25399 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO PLUMBING-I."EiL AICA L PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT ,,BUILDING Pill IDENTIFICATION 25399
BUIIDINGADDRFSS: //_'gyp SANITARY NO. APPLIGkTIONSUUHMH7A1.DAT
D6 S' a'✓a' �� UNIT N LOTH
WN SN E PHONE CONTRACTOR'S NAME, LIC NO:
-7 NTC ONTROLN
A CIIITEC7OhNGINEER: LIC NO: ADDRESS: ❑
ISINfACT: PHONE rs.
ELEMIrr,a"; +'..p.. ,.,T',"'
. BULL-DING PERMIT INFO
vQa iY:..aw'.rW" i ni a FEE P"
BLDG ELECT RL 10 MECH
j PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL ��IO
mwz I lactry affirm thu l am Recruited] pwu
under oviv °fChapser9(avmeercing with TOB DESCRIPTION
I C C Seenorfail fi
ccor
°r n off(KDIIvisii..3 of me Bwirwa and Profmiau Code,and! PANELSy It.m in PANS I
t2 Z... 11<ense Clu/ l(� U- .x 7�_ UP TO XIOAMPS 4-
Canuaeurn I 301-1000 AMPS TT O
ZOyZ T�7v`T XItCIIRLCFSDE Li SQ.FT.FLOOR AREA 5/SQ.FI'.
C'G-C IunlermwW my p4un mlWl bed iwpudic ramd� OVER IOOO AMPS
SIGNS ELECTRICAL
QYaJ Gandhi Pm(evnovl
OWNER-extent
asBUILDER DECLARATION SPECIAL CItCUIfRASC.
XC a FU 1 hereby affum thou, am exon"frau the Covvcmi s Lvenu w lafor me
fullowingrcon.(Satinn 7031.3,BuvnmWPmfevimu Code:Any ciryarounry TEMP,METER OR POLE N'ST.
wh'rh rtquim.penr i,to con.."after,im
prove,dertwlish,of reP.'v my swcoue
priormin u.uana.ditto rtyuirm me applir Ira With pvnut to fik N.igmi sutumr POWER DEVICES
I ihal he is li"oed no..an the prvlmannoof me Cow.cta's Llmue las(Ctyrsr
C v,_r�C V(cmmtrncing with Semon 7000)of Division 3.l Bung.... Pmfaiav Code) SWIMMING POOP.ELECTRIC VALUATION
(ka- y
an,thud he is comp thaefmrn read the bud fer do Mk-,d cacmption.Any v.hom of
tZ} Scctivn7031.5 by try.'Hi fa.permit Whop.the iipfi® to rcivU pmalry of 01 T -SWITCHES-FA-IIIRE-5 a �DD-
Q ml metre than five hundred&Mars[55001.
zF° ❑ I.uowrcrafthepmperty.amyemplo maim NEW RESIDENTIAL ELECIA _SQ.FT.
y wageuthcvmokcompvuatim, STORIES T'PE CONSTRL O\
3'�- will Jo me wak,code:
hectoreunatirumded Lowderawe(Se to H.Buircu
arttl Roleuiorim Cotle:The Catvanor s License law des not app1Y m m owrcr of -_
pmpmy wnawdama imprrremtheann.and wnnamm.mt watnimmelra mrragnw
emplwm,prorMd I,e such impmvmenu Kvar inmddavffertd fatale.IL
OCC GROUP R NI S
he
owver,the building or ecf cment is sdd within vre yruof emtpletiw,me vara- TOTAL:
builder will lone e burdco en of proving thu he dM lett buildaimpmve fm prupm of _ p
Q>•Y.y�"Lily PLUMBING PIRMII'2- ;.`F. " .FEE J. OOD ZONE APN
❑ I.v ownu rf de pmpeny.amexclunvelYcmnrctitry aim lkm iemvanmty - � !,
act the pmjat(Sec.7044,Baaineam amt Pmfmiau Code:)The Conmeta's err
U.lawdae nd.pplywmowxrofpmpmywb DuiMa aimpmremacan.md PERMIT ISSUANCE
who eno.far such pmjecu with econvrtafsl lieenmcd purmrnatvthe Canuura's -ORAWdVE,YT-WA
Dane Lia. �) FEE SUMMARYrc:- ..
❑ 1 un exmtpt muter Sec .B&P C fa this omsan _ - ---
BACKFLOWPROfECT. VI ( .. r "� '
T N
Owner D>e DRAINS-FLOOR,ROOF. .A!'CDrhrl\/ _ ��II — L AX YECEIPI'x N
WORKMAN COMPENSATION DECL RATION ( 0
:-.�Norkash'tan°I;w�-.ortltuonettual "nr°n¢° weasiTial copy 'mvcor(S¢3g00.labC which 0 / A RECEB'1'♦ N
FIXT/RFS.PER TRAP - `
-- - ves.ellcmplo,Kj yMer tp�permit. McFflN
�y C(yQ GAS-FA SYSTEM-I P'C.iO
PoIcSN UILDLNG DIVISION FEES
COf1Pj°y ���Nl6 GAS-EA SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cenifrcdcopi, yf
`e Cvtifrcd copy is flN.im me city itupecum&vwo, I GREISE/INDUSIRL WASTE INTERCEPTOR GRADING FEE
(� CERTIFICATE OF EXEMPTION FROM WORKERS GREASETRAP SOUS FEE
COMPPI.'SATION LNSURANCZ
This¢s:nan need!not he mroplerd it permit is faos hunmd dollen(SIM) SEWER-SANITARY-STORM EA.^00FT. ENERGY FEE
or ITh.)
I nrdfy thu in the penfonunoe a the took for wldch dds pvtnit u iss,d,I..-u WATER MATER WNFNT/Ell
na emWoy any pttsai m Thr.of to to beenne Wil to the wonoor PAID
,Z Canpenvtim laws of CJlfarJa. Due WATER SYSTEAVTR&CTING Due RaciptN
A,Iic nt
z O NOTICETO APPLICANT:If.°fico making mu Ceral of Eaentdon,ym should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
fn Demme ubjeea to me Wahc'r C�pmudm prwisiom alh Labor Coda yw rmm
� > fumwim canply with much or this pemrit Nall be dened revotetl. I BUILDING FEE
a C CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z:, Z 1 thereby off dad mere Ire,cmbucum temierg rgerey ra one".Tartar¢at
U O the wort for which this pe.,is ivaed(Sec.3097,a'.C.) TOTAL rs� ELECTRIC FEE
IedO'm Nalre -E,4 r(. JIr�AY3 ' Ywe'6 as♦,ra
IerWer'.Address Q7',Y.- ." MECHANICAL.PEFMT'j, Lr, - PEE lY� PLUMBING FEE sl]
I cmrifLLIy That I have read this nppliarim ad made thu me.bade Nfamuim u -"C' - 't.w nar._.0"'v'-M, " `•, X'�,:
>-' a. rnnav Ivgrte mcomply wiN Jl ciry aortl caumy orrBnancv and sou mw.s rtlrnngm I PERSIT ISSUANCE. MECHANICAL FEE
f-' ,, building cauouetim.aMhereby.umaire mprumad ofthis mr,to mef upon de CONSTRUCTION TAX
U Z :move.,ioted poperry for impa'tion porpmcm. ALTER OR ADD TO MECH.
We)agree to mm iradcmnify and keep ha+mlm de City of Cupenhn agninmt
liabilities,judgmenu,a mW expertm which mayiruy weyacmre 21 avid Cry I AIR HANDLING UNIT(TO I0Il CFM)
•N f the f this permit.
AIR HANDLING UNIT(OVER 10,000 CFM)nreaenaa
u or AppthcuWCmd.cta pad EXHAUST fI00D(W/DUCII
PAID
HAZARDOUS MATERIALS DISCLOSURE I HEATING UNIT(TO IW."BTU) Dole Rete x x
willthe appli=t or future building a ,aur sae a handle haaardous muernal [-
asdefndbyflue CuperairoMuniciptUnite,Chepter 9.1 L ad me Health mJ Sum I !¢ATLNG UNIT(OVER,1W.fA0 BTUO TOTAL aJd
Cde.Smian 15531(.)7
❑Ye ❑No VENDLATION FAN(SINGLE RESID)
Will me pliaantmfumm buildingoavpmtmc I ROLLER-COMP(3fIPOR IOO,OpO BTU)
ISSUANCE DATE
rep equipmir Qu thvicem.,conem
haamdvu all cmtamiwnts v rkfired by Ili Bay Am Air Qmliry Mawgmmt ROLLER COMP(OVER Iro.000 BTU)
❑Yo ❑No NEW RESIDENTIAL MECfL SQ.FT.
I have read de M:udau rrocnJs rcWumam undo Clu er 6.95 of the �OV 1 1993
Culifomu Ilculm A Safety Code,Sadao 35505,}533 road 255N. I uodenuod mu
if the building dm not currently Mvc o tenant,then it im myI i,nudlity to ratify d,e
u oI me ro uiremu w
enhicmn
h.be pi-m m.of a Cern..of
'
Mncra uum«iad ugent Duu TOTAL ISSUEDBY: