24504 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINODI •-hLhU1'u CAL PERMIT NO.
PLUM
BUILDING DIVISION APPLICATION/PERMIT BING,-MECHANICAL 24504
BUILDING PROJECT IDENTIHCATION
BUILDING ADDRESS
.
}/'�� /�I� R SANITARY NO, APPLICATION
SSSUUBMITTAL DATE
C) �/—t • W v-`TINITN LOT# I l —L `-q 2
OW�Aaa 1(]Nyl CfOR'SNAME EJC NO: N(C MNTROLM
\RCIIITiCT/PNGINI?ER'. LIC NO: A D N ❑
CONTACT: PHONE BUILDING PERMIT INFO
Qfy ELECTRIC PERMIT FEE
BLDG IM A .CII
PERMIT ISSUANCE,
LICENSED CONTRACTOR'S DFC RATION APPLIANCES-REST TIAL
mwz Ilcrebyeffnntlutlmnlicrn Mole vuiaaof Chapv9(mmmveingwith BDESCRIPIION
+I LOO Section 9007.(Division Jnfthe Bus—,Mel Profession'Calle,and my licenm is in PANELS
y U fait font aM cIf Ser •1 G% UP 20( �b
Qy .in,ue Lie., 1
Council.,TSD 20 000 MPS
Z Ova'iL Cuff he used ma
SQ.FT.ROOR AREA 5/5017.
OZ— IUMenlenJmypWsshellbcluCdupubldremrdv O IL\q AMPS
ryF 'NS ELECTRICAL 7� \I \ L Ia
<yrE[ Licensed Pmfasiaul
ay1t1U OWMR-BUILDER DECLAJOVHONSPEWI-fTqW. C.
X5�OIyR. 1 Aembllirtn
y athatm 1 eexpt embrainthe Cunlnarc 's I.idnu w IAC V
,sJ3pN<
following.(Section 2031.5.B.dra.and Pmfaaiom Case:Anyci,y m ly L POLE INS
C Ea y J which"at.a P end,to corLVrua.ally,itttgave,demolish,m repair my strut
S pr'v to to i,aM ,ales.rcyuirei lheappliceni for such permit to rile a signed sha PO Jt ICES
ace,s� a ) Wt he is licensed T+ulrvanllolhe Provisions a lie C.nI.Mrs Liernu Los(Chwe,
6Lo�' 9(cammneing with Section 7").f Dirmon 3 oflllc Basinessa
EI P.ofi.Code) CIUC •�
VALUATE)
dthaiheiaexmrA[ fr^mnthuvisf. thcallegalemwMyvelaof Gt6
ppkieMof FIXTURES Moa 7031.5 byny.,plicin,frirapmnit subjecu theac
not more Iten Eve Mdml"I.(50 . l03IJf�/awa
�'[� ❑ 1,¢anwnerofthe propanY.dmyunp1.yees wild wagesaa tacutudecanpenwiun. NBW IDENTIAL ELECfR _SQ.f7. RI TYPECON ON
y3_ will do this,work.xM lhestrunure urea intrnl l a.ibcood for aide(Sec.'1M4.Bushes
aM Professed—Code:'Dle Cutlracter'a Licasse law da¢nut apply to an mwucr of
propcny who builes or improver therm,and wtocloo swch wok himaelfathm.gh his
empbyen,pnrvidMtlw slrchimpmvrnenuve rid lnlerLLHaoBemdrim We.If. ' t OUE NITS
h deice ill Wet1he orimpmremCm u mIJwithin arc Yeg or mmr,ve for theow,lerf C
Wilder will Iwve tFe harden of proving IhBI he did not bund or improve for puryoc.( G
solo). QTY. PLUMBING PERMIT FEE APN
g61N[t the pmjecs(Sec.9014,Itmittea and Nofe.ssitms Code:)The Conlnmar'rIF —
licvueLa ber.sh eVecta^ownero(proo t)aha builds aimpmves Carr ,add PERMIT ISSUANCE:
[it. awe forwch projCclawitAuconuecla(s)IittttsW gtnwwmlltcCmtnctor's ALTER-DRAIN&VFM'-WATRI TA)
I.icrne Law. TEE SUMMARY
❑ 1 vn<rempt.,der Sa. B&P C fa,his,uxm
BACK ROW PROTECT,DEVICE SANITARY YN
Owner Date DRAINS-FLOOR,ROOF,AREA,COND. RECEIPTN
WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N
❑ Ihcrtby MlB,m IMSlhaveeartif ate al N¢Y,Il to aeB-Iwue.decerdficutc of FIXTURES PER TRAP / RECEII7#
Workers Compmwtiw T,ssuvnrcmaccniricd copy thtteuffs<zJBW,Irb C.)wNch PARK FPt Y N
mill employee's Moder the permit GAS-G.SYSTEM-I INC 4 OUDETS RECEIPT#
boliryN �� BUILDING DIVISION LEIS
C.mpanty GAS-EA SYSTEM OVIJt 4(EA) PLANCIIF.CK FEF. �O
❑ Catifed copy u he,eby fltrrdshcd.
❑ Cenifedcopyufi dwiththecityinspeelimdivuiaa GREASIONDUSTL WAS-M TNTFRCEPTOR GRADING FEE �.
CERTIFICATE OF EXEMPTION FROM WORKERT GREASE TRAP SOILS FEE
COMPINSATION INSURANCE
(This.actim tteN ou be svrnpleicJ iflhe permit is fm aic hundml dallera(5100) SEINER-SANITARY-STORM E.A.20017. ENERGY FEE
m les,)
I emifY thw in Me pMomlaett.fthe wait f.rwlech this percri,is usuM,I sM1il1 WATER HEATER W/vEJELF-CIR
nd employ any ycrssa in any orainisir
so
as to beans subject to Me Woroot' PAID
Canp^s
eoba .-awaof CilDat
irornw. Date WATER SY,SEM/I'REVDNG n"�• RaacipN
Q z Applicant
Z 0 NOTICETOAPRICANT:Tf,aflernWingthiSCMiriauoflieemption,yoUshmld NEWRISIDP PLMIL SQ.FT.
Fbnvrc subjctlo tAe W.rkrr's Canprnsaion pmvidom of Ile lsbar Cede,ya mart
a ruMwilA comply with such prvvisiaudlhu pe,mil shill be deemed mokM BUILDING ITE ^ate
Z CONSTRUCTION LENDING AGBI, Y SEISMICFEE
I hereby aR Butthen u ar.tion lading agcrey for de per(.,of
V O Me wank fir which this Permit is mocal(.Sec.3(99.Civ.C.) E].ECIRIC REE
Lender's N. PLUMBING Mr.
I l
Q Irnd -Mf,y QTY. MECHANICAL PERMIT FEE
cmify that I have tad Ihi.r eppliumian aM sae Out Etc stave infommtion is
�"' corral. lagnce,o comply with Jl nlyaM county adirurea end ne¢Irvs rotating In P13RMD'ISSUANCE +� MECHANICAL IEC
I aa
F' btuse-MeM wed ,,.ad herebypanache rc,emwiscs d'thiadrylo rnlec upon the CONSTRUCIONTAX
U z xbnve-mentiareJ orr.penyfa iunify nim seen has. ALTER OR ADD TO MUCH.
(We)Mgree 1.save,iaodc,s y and ACCP harmless y y of mento dsI C'E t
Iebilitics ariii H.mwaM Cxle¢scswhich may! Mny wyamue egd,ut viol Cry AIR f1ANDLING UNIT(TO 10.000 CEM)
Jnli of lha6. ' prnniL
AIR I]AN IDLING UNIT(OVER IO.UO(I CFM)
Si •of plirunU mtacta u EXHAUST HOGG(WIDUCq
PAID
IWARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) �a Da¢ Rcce A 0
W Il Ih.applicant a faire Wilding suupwl store or hurdie hewJau materul is
sdefimd by Be,Cupenino Municipal Cade,Chapin 9.12,and the Ilealih vol Safety HISATING UNIT(OVER 100,000 BTU)
Code.Secdm 25532(x):' VIIJ'lIL'ATION FAN(SINGLE RESIDE D t
11 Yen ❑No
ISSUANCE DATE
Will IAeapplicantd faun building by the ,use Are Air ordevimraw remit
BOIIJiR-COMP(JHP OR 100.000 BM
�hvvJ.us air cnnlami,latns m JefinM by the Bey Area Ah Quality Manegntenl BOILER-COMP(OVER I00,Bg)BTU)
/ Disaicr'!
Cl Yea ❑NoNEW RESIDENTIAL MECH. SQ.17. R] ,A O
I have read,haam
e hdoua mvefinu 5%S,cments.Mer Chapin fi YS of theC. r YU
iftho building
&Safety Codc.Seer hoo55115."it
yrepaandi :41. IuMnstvd thin JAN - 5
if Lha M1uilJing dote Mal cMncmly have a team.That ii iS mY repocc of iry to tndfy the 1993
��"t Mthe rtquirnrents which must bearea prim to iuuvec ole Cenlfcatc of
(kcuTmncy.
1
C1117
,d ISSUEDBy:-yL:1:51 :!l j
Owrtnmeu,hmiud og
` OFFICE