pmving tMe he NJ not build w Improve for purpae of
k.).
❑ I,nowrcrof,hc latrlcty,sm exclusively conRtwtietg wltM1fan.sM mntmetm to QN'Y PLUMBING PERMIT FEE ROOD . NB APN
umwvr the pmjecl(.Re.7(aW.Husinev ern Profeisints Code:)'Ov Croundoor'a
Licerue lawdas ml4TlYw miownvofpvpmy wiwddlNrcimfvoves tlrrmLWPERMR ISSUANCE
w1hocron .feewch Project:witheconwnm(xl lkmsM punusnt to that CmUeclNs
Llaee law. ALTER-DRAIN&VENT-WAFER(IIA) FEE SUMMARY
❑ I w exempt wtle Sec. ,B A P C fI E
BACK ROW PROTECT.DEVICE SANITARY V N
DRAINS-FLOOR.ROOF.ARG,COND. REMPf N
WORKMAN COMPENSATION TION SCHOOLTAX Y N
ElChs byaffmmtM1mlbaveacenlf tm.clf-inawe,maanifcue of RE.CTEIIT#
EUCDIRES-PER TRAP
Woegeri CenPtnwionl earufiedcopy therm((Sa.JN00.Isb C.)wN<h PARK FEE Y N
vm Vl awtler Wa p.smiL GAS-EA.SYS1h M-IINCSOl11LEIS RECFJPPN
Pdlry N BUILDING DIVISION ITES
Cumpany GAS-G.SYSTE OVER 4(FA) PLANCIECK FTE
❑ Cenifudropy sherebyfumisM1N. l
❑ CrnifMttgy flW with thcciryinaPccum 'alai GRFASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CFR ICATEOF OM WORKERS' //a�� RGSETRAP SOILS FEF:
COMPEN. NSURANCE '/7 ' ' N/I
('Ihi.ssection not bee ,hie permit ufororteN I. 1 ) S ER-SANITARY-STORM EA.SOFT. ENERGY FEE
or les.) J
Icrnify thu in 0sc rftumueeo a oA furor ' this permit is ivuM.l WATER HEALER WNFM/FJ,ECfR
not employ sny Perso in eny man m v t oene .abject m the W PAID
z Cenps,.ion Laws of if.. Dere WATER SYSIIEM RGTING 0.,e Reailn N
Alalic m
C) Q NOTICE 10 APPLICA :I'."making this Crnirime of Ex ,yw should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
(/) bta,m ,ubjm a IleW cr•Cenpmation ProvuioeLLofth. Cade,youmuu
x >
laMwlth comply with we isimu orchis pemut shall b, te'.1sm. BUILDING FEE --N
0. CON UCTION LENDING CY SEISMIC TTP 1
U O 1lertby ef(chs,therei rarsuuction1 '.'eeryforreperformanaof
thu work fur whwt this trout is i (Sec. civ.C.) TOTAL: ELECTRIC FEE
V. Ix s None PLUMBING FEE
O Istsdv's Andras QTY. MECHANICAL PERMIT FEE
r W crn�c'nity to I have read this application e,c slate Ines the above nws mMng is MECHANICAL ITE
egrtetoc ,wdhmby city udrounry wOvi rsattduar.Hwsrtlatingtn PfRMff ISSUANCE
F-' y M1uildingrnnatrunion,endhmby authaire represcnu0ve of Nis cry to rntcr upon this CONMUCItONTAX
U uhw(We)ionalpopenyfaeinfection keepmcs. ALTTR ORADD TOMECH.
(We)agreeto ruousts and x,,efy sed kapharmlm the Cry of Cupmirw dCity
u,,ilitie.jnceorus.emtsendexprux ilchmayinaty wey.eemeagutm WdCry AIR HANDLING UNIT(T010.0()0 CFM)
nseyuena n[ egmnting [,his permit.
AIR HANDLING UNIT(OVER 10.000 CFM)
I
gewtutcof Appl' on r adnVCDat. EXHAUST HOOD(W/DUCf)
PAID
PRIS
HAZARDOUS MATIADISCLOSURE HEATING UNIT ITO 100,000 BTUI Due Racipt#
Will theepplicattt a Ia,.buildingoc.w,wren,handle hvardoy.mae,ord HEATING UNIT(OVER 100,003 BTU) T
def nen by tk Cuperana Muaidpal Code,Chaps 9.12.auw!the Hmlth rind Safety
ode,Section 255]2(.)7
❑Yes ❑No VfMIGTION PAN[SINGLE RISID)
BOILER-COMP(3HP OR 100,000 BN) ISSUANCE DATE
Will de gglicmitsrfwum building by not,Egsbtuy equipment oedevy Mdnaehemit P A I D
hvudnus air ormwmiewnLL u dented by 0te Bay Area Air Quality Manegcmrnt BOILER-COMP(OVER 100,(100 BTU) IY
imict7
❑Yes 13No NEW RESIDFMIAL'MECH. SQ.Cry'. SEP °O X93
I have recd the banMan etvrosm,rtgtdrtmmLL wick Chapter 695 of the SEP
California II WN A Sa(ery Code.,Sections,25505,i 533 and 25534. 1 wdvnvd thu
if the building dies not cumenlly M1eve etawn(0ut i,is my tegtonsibility to notify the CIIY Ur ( Ur Ghl Iv_
oocttpant of that rtquimnmu wticM1 must be road prior b issuance of•CertifKN.of
Owner or euthoriml agent Due TOTAL: ISSUED BY:
OFFICE