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25119 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUIL DR•. ,, PERMIT NO. 2 5119 APPLICATIONIPERMIT PLUMB ;-MECHANICAL BUILDING DIVISION BUILDING PROJECT IDENTIFICATION BUILDING ADDRF . SANITARY NO. AVPLJCCA�'DOrN SUHNIGTAL DATE OUNIT N LOT N NEKS NAME. PHONE ACTOR'SNA LIC NO: T N/C C NTROLN ARCIMECUINGINEER: LIC NO: DRESS: \ V O a CONTACT: PHONE QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO F1.EQT PLUMB MECH PERMIT ISSUANCE `Cp]{l El El LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RPSLDENTLM, p y�Z Ibertby elT Nellem liav,JUMapronaiwua(Ca}^-9(manmK'vie with JOB DESCRIPTION ( 0{ 0 S isiss7())of Di,isin 3 lb on and Prof.iaa Code, it my[I.u in PANELS QUaI5 full face uui i,ff,sTQ` FZ,R( License Clessyl�Ix2fJ0A .N \O UPT0 v< IAac Cnnimcta 'C' 201-1000 AMPS CT v ZSyZ ARCHITECI'SD TIO OVER 1000 AMPS SQ.FT.FLOOR AREA 5/sQ.FT. 0'L—La I uMmavd my pW shell be u u public rccoNs. F1�`1 SIGNS FJPCIRICAL © I Y - <YEj LiccrsM Pmfeulmal XXdCX< OWNER-BUILDER DECLARATION SPECIAL mcuff/MLSC. W i.UF. 1 hvcby ellrm iFw I an,exemptfvn Je C000nm Liansc Law fo 0eER uJ3py IN lowing rtnson.(Satitn]0315,Bwi«aa sal Profasiau Code:Myntymwunry TEMP.METER OR POLE INST. C�y which rt luirev a permit u rotu'Imca,alta,improve,demolish,ac oip any a urn �-S f YS pda n its ismancs.alas repuuu the WpBwu fasuch pamil to fik adge,d uv,mmt POWER DEVICES IJ W <p Ihnt he is liansal pursmant to the Pnvisioru of the Conuen�x's Liave"wlChaptm aa.CC �C 9(cammmcittg with Salism]X07 of Diviaian3ofthe Busirrn and Raf. ._ .Code) SWIMMUNG POOL VA re VALUATION or that he is acme lhcftm tcoand rte hois fa aaem the esPlon.MY violation of F-< Sc,,ion 7031.5 by onyepplinnufor.permit subjecu thea 1,1kmt to e civil paWtyof OUTLETS-SWITCHES-FIXTURES ret m«,than f vc banjoist"I.(5500). z t-o ❑ L.vuwnendtM1e Psycny,«mycmpluym with wegn¢stlrireolecum NEW RESIDLNTIAL ELECiit _SQ,FT. poualion, SICJNIE$ TYPE CON UCII N 6'3 e—a willdodrwah.arddc uauclurt,Nr,s`l Ldc,,dm uwdo,on, to 4. wncrof and PnY-1iao Cad,:The C ipso to s lisrnse Lew does.apply to en owner of own cnywtuh.,rcorimproves 1hirr n,aMwroac, wch woh WtveDa dvough his ownempkym.psovidedthnsuchi Tis ohm within rnlimeMMao(ferM f«sakIf. OCC.GROUP .UNITS M�wnu,Ibc building«imprnvemrnl i.mid within on,,yearofmmpletion,Dc aw«r- buiderwill hove Ne bur4e o(PovinH Ihm he ditl rot add a irvPuve f«impose of L m e). ❑ ,ohs T.-,I openy,isoB iso,ivelul PonfcMgwimlice,:dcamantmro QTY. PLUMBING PERMIT FEE D'GONE APN coravun 0t,Poi.(Sec.7014,eosins-aa vd Roh.buils code:)The iib.,us IJanm lawdocs m,apply In en uwrcr ofpmpcory who buida orimpmva thvcan,surd PERMIT ISSUANCE whoc Law.fasuch projaka wish•mnlractar(a)licenced Puauena to IIIc Ctnnaelua licvuc Lew. ALTER-DRAIN h VENT.WATER(E/Q- FEE SUMMARY hhh---��� ❑ 1 ern cacmP under Sec. ,B A P C(m thu tenon PACK FLOW PROT:CT.DEVICE 1 1 / SANITARY YN 'IJ 0. e DRAINS-FLOOR.ROOF.AREA,CONU. RECEIPT'. WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN ❑ Ihaehy affirm tMtlhsveaanif¢a(cansenuu sdGimwe,«vicenificoe of RECEIPT# W«kai�im Iwo lruurvxx«a anillal IIXTURFS-PER TRAP aPm� mPY lha,of lSm]HX,Lab C.)which PARK FEE Y N mall 5 r GAS-EA.SYSTEM-1 INCAOUM1 RF.CF.IPTN PMiryN 1u `VO BUILDING DIVISION FEES Ga a Y 1 �a ❑ Crni�mby���L-DKJkTfI�'�f— GAS-EA.SYSIFSI-OVFJt4(FA) PLANCHF.CK FEE ❑ Catihal on,,,is filed with the city hLspeeuan divuiaL ../ GREASFJINDUSTRL WASTE IhITERCF.PIVR GRADING FEE CERTIFICATE OE EXEMPTION FROM WORKERSGREASE TRAP COMPENSATION INSURANCE SOUS FEF, IO (This cation trtcd mt is complem ifthe introit is fa an hurMred dollas(S IX) SEWER-SANITARY-STORM EA.2(KR. ENERGY FEE or lea) I mtify,that in the p, orsrsnus of Die work for which this p, this,u Ishell WATER HEATER W/VENTELECIR Iwl employ any pcano in any m m to lhs m aub*I to the Workm' PAID Compensvloniawaof Calif.tic Due sa WATER SYSfEA1/UIEATING Dme RcaiPN 0 Z Applicmt Z NOTICE TO APPLICANT:If,a her wking this Cvaf m M Eaemptioo,yw ilnuld NEW RESIDENTIAL PILI B. SQ.EL TOTAL: VJ banK mbja,to ft WorkK.Canpatution pmviai«u M the Labor Cade,you muu c a; fonhwith comply with such provisions«iNs p nrtil,,E ll In d«mm myon. BUILDING FFP ILI Q CONSTRUCTION LE2,IDING AGENCY SELSMICHM •^J 1 hcrtby afhrm ulbs�th a is a cmuvuaion kMlnp aperwy for the pafasmuta a! 04 V O Ik wohfor which this permit is ivuai(Sa.3097,0,0,C.) TOTAL: ELECTRIC HE ss,. Lcodcr'e Nam, O Irdels Aa QTY. MECHANICAL PERMIT FEE PLUMBING FFP Lia I cenify That 1 have rtad this applimtion aM pale that the above io kis ou is NfltCt.Ingres nc�mply with ell city mtl c«mty adirurca and sus hwsrtWinem PERJUT ISSUANCE MECIIANICAL FFP F' y builaingamnructiwt,arW hveby eulhoriss reparnlelivee of thio rity rn rnta upon the U z purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX (Wc) to ave,i ify and keep hinnies dx Cry of Cuperdo id City liabilitin' awldch may in my way arneaeeivt.mid City AIR HANDLING UNIT(TO 10,000 CFM) of M1is AIR HANDLING UNIT(OVER 10,"CPN) urtcf ApplicmoCioaso- pate EXHAUST HOLD(W/DUCFI PAID IIAZNRDOUS MATERIALS DISCLOSURE HEATING UNITG701X.0()0 BTU) Doc Ra i,N Will ft s,plicam or fit.budding« ,mt store a herdic himmdous muaial HEATING UNIT(OVER 10),"BIC) L az defined by the Cup,nino Municipal Code.CTupta 9.12,and drt Health sural Safety Cods.S.im 25132(.)? ❑Yes X No VI?NDLATION FAN(SING LERESID) WiUrnplicamafutumbuilaingaccupmtux uiP lN« icawhichmiii BOILER-COMP(3HPOR 1X,000 BTU) ISSUANCE DATE I dr conwnaranu a finM dcby NArte Aur Buy AAir QQualityMarcgeraN Wcoio?strivBOILER COMP(OVER 1X,000PN) Cl Y,,, j.'o NEW RESIDENTIAL MECfI, SQ.EL 1 hnv,rt tk bvarbns materials mryi.'s oda CMP,6.95 of One A Culifomia l leulthASofety Code,Sections 25505,25533 ud 25534. 1 undvsund llut -4 O if Ne buil offfdnot Nirc arndy h.w<•ten�nt,Noit is my mparuibil.Cy ,fi ify dse 4( I of uimmrnls which nal M mel pn«to i,susnn:"I.Cto lhrau of ewbndd wean Ove TOTAL: ISSUED BY: 9