26020 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO ti1Tll,"UsIm—KI,F:UfR_1,AL PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL. 26020.
BUILDING DIVISION BUILDING PROJECTIDENTIFICATION
BUIL.UING ADDgRE�SS: �p_�wn�[ j/s/k SANITARY NO, APPLICATIIOONNr SUBMITTAL DATE
2 W [ l Usi LOT# �
PiloE: CONTRACTQR'S NAME: LIC NO:
tTR�I sw�1L 964- a2sto NIC COhTR01.N
LIC NO: ,PDQy I �u �s ❑
CON'T'ACT: PHONE: [•� BUILDING PERMIT INFO
QTY. IiLEC"BIC PERMIT EEE
,Ill,q', ELECT PLUMB MECII
PCRMRISSUANCE
LICENSED CONTRACTORSD[CLARA'TIONAPPLIANCES-RESIDENTIAL
OaZ Iherthy nffimhlhminm license)undcrpnrvixiom of Chupmr9(commencing witM1
{+1010E-- Seaion]alpl of Divisionlnf the Businns and Pr.faaion.Gude,and mylicense isin PANELS h` ` {►r
<tei. hiucnse Clad cff �l Lic.N -T UPT02W AMP5 1
H=y Date Contractor- 201-1000 AMPS
F-'z RCHITP .'SDECLARATION 9Q. R EA S/SQ.FT.
ZOva— OVER IM AMPS
O Z�❑ 1 and . d my planx shat he c u public rtcmLs. _ �t� .r..
�.Y F m SIGNS ELECTRICAL ^ �` r p p �{� I--)
Liwicse / IIIA U V
tyK< en nu O -D UILDER DECLARATION SPECIAL CIRCUIT/MISC.
KOaU I hereby affirm that 1 um exempt faun the Contractor's License Law for the 1
4134tF,, fnl.w'ingrcasnn.(Section]031.S,BuxincssandPohfeeai.mCd<:Anycitynrcoumy TIiMP.MGTLRORPOLCINST. �?1� . J
DAT
,,I which leslaiies a permm it construct,after,improve,demolish,or repair Nny nanre
uu
,WY2 prim in its ixsaance,roh.acquires Ne.pplicart far uchperam,to.file a migrdaummenx POWER DIiVICES
,=<O thinhe n licensed purs......he pmvm.m of she Carriacou'.License Law Claque,
ddaFe 9(commencing with Scoom7")nfDivision]nfthe Business and Professions Cdel SWIMMING POOL ELECTRIC VALUATION'
W❑y or that be is exa11ph therefrom and the busts for lheadleged exemption.Anyvioletionof UTLEfSSWITCIIIS-FIXTURES �� ^ r�(�
,.Z< -
Section 7031.3 by any applicant for a permit subjects the applicant b a civil penalty of `
5 R C not more than five hundred Jollara(5500).
CL-: ❑ ...le compsaim, NEW RESIDENTIAL ELECTR S .FT.
STORM: TYPE CONSTRUCT]ON
W
m3L willduthcw..k, it thmn.aare is nnlmlendcdoroffvd for sale(See7(94,B as
and Praleseione Cde:The Cnmmemr'a License Law done,not apply m an.wren.(
,,.,my w1m build..,Impmvcs Battens.ad who cars much work himself nr through his OCC GROUP RIES.DNITS
tun employecw,previdd that such improvementsarr not intendedoraffemd insists.IL
h,sevu,the buildingor impravcmcm ix sold within one yeurnrcnmpletier,the come, 'AL:
builder will have the burden of proving that he did not build or improve for purp.se of
❑1l QTY. PLUMBING PERMIT' FEE ROOD ZONE APN
Lct be profit(Sec. ny,am Business
ss and rnmirg s Code)emed c.ntmmmxm
icense the msnot(Stu.elank, ncrafsx ud Professions or imve Carman,.,'r's PERMIT ISSUANCE
License lawdoca not apply to an ownerol property who build.or impmveathere.n,end
License
LaasfmxucM1 pmjectx wixhu<unmacma(s)licenud puuuenu.tbe Contrsmrx ALTER-DRAIN&VENT-WATER(EA)
Li<ena law. PGE SUMMARY
❑ 1 em exempt under See. ,B&P C for this mason BACK FLOW PROTECT'.DEVICE OUTSIDE IBES
SANITARY Y N
Owner Date RECEIP #
DRAINS-FLOOR.ROOF,AREA.GOND.
�• WORKMAN COMPENSATION ofcon DCCIARATION SCHOOL TAX Y N
❑ Iom'Co Compensation
that Insurance
ora ccateef copyther,f(Sscilt to neum,.,Lab C.)ew0f I>IX'1'URIS-PIiR TRAP RECIiIPTM
Wnr4erw'Cnnspenmainn lnnuruna mo¢nified copy0ar.f(Sec.3tl00,Luh CJ which PARK FliIi Y N
mvrr.all empinyeb undcnhis permit/ GAS E.A.- SYSTEM-1 INC.4 OVfLETS RECEIPT N
Palicy N BUILDING DIVISION FEES
Company GAS-E.A.SYSTEM-OVER 4(E-A) PLANCHECK FEB
❑ Ccnind amY ie hereby fumiahnl.
❑ Cenifrd canis old with the city inspection division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICA'I H OF EX17MMON FROM WORKERSGREASETRAP SOILS FEE
C(lMPf4JSAfION INSURANCE
(This section need not becomplard ifthepeont isforoa,hundreddllm(5100) SEWER-SANITARY-STORM FS.2WFT. ENERGY FEE
or Is..)
I certify that in the performance of the work for which,hi,permit is issued,l shall WATER HEATER W/VENjELECIR
11111 employ any person in any m4ah ex to became subject to the Worker' PAID
z Com,ni.ti.n Lowsof Califomis. DateWATER SYSTEM/IREA'HNG Date Receipt of
Applicant
OO NOTICE TO APPLICANT:If,after making this Ceirficrm of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. 'TOTAL:
(--1 y become sabjecto)tJoe Wmlier',Coopensationprnvisiom.f the Lodu Code,ynu mot
fY fonhwitM1 comply with rveM1 provisiom nr this permix.ball be Deemed rcvarked. BUILDING FEE
0. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
p Z hereby affirm that ahem is a construction lending agency for the performance of -
U O the work!ur which this permit is issued(Site309],Civ.C.) T I ELECTRIC FEE emomm,r
Leader"Name
OI^ Lendds Address Q'T'Y. MECHANICAL PERMIT FEE PLUMBING FEE a/
4 U 1 certify hhm 1 have rend this application cadmium that the uhsve information in MECHANICAL FEE �a
corrtch. ]agreemcomply with all city and county ordinates and from lawn relaxing t. PIiRMIT ISSUANCE
Coo) building consmeion.and hembyaummiix acpmunutivea.(this eitymarerupon the CONSTRUCTION TAX
U 2 .boventcnti.nal property for inspection purposes. ALTER OR ADD TO MECH.
.-i (Wc)ugrte n save,indemnify unJ keep M1emJen's hhe City of Cupenin.uguinwl _
Iiabilitiex.jud8n el,cost and expenses which may in any way accrue againntsaid City A IR HANDLING UNIT IT 010,000 CPM)
m grentin fthiapermit.
4a / G
/r0 AIR HANDLING ON]T(OVER 10,00[0 CFM)
S' nw of AlTdi nh/L rector Date EXHAUST HOOD(W/DUCD
PAID
RDOUS MATERIAIS DISCLOSURE HEATING UNIT(TO 100000 BTU) Dam Receipt N
Will xhe applicant e,future building rccapant store to handle havNous material I IGTING UNIT(OVER 100.000 B'1 U) 'TOTAL:
am defined by the Cupertino Municipal Code.Chapter 9.12,and Ibe Health and Safety
Cdc,Section 23332(a)?
0Yes 13 No NTVEILATION FAN(SINGLE RESID)
Will the uppl'mwt.rlmum building occupant use equipment nrdevices which emit
BOILER-COMP(JHP OR 100.000 B'TU) ISSUANCE DATE
hmmd.us air conte minmem um defined by the Bay Arca Air Quality Mrnagcmcnt BOILER-COMP(OVER IW,000 BTU)
District? Y" P A r
❑Y ❑Not NEWRESIDENTIAL MCCII. SQ.PE D
1 have red the humdouto materials requirements under Chapter 6.95 of the )AIV 18
California Health&Safety Came,Sain
Sometimes 25305,25533 ad 25534. I understand mat 1994
if the building Jces not cwnenty have a tenant,that it is my uxrysnaibility to notify the
cupaln of Nc rc,morra nd which toast he ran prior It,issuance of u Ccnificme of Cl �/
Occupancy. Y V1'�/rlCIJ/'J
Owner or author<J agcm Date T ISSSS UED 9Y:
OFFICE