26659 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO ,i-El.EC ICA' PERMrr NO.
APPLICATION/PERMIT PLUMBIN<:.MP.cuANICAL
BUILDING DIVISION BUILDING PROJECT IDP,NTIFICATION 26659
BUILDING ADDRESS: d.A�. •7L0
1,-07�Z- SANITARY NO. APPLICATIONSUBMITI'ALDATE
dTI S. VI L UNRx LOT
OWNIRS NAME: PIIONE CO CIT)R'S NAME UC NO^:
U Q ! q NIC CONTROL#
ARCHIT iCDEJOINEFR: NO: AD S; _ l (�Q' ❑
�ONTACT: PHONE `J BUILDING PERMIT B:FO
QTY. ELECTRIC PERMIT FEE
BLDG ELECT PJ.Uh}B MECII
PERMIT ISSUANCE ❑ 1 1 Ip'I�
UCFIJSEDCON'IRACIlIR'S i DECLARATION RATION APPIJpNCES-RESIDENTIAL f IOB DESCRIPTION
p00 I70(K) ff Jotl3alb,,Bu..'provuimuot(Lugo9(camnariy with ^Q �)
LDOO Illi aUlafDivisionloflhcBuu«seesdPmfusimsCnde.endmYli«nseuin PANELS Re
s Toni rnr«.rw.0
FatW Ijcalee C I.ic.# UP'IO x00 AMPS
y,6=to Deo Co . m1-1000 AMPS
ZOyZ ARCHITECTS DECLARATION OVER 10013 AMPS SQ.FT.FLOOR AREA S/SQ.FT.
O Z—D l usldcnlud mY Pu^a shall be oast m publr ravrdv
F� SIGNS ELECTRICAL
�zKvOWNER-BUIIDERDECLARATION SPECIALCIRC�IIT _ (�A
igqi(( 1 hmrtby.Mrm Ihet 1 sum i,ml tsvn the Com utm's Ijame law for Ju
mLLQ`�i followi�rearnm.(Sxlion'IOJI.S,Buslrcaa and Pmfasims Cade:Mycity ormwlY TEMP.MEIFR OR l�
(:'_y g which rcquita a pmNI to cmnuuct*)w.imgwe.dare is or mpain any svucme 1' I IIII 1'
;FnYM miu mumc,elw POWER DEVICES
M
prim rtquim the eppliw.fmsuchpacutloLieevyrcd Yat'
Wzp14 O 9( heislicrnscd Wuumsnds)ov vtmof Ju Cmuauols nod PrcI ins Cq)
d0x , 9(rntht nos tmnpa Sauon'B"ht,D'lsision use the Buvirlasend lYAnyvwe Cadc) SWIMMING POSIL ELECTRIC_ VALUATION
u1—.n orioo731 ebyny.fmnn,ficarMthc brut mubj.k a,lipi to.Myl pd ,ya
�ZQ Sa.thul.56y hou li"Itrs($M)mit subjauthe eppliant toacivil pawryd '�- ��- RES Os /
� O oaa snare Jun rash hNny, r yenip. NEW RESIDENTIAL FL.ECLR _SQ.FI'.
� ❑ I,vaw«r Mlh pmgny,mmycmplayw with wegnuJeuxoleccanpwuim, TORIES TYPE CONSTRU O
ywill do Jrwmk,aM Thecmreurn's Liccdar Law
not
to so,Rmislef
erd Pmfevima CMe:The Conuumr'e license Isw d«s not appy to N owrcr of
progeny whomilch orimpvvalhemuL adwhodoa such work hl.melfulhrouSh his
anpoyw.pmvdad Jwtsuchimprnvemcnuaren«intcNeJ oraffaW fwde.D, OCC.GRO P .UNITS
bowers,Jlc Wildin8mirtrymvnrcntoadd widlin«x yor olcmlpklion,Ibeawtcr- TOTAL.:
bu11Nawill hamIM burdenof Proving Thu hodid mnbuildor impmveforPurr, sof
a.lc.).
❑ I.uowmrofinepop y,.meuluvivelycon Ln ngwilhliansedronue to QTY' PLUMBING PERMIT FEE FLOODZO "N
I.t ft pmjat(Sec.]DIA,Rum.a.d Profeuiuu Codc:)The Comrato:. n
Ijca Lal d«anol epplylowownnofpm,,:nywMbm&m impmvee lhannand PERMIT ISSUANCE 3 d
whoconrmcu fa au Jl projav with a Cmlracbr(a)IkemN pmuanl totM1e Cmuractor'a
I,iamelnw. AhTI'R-DRAIN&VIiNT-WATIiR(PA) � FEE SUMMARY
❑ I mn aeon#unler Sec. ,B&PC f«this reaaon SII)12
BACK FLOW PROTECT.DEVICE
SANITARY YN
(}wtn Dau RECEIPT#
/ WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,COND.
�111etehY athrm lhullove ac�aR of camentmaelf-imure.a•¢nit to of SCHOOL TAX RFCI:IlTp N
F1XTl1RE5.PER TRAP45 OD
Nmkcri Ctxnpmvvtim lmurarrce«eccnified eopytham[(Sm 3SW.1�b C.)which e'er PARK FEE YN
coven ell eedoye� mWn lhn pmn L RECEIPT#
Clicyy# Vb/1 -`l4 t e GAS-FA.SVS'IP.M-I INC. OUTLGfS BUILDING DIVISION FEPS
--'a��>qF GAS-GA SYSENLOVER 4(EA) P' CIIECK FEE
❑�rdrted copy a hereby with
Rhea
Certified ropyufled with the city impatlm division GREASE/WDU.SIRI.WASTE INTERCEPTOR GRADING IEE
CERTIFICATE OF EXEMPTION FROM WORKERS GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(Thuaeaion red not hcompaed lfNe pe.rnit u forme bmidretl dollan(SIM) SEWER-SANITARY-STORM EA.Z(X)FT. ENERGY FEE
u lev)
I cesify Jut in Jic perf«tmne oftie work for which lhle person is Luued,T all WATER HEATER W/VENUELEC1R
rat moPlor my person N any m.rma w u to 1 c subjen to the W«tai PAID
Z C✓n mulonlawaof Callfomia Due WATER SYSIEM/IREATING Date RaripY
Alglicenl
O NOTICETO APPLICANT.If.efts stoking this Cemif"u M Paatsptioa,you shouts NEW RFSIDEN1'IAL PLMB. SQ.FT. ;MTA�L'-' hcorm subject to lbs Workes Cmipewdm pnAximie of Jle l�bur Cone,You must
fmhwith comply with suh poviumo«Ihla pemat"I be hrnN revakeQ HUIg
CONSTRUCTION LENDING AGENCY SEIU ZI hemby affirm that Jiac u a caetnuuw Icsdlne epercy fm the pMornonce of
U C) dx work for which this pandt is ivucd lSm.Jo4JCiv.C.) TOTAL ELEN.
C) U1<idrl.Add.eaa QTY. MECHANICAL PERMIT FEE PL
U I certify Jot I Irv.reel Nu algliutim erd sure Ihot We above'ulfntttwbn Ie
>" H.1 caran.lagmetoromply with Hl cityard county mdirmcv erdetue laws reulin#lo PERMIT ISSUANCE ME
F" Wilding comnucrion.and lneby aulhoriu nnr tmive of Nis city to aver upon the
U Z above-mennmcd le.TatY for Inspection por, + ALTER OR ADD TO MECH. CONSTRUCTION TAX
(We) S,¢ to save,indemnify and keep bumlea Ne City of Cupenlm ageism
Iiabi'im,jWgmu4awamdcapascsr rh meyin.7y wey ecaye eine svd Cly AIR HANDLING UNIT(TO 10.aq CFM)
yi om of tM1e grwti o J1u J�. (IO.i1
.4111 O AIR HANMING UNIT(OVER to,"CFM)
Sid =of Appli meta r Due EXHAUST HOOD(W/DUCD
PAID
IIAZr fulum MATERIALS DISCLOSURE HEATING UNIT(TO 100,0(0 BTU) Wtc Receipts
Will Lie tfpCol or Tomoici nd Coccupantelms2,boodleh.canWra rmtvvl
uMi do lZ5532(cstim Mwidpd Code.Chega 9.12,and the Hallhand Safety HEATING UNIT(OVER IW.IpOBTU) TOTAL
Cade.Sadm 255J2(e)R VENTILATION PAN(SINGLE RID)
❑Ya ❑No NS
Will BOILER.COMP(3HPOR Ia.000RTU) ISSpU+.AN(�CEDAA1,
DiurM'f.air cmtanwunu m dcfiwl by the Bay Asa An Quaky Menagcrtent BOILER-COMP(OVER 1001000 BTU) 1�oIY
1 1 ❑Ym ❑No NEW RISIDENIIAL MECH. SQ.PT, AUG
1 hooe reed the hoodoo,materiels oqui.ts miler C'hnpef&95 of tic
Celifornu Ifs th&Sefay Code,Suoms 25505,25533 and 25534. I urcemnnd that
if the huildinyd«,e not uurtmJy ha.c a...o"t.Lha it is my to uibility to mdfy the
�uNn of the o,,horrlsnls which muse Inc mn prow to i.auttoce of Cmifrnte of
Gn � I!Y ur V irtl
.J
owMr or euNorlaL agent Doc TOTAL: ISSUED BY:
OFFICE