25191 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO ItUILVING l 2 5191
APPLICATION/PERMIT PLUF181NG-MECHANICAL.
BUILDING DIVISION BUILDING PROJECT IDHNI'IF'ICAI']ON
BUILDING ADDRESS: I,! UO• Dn SANITARY NO. APRJGRI
TN SUHmrUAI.DATE
fej� ODI 1 - UNUN Ivy L✓OT4
OWN SN E ON CONTRACIDR'S NAME LIC NO:
d NTC C'ONTROLY
RCHITF:CDENGINEER: LIC NO: A S ❑
COM'AM PHONE
"rq QTY. ELECTRIC PERMIT PEE BUILDING PERMIT INFO
�t� 1
BLDG LLE ,U MECI{
PERMIT IssuANce
LICENSED CONIR iCTOR'S DECLARATION APPLIANCES RES
pcc Ibeach,7")off) that lem ifteil tmtlmoUtomanfChapter nscodo9(commmcasaisin DISCRI N
�'CO[ Smti ]aao)of Divisi Softh tlumiesaWP(m�rwi«u Code,arM my licemeuN pANpS �1.
FFa.ZU fuavc(ud c(fmn. Iic.Y `-\ - 3 RG UP TO LIOA
r�6d Du< Cmiwcmc -aUuicd -1
F� RCHITECTS DECLARATION
O'/z-a I unJcn y plum shall le rscd as public ncords. VEA SQ.FT.FLOOR AREA SISQ.NT.
Cyt Lirxn.ved l'n,fwitxial NS /
�Y Q OWNER-RUILDER DECLARATION C cuumSC. `
K
jNOyF I ncrtby a.(S thou 1 31 ucmnt from Nc Cmictim 's Ii«rue I�w co the
W 13i.LLO p¢' following moron.(Smtim]0313,Busbea errd Ymrcasiom Code Any<irywcouuy .METER OR POIR INST.
which na,ai.a permit to conwnct.alum,Improve,danolish,or.—any swcnne
fK N� prim 1.1.i.uran«,slimregri«s Ne npplirwnt hnauchpmudt to f lea allot mmevt POWER DEVICES
W_�p that k u Ilc a Pomona,to the pommits of Ne Conmct "tiurae IAw(Chapin
daX.FC 9(.i.,with S,,Gior,7")a Division 3 of Ne Bosm.and Pmfecdon,Cade) SWIMFHNG POOL ELECTRIC VALUATION
W❑N or tout he is escmpthcrcfmm and ma,c bfm theHkgnl esemntim.MYviolatim of PUTLETS-SW ICHES-FIXTURES �� OD
tZQSctlm,tIttm by miYgcd claHf ($N)T,tsubjuv Jse applkvtt toecivil pAulty of
z nth dp-
m.wownEvchmdmJ da,wmym).
�C$ ❑ LIN, ofdepsnactu orsnotia oymwWwaYnvtlit,( .Z NEW RESIDENTIAL ELECIR _SQ.FT.
pmvrim, RIES TYPF:CONS-IR N
a3_ anal dodework,Colo; awctuaianmintmemmofferNot not oWlytoan.euonm
nM Pnfcssinns Cuk:The Cmurcmrs ani Law docs not apply to an gh of
O"Mplohrbuildr«improve toemoov wlmdo tint n n off vfxm ,his
wnemporr�.lno.'iaw wt.NCl,impro.m�mu.mmimenaaa.orrer�d roraw�.if, u NE)i Ts
howcvcr.the building or'unpovcmcnt is.wld wlthlnorc ywo(rnmpledm,the owrcr- TO - % L6_. 11�1a
bwldm wall love the buNm of poring Rat he did rant buiM m hnpmvc!m purpoac ofOmpu
❑ I,uowrcrofthcpopny,amcaclurivclYmnrrenluq wlNlitttud cmtractm to QTY' PLUMBING PERMIT FEE FLOOD ZONE�4
� N
c«enuet the NVcct(Sec.1014,Business anal Pmfeaims Code:)The CmmNGo.'. PERMIT ISSUANCE' �� DATE
License Low Joesnrt apply to an owocrof popeny who builds ar'unntova therein,arnt
vhocvitracufor such pojau aoN aimannctar(s)lirenxd putwm In Inc CoomxtKa
Li«ve Law. AL.IER-DRAINA LENT-WATER(FA) r► FEE SUMMARY
❑ I am enempt urudn Sc. ,B A P C for Bila rearms BACK FLOW PROTECT.DEVICE 1
SANITARY Y N
Owncr Date— DRAINS-FLOOR ROOF.AREA.COND. RECEIPT'#
WORKMAN COMPENSATION DECLARATION SCHOOLTA% YN
❑ Ihrrtby affirm thetl laves«nif eofwnant to xlf-inaurt,mecmi0cue of FIXTURES-PER TRAP RECEIPT'#
Wmk,%'Cmulen.mtion Wuwt«ma«nJicd cant#thnmf(Sec.3800.VM1C.)which PARK FFM Y N
Policy# 1L'I-� Q GAS-GA.SYSTEM-I INC.4OUTLETS, RDIVL Y
LDDILL
BUIING NFEFS
Company 4�Li? FU.y GAS-EA.SYSTEM-0VER4(EA) - P,ANCUECK HE
❑ Cmifu 1 uyy la M1ereby rumishd.
❑ CrniO i copy is file)with the city itupectlan Division. GREASFJINDUSTRL WASTE INIERCEPfOR
GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS HE
COMPENSATION INSURANCE
01,1, 6.ucd rmt be completedHNe permit u for one hard.edde0m($100) SEWER-SANITARY-STORM EA.200FT. FNFRGY FEL;
n lea.)
I writ,this in the Puf«nmi¢of this ww4 r«which this pmnit u issued.I sJoA WATER REaTFR W/VFM/ELECfR
no,mploy any pn oso in any mama an u to Iecavu abjen to the Workvs' PAID
O ,Z Canpenntian"wsof California. Ute WATER SYSTEMUREATINO Due Recc"#
A,fiaa a
Z 0 NOTICE.TO APPLICANT:ILeM making this Cmifiwe of EeempOm.you should NEW RESIDFNIIAL PIMB. ML FT. TOTAL;
L^' hcmusobit"to the Workv's Compensation pmvlalan of the lug Core,you smut
FF-- f«Nwid,mm Ply with wch morisi«um Chic permit shall be hrnr4«yoked. BUILDINGF
GQ CONSTRUCTION LENDING AGENCY SETS
Ih by aff that there is ewnmuctim lending agrnry fm the perf«merve of It-
T EJMCDHC
U p this,wmk rm which Nis pmdt hits... (Sm.Doff/,Civ.C.)
Irnd e.Nair
0 V. rr In AM. QTY. MECHANICAL PERMIT FEE PLUMBING F:
LQ 1 urdfy that,I ti«and Nu apPliaim evil sure Ntl Ne.bort infomaJon Is
atorten. Iegrea to cmnply with au city aril count,mJinv tux]state laws mlatingto PERMIT ISSUANCE MECHANICAL lw
r/J building cau'ucamon,utl hmeby suNmiss rcp naris oftltu city to mm upon the 15
V z above-mrnuorcd properly fm mrpa.Tim Pse o ALTER OR ADD TO MICH. l' CONSIRUCII TAD(
(We)agra to sever,Indmanify cont keep harmless Ne City of Ca�enina agalnu
liabilitics,judemmu,cmbaod=p which nay inany way.ccmc agaiw a aid Cit, AM HANDLING UNIT(TO 10.000 CFM)
in
entt of Be IPantin6 of Nia pertnit.
/ 14}I�,/t (�.�L AIR HANDLING UNIT(OVER 10,"CFM)
y s [ S -4
Siptmumof A,Ti�mmr csr Dmc EXHAUST HOLD(WMUMD
PAID
I IAZARDOUS FI5TpR1A1S DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dat, Rcccmt N
Will the nlplicam m future builJing occupant alma or nendlc he`sNous nalcmi]
u dceu�by ale Cupenim Mtmicipel Co ic.Chanter 9.12,acnt Jre HulN and Safety HEATING UNIT(OVER 100.000 BTU) L
Cade,Salm 25532(.)?
❑Ya ❑No VENTILATION PAN(SINGLE RPSID)
BOILER-COMP(JHP OR IIXt,IXlO BLV)
ISS
DATE
/../ Will the appiranmrfrmm lvildingoccuparn useeyniFncmmdevica which emit .1 p I D
A 4vpadoua air mm.nNunu u dcEnd by the Bay Arca Art Quality Maeayvrcu BOILER-COMP(OVER 1 W,fgO BEV) /_ M
cine ❑Yc. ❑No
NEIL'RESIDENTIAL MECH. SQ.FT. JUL 1 3 1993
1 hive reed the hvmDms u Ilwo,s rcquiremcnu uMa C.1 co 6,95 of Nc
ifthnmio IIeWN&Safety Cade,n,tlw 25505,2553]and oro I onfifthis y)II Nf
if thenuildinQ d«amcunen0ylureaterun0NetiIa myceapaeibila cmdfY the FYUrCI'71II`Il/
�«apant of trr regrircmcms wmen mnu Ic�m pim m ia.a.rtae of a emiR«te of
oreapm y.
Ownm ur eutluxlzcd again Dae ISSUED BY: