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27949 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO UIEI`JNU-p`FCTRICA' 1'ENMITND. 27949 APPLICATION/PERMIT PLUMBING-MECHANICAL RUII,UING DIVISION BUILDING PROJECT IDENTIFlCATION BUILDING ADDR2SS: SANITARY NO. APYIJCATIONSUBMfITALDATE sf UNIT LOT# OWNP 5 NAME: PIR CONTRACTOR'S NA WC NO: 7 {� O A l ' 04, u NIC CONTROL N •AR I /F INI:I?R LIC NO: Y AD FSS / : ❑ cGNTncr:{O C AOA.GO I'tIONe QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO BLDGFl ECT PLUM F1ECH PERMIT ISSUANCE El ❑ LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RFSIDEM'IAL upW1wZ Ibtchyaffirm dw l un llcassal wdctpwrviomMpuga 9(cmmaaingwnb JOB DESCRIPTION u~OU Sc,doo70m)of efDl,eminn 3 or the Bwir...ad Pmf.ona Cade,ad any lin/rue ism PANELS w 1F<..Zw Licma CJpes d .ZO Lic.1 L� UP TO 300 AMPS tn?y Dem Cmtrrr-��_S�� Ejey 301-1000 AF1PS GO,z ARCHHECTS DECIARA (ON OVER i"AMPS SQ.FI'. RAREA "Q,FT. p Y"O 1 undcrsnnJ my)Jws aM1WI Ne uvcd m pulaic F� W SIGNS ELECfRIGV, 6 Lkemd Pmfevfmal Kw yrw< OWNER-BUILDERaa IteC ATION gPECIAL CDtCUR/tASC. 1 rt,. '.firm than 1 em e.emq Tran Nc Coward.Licata IAw fa be r+J3t'-vi following.cn.ur.r( i1.coa1.S,Businrxswd Pwf¢slmn Code:Any ciryacaunry TFI./P.FfE1FR OR POlE INST. whichn a.I mapermit manstt alta,im for Jem iter­,au eirmymrvcmrt �t.,r.u<0 pelma iuls.uuee,droaquim th ituctntf tieuchaa sBkaeLa smtemmt POWER DEVICES j w p then he u ncen,w th Se,o to tk)oviuom of Ute too Boo ads License Law(Ch" code) SWPvI IING POOL ELE 4dXo� othat eia withSenim]aralthf Divi.ion the theBminma staad.Any aau Code) VALUATION uJ:w or that he is cxcmMihaeftant ernd the bu..i.for the olkgd exwgion.Any vlalation of OUTLETS-SW tz,¢ Sarion7031.5 by miy.,11e1 torepermitwbjauthe y+p4".t ,.eMIpenah,.f �. rwr nta.e Nen fire burdrd"I.(SS00). �O'�� dF� ❑ Le.awncrnflhc NEW RESIDFMIAI. pml.tua.rmyemployemw.ff eJ faetae,(u .mmpvmtioo, STORIES TYPE CONSTRUCTION a3� al do Nc,ion,mdthe ena.aloto-tt�'.0�aema.do,fa .,Iy.,.. .of end Pwfeasiun.cmc:Tne Conincim'.I.icrna law aces rwt apply to m owner of IstopmY wMbuild.a'vntgnrm Ihcrtm,mid whodmsuch wtrck himsclra Nmughhis ownesnploy�povidcd thusuchlingovemetu.uenmimeatdcdaoffcad fasWe, If. OCC.GROUP RES.UNITS h,nldkT ,rhe building or de.of,.tram is rod within ate ymr ofcmttpl,e fbr the owncr- huildawill nave the burhn of graving Net he did tta bw10 a hnPm'rt fa puryox of IA � ❑ I,uawnao(Nc Txnle'+tY,mnc.aclmivclyconvatingwirh liccnud contrena.m QTY' PLUMBING PERMIT FEE ElOOD ZONE ppN comtrvct Ne feoj t(Sec I0m4,Bminea toad Profo.iau Code:)The Cm ,, -t-- IJLawJannorepply tntnowmrofpapaty wlw bulld.aimgova NveaF adL, PERMIT ISSUANCE wacta forALTER WATER(EA)suchfrmlauwirM1ernnwcror(s)Iittnad PunuenOo Dr Conuards Li.L�w. FEE SUMMARY ❑ I sten e.anq ranch Sa. ,B&P C fa Ni..raum BACK FLOW PROTECT.DEVICE OUTSIDE SANITARY YN Owner Dam RECEIPT. WORKMANCOMPENSATIONDECLARATION DRAINS-FLOOR ROOF,AREACCOND. SCHOOL TAX T N e ❑ Ihaehy affirm dwlheveecmifeme of mnmtm:If-insert,oreanifcue of S-PER TRAP REC [n# waren'C FlXTllRF anpatvumtlmureatcsmeccnifid copy Naarf(Ser.JBlp,lab CJ which PARK FEE Y N coven all emplGAS LA gcNNy/ndv�lry b�'� RECEIPT# Itch,N /(/M ( 7,� - .SYSTEM-I INC.60UILLTS BUILDING DIVISION FEES Cmnpwy �w w .n d GAS-EA.SYSTEM-0VER G(EA) PL ANCHECK FEE ❑ Certified mPY it hereby fumi.hd. ❑ Cenifed copy i.file with etc ciry ieeparlw division. GREASWINDU.STRI.WASTE INTERCEPTOR GRADING FEE CFRTIFlCATB OIt EXEMPTION FROM WORKERS' GRFASETRAP SOILSFr-),B COMPENSATION INSURANCE obis section need not be complete iftbe p it ie fm one hundred!dollas(SIM) SEWER-SANITARY-STORM EA.JMFT. ENERGY FEE wk ) lcenifythetintheperromuaeofthewakfmwhichthupm tise.ad,I.lu11 WATER HEATER WNENT/ELECTR ton employ any p in any menar w as to beanie.abject w the Wa.k<n' PAID Compcwrlm Lows of Glifomie. Due WATER SYSTEM/URFATTNG O z Applkmu Duc a<igM APPLICANT:If,erur oa1ing N Cerofiwe of Excmpin ,ynr thoold NEW RESIDEM'IAL PLMB. SQ.FT. V) laane subjar to rhe W.AeY.Canpenurim povisioru of the labor Code,You 0 NOTICE TO APvuau TOTAL a > forthwith campy with tach pmrisiaumthis PmNtsball be dmad make, BUILDUNGF y CONSTRUCTION UENDING AGENCY SEISMIC Z) z I ten,by tff dad,dtece is•caeutezi.lading egcmy for rhe pMarru e M l, lf�L,7eTArELECTRI U O Ne wak ra wni.n this permit le l•"_ (s«.JovJ.cit.c.) Le do's Nanta Qlit Addtas QTY. MECHANICAL PERMIT FEE PLUMBING FF:E U I cerafy that 1 have reed Nis ts,licuioa and Awe tJua the above infmmetial is �" F17 caoar..'gree to wrrylywiNdlciryW rowry adlestr<.and�elawertwing to PERMIT ISSUANCE MELT IANICAL E (•- DO building etmetrecrion,end ltnehy euthorite tete«taod ofdda city mmw upun Ne U z above mcnfimcd gapen ty for inspection putryar.. ALTER OR ADD TO MECH. CONSIRUCfI TAX (We)agog to.evc-iMmaJfy ed keep hannlns the Cl,a Cupcnlno egmano t/ Ii.MnYm,judgaaw,rose stand e.pmum which tray in any wry acNCagstinq.aId City AIR HANDLING UND'(TO 10,1100 CIM)/ /s L mna4aae of be iranting of this p ir. 1j yy AIIt HANDLING UNIT(OVER 10,000 CFM) _ v+r Si meof Applieant/Cm is , Date EXI IAUST HOOD(W/DUCT) PAID I IAZARWUS MATERIALS DISCLOSURE IIEATWG UNIT(TO IMI1o0 BTU) Dote Re,ci,I Will Ne tt,h-nr a fame building..,.nr.a hnMle,6ermdoue muainl IIEAT'1NG UNIT(OVER I W,11W BTU) L m dcfind by the CuPcnirm Muniripel Cee,Chato 9.12 and the I lealih arta Sarny Cade,Soli 2SS13(e)] 11Y. ❑No VENTILATION FAN(SINGLE RESID) ❑ Will rhe apgicantorPomrehuilJingaxupem uaequipnenra0evke.wnichaoir BOILER-COME dHP OR IWMO BTU) ISSUA A E hav o air cannminenu m defined by the Bey At.Air Quality Mmmgrnunr BOILER-COMP(OVER Io0.0o0BTC) 10 Dishier? ❑Ya ❑No NEW RISIDEbMAL MECH. SQ.FT. I have.sad S hverNw Sections teyuire 533 under.XL I a 6.95 of on 4�1 if do, niallcdrh&Safety CNc.Scctions33a00.2953Jand ,,onmu ImndasaoM don 1996 itNebuiloft Jonan,anm t,lb vnerut,rae, it ismyns .oil.Ceir notify the r (fir recuPstnt of the mquirttaou whdh rtwst be met Irian ro ivtumx of•Cmificate of LL OcIN��ma,d.gt Date ISSUED BY: