28835 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL PERMITNO. 28835
BUILDING DIVISION APPLICATION/PERMIT MUMBING-MECHANNICAL
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
9 -5-0 I.G--.sttc
OWNER'S N 1Q G PHO TRACTOR'S NAME,J C LIOC NR WC CONTROL e
ARCHITEC/IiNGINEER: LIC NO: AD RPSS: ❑ -'
CONTACT: - PHONIL BUILDING PERMIT INFO
❑ COnmltant Fees Paid by Appllcant(Initial) BLDG ELECT PLUM MUCH
❑ ❑ ❑
LICENSED COtmtACIDRS aebo'.of TION QTY ELECTRIC PERMIT FEE
1 M1y drum 1 em lice^wt under grvivau of CM1arommmei
gtt 9( ng JOB DESCRIPTIO
Xizz
00 win,S tion7M))ofi)ivbim3ofthe BusinecsaNP fcsiona Croce n,ylicenui. PERMITISSUANCE - RESIDENTIALWW 5 :
�� in full form code t
�"3Gc. la yo It ❑SFUWL 7CHPNRFMODEL
�z Lode Clara Confr ,APPLIANCES-RESIDENTIAL I]ADDIl10N LUMBING RE-PIPE
Q L Dvc Cmvxvm
ARCHITECTS DECLARATION ❑MULTI-UNIT ❑S RUCIVRAL
z O v2 Z 1 undnmmd my pkv shell be used a public records PANES MODIFICATION
OzFFF-Fo UPT02W AMPS C1 INTERIOR ❑CHIMNEY REPAIR
F- Licensed Pmfcssimul 201-IIXXIAMPS IMPROVFMENT
Y
Oan I an eUILDER DECe Contractor
ontr ON OVER 1000 AMPS ❑BATH R MODEI/REPAIR [I DEMOLITION
y�K 1 emby.Scale.
Ihm 1 1. exemq Irvin the Citta.C'.r :License.,a law for the
x O6 U which sex fire,a Sartre 703 comm:Bueiner.sial Pre,als aar Gide:Ary city or county SIGNS ELECTRICAL [I OTHER
30 whim rcquirtanprnnit nemna,the, alar,impovc,iainch pernit t fie asigned
ir ed Nrixtum
E"�•� nmthetheimeicew fm Contaier'toivemse gt inlower9 SPECIAL.CIRCUITMISC.
prior m its instance,dw
rWrW��} tMokuliccnsed pursumnwde govisirm ofae Container's Licrnx Va'(Clugm9 COMMERCIAL:
' 6�'p�y (comvett xem,at Serefrom 00)of Division J of the Busircsaarplon.Any vilatdc)a 7Eh1 P.Ml;fER OR POLE INS?.
dpx,e LL my he is exempt zany ap li ed the haeis for the Jlegd enemgion,Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
W^m not marTmn by him,nelicanl for upernit subjects the epgicannre civil pcnnity of POWER DEVICES �THPROV [I FOOD SERVICE
�Z<
not mart duan Evc M1msdrtd dolWrs(g5g11. IMPROVEMENT
Q ❑ 1.vowrta of Ns pnsperry.mmycmployeawiN wags a+theirsokmmpervti�xt, SWIMMING POOL ELECTRIC
tl1 Probewoh.stdekhs,C iste ,Lice a ovclovfa wleISec.TOod, ..of OTHER
3 and erty wha h Cal:Inc C e&hearin Liamc Law Pea rmt rM1Y s if rwrcr of OVILETS-SWITCHES-FIXNRFS
11G qty�hands or imgow insuch i tied who dm such ime himself m through
nes own employeee provided nut such me mvrnki within ea cote iyear
ear of a olfrfed forme NEW RESIDENTIAL ELECIR SQ FT.
m1e.IL hellos ill h builmefraica of mem iwsoN id l h yeurofcompletior the SQ.FT PLIX)H ARPA - 5/SQ.I°I'.
nwn
car-builder will have tk bonder of proving that be did con hu IJ rr improve Grpury
m - p
Me to ru,ne s -
❑L m owner of dm pee,70i em a .road crraar'ting with I)The C cmwor. - TOTAL: A
commit de ea.i(See,]Ott,&.N std Howitoau CdeO mutinies
itis bemrra and /A�*
censeLos,
..forroagdyjets owrcfMgopmyw vr,e,lpa mproves fferem,eul QTY. PLUMBING PERMIT FEE Ov/
wb mnuecufa such prgtttx with ernnlrecta(s)Ixrn.ipurwwto NeCmtrectus (.}
Ll.law' PERMIT ISSUANCE
❑Ism exemq order See. .B&PC fornin reewn 177 Uhr v
Uax ALTER-DRAIN&VENT-WATER TA) VALUATION^ Cull If,
W'ORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hereby affirm under pmulty of perjury one of the following daWetims: -
❑ Ihavc ivd mill mainuive Ccni(to MCrnscno to xlf-emote fa Worka'n Crnipen DRAINS-MOOR.ROOF,AREA,COND. y-R)RIPS TYPECONSIRUCf10N
cation,m Mvided fm by Seerio^3](X1 of the labor Code,fm the p,,frrronce of the
work fa which this psmut is kated. FIXTURES-PER TRAP
E] 1 have card will muirmin Wor9m'e Crmpenmlim Immuno,as required by Seeder -
3700 ofielav,r Col,for the parfammecufde wort Be which NN permit it irs^d. GAS-EA.SYSTEM-I INC.4 OUTLETS
OCC.GROUP APN
My Warkrr'n Cmnpenvmion lnwmrta rm'crarla licy nuttier art:
Comm hPolity' o OAS-FA.SYSfFbI-0VFA4(EA) .
UBIT RCATE OP d'S MWORKERS'
COMPENSATE NCE GRIASFIINDUSTRL WASTE INTERCEPTOR
(This extim need mo be comp i.IcorJMlue(510p) BUILDING DNISION EEL'S
a ls,uJ GRIiA51;TRAP 04 IIANCHECK PER
Icmlfy lhat In R nl the ww4 f'�/y�(
mo-ored,I had
ma angry tiny pc.a c�vtesu\i lar Left
CnmR^ SF:WI:R-SANITARY-STORM EA,2(X1 FT. ENERGY FEE
O Z vtira lam of Celi(ania C WATER HEATER WNEM/ELUCfR
Z 0 Appleton, GRADING FEE
rn NOTICE TO APPLICANT:t1liefa,r Id\g1f.Catifcuc of En niNion,you snmd WATER SYSI EMI BEATING
Iw.vne subject to the Wartrra Contpenmtitm provision,of her[a Code.you must Sols FEE
at gat frmhwirh comply withnmh pmvinimos or this lennit mall he,deemed revoked. WATER SERVICE
4'Q
�O CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMH. SQ.IT, PAID
Ihembyti0msdwt isecm fienlmdingegencyfanceperfoormccol Dare - Receipt♦
IL �-+ Nmi
e art fa which this pert is owed(Sec.3097,Civ,C.)
I-" Iadch Nude TOTAL:
WIav1a's Address 1 t
I verify that 1 have read this applirvimW Nmc lel the alcove informvion is BUILDING FEE
[aiJ cmmct.l Agra to comply wish ell city and county oNirunan and slmc laws mlaling m QTY MECHANICAL PERMIT FEE
U building construction,uM hereby umlsurin rcprs,xmmives rt thivclty to enterupon the SEISMIC PER
shove-menrilmN pnryerty for Impectiern pmlwsea. PERMIT ISSUANCE
(Ws,)eget to as,irdttmtify and kap trendless de City of Cupmim epiw Fri FMIC PER
livbilide,jtdgnrnu,cos¢card experu«which vary w any my came egdmt aid City
in comequc eMthe gvnirsg of rein lcrmiL AI,TERORADDI IMECH. PLUMBING PER
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,UW CFM) MECHANICAL FEE
SOURCE REGULATIONS
AIR HANDLING UNIT LOVER Iq(KKI CFh1) [pNSTRUCDON TAX
Sigarmrt rf peirenUCmvacmr - D. EXHAUST HOOD OMMUC)
HA'LARDOUS MATERUGelSCLOSURE HOUSING MITIGATION FEE
Will the amoicna or home hiding vemlent Notes,a hemlle hvudoua mounted HEATING UNIT(TO 100.000 BTU)
u clefinrd by vee Ca error Municilul Code.Chastiser 9.12,end the Health od Safety
Cod,Section 25532(11)? HEATING UNIT(OVER 100.000 BTU)
El Ye,, L]No VENTILATION FAN(SINC.1.1!HESID) PAID
Doc Rmeipt N
WIII the e r eatrate m encore building by the Bt six cyui it Qu or,M;unw which BOILER-COMP GHP OR IUhO110 BTU)
emit ief? a air conumirtmn,as Jcfrted by the Bey Arun Air Quality Memgcment
Dist/cR
[3 Y. F1 No BOILER-COMP(OVER 100.000 BTU) '
1 brave read de berifdau rrwttil rtyuhemrnn under Clugtt 695 of de,Cali- AIR CONDITIONER ISSUANCE DATE
forma Heelth&Sefcty Cdc.Scctitmx 2.55115.25533 and 255:M.1 utdasrvd thin if Be: NEW RISIDENIDA1,MECH. SQ.FT.
Emilding des nu currently have a tcmm,tet it Is my ovspuuibiliry,,unify the mvvpvn
of Bs,mqunttrcrur whkh man 4 ma Ixjuf m uwnxe of ca cedifican d'Occvpaw'.
OwrrmeudwrirN rgttll Dole TOTAL ISSUED BY
OFFICE