24732APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO
n I OLNG- KLEC7RICALHANICA
PERMIT NO.
PING
24732
BUILDING DIVISION .APPLICATION/PERMIT
BUILDING PROJECT IDENTIFICATION
PROJCTIDENNIIC
BUILDING ADDRESS :
NO.
AVII.ICATION SUBMfffAL DATE
` _SANIARY
` LL12-1-50_" —I�` VN c -D c-
UNIT, LOT♦
_1511A
11NEr^IL PHONE
CONTRACTORS nAME EJC
NO:
WC
❑
CONTROL
Sc LLd�.
ARCHITECUENGINEFR: LIC NO: AD �q,�/LVC�-DM�'A�
l e[ 1+
CONTACT: PHONE
QTY. ELECTRIC PERMIT
FEE
RUILDING PERMIT INF -0
BLDG FJ� u I;
PPIT ISSUANCE
�.
LICENSEDCONTRACT DECIARATUN
APPLIANCES -RESIDENTIAL
JOB DESCRIPTIQN
/
Iberehy affnnisml amlicensedunossudi isrvnvofCluper9
er,mo (commencing with
my
of fie
of Divisin3MNc Hluiren uad Rvfrniau Coil,, ami my llceose is in PANELS
full Tara ales cffm.
bell f.
Con
UPT
Gorl rJC��.wL�J
Lane C.
Doc Cmwnm
1000A PS
MP$
��� �
ARCIITIIiewc]DECLARATION
OVER
OVER IIXp AMPS
R 1000
R A
SQ. IT. FLOOR ARTA
S/SQ. FT.
1 umleramd my pWns droll W uai as public rtcmJ..
SIGNS ELECTRICAL
I.iccmei Pmfcvimal
OWNER -BUILD ER DECLARATION TION
SPECIAL CIRCUIT/MISC.
1 hereby Jut 1 un cxcmpt from the Cmtrxn Liana law feeem the
real m. ( Co
aM Pmfemirms Coda: Any my orrnumy
followingtceti.
TEMP. METER OR POLE, INST.
Permit .ourear,Buane,
whichmyuim.,.salt to connrvcbalter,im acnrorm1 azpairanyaaenu.c
foci
prior raid.startle,alwrcyuimslhroyisicunlforslschpenitto Lleione
POWER DIiVICES
ntheisliccazdth m Lastmertent
iiauof the dormer«s Linoting
dtmarc)of D fe,Sof aIle
9 Professions Cofer
au Cak)
9(cwlnrreingwbh Ser ion]Osd
SWIMMING POOL ELECHIIC
VALUATIOIiK.
the
«aro,cis 1a byPtry, irf,anuaam. paisfor the als tho eaemptwm Any violuim of
ilexemudar.Any
Smim703 anYireddantfaxpermit subj.cU the epplirant toacivilpaWry of
V -�-SWRCFffS-FlXTIIRFS
O
I!� r./�
�,` f1Aii ►^�
, than five
trot rove than
rofiu rodoy,lerr(SSW).
❑ Laaw",andepto nrycmployblorofwagsnthetr cum,ematim,
NEW RPSIDFXITAL LLECIR SQ 19'.
(1µ1F TYPE CY) Sl ON
buranr ]BW, Busing.
will mthe warn, and Nc,tractor. isnot ',
usw
LiaccAa
ares Pmfealms cote: The Cmtracnr's Licne law dm not apply to en owner of
dofeno s not ,My
IeoP.rtY w W W iMfamimpornthcrmn, fold wW d«s ,itch roan Nmzlfm IhrougM1 his
.offered forde.If.
wnaoployen,faovidelnWoestormissold
RCS. UNITS
within one,oir.f
howlerr will Wc, he arrenovrnen,thin be
W ider will M1ave he barren of ptnving that he dial r.tt W ild m impmve fa ptupnx of
not ream mpnnlm faror, aurpoe of
C
Y U T E
pLr�_
ulw).
❑ E,nowrer Mlle prnpmy, unudusivdycmuaningwiNllcemW emtrecmgto
qPY. PLUMBING PERMIT
�=N � APN
erutrvct th< pmlct (Side. 701 Bud. Lid Profedms Cadc:) Tho Contract«s
Liana law doesnm apply to m owrerofpropcny who Wilds nimprovnthvcon, itid
PERMIT ISSUANCE
whocmtncutfor such pmjcm with acsnnxmar(s) IlttnsM plananit to ale Cmtnet«s
FEE SUMMARY
�. .DftA1N&VENT-WATER (EA)
License law.
❑ 1 am exempt uMee Ss. , B lb P C fm this r.anm
BACK 11.0%` PROTECT. DEVICE
SANITARY YN
RECEIPT*
Ovmc Dme
WORKMAN COMPENSATION DECLARATION
DRAINS- FLOOR, RODE. AREA. COND.
SCHOOL TAX Y N
❑ Ihertby effrm NUlM1aveacenUie.'•olcamcnt to zlf-instrrt.aaarniflnse of
FlXNRPS-PER TRAP
RECEIPT♦
PARR FEE Y N
WmkcriC tion lrawrvexaamtifiW
tsrttpcma crypt thuwflSs lXW,lab C.)which
covers, JI employee's under lir Kroni1
GAS - PA. SYSTEM-1PfS INC. 4 OUTI
RECEIPT
_#
BUILDING DIVISION FEES
Prdi y 0
ComlmnY
❑ Cmifd apy is hvcby fltrnisWd.
GAS - EA. SYSTEM-0VER 4 (FA)
PLANCHECK FEE
❑ Cmiflcdco isfi Jwitht dtybiye wdivWm.
GRFASQWDUSTRLWASEEIMFRCEPfOR
GRADING FFE
CERTIFICATE; OF EAEMPDON FROM WORKERS
GREASE TRAP
SOILS FFE
COMPENSATION INSURANCE
(Otis section no ima W tort,dred ifae,milt is forme hmslrtd Mllarx(SIW)
SEWER - SANITARY - STORM EA. 20)FT.
ENERGY Flip,
or I.n)
I ast tma in the perfmm.nce of the wort fm which Nis permit i, i.wed, l shell WATER HEATER W/VFNTM1:IFCR
tad employ any pawn in any rrvnrsn son to became subject to the Work.'
PAID
Compewtim laws of Cali(omu. Date
Appliont
WATER SYSfFJd/IRFAUNG
D. Ree.ipt0
NOTICE TO APPLICANT :If. •fer making this Cinlfiole of E.emplim,ynu slnubd
NEW RESIDENTIAL PLMB. SQ. IT.
TOTAL
bcome wbja'd to the water's Contpenmtlm pmviaitms of the labor Cak. you must
BUILDING PEE
forthwith eom,ly with suet pmvisioru or Ni, pe.t "I W deemed revakm.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
1 heeby.ffrm this there is. mruvuction le ding egney for IJe I erfntmmtee of
ELECTRIC FEE
Ibe work fur which this,err it i, issued (Sec.109], Clv. C.) T
lender's Nam.
undid', AM—
QTY. MECHANICAL PERMIT
FEE
PLUMBING FUH. �r
1 emlfy that 1 hove teed thisii'licatim wd,arae and ale.Wve in(omutim is
cmrtn.I.grtetocanplywithallcityandcauntymdiltulcnnd wUwsmW gw
PERMIT ISSUANCE
MECHANICAL FEE
Wilding c«utrunim. ares hereby euthori ee rc}vnerluava of this citytoentnupm ale
CONSTRUCTION TAX
above-mentimacd property for P
im.nien puryozb. ALTER OR ADD TO MECH.
(We) egve,indemnify antes keep Hornets the City of C.,cnim a,.
aostswdexpenevwhichtwyinmyweywmeegulnw.aOCity
liebiliiio, g
AIR HANDLING UNIT (TO IO,N)) CFM)
in anscy agren4ng of this ,:omit.
AIR HANDLING UNIT (OVER BLOW CFM)
r NA
Si ureofA cul tnctn base,EXHAUSTHOOD(W/DUCU
PAID
HAZ'DOUS MAIERIALS DISCLOSURE
HEATING UNIT (TO [00,000 BTU)
Ore Raceipt0
Will theap 'roam alar. buiding atcculnnt ,raid mhaMlc hvrudous mmcial
a hea ftby the m Municipal Cod., Chapter 9.12, eml the Heal orad S.rdy
HEATING UNIT (OVER 100,000 BTU)
TOTAL'
Code. Secsim x).
ye,
❑ Yo ❑ No
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
BOILER - COMP (IHP OR FIJI," BN)
Will Jreopplieantafumrt huilJingacupalmxequipmrnt adevicn whichemil
eneena
5rdwe a snnla nminvns ilefinai by the Buy Aro Air Quality Mgemm
BOILER - COMP (OVER IW.BTU)
IXIU
atrim?
❑ Ya ❑ No
NEW RESIDENTIAL MECH.—SQ, FT.
n p p
V" Pi al
I have reed the, harardous mood IIs restate rnu Limier Chapter 6.95 of the
California I leallh d Safety Code, S,tGims 25505, 25533 end 255:14. I undo m.rd this
if the Wilding abn not camently have • roam, Net It i. my roponeibll ity to notify the
y.
FEB
occulrmt of The which be to isammc Cmincue
19C
"truemmis mut met prior of a of
Occupancy.
9Y: l J IIVV
th rcr a.Wrorisces agora WtcISSUED
,OFFICE