28225APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING- ELECTRICAL
APPLICATION/PERMIT PLUMBING - MECHANICAL.
BUILDING DIVISION BUILDING PROJECT IDEYPIFICATION
PFRMITNO.
/� O f� C
G o G L J
BUILDING ADDRESS:
SANITARY NO.
API'LICA'IIONSUBNHTALDA9E
3 1 NG. UNIT# LOT
O'2 NAM �y PHONE:
EFF
CO 'g NAME_ UC NO:
NA2
El
CONIROLN
..RJHI'IIiCI' N ]NEER LIC NO,
00
ADDRESS:
CONTACT: PHONE/2�
T'jOv
L_erlf� (Z'b9ewl V
—17q • U2
QTY. ELECTRIC PERMIT FEE
BUILDING PERMITINFO
Rk ECT U MUCH
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I haxeby Jinn th.t l em licemed underprovisions ofCTmpur 9(commendllg with
gPPI.IANCFS-RFSIUFNIIAL
IOBD RIPHON
PANELS
Section 7000) of Division J of the Boniness and Profeaimu Corle, sand my liame a in
full face and effect.
acrnx Cleo Lic.N
UP TD 200 AMPS
Data Gmlracnx
y(d- OWAMPS
ARCHITECTS DECLARATION
1 umknund my p1.m.hall be used m public r«vds.
OVER IOW AMPS
SQ. FT. FLUOR AREA S/SQ. F1'.
O y .mow
,�/r�1`)
SIGNS ELECUUCAL\\[\�V\
ufemea PNfm,iana
OWNER -BUILDER DIibe RATComoION
9cano
SPECIAL CIRCUIT/MISC.
I am
affirm IM1m I re fmrt flat the Cnnlrwlors
1 from cAnw law the
TL'MI'. Mh-ItJt OR POLE INSf.
e
n, re..
follnh recut nvn.(.lion N315,Busies, mpr Profmaiam Cak:Any city orcwnty
se enemy
-
which rfquile\. p[nnil to aMlstmfl, eller, myons[, deam Npir any[Npm
iiuwspplkemfore ornitto.. clserenenl
Use
POWER DEVICES
1
that he a licemnl ro le rovuiorIF ComoseUc(CTet«
9(roonnereing with«isw 7p) ofDivision Jnf dF RRusin'.uri ltofcssiom Cudc)
SWIMMING POOL ELECTRIC
VALUATION
critic, be, kexcmp thmcfram and t he bads for lbc d lcged eerntptinn. Any swhiranof
Section 70315 by any applicam fm a permit sabjmN the mgtrm
licl o civil penally of
rl'LEIS- SWITCI ILS - FIXTURES
not more them five harxhed dullu 5500).
❑ I,mowrcroftheprnperry.mmyanploymwith wagemtmirsdecanrpmuellw,
NEW RESIDENHAI, ELECITt _SQ. FT.
SfORIF
TYPECONSTRUCTION
till dndFwork, endthc ndNa
he Croclsres" L'u ki not'IymN4,Buuws
reJ Rofesions Code: The ConBmr, re lea ret apply torr Damm
propmy wMtM1oildamimprovu dFrrma, end who tNw'e«M1 wont himxlfm Wuagh hit
ndce lm uch is
employuaildin,dW lf,
eitt.rd
OCC. GROUP
RES. UNITS
�
aloov.,i, told i.hin oner liatiei Breovi
hnwevea the have
Wing ur impmvcmenl is sold within site yes afcnmpledo r the owl of
buiWv will Imve Ibe Kaden of proving that he dW nd build «imgave f« pulpox of
QTY. PLUMBING PERMIT FEE
IFrNde plopen3. em exclmivdyconuecting with Hermaed rnnn.clmle,
FLOOD%A
APN
os I the lied (Sec 70W, Busllea read IhofcOiau CorI The Cona . M.,,
Pf;RM19'ISSUANCB
Liar wdar lac apply toemawnmo[prep`ray wMl Wilds nrimprnvulhcrcw. wd
who anla \fnrwch gojccu witheconlrvhe s)Iia xdpulsuam Mtbeconlranur'.
ALTER (EA)
FEE SUMMARY
licmc Law.
❑ I son axe 1pl er Sec. , B & P r Ida I<a.an
BACK FLOW PROTECT. DEVICE
SANITARY Y N
REL11�N
�e
DRAINS- FLOOR, ROOF. AREA. COND. -
'ITvrcr
W( K C LION N
SCHOOLTAX Y N
rc
❑ Ihcrthy affirm bu tam nfn x If. w ,Inn a+lif le of
workca'Corllre., aarec Red y .3g0MLab C.)which
FIXTURES - PER TRAIT
RECF;IPTN
PARK FEEAilii, N
GAS-FA.SYSLCM-IINC.4OUHLIS l
covin Ai empty«'. pennll. ('
NBryN
#
BUIL ION FRES
PLANCHECK
O
Co -carry
GAS . EA. SYSIEM_OVER 4 EA)
[IEFL'
hbyfa MJS,vL
Ccmr.cd Wyume
(l Rll SIYINDUSTRL WASTE INTERCEPTOR
❑ Cenl6fd copy is filed with the city inepecliw JivLsiw.
GRADING FEE
GREASF,TRAP
SOLESFFP
CFRTBICATE0FEXEMPTION FROMWORKERS
COMPENSATION INSURANCE
SEWER - SANITARY - STORM EA. 200FT.
(This xnbn read culthe complew ifthe pemlil is for one hundld ddlan(SIM)
RNFItGYFEE
or lea.)
WA'IY.R BEATER WNI'WTELECIR
I can try that in the Perfmlmnce of the ark for which this perout is iawed, I.ahell
so
not cmplo, any porton in try n m M bernrne mbja'I to the Work.'
PAID
Compcnswionlswsaf CJiferna Dose
WATER SYSTFlI.1T]UATING
Done R«drt
Applinsinl
NOTICE TO APPLICANT: If. ger meting this Crnifiote off empirm. you sbouW
NEW RESIDENTIAL MAR. SQ. FT.
TOTAL:
become subj«I to the Worker's Canpcwlima proGoiwu of the Isdm Code, you Must
fmbwith rnmMY aith such provisions or thisprnnit shell be deemed levnkN.
BUILDING
CONSTRUCTION LENDING AGENCY
SE'S IC E
1 hertby Irian that thae is a consm ion Imullog sgelleY for Be perfmmnx of
Ibc wM for which this permit is issuN (See 3097. Ci, C.)
Lsrm
TOTAL
F2F. FEE
e , N,ime
lander'. Addle.+
QTY. MECHANICAL PERMIT FEE
PLUM G
I coolly Ihm I have nml this eppliaakn wall are that be above infmm.tiw ieMECHANICAL
onsn .IagncmamplYwthJ city erd cwmy uNinarcca wd n.¢Lw. ¢luingm
PERMIT ISSUANCE.
LE
buildiogmnvrucdon.end hrrtbY authorira reprvmuuivtt of this City mrnlcr upon the
ebwemmtitmcd pNpcny f«inrycctian purpees.
ALTIJ2 OR ADD TO MECH.
CONSIRUCTIO TAX
(Wc).glee M e, iladcmor and 1, hemlea Ci of Cupmmo wrest
Iwbililim,judgme onaendexpcMa' aimirsaid
m
IIANDLINGUNTf(T010,w:lct M)
in onrcyuenc ing of mill.
ALR HANDLING UNIT (OVER 10,W0 CFM)
MenVCmvrl«
41>wHEATING
PXHAUST HOOD (W/DUM
PAID
UNIT(TO 1(p," BTU)
HATARDOUS MATERIALS DISCLOSURE
Dale N N
WIII applicem or future huilding acculunt slam«M1ardle hauutkus nmrmial
m dcfired by IM1e Cupmirxr Municipal CMe, Charter 9.1; uJ the Ihulth mJ Safety
HFAl7NG UNIT (OVER IMOM BTU)
A - TDl'AL:
VENTILATION FAN (SINGLE RESID)
'y
Code,SMiw 25532([)7
❑Y 13 No
Will dae.pplicma«futurthuildied 1, 11u, ux c,"AirtQdrl ttwhigemena
azardws sir cnnmminmts es defined by IbC Huy Arm An QuNity M.n.genlrnl
ITanin7
BOILER- COMP(3HPOR 1M.W(I BTU)
/� _ISSUANCE DATE
Va f/J
C/l y 1995
H1I11,1iR -COMP (OVER I W,w H'fUl
❑ Y. ❑ No
/ Lr L
err
NEW RESIDENTIAL MECH. SQ. FT.
h�/ryU
1 have rind the hvstlaus materials rection us under Cbeper 6.95 of the
CJifanist High & SJely Cade, S«doru 25505,15533 end 25534. 1 urNnstud Ih.l
if tbC building dont not cti hove. temp, thin it is my am nomibility to notify ft
occupanl of IFc nNuircrcnu which mml be incl prion to I.sowec of a Cmifieme of
Ofwyncy.
ISSUEDBY:
Oww m.mhmi iagtm Due
TOTAU
OFFICE