27165APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT•PEN ONLY
CITY OF CUPERTINO
APPLICATION/PERMIT
MIAMN, - EUCTRICAL
PLUMBING MECHANICAL
PERMIT NO.
27165
BUILDING DIVISION
BUILDING PROJKCI' IDENTIFICATION
BUILDING A DQQDRISS:
SANITARY NO.
APPLICATION SUWAMAI. DATE
v m
UNITY LOT#
I \ "
V V
OWNERS NAME: Oyli
CONTRACTOR'S NAME LIC NO:
NC
CONTROLY
5
❑
CHITECIYFNGINEER: LIC NO: ADDRESS:
CONTACT : PHONE
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
BLDG ELECT PLUMB MCH
Wo�y-�7a
H-E/4;rj
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION
AP%-IANCFS- RESIDENTIAL
JOB DESCftIPI'ION
1 hemby affirm then 1 ant liemwl under pmviainan ofaapter9 (commendogwith
Uivixi.m3Mthe Baalreas entl Rofcvims Code, mrd my licaue isd
PANELS
,ao,,1of
fallSecdco
full Tum anc CRM I �I
U.Clens SPO LK.Y �� �
IIP T0200 AMPS
Det, Courxv«
201 - 1000 AMPS
ARC]UThCTSDECLA TION
OVER IWAMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
I mdavanc ro Plans xhall be used as public rec«da.
SIGNS FJE,CfRICAL
Licrnscd Rofeationul
OWNER-BUILDERDECLARATION
SPECLV. CIRCUIT/MISC.
I hertby affirm that I am exempt from the Cmltma«'a Lew for the
ainnsanJPnteslom Code: Any city orawnty
following e: Any
TEMP. METER O0. FVLE]NST.
re emwrve, improve, dverou", m rtpair any unhettve
which nteireon.(conir 1.ID3LS,t.
a
i. oraa oalter,pposed
e. Moo
poortoiukauurzm,alaorra,rob tpowklnntf«al xTmactoeofidaaignedouhapter
POWER DEVICES
he ix licir,wpSeetiotothprovklonof to C« Bre. Luarxlaw(Chapter
VALUATION
9 Section Divinm3e P Cod e) SWIMMING POOL ELECTRIC
9b
thmhmrneingwith alk ede-and
Any,tols
one)of
SethioFels1 exemN W,eempinn. Anyvidaionof
hevisfmtjects
bytryaffmnemdthe
by anyapplicanto, apvmit olrbjauthe eppliwnt to•civil paWty of
l
Sono
OUTLETS-SWITCHES-FIX'H1RPS
thorn
na mrrt Chao fire hlmdreJ doll.n ($500}
NEW RESmFNTInt ELECIR SO. ET.
_STORIES
TYPE NSIRUCTI N
❑ I,uowrvof thepropmry,mmyemploymwith wgn ntharwkcompemuim.
will Pathe fix
tenmmmmci. rotimeMeJ«atw
do ownerof
asst IMtessians Gdc: The Contractor's Licenuc law don tut apply to at owner of
otros Co nor apply
prnprny who builN «imlawo Ibertcm, and who don such woh himself m damoth him
OCROUP
BPS. UNITS
own emPl%'ea, provided tMtsmh imlmhvarenuem las imencW «oReml f«oale If,
hwerm. the building m brrymvemm u.aM within «m year ofnxnPlctim, the owner-
TOTAL
budder will havoc the burden of p enrmt 0w he did rot mr[ld or iml eme for W rNx of
cele.).
Qom' PLLIA'16IN('r PERMIT
N
DL E
APN
E]I. av owners the PmPe+ty,amca<lu>ivelycunlracungwith liatuW canttactm to
mantrmct the project (Sec. 7044, Business and Prodew. Cole:) The Canuecmr'a
licrnxlawdoa mtapplytoanowrcrmf psmperty who dddamimprovathucvl,vd
PERMIT ISSUANCE
whocomo ns for such Mjecu with a conoaemr(s) lieenxd purwmlt tothe Conno cto's
Lice me law.
ALTER - DRAIN R V FJ T - WATER TA)
FEE SUMMARY
❑ 1 am cxemlg urdm Sec. . P dt P C fa this reewn
HACK FLOW PROTECT. DHVICE s
O SIDE FES
SANITARY Y N
RECEIPT X
Oemef
A
WORKMAN COMPENSATION DECLTION
DRAINS- FLOOR. ROOF. AREA. COND.
SCHOOLTAX N
❑ Ihcrchy affirm thntl hevcattnif mof uaxmmself-inawe,macenlficae of
FIXTURES - PER TRAP
PARK FTP- V N
W«kco'Gayan,ation lecuranee or a certified enpy thereef(Sm 38W, Lab C.) which
wets all employee', umber that permit. (r .1^��O��p,
GAS -EA STSIF.A1-I INC.40I1TLETS
BUIDIN DIEIO"M
Policy# /T
frr r 1Ti
C«npan)'
GAS - EA. SYSTFM-OVER 4(EA)
%A CK FFt
❑ CrnifaW copy is heavy famished.
GFFTi
J<*Certir,dc,yisfildwiN cityin li"ndivlsion. GRIASFANDUSTRI. WAST: IGEPIDR
CERTIFICATE OF EXEMPTION FROM WORKERS'
GREASF,TRAP
50 FEE
COMPENSATION INSURANCE
NERGY FFJ
(LTi, txcdom rudnet beaenple�M iftbepamit u for one haldrtd dbllua($100) SEWER-SANITARY-STOR EA.2WFT.
or lma)
I certify two the perfmma .fdr, woh for which Ima permit is itoced,I shall WATER HEATER W/VIIA:LE
not employ any pman in any manner se n w become aubject to the Wex*m
PAID
Cvrryematim Taw, of Califmou. Dac
WATER SYSIFMTREATING
Applicarg
NOTICE TO APPLICANT: If,anmmaking Nu Cemlficaeof Exemtior. you should NEW RESIDFMAL PLMB.TOTAL:
become aubja:r m the Workm's C"mpcmatim primemor u of the labor Cade, yw mar
YQ-
forthwith comply with ouch praviil«u mrthupeor t.I.-I m
be, deeed revoked
BUILDING FIT.
SEISMIC FFR
CONSTRUCTION LENDING AGENCY
I hereby Nat that, u • commhee le vgeruy fm the pvfmwce of
1buch I . Co
the work for when thio permit is issued (See. J(yl], Cir. C.)
TOTAL
IiLEC1RIC LTG
lance's Nem
I<Mc'a nmre.
QTY. MECHANICAL PERMIT FEE
PLUMBING HE
7.44�CHANICAI,
I certify Nu I have rend thio npliadon and awe that the above inf«nutm i,
Sect. Iagm to comply with all city and eanry ordlxwuea and mane Iowa relainY to
PERMIT ISSUANCE
buildingumaauaim,end h—lare nth o,pm=•nuaivnafthiaclty, meaterulXm the
CONSTRUCTION TAX
above-mentioned pmpcmy for impatiun q T,,ee .
ALTER OR ADD TO MECH,
(We) agree to ,arc, balaonify ad keep harrnda the Cary of Copcatrm agahnr
liobilitiea.jdgmrnu,<oRs andexpam whieb may in any waymcme egaimt mid City
AIR HANDLING] Fl` (TO 10,M CFM)
in rnmx tonvmof the granting of thea crom.
AIR HANDLING UNIT (OVER 10," CFM)
PAID
Sigwturtof AppliunitConeractm Due EXHAUST FOOD(WAIUCT)
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (TO =,o00 BM
Dane Receipt Y
TOTAL.
Will the apploam «future building occupom more or he"le b.+..dnus nmterial
I]BATING UNIT( OVER 100,0W BTU)
at definer!by the Cupmtlro Municipal Code, Clapmr 9.12, anc the Health anc Sofety
Code. Section255J2(a)7
0yet 11 No
VENHIATION FAN (SING..- RESID)
10 ATE
uae
Will thcepPlichnt hrzfuturehuildingarupalt cyuipmenl«Jevicsswhichemit
BOILER- COMP(3HP OR 100." BTU)
P' /H�
H'Tr
hvuhlous air comwnimenu n dcfited by the Bay Area Ain Quality Marugmnent
BOILER IM,0009TT1)
DirieU
a 0 N
❑Y-�,
NEWRESIDENf1ALMLCII. SQ. FT.
N
NOVi 17 1994
I bave mad thl hvmdouc nummols rcyuinenenta urda Cheper 6.95 of Ile
CII
lu
CelilirmieHWIM1&Sof«y Codc. Scerirae 253111, 255J3 end 235J4. ndmwnJthet
V T ut-Luf
ermoat the
ifthebuildingdnaruseclurealyhoveatrnenmt itrto martee
tMIIN(1
of
«cvpvlt of Ne rtquiremenu which most w con phi« to issuurtt of • Certificate of
'•ISSUEDBY:
c! �Gm eutM1mnaal agcm Da,
OFFICE