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25660 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECIrWICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 2 5 6 6 0 BUILDING PROJECT'IDENTIFICATION UILD�G(DDR�: UN1iT SANITARY NO. APPIACATION SUBMDTAL DATE LOTH I /1IIIRI�I �{dCOA 'S N LIC NO: ` U.JT—W Ugm4U4 NIC COM'NOLN RCHH71ECT/FNGINEER: LIC NO: ADDRESS ❑ CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO BLDO ELECT PLUMB MECH PERMIT ISSUANCE / ❑ li4 ❑ ❑ LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL mwz Ilrrchy off that l am licemcd udaprasvimuofCYupc9(cmmcocing with JOB DESCRIPTION 4100 Section 1000).(Divisim3 ofde Bwinas ab Prufesti«u Cad,and my license u in PANELS ywfull force adeRem. arnm LIa--Z LiClue Lic.Y UP TO2W AMT'S Ir�J7Y�_7/'A-T rxs a6 H Data Cantrecta 201-1000 AMPS F-y> ARCHITECTS DECLARATION SQ,FT.FLOOR AREA S/SQ.PT. 70rn— Iwdc«and mY plaru shell beuscdupublic rtconla. OVER l000AMP5 Fy(_41 SIGNS ELECTRICAL a yKj Licrn 1 Rofessiaul Kaa41U OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. x0' 1 hereby allirm iMm 1 stn excmM fmm the Cmtrvetar's Lkcnse Lew firOne fit 4134-rFn following reason.EkOion]OJI5,Business anal Professlom Code:Any cityacounty TEMP.METER OR POLE,INST. which tequ'ue a permit to c,mv ,Win.Impove,dmnlith,an cl it aoyswctwe prim to i4 isauwuz,also mryves tbeii'limnt for such pemdt to filcaugrd nntnrcnt POWER DEVICES a0 that k is lice w pursuwno the provisions of the Cmtmcror'a License law(Chepta SWIMMING POOL ELECIItIC 66��' 9(commercing with Sectim]000)of Dividm JoftheBwinesx and Prvfwimu Cale) VALUATION soh a Oat be u caemlx therefrom vol Oc basis fa the alkgcd cscmgim.Any violation of $inion]031.5 by anyapplicant for a permit n.bjt.the cep Aicmitul civil pointy of OUTI_US-SWITCHES-FIXNRFS n«more Own five hardier]dJlvn(SSWJ. NEW RESIDI3J'11AL ELECIR SQ.FT. ❑ I,wnwneroflheprapenY.«myemWoYm withwagnwthe'vsole RIES TYPE CONSTRUCTION 3� will do thew .ard the tRacNrt is trot inreMN martv i f«uk(Sac.7faM.Bootlev sort Profevims Code:The Cartwnals Lit.law,l rot stiffly to an owner of Poor y wlhohaiMs«impavrs Oorcon,and whndoeiiii work himself crOraugh his son empbym,providcd that such impmvcmrnutirt ma iNeMcdaoRcrtd fmmlc.If. GROUP RIS.UNITS bane r,the Wildingo-impwaantusold within acyw ofconrplaiomtkowm- Wildmwill lave the budcn of lowing Nat he did trot build a improve f«purpose of sole.). ❑ Luce o,,eh(See. ny.amexclusiv and Prnactingwlthal Th Concraats to (p'Y. PLUMBING PERMIT FEE OOD APN Lnc t the project(Sec.71lowo Budof and Tsofr ild Coal vc Th 4 ,cels whocorl2wdmnell rojc with atfafpfnpary roto Wildor,oa va thmromard PERMIT ISSUANCE who Lawr«.vuch prnjav with avantrenm(e)Iian iwtauenlmtheconusctNa IJccx taw. ALTER-DRAIN h VENT-WATER(EA) FEE SUMMARY ❑ 1 am exmqu uMm Sec. ,B A P C for Nu reavon OUTS,IDE FEES BACK FLOW PROTECT.DEVICE SANITARY Y N Owam Date RECINP1'N DRAINS-FLOOR ROOF.AREA.GOND. WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N ❑ eh'C df iohI ve or aecac ofc oUihoulf�imure,«•ob C.)tech EXTURFS PERIRA, RECY:IPfY Wakai C«nprnmtim lruwvcc«acmificdmpythcrtof(Sx 380(1,Wb C.)which PARK FEE Y N m oll etnpleec's under olds lis RECEIPI'N Y Pe^" GAS-EA.SYSTEM-I INC.i OUTLETS Pdky N BUILDING DIVISION EELS COr"W"y GAS-EA.SYSTEM-OVER 4(EA) PLANCHFI FRC ❑ CcOifiedavpyiahembyfomlahed. ❑ Ccr rlf cwyuflNwi$r ccityinspcctimdivixim, GREASIWNDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF FXFJdPUON FROM WORKERS' GRP.ASF.TRAP SOBS FFA? COMPENSATION INSURANCE (TJusxectionne not WcemplchJ ifihe permit is formehwdred dollars(gl W7 SERVER-SANITARY-STORM EA.2(303F1'. ENERGY FEE a leu) I cmifythat N the pvfattwceoftle work fawhich this p n is lvued,la hall WATER HEATER W/VEN`GVLCIR not ..ploy tiny Paaon in any ow as to Wcette subject to the Womkm' PAID z CanpcmNinn Wws of Cilifomia. Date so WAWA SYSTEM)TRE.ATING Date Ra ,a# Applicun 00 NOTICE TO APPLICANT:If.Nm resting 0.Cmificate aEaemptim.ym should NEW RESIDENTIAL PLMB. SQ,FT. TOTAL' I-- y became subject to the WorkersConn,nrtim pruviaims oft he labor Code,yes nowt C4 > fonbwith comply with such pr.Ga.o-thu permit shill he ii revekcd. BUILDING FEE G (] CONSTRUCTION LENDING AGENCY SIISMIC FEE UI trebyaffirm that Ilwse i,et ot,iruction leading agency f«the fs fomuNc of O the work(ar which this pnmit is issual(Sa.9091,Civ,C.) TOTAL: ELECTRIC FEE O 5 Tndefs N. PLUMBING FEE le"dcls Address QTY. MECHANICAL PER MIT FEE I certify that 1 have rod this applicalim and some Them Oc above informatim is mrecu I MECHANICAL FEE agramwmply with all city and caunry ordiramv and some laws relating to PERMIT ISSUANCE, f— C/� Wilding conwaction.md hncby audwriae teprvrnotiva of Otis city tomta upon the U Z above arndoonal prymty fo-iorl,elianpor,oal ALTER OR ADD TO MECI I. CONSTRUCTION TAX (We)agne to rave,indemnify aral keep haorO,as the City of Cupenim against liOiIOa,jtalyrcms.cw aspcmu which fay many way eaw ageiw said City AIR HANDLING UNIT(TO 1),000 CPM) N (Toemeoft eNingofthiapmnit. 6 � 12— 1 AIR HANDLING UNIT(OVER 10.000 CFM) cof A'Ii Coon. Dare EXHAUST HOOD(W/DUCD PAID HA9ARDOUS MATERIALS DISCLOSURE HEAnNGUNIT(TOIKt WBTU) Dere Rccei,# Will Oe r the suntor MuWdolingoccupantninear handlehamN«umatrnd r 1 the - u Jefby Cuni perto Ftuticipal Cade,Clupmcr 9.12,aril rhe Ilcdth and Safety HEATING UNIT(OVER IW,000 BTU) TOTAL: Cak,Sema"25532(a)] E)Yea No VENTI ATION FAN(SINGLE RESID) ❑ W01 Oreappticant or furore Wildineocctµrw toecgwpmmt«dcvimwhichmtit BOILER-COMP DHP OR IW,OW BTU) ISSUANCE DATE haaardora ah cmtandwnu as defined by Oe Bay Area Air Quality Maruge t DisOict'l BOILER-COMP(OVERIW,OW BTU) PAID GA ' ❑Yes ❑No NEW RESIDENTIAL MECIL SQ,PT. 1 have rad the Incfelt'Coos rwmerlrs 505.25ena rt 25 C. 1 ur 6.95 M Ore OCT 2 Glif have eonac&Safely C«k.Sections 25505.2 533 sod 23534. I Chapter 6.95 ul Nat if Oe W i",dues ml c.orly have a taunt,that if ;my retponaOility to notify the occu(mN Of the rtyUITIC114 which nom be met Polo-b iuuanee of a Certifies¢of n, , 1 NU Occop . Owrcrm auNodacJ agent Date TOTAL ISSUED BY: OFFICE