26322 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
'A HJUHT NO.
CITY OF CUPERTINO PLUMBING-MECHANICAL 26322
nY OF C u ERIN APPLICATION/PERMIT
ut<.".r=, BDILDH+c PROLE IDEN-THTCATION
�11U1LDING ADDRESS: SANITARI"NO. AIYM('ATOI:SUHMITTAI.UAIT
LW" p� c ITr� CA 9 LOT
.RS[yAMp, a CHot1� 111�_I �� O ACfnR'PS�NA LIC NO-
/TI`�U ACRS NF CONTROL
<CHITECT/ENGINEER: LIC NO: ADDRESS: ❑
.. oNrncr: rxoNE: '11j* t i- BUILDING PERMIT INFO: -
QTY. ELECTRIC PERMIT. r'
,a., T'+^. +-A,d:,.:ua••_.: r- v^ - "� BLDG IiLE T PLUMB MSCI{
PERMIT ISSUANCE 5
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
=Z 1 hereby effamthat I son lice ed wda povisiou of Chaper 9(commencing with
,00 Section 7m)of Division 3 of the Buvmesa am Pmfaiau Cod,,and my lice.is,. PANELS
IVU full fora and eff.. UPTO"AMPS
�ZJ U,,emse,Clan Lc,a
Lets Cmtroaw 301-UM AMPS
ARCHITECT 5 DECLARATION SQ.FT.FLOOR AREA Q.F1'.
I vndomand my pl,...ehall Inc o,c a�public r,c
Lq OVER IOW AMPS
- SIGNS ELECTRICAL
Yi Licensed Rofeiaonnal
y adQ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
tic. 1 hereby of imn that 1 em exempt from the Cnmo-aE«a Lcmx law fa the
, following acasan.kation]0313,Btviress am PmfcWms Cadc:Any city or count, TEMP.METER OR POLE INST.
tT J pact its
a Pamir to cawmct,,sic impose,daemon'm e.sir my smcmre
yi- peww iu issvawc.dwT to the tM appliuntf Uou pxmit rof emise, astatcmmt POWER DEVICES
Ca, Elletleulicrnaetl pneumttothepovidwuof the CwmaelWi Licenselaw(OupEer
. ❑ SWIMMING POOL ELECHUC VALUATOR
.X � 9(mrmnt is exewitlt Seaim]000)of Division Sol Elle BusiwuaMP Any vi Code) —�
V_H or,Se Buthai31e by nskoetefmmmimEd ffic bamnil EElle Ellettteaemptiom cimlPeauon of
�cc Senian'lOJlS by ane epplirantlona prtnit wbjav the�dimntoa civil p,mltY of 011fl'EIS-SWTTCTQ'S-FUCIl1REi
=., mE dor five hwdwd dollen(SNt01NEWRFSIDENTALELECIR _ Q. RIES TYPECONSTRU ON'
z F-o owrerofEh,popmy.wmymgloyasxithwaPautheirade mmpxmtim,
_3m wmdo de wwk.wade.matweiand mtadmwmrtamrw We(sa.Tou.Baaittaa
erd Polusiona Code:The CmEraaors Licaue Taw ma wt opply Eo w owwr of
pop+ry who buildswimpovcs.`- .sad wdwdoca wdtwmk hinvelfw Ovough his OCC.GROUP RFS.UNM
ownemploye .pmvid t wchimpove ntsoreminwm woffacdfor We,If,
hweva,the W ildinP w impwamu is wd xithin ore ya of mrryledm,dx ower- TOTAL
Wilder will have ifit burdat ofpmvimP that h,did nol build w umpmve for puryoae of -65 _ vim ._.
ail,). pgeny.am cw wivcyrnn ywi ``r L ��I _t'..FEEC=: FLOOU ZONE APN
I,snwwrnftle mxEin th lieencl cmurmAto -�e _ i i�:"±
cwuaoct the project(Sec.](W,Business and Profssiwu Code:)M Cwnmes PCN.1ITISSUANCEv1 ,,' `
Liam Lawdm not apply to an ow+erofprofmy who Wilds w mro,mva thart and
who®nmafwwchlvoXcn withaconuactor(a)IiccmN punmantw Oe Cmtranw's - -� - 1 s n_ v
t�_ ' '"��. �
Liu me law. ALTER-DRAIN& -WA IEAI -' �cri :;- FEE SUMMARY:._ ,.j.c��•'e
❑ 1 am Hemp order Sw. .B S P C for this rruon
t BACK PLOW .V ! SANITARY Y N
RECEIPT.
Owx Dote DRAW .j
,F WORKMAN COMPENSATION DECLARATION '- - SCHOOL TAK YN
I lereby affirmthal l tuvest it..of Rmemlm W f-Innue.wa artifoEe of FU(TUNFS-ppR p RECEI N
WM.Canpenaatim 1.or. Utecl copy slammf(S .38W.lab C)whits PARK FEE Y N
covet all employee's ismer this Amnia GAS-EA.SYSTEM-I INC.4 OUTLETS RF.CE N
Bmic,x _- BUILDING DIVIASWJWE.FS
Company GAS-EA.SYSTEMOVER 4 UDO 'ECK EEE I Q'
❑ Cmif,d cgryis Fereby fwtished.
❑ Coifed copy is filed with Oe city impectim division. GRE15PlINDUSTRl WASTE INTJRC',",,.. I - GMOWG FEE
CERT[MC TE OE EJ EMPfIDN FROM WORKERS GREASETRAP SOILS FEE
COMPENSATION]NSURANCE
(Thin section not be completed fN,permit is fn ore human dolls (SIW) SEWER-SANITARY-STORM EA.300F7. ENERGY FEE
w las.)
I cenlly tMt in tltepWortttanec of Oe work fa which this permit is iswed,I"I WATER HEATER w/VENI'/ELECIR
not mtplq any Amore in any msma w u to hecww wbje t to the Wortai PAID
Comenwim Lawsof California, Date WATER SYSTEM/IREATING Date Roo
Z
Z2NOT�sIO APPLICANT:If.after mating this CeN�tc of Excmpian.ym ahwd NEW RESIDENTIAL PLAID. SQ.FT. TOTAL
Tn became object to the Workers Comcnutim prnisiwtt of the Labor Code,you o,,.,
Y7 forthwith cwvply with such pmv4ims or this permit"I he deemed revoked. BUILDING HE
ij /� CONSTRUCTION LENDING AGENCYSEISMIC FEE
D Z 1 hcom y affirm that tbcre is a comwuctim IendinF aPm,for Elle perform t,of ' TOTAL: ELECTRIC FEE
p Elle work for,vhi,h this permit is issoed(Sec.3097.Civ.C.)
Lmtla's Nanoi4.Y'^.r{"-�• ,m' �-,[ to;ry FE
PLUMBING E
F Lender'.Amro. QTY. -y. MECRANICAL'PERM1ifI'- �_Yn. y' FEE p:
i- LS] 1 ecmify Ihat I have reed ppli
this application and o,,,, e Nabus
ac the e iNormsrm is 's'mw MECHANICAL
LL) cect.l oprec comply with dand
l city counn orde uWase
inancelaws neletinP to PERMIT ISSUANCE
_ WildinPcmrt,uucdon,en ov thorins Tivesofdoisciiyn,cmcruponi1hc CONSTRUCII NTAK
Z atuve-mentioned ce tion ALTER OR ADD TO MECH.
(We)spree m I nifs once
Ina the City of Cti ,riinu against
IiabOitia,tud caprn .whmavinany wry acro ePvmt Wd Ctry AIR HANDLING UNIT ITO to."CFM)
cros,.oenc to or th' it
AIR HANDLING UNIT10\'ER 10.000 CFTfI
Sipnut uC rn -M EKHAUST HOOD IWMUCI) PAID
HAZARDOUS MATERIALS DISCLOSURE BEATING UNTT(TO IW.000 BTU) Dat, Racipa
asm VOWil uappic.ntofurure building occupant store orhwdle haurduus matend A
I by tM1e Cupnim Municipal Code.Chaps 9.1?.and Ehc HedtM1 and SefaY HEATINGUNIT(OVERUO."BTU)
Crcle.Section'_5532(.)?
❑Ya 13 No FAN(SINGLE RESID)
BOILER-COMPISBPOR UX)"BTU) ISSUA
Will de orMlioni arfuturc building wcupant use,quipmcm mdcvicea which emit
VE-DATEl,toanlmus oir conwmminu es definedby Iperrem re Bay Aro Air Quality ManaBOILER-COM PY,'ER IWOW BTU)
❑Yu ❑No NEW RESIDENTAL MEC I. SQ.FT.
1 hove red the�materials regso.ts u Cheptw 6.95 of the
Califwniv llralthS Afay CMc.Scnims33305.33533 and'33 W. lomenundths `flfhl n
if the wiMmg data wx curreml,hose.torsion,the it is my,es Pomi,il,,y mrtwlf,lk ukv, R
wculunl of the rryuiremenEs which mum Inc met prix to wuscc of a CemiGeate of
Oeeopawy. `t t ,,
(Iyer w avNOrivM.Pmt Date TOTAL: ISSUED BY:
OFFICE