24741APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPER'fINO PLUMBING MECHANICAL
APPLICATION/PERMIT
BUILDING DIVISION BUILDING PROJEC1'IDMNTIPTCATION
PERMITNO.
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L 4
BUILDINGADDRE.SS:
SANITARY NO.
APPLICAT[ONSSUBMHTALDATE
UNIT# LOT#
Z� a ..Z
I —`J
OiVNLRS NAME PHONE: Oe-
/CTGti/!/ S/>��A32DJ C. 2J�-2 CC
COYIR/A�CfOR'S NA LIC NO:
y
NtC
O
CONTROL#
iROIIIECDLI401NEFR: LIC NO:
ADDRESS:
CONTACT: PHONE:
QTY. ELECTRIC PERMIT PEE
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE
0
LICENSED CONTRACTOR'S DECLARATION
I hereby afOw that l unliunnedunderprovuion,ofChu er9(calmnencingwith
APPLIANCES -RESIDENTIAL
JOB DESCRI ION
PANELS
S,,ticn 10(01 of Division 3 N to Buainna and Peofeasiwu Code, and my liccnx is in
full force and effect.
U. 0. Lic.0
UPT0200AMPS
Dale Conran-
201 - 1000 AMPS
ARCHITL'CTS DECLARATION
w
I undcnul my plan, shall he uxd a,'Wie secants.
OVER I000 AMPS
SQ, FT. FLOOR ARCA $ 5Q. lel'.
\
LED I
SIGNS ELECTRICAL
liarocd Nofcvi-el
OWNER -BUILDER DECLARATION
I hereby df tem exempt 1 eexemau pt frEsc Contractors ois Lilaw for the
SPECIAL CIRCUIT/MISC.
}^(
TEAT. METER OR POLE INST.
full..,oceson.(.Seninn]031S, Business, mud l4ofm',k-a Code: Any city i, or,
P UTE , a
which require o permit m coewve,' mEr, improve, demolish, or tepvU tiny seunone
prior m its issti.e.alao rryuims the ulmlictnt Ter such lxnnit to flee aipW,tetcmenl
POWER DEVICES
Ilan he is Iicynaal suruunt m tc peri-. of the Cenux'm's license law (ClasperDATE
9(commencing with Section 700(E of Division 3 of the B -poets and Professions Cede)
ALUATI '
SWIMMING POOL ELECTRIC
m thou be is esemp,herefranions! the bmis fn the elkgcd esern,nion. Any Holm—of
Sacci -1031 5 m
by y ti,kno I-. pmt,,.bje
cc. lose ppllcant m rn
a civil pahy M
OUTIITS-SWITCIItS -FIXTURES
,titin Bve hu Aollafr(f5W).
Ltisownernfthe ppeny,orenyemploym with w,.,.tcirtinka
cnpynwion.
NEW RFSIUFl,'DAL FlECIR .
5 Q FT.
STORIES
TYPE CONSTRUCTION
aruc-rhount intcndeTmit. fnrolc(Sec
un,thssitos Cdtc
and I feoions Code: The C -tante', Liana law don not apply or tin owner tf
properlywhobuildsmi l
M1irroclfm through his
bustsuthemes,redwM10 mnobfihwork
own cmpinyca, providcllJW such impmvcmcru, ane nmletcrdN Wei fa,ek. If,
OC GROUP
RFS, UNITS
TOTAL:
Inweven ie building or i -pave -crit is sold within one yrs ofrnmplciion, ft owrcr-
builder will have the hmkri of pmving that he did no; build or improve fa puryose of
Qom' PLUMBING PERMIT FEE
We.).
❑ I,nowrherofte prvPcr,Y.amnclwivclYcmhurtrtg wlthlittnsN eontrxrm,o
FLOOD ,O L
AIN
amhoict the berries, (Soc. 9014. Business erhd Pmfrx,ions Cede) Tic C -,rector's
lirvue lrw donmtapply Ian'owrcrofpaupcny win buldarcimpovcr lherc9rt,W
PERMIT ISSUANCE
who,—wets for itch projects with. conbru'mKs) I..d punuun,.,he Coet-noes
U. law.
ALTER - DRAIN & VENT - WATER (EA)
FEE SUMMARY
❑ am csanpt miler Sec. , B & P C for tris ream
BACK FLOW PROTECT. DEVICE
OMIDEFEEs
Owner Dere
DRAINS - FLOOR, ROOF, AREA, COND.
SANITARY Y N
RECEIPT#
WORKMAN COh1PENSATION DEMRATION
❑ Ihe,etry tiff twlhtiveaceni0utc of conxn„o xlf-insure,avicertficae of
Wuteri Cempersall mle.see or. eatifiW copy tcreof(Ssr. 3500, Lab C.) which
SCHOOLTAX YN
RECL'In#
FIXTURES PER TRAP
PARK FEE Y N
OAS -F SYSTEM -I INC. 4 OUTLTS
cieverit db cmpl'." mdyr Nis Perron, -
poic, #
RFCEI"#
BUILDING DIVISION FEES
Cornpany
GAS - FA. SYSTEM -OVER 4 (EA)
PLANO BECK FET?
❑ CeSW copy is hereby fnhishec.
GREASEANDUSfRL WASTE INTERCEPTOR
GRADING FEE
❑ CmihN eegyu hlM wiN teeny irapnpmt division.
CERTIFICATE OF EXEMPITON FROM WORKERS
INSURANCE
GREASETRAP
SOILS FEECOMPENSATION
SHWER- SANITARY - STORM F. ZD(IFT,
ENEWY FEE
(Thls,ectan reel nmhem-pined ifthepmdbia (m arc huntlrtd ddltin lglro)
Nr'.)
WATER HFATFR W/VFNUU-LECIR
- I certify toss in tc pMvrvarce of We work for which this permit hii,seed, I sPWI
nv cmpby any porn in any men as ,n haven: subject w the Workers
PAID
Compcmuvnuss'.f CGllfmrdti. One
Ap,Ai,mu
WATER SYST L RFATING
6bc Rylip#
NOTICE TO AMACANT:If, after, making this Certificate of Exympivn, you sNouW
,vriss,hpob,offic Worker's Compraati—ti—isinvof tc LiFbc Cede.you on.
NEW RE!I]DEN'HAL PLMR. SQ. FT.
TOTAL
fu'hwith--ply with such povisimu« this pertN, about he deemed nvoky.
p k ai�
BUILDING MT.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
IherehyeRrm tut there u aamvuni- h,wingagrnay for the enfomunxof
TCTIh
ELFCIRIC FEE
the wok fm which this permit i, isw l(Sec.3091, Cis. C.7
Lenlcr'a Narrc
.Lcnder`,Ad ,
QTY. MECHANICAL PERMIT FEE
PLUMBING IEE
I certify Net b have rmd this application ad. thin Etc tibove Infor-titan is
arras. rages b9 romply with nil city aril uanry lxdimna, ural ante lew•mlaingm
PEFtMl'T ISSUANCE
MECHANICAL FEE
building c.lion, and hereby tiutariac reoa mouser d'his city -enter tpon the
above-mmton,d for in,lcai-
popery
ANTER OR ADD TO MECH.
CONSTRUCItONTAX
kneft Ke.
(We) agrte,o sive, irrdenmify tiM keep harnrlcaa the City of Cupenirudo
liabilitiy,,judgmrn's.n.us and capnscr which maue any in any way ucagaw wk City
City
AIR HANDLING UNIT (TO 10,000 CFM)
n caasecu of e#mhtng of,hu permit.
AIR HANDLING UNIT (OVER 10,000 (FM)
CH
[XIIAUST HOOD(W/DUCT)
PAID
10
#wore of Algliavnh/Conwcmr Dem
HEATING UNIT (TO UK," BTU)
I TAVARDOUS MATERFAIS DISCLOSURE
Dae Reaip #
Will tee epplia- or future building acvpann on, a handle hvadw, mueriel
it, rkfnnl by the C,upynino MuniciptilCode. CTuper 9.12, and the l lnith and Safety
HEATING UNIT(OVER 1001000 RTU)
TOTAL:
VENTILATION FAN (SINGLE RUSID)
Ike
Cade. Section 25531(a)T 11 No
13 ye,'
NTIITe fubme Widirhgacupam ux Ain mdevimwhkh emit
eppEcmum
BOILER - COMP(]fIPOR I -,-O BTU)
ISSUANCE DATE
Abbi
hvmdwti tar cantaninan'a m dated by ,he Bay Area Air Quality Mvagemen,
El year ❑ No
BOILER - COMP(OV�R 100,000 BTU)Disuk[1
j� /fir
° ^ O D
NEW RESIDENTIAL MECH. SQ. FT.
1 here read the laumdous Sodic ns 505.r 533 order Chapter 6.95 of ,heCai
ore25534.1uMoonsif tar
if the huitiing &Safety Cady,oven Leith, that It
ifthecarril 11errsnotrnents ylavea,cntnkthei,, mympnib,of a Ierm,ifythe
scutum w'he rryuiremena which mw he mn prize to rvu.rcc of • Ccnihate of
txenpahey.
FEB 31993
y
`,
�m�'jy�F�f ,4'{/u��'►• • 1 #1 /
ISSUED BY:
Ovner or nutM1uveJ a a't Dare
6
TOTAL:
OFFICE