26879 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO , ING-F.LE MIM. PERMIT O.
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 26879
BUILDR C ADDRFSS: rySANITARY NO. APRJCATI(IN SUBMD'1'Ah DATE
ON"# LOT#oO
soWNP NA +ONE: CONTRA RSNAME UC NO:
i14N✓I�'O 7J 0959 we CONTROL#
�ARCHI'IECT/FNOINF'tR: LIC NO: AD S: +
Q 6 ���� ❑
CONTACT: PHONE
QTY. ELECTRIC PERMIT FEE BUILDING PERMITINFO
$LDQ TX PLUMB MECH
PERMIT ISSUANCE. 'L�-(C. ❑ ❑
LICRNSF.DCONTRACTORSDECIARA'IION APPWANCPS-RESMD AL
mwz Iherehy affmithd l anttinneed urderprnvuioru of Claga9(momtencingwil IT.DCSCRIITION
QWU 02 lull fr+a"erid)of effaitvision3of the Buairia,uvl Pmfes.iom Code.and my licrnse Vin PANELS
IP...Zw License Clvs Lic.N UPTOMAMPS
y?tA Date Cmtrsacmr XII-1000AIAPS
ZOyZ ARCUITECTSDFCGRATION OVER 1000 A10P5 SQ.FT.FLUOR AREA $/SQ.FT.
0z a I uMerdutl my plmu shall M uaN u publk enada, na
SIGNS ELECTwcAL rIn
°LB�
a ' trnxd Professional II•� V'
HSLi
< OWNER BUILDER DECLARATION SPECIAL C'IXNTT/ABSC. IT � \ (,-, t'�.
C"U 1 haaM1y air tWt I do esampt from de Cmensctas Lwrnx IAv for the 11 n
w pry following neaten(Serum'/031.5,Business and Rofasiom Code:Any city ce county TEMP.METER OR POLE INST. I IMI u
C-05 which requires pmnit u comtrucL alcor,improve,demolish,or repsair any assents,
��:IY� Tvinmiu lasuame,.fsor�dtea the epplioru for wide permit to fikedgrtd atntvomt POWER DEVICES
_OC ffiOltc is liccrxdpursuant to de proviaiouafthe Cmtnmur's Licmue Lsw(CIopm
as �' Y(mmmocin%with Sarim'1000)MDidsim 3MtheBuirXs and Rofndou Cods) SWIMMING POOL ELECTRIC AI VALUATfDN
wnar bar he is temp 11k efrrar arrl the hnvi,Lucius allegM exeroNon.Any violmimof OVDPfS-SWRCfffS FIXTURES
CZQ Sation7031.5 by any apps wast fora Permit staler the ap,liesm to a civil penalty of
m In five hurdled ddlvs($5(IDy
K p wrerof0epmpmy,mmyempbYaewith wa 0eiraokc NEW RESmEht11AL FLECIR _SQ.FT.
gnu oropemdiom SI'OR t5 TYCONSTRUCTION
y3� dldat v k,wdthestrunweianoiinicndcd«offctMfm,ele(Sec.7/ ,Bovttas
and Profccc.Code:The Cmoevi U.Law doss not apply m an awrin of
prtperty wlubuildsmimpmvn 0ertan,W w W hea.uch work hitrixlfor through bier
empbyee itdid,or ins,tatchimpnuvehenissrenot intudd moflrml fmda r. OCG GROUP NITS
however,Re W e imlewemmt la sold a did
year ofcomplctionr Bre ower
M1uilder will have Bedie burden of proving ihnt he did rW build m bnpmve for prupux M
We.).
❑ I,auwmrufthc prolenY.amcadurively cvnoatin8 with lintucdcmtrectmm Qom' PLUMBING PERMIT FEE FLOODLONI% APN
umtfuct the Enmjat(Ss 7064,Busimass and Prafuaiom Coda:)The Contramaia
I esn,cl.awduc.trot apply toenowteroflmperty who Wildsmtnprovn there�n,ud PERMITISSUANCE
whocaitecn fmsatchpmjecuwlthscontrxto(s)0c dpunuanttodu Cmtr 'a ALTER DRAIN (FA)
Dr.law. FEE SUMMARY
❑ 1 nth exonpi under Sec. ,B&P C fm this rtuon BACK FLOW PROTECT.DEVICE
SANITARY YN
Owe Um UNAINS-FLOORROOF. COND. RECCUT0
M
WORKAN COMPENSATION , . ,ON DECLARATIONSCHOOLTAX Y N
ElThereby eft thatlhnveeanifnm of eimsem mxlf-insum,mneatifenm of RECEIPT'#
Wmken'Compumtion Itvunsar,ce ors entified FIXTUR[S-PLR TRAP
PARK FEE Y N
versall emploYee.under this copy tliereoflSre JBaD,t�b C.)which
PolicyX pmrnrt OAS-G.SYSIEM-I INC. OUfLE1S BUILDING DIVISIONF�S
Company GAS-PA.SYSTEM.OVER 4 EA
IDCcr,dedcopylsbaehyfumighi ( ) PLANCHECK FEE
❑ Certifxd copy i,fikd xiN the dry irapectimdiviuoo. GREASFONDUSTRL WASTE INTERCFPTOR GRADING FEE
CERTFlGTE OF EXEMMON FROM WORKERS GREASETRAP SOUS FEE
COMPENSATION INSURANCE
(Thi,section dud that la,complemd irthe permit is forme hundred dolWsa($100) SEWER-SANITARY-STORM EA.210Ff. FNEtGY FTE
a loo.)
I cedlfy than In Re pefoomece,ofthe work fm wldch thupmnit is[addw lahall WATER HEATER W/VENT/F CTR
tut emPoY any person in eny nuneerx o m e beenssubject to die m
Wrsl ' PAID
z Cimpwm Liw
rnisrf California. One WATER SYSTEM/IRFATING Dem RaxipN
Appl am
z O NOTICETOAPPLICANT:If,after milking this Certificate MExcmption,you mi NEW RESIDENTIAL FLMB. SQ.FT. TOTAL;
V] b case subject to tIr Wotken'a C drxim Bon povi riau of the�Cale,You rood
forthwith comply with such pmvisicus ce thLL Enthral ilall he deemi revrrkM. BUILDING FTE
0. Q CONSTRUCTION LENDING AGENCY SEISM c m!
z I hereby grim the does is conwuction lmrditry agency for rte performance of
V O Lha wont for whirl this peanut is ranted(Sec J 7,Civ,C.) TOTAL: ELECTRIC FEE
OLcoc!c+x Name
LeMer•s AAdfesa QTY, MECHANICAL PERMIT FEE PLUMBING FEE
I certify that 1 have rem this epplicvion and date flan the above iofscmulm L
F" D1 carat.Isagra mcanply with Wcity amdcoumY«dlnumWswelmrtleutigm PELUffI'ISSUANCE MECHANICAL FEE
F-' ,, building cordrunim,W hereby eulorirs,trpvenwivn vDia city to into upn the CONSTRUCTION TAX
I, Z abovc-mentiorterl go,,edy for inspection ptirpay. ALTERORADDTOMECH.
(We)agree til save,iMcmmufy and keep hated...the City of Cupcnin0 epdmt
IiaNlitin,Jrdgmem.,mass and eapcnxs which may i ywaysanra vgaiEot1mICLV AIR HANDLING UNIT(T010.000 CFM)
in of the gRf this permit
7 AIR HANDLING UNIT(OVER 10.0W CPM)
,offignmurc fAppliwn rhai FXIIAUSTHOOD(W/DUCII
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT CTO 100,000 BTU) Dae Receipt#
Will Else,applicant«futuse building occupant dare or hardk huardaa eweaial HEATING UND'(OVER 100,000 BTU) 1'
u de0rd by the Culiehiro Municipal Coda cbs ger 9.12,sand the Ilmlth and Safety
Cade.Section]553]Ia)'t
❑Yes ❑No VFMIIATION PAN(SINGLE RESID)
ISSUANCE DATE
Willtha tm(uwmbuildin8onupmt tail ' BOILER-COMP(JHPOR IW,BOO BTU)
ecorimm Aren Air
a lh,rriurdoun nim yi,' nwu m defend by the tleY Aron Air Quality Mmmgerrunt BOILER-COMP(OVER IDDOX)BTU)
❑Yn ❑No NEW RESIDENTIAL MECII. SQ.FT. • ty'
1 have mad the,hancorkos mmaa s1,reavirrncnts under Cheptu 6,95 of the
Caufumis health&Safny Crile,Scctiara 25505,25513 ud 255Jd. 1 undentnmd that
if he Wilding •neoatcuocnily levee tenant,that it is myncspumablitytu ratify the 19
cecufant of the myuircocru which must be rent prier to ostance of a Ceroftrate of C))r vh ���
Omar m authMaM agent Dme TOTAL: ISSUED BYsi", I
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