24981 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
PERMIT NO 24981
CITY OF CUPERTINO APPLICATION/PERMIT PLUMUDAIIIIIA BING UMBN'I:-MF.CiMIC I
NUII,DING DIVISION BUILDING PR0JF.CT ID6\'I'IFlCAT1ON
❑UILDING ADU/H�P�S1S: R // o //� SANITARY NO. APPLICATION SUBMITTAL DATE
UNITY LOT# 4IC13
OWNERS NAME_ PHONE: CONTRACTOR'S NAME
F 4- � L on Q7l760 M'N&_ SG�G(�L CCY �N NIC CONTROLI
iM1 ARCEIL'IT:CpFNONEER: LIC NO: ADDRESS: ❑
l 1X12_2_ ems?o G tw e S. IoJ
1„ CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG EEE.
PILIWB MECH
PFRF1iT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES,RESIDENTIAL
by sffrm than l em l iarucd udcrproCn
vismmsofriptu9 eomramcm,,with ./�tY y1 BD I P
I:IOtr�C) Der
F. Section]000)of Division 3 of the Busircss.nd Professlan Code.utd my Brix min PANES
F�uU full force said cffm. IIP TW02AMPS
Da
FaF y ly D. Lonox 301-HkO AMPS /
Nay
Zpy Z ARCHITECTS DECLARATION 5f1 I-T'F100R S/SQ.IT.
OZF® IuadmtW my,].tlWl be useda
v WMic aordsh. 0VBR 1000 AA¢$ r ^
SIGNS ELECTRICAL
<'r 5 Licrnscd Rrfcuiaul
OWNER-BUILDER DECLARATION SPECIAL CDRCUfI'/MISC I` Igo R
XdXOsFU I hereby dfirn Int I un exempt fin the Codamtea rs liccnx law for the • f
W 3 w rQn fallowing reason.(.Sccdat 70313,Burm..1 Pfofnnoru Code:My city or axon, TEMP.METER OR POLE MST. /
whialt require.+.pemlil to cwwrvct,ther,improve,demolish,or rePa r my iarvctun / R 3
prior to its issuance.also requites Ota upplaitat for mchpmnit to file atuip icamemeu POWER DEVICES
�K�p That lx u lianxd pm umtothe pmrisiem of the Contrendt License Low(Coriptee SWIMMING P00L ELECTRIC
aXdX �d 0(antm isexgwim Sofro ardidrf Uvi.for te(the Bunrcoed Pmnyvlau Code) � L
yI'9_'yt
or Thin he uexemptlhaefmm ed ilia briutfo-the dkgcd exmtption.Any videtion of OVREIS-SWITCHES-FIXTURES
F_ZY S Lino 9031.5 by any epplicim for-a permit mhjeeu the applicant to a civil petWty of
Q
not owrc then five hunchd dWlus fS5f1B).
z�� ❑ I,us owrcroftheprnpertyarmymtTlloywwith wa Ihelrtale<om NEW RESIDEMIAL P.I.ECIA SQ.Ff.
4411 gn lis perdriuon, STORIES TYPE,CONSTRUCT N
mady�_ will dolhe worms,Code,
aCalsatolinluddc Uw drn.or mplowner of
1-Pmfevinnn CMe:ITe sesubmtar's Llanx Taw Joel tnl apply l an owner is
ownem whobut cosi imprarueham,^n,udwhodoesouchworkhroffeed dtmugh his
cmpbymddin,ce impar!that uchimprovcmmumoss,me iear.ednoRctcd fneuelL OCC.GROUP RFS.UNITS
horevn.thebuildingnitm ofProxa,sin utold e di root cur omn,00seforfeturnletion,pieosa ato
of
Inds).r will have IFC burden of proving then M1c did not build m vnPmve for puryox of TO A
semen. TY. PLUMBING PERMIT FEE FLOUD'lANE APN
❑ I,umwalcof the pmperry,eco exclusively crmtncling with liamd contrricmnm Q
cancan the Miject(Sec.]DK,Butineat shad Profusions Code:)The Caunctal
.1wearLriw0ocanwripplywanithecroutterony who bddtor O.the Coad ami
PERMIT ISSUANCE
wltoc Law.fasuch pmjecu wllhecontrxta(a)Iicrnxd punwntopr CaevriN. ALTER-DRAW&VENT-WATER HA)
Liana law. FEE SUMMARY
❑ 1 am cxmtpt under Sec. B&P C(m pds aeasanE: .
PACK ROW PROTECT.DEVICE SANITARY Y N
Owner Disc DRAINS-FLOOR.ROOF,AREA,COND, RECfi1Pf#
WORKMANCOMFESATIONDECLARATON SCIIOOL TA% T N
,:cThereby effimtthultuve•cerpBrue ofwtxotmclf-insurt.aearuf to of FlXT IrsFe.pER.TRAP I� RECEIPT.
75 Whrkm Cmglernuian ltuurutcemrimtifid rnPy thercor(Sec.JgOD,I<b C.)wM1ich PARK FEE Y N
even all employee's miler tldt permit. GAS-EA.SYSTEM-I INC.d OUTLETS 3"'.Policy# BUILDING DIVISION MS
Compriny GAS-E.A.SYSTEM-OVER d(EA) PIANCHECK FEE
❑ Cmifid roPY is hneby fumiehei
❑ Cenifid copy is fled wilt the city inepttutn divltlaL GREASMNDUSTRL WASTE:INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS FFR
COMPFfISATION INSURANCE
(Thisfaction anvil no be rompletd ifthe Farm,is fa came mndad JcHans(SIM) SEW ER-SANITARY-STORM EA.2WFT. ENERGY FEE
or less.)
I certify pat in the perfmmucc ofthc work for which dais permit is isw Ishrill WATER HEATER W/VEN'D;LECIR
rut employ my person many nurser x m to bennrc subject to Ik Waren' PAID
"pcmudionlswsdGifsria Due WATER SYS MTREATING Dan Ramp#
Applicator
� Q NOTICE TO APPLICANT:If,dash,nuking this Camif to of Exemption,you should NEW RESIDENTIAL PIMB. SQ.FT. TOTAL'
becvrc subject m the Wmkele Canpemmim poruien of pie TAbor Code,you run
forthwith comply with rvch pmrisinn ar this permit tM1Jl ba dearcd eevokd. BUILDING FEE
0. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE `
Z 1 hereby riff Thu there Is•Ivnunscpon lending iiPmay for the pnfmmurce of
U O the work for which this permit It timed(Sec.J09],Cis.C.) T �w ELECTRIC FEE
O Under'a Name
I<dKs Name PLUMBING Fl:F.
1 vanity that I neve rend thin QTY MECHANICAL PERMIT FEE
ql and con nta riwe Thu the ribove hdarhnin,u
Irigratocn."wlNdlatyutdanmy mmive,;and nualewsnluing a PF,RMITISSUANCE MF.CHANICAI,IEE
U Z above
bMild, sen Wctiomud hen ay impecuv<,Posseenuuvn ofthit airy mmtm upon the CONSTRUCTION TAX
I..) z ebav(Wa)tto-cd popwy mnify tion purymu. ALTER OR ADD TO MECH.
(Wc)ogre m save,irdnonify erd keep himidnoy in
We City of Gep0 air stand eCity
liribililiw.jdgmrnu.emuud expernu which wYin umY weY riccrverigriinn City AIR HANDLING UNIT(TO 111,011(1 CFM)
n cltnsryu Mil grrinming of Nis t.
AIR HANDLING UNIT(OVER IO,000CFM)
Si1Tnu pplicmmt/Contrrta /— Disc EXHAUST HOOD(WMUCT
PAID
FATARDOUS MATERIALS DISCLOSURE HEATING UNIT(T0 IW,000 BTU) - Dete Rcceip#
Wi111hetiPplicunl or future Ituidimgm Wlpore or hurtle haunts.mnleri4
u deftoed by the Cupemon,MoniciTal Code,Chapter 9.12 rid pre Heald nta Wely HEATING UNIT(OVER 1 WAW WITT TO
Code,Sacaon 25532(u)i
❑Ye 0 N VIMTILATION FAN(SINGLE RFSID)
ISSUANCE DATE
Willttre liontnfwunbulldin attupW ux BOILER-00F1P(JHP 0R IW.00D BTU)
pp g
hvnNArea t mr-dertmwhichmmt
ous untsaa d
r conlvnmx cfrcJ by IFC Hey Area Air
Qwlity Mwngcntmt
BOILER-cow(OMR IW."BTU)
Diurin] P
❑Yee C1No NEW RfSIDPl.'77AL MECH. SQ.FT. IV
I hive read the IweNous mucrieb«quiremenu under Chmpm 6.95 or the Op .
iftCi,he I nil Haiing do& or cur Cade,have
a'c 25505,25333 mad x335]1, l uedntunt dist (� /)
aorta hnilaing arc.nal enremtty n..enternnt.that it is my tnytllm.dbirtywnaJrr the L(/ fonY V
uccu{um of rtqulmrcnn Which marl be mit pna b issuance mf•Cemf to of /yJ
Gau�,�ricwT,
O"'ne 'd rigent Disc TOTAL: ISSUTOBY: