25145 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
Cll'Y OF CUPERTINO �D' - A, PERMIT No
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 25145
BUILDING PROJECT IDt1N-1'IF'ICAIION
BUILDINGIT/L3. I{,QQ�_ I /y1 QCT SANITARY NO. AfTIJCATgNSUB/M7fITAL DATE
UNIT# LOTH
OWril i NAME PHONE: CONTRACTOR'S NAME LIC NO: IIIYYY l
fv NAC CONTROL#
CHI'ITG/PNOINHEIU LIC NO: AD 3SZ F� 3 OS
CONTACT: PHONE
�µ1 F1Lo 1L1y/1L(5�{1,F� 1I QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
te— AP--E) l{�YF1Iw�'h' � o PERMITISSUANCE 'pl PX 111���"'��_M1�
LICENSED CON RACTOR'S DECLARATION APPLIANM RESIDENTIAL
FI ///��
per/ Ihcleby affirmthan l am aicemeduMer pmvia cm.17Cbaper9(commel with JOB DESCRIPTION
{+100 Scclion7")mffthvlsion 3aflMuai
Breu said Professions Code,sad my a toms u in PA
Err W— full! rad eR l/ ay� /�
1' m cI )3 L ue.is `/w�l 06 ,L Pro oo AMPs
e Com rs 301-1000 AMPS
F-0 ARCHITECTS DECLARATIONOVER 1000AWS ` SQ.FT.FLOOR AREA $/SQ.FT.
ZOm—cl .— Iwdrnlondmy piturt,shnllhused mPublic records. 2 q Roo
QNf-j IiemsM Pmfmi«W SIGNS ELECTRICAL "J I I Rrn73
xK�d'Q OWNER.BUILDER DECLARATION SPECIALCIRCUR/MISC. r
I am exempt
ul�LO rFir w flat the
fdluwing brat ISecuce lanl]0113,Bmulmsf uld Pmfunessiaru Codeuraccams :Am,cicense ty err coal TEMP.METER OR POLE ISM
y j which rcyuilen i pCnnit to c«uwn,alit,.improve,demolish,or re sur wy small
primPOWER DevIDEVICESvv1D
mits iauan¢.elw aaldle flux rm.acn pemlilbfleeai�ea.reamiem
IMa be u r"am"s pmwna m Jae povisimu of the Cmvrrals Iicaue I�w lCnsplc SWIMA9NG POOL ELECIIUC
1X05 9(cmmtetwing w'nhSmian TfY10)af Divnion3 of the Blu'ina's vnd Pm[evans Code) VALUATION
W Awa mWlM1c is ucmptneaefman and Ills baaiaf«dle elkged uearlpllon.Any vloHaion of
CZQ SmianTOJlSbysnysppliunlfa($500)srvbjecuaneygllantm•rivilperoltyof DVILER-SWITGHFS-FLCNRFS 3D7 9 17 , 6
Tp ml m.eowfofM1 pMjp y,l mymp NEW RESR)ENTIAL ELEC(R _SQ.PT.
E� ❑ I.wawnnuflnepropeny,«myempbym with waec.as lharwkc«I�penavion, RIES TYPE CONSTRUCTION
d3 wall Bothe soles.
m.CdBe avunure iaalainlI.i.LHertdf«mle(Sy TOM.oBusuiressa
l4
sad im,wishma Code:The Gmusm/e ad!woe law drcn moa appy to en owns of
pofedy wbo nailw«impovo Jelem,ams was ams,even wart mmseB«J,mngn w
however,
owauchimpovmelluue os,ieaatleimdfaM f«ownIf.s. OCC.GROUP FS.UNITS
however,Ik buil ding«cenoof mmlisuddwithin oreuld or ifir lelion.Incrose of
buider will neve Ins burden of pmvmg tnnl he did rd Wild«'ulyrrave f«plrpwe of
❑ Lm JbcpmrJ�e Sec.7y,4, utaine is and rof.d withlic:)Tbe uemonm QTY' PLy1MBING PERMIT FEE �1.00D'LONE AM
romlruct J1e project(Sec.]D14,Buainev rad Pmfealons Code:)The Conhecaa'> n'
Llama Uwdoes msappYloawith Rc mmic nY whobuiWaorunpoi Comisu,road 1'FltMITISSU II o V
r N ,!!—
who mnlnNr«such ln�jmswith amnlrecw(Olicrnwlpunuanit 100r Cmusmur't -
Lirmac Lew. ALTER-DRA N A r3scr-WATER(EA) I FEE SUMMARY
❑ I am eaemq under Sec. .B,II P C f«than mason
BACK FLOW ROT .DEVICE OUTSiDEMES
SANITAR Y N
Amer WORKMAN COMPENSATION DECLARATION DRAINS-FL �S
R.ROOOAfOND. AX YECLIPF# N
1 ht,cby shim I have a ecnifine of ccmacnl In self-iluwe,or e cu0fwtc of _ CHQ(11 RECI;II'1'N
PARK FEE
!JU�-<Jfit
FlK'1'URFS-P YNGAS-G.SYSTEM-1INC.4 OI TL= RECEIPT#
BUILDING DIVISION F31PSGAS-FA.SYSTEMOVER4 HIM PLANCHECK FIJE copy is hereby fumuhed.
Pit Caaifid rnpy is fled with Nc city imgactim division. GRFASE/1NDU,STRI,WASIHINTERCEPTOR GRADING FET:
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS LEE
COMPENSATION INSURANCE,
INSURANS-a
MP
(I'll section need a.#be completed ifde permit is f«ase hwdcN dolWs I$Did) SEWER-SANITARY-STORM EA 300FT. ENERGY
ce,lm)
I certify than u Jac pi m.e of the work for which thla pimp is issued.I shall WATER HEATER WNENT/FIECIR �
11m emoy may rectum N any ral to m to become aobject m de �lWorkers' PAID 3
O Z Cmtmmwmst Lawaaf Cslifarom Dace WATER SYSTE,1,TlU TNG Dale Receipt
Z NOTICE TO APPLICANT:If.after mating Ws Ceafieseof Esemplloa,you tM1wld NEW RESIDENTIAL PCMB. SQ.FT. TOL:
af/] be«ae ry ump to the Wuch Campm®dw parmail a of the labor Code,you Imu
; fvMwilhemnpy with such puvivmam thin permit shJl bcdmrcdacvotcd BUILDING FEE /
A CONSTRUCTION LENDINO AGENCY SEISMIC FFE C c+,U.
IMaMy grim thac there is.coeametin ledlagagcncy f«Brcptafmm sof
I V C) the wort f«whkth than pemdl V issued(See.3)97.Civ.C.) T ELECTRIC FEE 6
I Leodvl N.
O L Imdels Adtataa QTY. MECHANICAL PERMIT FEF, MUMBINCt
U I eerJfy duo 1 laeve read this applicaaiui aid acace thac the above imf«mal i.
LIJ cm¢L PERMIT ISSUANCE MECHAN A E
(— a' buieinl,com ucaion,ud he byeudwrite lepesenuuveofthia city tornterupm the
I U h CONS ICTION TA
U z uhovelre)iii to co'. («impativn Purposes. ALTER OR ADD TO MBCH.
(W<)epee m save,iadcnvdfy aid keep the City ofe n&n am agaims
Iiabiliaica,jWgmrntr,mrit aadeaphis which neny way+arae egainal uid City AIR HANDLING UNIT(ID I(1.0f10 CIT1)
rnnacyuemc of the granting
his ^ SIR HANDLING UNIT(OVER I0,000 CFM)
St"mno rpi.hUmaecl VW DoR E01AUSTHOOD(WNUCT)
PAID
HAZARDOUS MATIAIS DISCLOSURE HEATING UNIT(TO 10(1,000 BTU) Dace RceeipN
FR
Will the npplicenl orNome huildimg«cupaml spore«handle hmvdmus mummull HEATING UNIT(OVER 100.000 BTU) TOT
m dcfeed by theCupmino Municipal Code,Cluper 9.13,surd tae Health rad Sefery
Nc
Cf
Code,Section 255J3(a)T
11 Yet ' El No VENTILATION FAN(SINGLE RISIDI
IISSUAN
gg�� p ,DATE
Will Je epplicem«lmmc building«cupenl uscrywpatmlmdevieeawhichcmil BOILER-COW(3HP OR 1(01,000 BTU) 1— M I D
svrtT vartluus av comanamm.ea defined by the Bay Area Ao Quality Manupmrnt
BOILER-COW(OVER 100,0tp BTU)
❑Yea ❑No NEW RESIDENTIAL MECH. SQ,PT. 21993
I neve read Ne M1uudous maauiela rcgaitalenu matterChapter 6.95 a(Oe AUG�'I (�
CWifomis Health ASafely Code,Sectiau 25505,25577 sad 35534, ImdandnlnNal CITY Uh CUFttiluv
if the bui Wing Baler II«cumewy M1ave ucun4 that it u my respnuibility wscnci Ins
acupult of Je reyuvemenu which nuan be met pi«to ivunnae of a Cmifoae of
Ower orawhmrfossgrns Daae TT ISSUED HY\lt\��