26590 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY V
CtPY O CCUPERTINO BUILDING- .LL. R AL PERSHING.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 26590
(WILDING PROJECIADENTIPICAT'[On'
BUILDING ADDRESS�`a Tar A - ,..•r SANITARY NO. APPLICATION SUHMITTAL DATE
2 �O UNIT# CWJVS_/S I LOT# 19
OWNERS NAME: PHONE: CONTRACTOR'S NAME: LIC NO: ���DDD
� Cr-s- N/C CONTROL p
•ARCHITECT'/I?NGINRF:R: LIC NO: ADDRESS: n ,f� .D\ 'a�x ❑
ar
CONTACT: l f/I A P�SW A
C/ nn QTY. ELECTRIC PERMIT FEE BUILDING PERMITla,AINFO
ln< �� 1 O' I✓ PERMIT ISSUANCE PLUMB MICH
ip y}
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
2=z I hereby affirm that l am licensed under provisions of Chapter'mmurnencing with JOB DESCRIPTION
u100 Section 90(%q of Division3af the Business enJ ProfmsionsC end my licenseis in pgNNIS
cave fuilfortx and IT - a 2
UUIy License Cla.v Lic.p L UPT02MAMPS
Njy Date Contractor g5TGNS
MPS 1
F y Z AR IITEC`PS DECLARATION SQ.FT.FLOOR AREA 8/SQ.FT.
ZOy— AMPS
F=-® l understand my plans shall be used as public rccnnls.
.�.1 IRCUTAL ��6 Ltunsed Profcmonal U hon IAm-BUILD fr DECLARATION RCUIT/MISC.O501 hereby affirm Nat 1 oro exemry from Ne C..o s Co License Lew for the •0�
3Oywhich ingmaua.ermittn90)15,Businwend Professions Co de:Any cin SomeneVTCES POLE(NST. qn J� 24 y1 which its iIx dna,-Iit tocnmw c.14gimproOmb molish.ore.vd,umyswcmre<0 Adore.slicensed puprottth Nevisionocam fthe Copemtiuo Licese La (CementVICIS
C a 9 R he is licensed w pursuwn m the provisions of the Contra....License Law(Chapter
W 9th.,hencingw1teteion90nd me
3oFlM1e Business end Professiom Cade) SWIMMING POOL ELECTRIC VALUATION
ty_y CNC h7031.5 by tyapplimaod Ne bmmt subjects thedexemand to Aivilpc inn of 4
_ZY Section than vehundreddomsfor a rs($50rnitsuhjedstheepplicennoecivilpenahyof OUTLETS-SWITCHES-FlXTURES \O lh3
not more than five hundred dollars(ESPN). ` T
�Fm ❑ 1,mownerofthe n,arm m to eeswithwe ursalele(Se.c0m NEW RESIDENTIAL ELECIR Q _ness SQ.IT.
ProPe Y Ye P Y 8 penmti.n. � •�g STORIES TYPE CONSTRUCTION
a3— andwill dO Newark,Code:
he Contractor
oeisnm is License
doesned for not
to ano memo
pro emy who bu Csativ:The Cunlrac on.nd w1be Lew such
or hmou to an owner of
own can tale buildsviimproves Nemproand tabes does such work himulfortluouge.iis
tan aveyloyecs,p or i improvot such ement
iovememseenot eyearofoomplethod the owner. OCC.GROUP RFS.UNITS
r.
builder,thiolbuildingteburden of patent that edidnoneyear of� prove for the of TOTAL: AA
builder will have the burden of proving that he did not build or improve for purpose of `sTl •Z
salt.).
❑ I,as uwner.fthe Properly,mnexclusively contracting with licensed contractors to QTY, PLUMBING PERMIT FEE FLOOD ZONE AI'N
com.wcl The project(Sce.7044,Business and Professiom Cul The Coronations #5
License Law does not aPPlyto an ownerodproperty who builds or improves thereon,and PERMIT ISSUANCE 3z.vv,
who contracts for such projects with a cro ractoga)licensed punuunt to the Comoodor's
License Law. ALTER-DRAIN&VENT-WATER(EA,) FEE SUMMARY
❑ 1 am eumpt under Sec. ,B&PC for Nis reason BACK MOW PROTECT.DEVICE. SID.FEES
Owner SANITARY Y N
Da¢ DRAINSF100R,ROOF,AREA,COND. RECPP #
-
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y_N
❑ (hereby vffvm Nmtihnveattnificam of consenuo ulLinsore,mecenif¢me of MIXTURESPER TRAP RECF.IPfp
Wmkeri e
Compensation Insurance oracerified copy lhcof(Sec.3800,Lab CJ which PARK FEE Y N
overs all employee's under this permit OAS-EA.SYSTEM-]INC.4 OUTLETS RECEIPT#
Policy N BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCIIECK FEE
El Certified copy is hereby TumieM1CJ.
Cl Certified copy is filed with the city inspection division. GREASPJINDUSTRLWASTEINTERCEPTOR GRADING FEE
76 -ab
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS PEE.
COMPENSATION INSURANCE
(This section need not be completed ifthe Permit is forone hundred dollars($100) SEWER-SANITARY-STORM PA.200FT. ENERGY FEE
.dexo.)
I certify that in the pmmorance ofthe work fm which this permit is issued,l timid WATER BEATER W/VEJsUM.ECTR
not employ any Fenno in any manner so as to become subject to the WorkersPAID
z CPPI�' Duro eition Laws of California. Duro WATER SYSTEMITREATING
O N
• O A
•ry;es�y NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.Ff. TOTAL:
f^ jV) become subject to the Worker's Compensation Provisions of the Labor Code,you must
1W . forthwith comply with such provisions or this Permit shall be deemed evoked. BUILDING FEE
6. o CONSTRUCTION LENDING AGENCY SEISMICO
a z I hereby affirm that Them is a construction lending agency for the performance of Zen
ay ��
V O the work for which IF is permit is issued(Sac.3099,Civ,CJ TOTAL: 'a•#' t'-I ELECfRI F,
Lender's Name I q1
I.L.
V Lenders Address - QTY. MECHANICAL PERMIT FEE PLUMBING FL
I certify that I base rend this application and state that the above information is
�^ 0. corect.Ialone,to comply with all city and county ordinances and state laws misting to PERMIT ISSUANCE Z MECHANICALFEE
.' 0 building c.mwction,and hereby nothonaerepmaentatives ofthis city to enter upon the CONSTRUCTIONT X
V Z above-mentioned property for inspection purposes. ALTER OR ADD TO MIiCH:
(We)ogee 1.save,indemnify and keep harmless the City of Cupertino again(
liabilities,judgments,costs and expenses which may in any way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
in const uence of the granting of this permit.
G /1 A� AIR HANDLING UNIT(OVER IO,OW CFM)
Signature of ApplicanUCuntmctor 1) •Dale EXHAUST HOOD(W4lUCT)
PAID
HAZARture b A,nuenj n DISCLOSURE HEATING UNIT(TO 1tX1,p00 flTll) Dam RmeipsN
Will lhefficC eemno Municipal
Code,Cantamrtor hanadd
dle the Health and Safety
HEATING UNIT(OVL•R 100,000 BTU) TOTAL:
al
m defined by the Cupcnino Municipal Code.Chapter 9.12,enJ the Health and Safety
Cale,Section 25532(O?
❑Yes 11 No VENTILATION FAN(SINGLE RBSID)
BOILER-COMP(3HP OR 100,000 BTU) ISSUANCE DATE
•hmair conwminants m defnetl by the Bay Area Air Quality ManagementDistrtrict?io? t BOILER-COME OVER 100,000 BTU) C
❑Yes ❑No NEW RESIDENTIAL NIECE, SQ.FT. AQ ,� y�0� 1994
1 have read the haramaenads aenads onpirements under Chapter 6.95 of the -• s
Co form.Health&Safety Code,Sections 25505,25533 and 2.5534. 1 understand that
if the building does not currcnlly have a tcvm,that it is my msponsibility mortify be v 1U1r VVI,Gro IIIVIV
occupant of the requimments which must be met prior to issuance of v Certificate of GI1 4
Occupancy. V l 5I ! 1
Owner or emhorizeJ agent Date TOTAL: ,s'7 ISSUED BY:
OFFICE �