26509 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BurCOM—MurRAPPLICATION/PERMIT PLUMBING-MF,CIIA ICAL PERMITNO.
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION O
BUILDING ADDRI3S: SANITARY NO. APPLICATION SUBMITTAL DATE
GC..d_. Ir 4N—CA C_ UNIT LOT 1-1—J.
O 'NIRS NAM ZONE: CO CfOR' U LICN(yVJ NQ _
4•. .v ZA yo 4Ecr //c/� /c CCa 77 NtC CONTROL"
•ARCPITECf/ GINEER: LIC NO: 5 N •�I �/✓ ❑
C JIf
caNrncr: n ^AXON Z 67;4, ELECTRIC PERMIT FEE BUILDING PERMIT INFO
S,J �� BLDG ELECT PLUMB MF,CH
3 PERMITISSUANCE ❑ ❑ ❑
LICENSED CONTRACOR S DECLARATION APPLIANCES-RESIDENTIAL BD[SCTUPfION
Ihcrttry offDi UtesI am the Bu Arch proviaaouMOuptee9ndmy license wish j�
fooF sxawmt]BBtnmrDlrl.��n3w'meBneu��al+nrc�Jan.caa<.anamrlir<,,,euin PANEIs � SOvno� W4 � l
ydF full forceardeRccL l;c.N Lf 7(
QL Lunn.Clue UPTOMAMP5
N 6 Date f�yy'�/_C=S w Z(11-7000 AMPS
ZOy� ® 1P—J RCIifrT;CTS DI: IARA110 «J OVER 1000 AMPS SQ.PT.FLOOR AREA 5/SQ.FT.
Oz—a IuMnswd my pteu"I be used upublic recemB.
Py � SIGNS ELECTRICA
Poll.ioeul L
�KeeQ OWNER-BUILDER DECLARATION SPECIAL CIRCUPTMSC.
�qS O
WI I bueby eflirm Kul I un exempt from the Cmmnor's iLtw for th
r+i 3 E N4 following rmson.(Section 7031.5,Bwvtnv uM Pmfeaim.Code Any city or county TENT.METER OR IVIS INST.
F�' J which requim a permit to cornme aho,imfrmve,demolish,a re to.my sm.cmrt
Ka$ prio'.its i.e,Mao requite the appliwnl for such pemltto fileeaigml swemem POWER DEVICES
w—OO Ihm be is Iicemec]ptmu son to the povlsiom of the Cmvrbr•License Uw lCK m.
da �mm�.um SWIMMING POOLE CIRIC
Xo� y(commencing wish Section 700(1)&DivTMm 3 ofthe Bueinus test PrtfeeMoss Code) VALUATION
w_y or thou he is exempt rherefvn and th buiv roc de allcgul namptim.Anyvidvammf
Section70313 by any applkau for a permit subjecu the applicant to a civil peulty of OIIDEIS-SWITCHES-FIXTURES
Q tet rmore chre huuJml dm11a0(5500). .J vv
��� ❑ I,uowrerofJeprsrperty.mmYcmploymwiN wagnu0evwkcmrnpteuatim, NE\V RPSIDIND'M'ELECtR —SQ.FT.. RIES - TYPE CONSTRUCTION
a3— will colhewmkmd Ben.tre iatrd intended m.ffered for ole(Seei.TDM,9nlnee.
sed Pro(nslnnf CMc The Convacmr'f Lime i does no apply us.n owner of
Proycny who builds orimph
roves I2+m,ank hi
d who dun aucM1 wormself a Through hu
wnempbyees.ptovNd tMte�ch imlaovmentaarttu imaddee Mfacd faaelc.IL
.GR UP RES.0 115
Mweva,the huilding oo imProvemcnc is sdd within one y�afcanplaim,th owrta-
hualder will have the buden of Proving Nu did te
he t bo improve uild Impre fx pvpwe a TOTAL:
We.). TY, PLUMBING PERMIT FEE PLOOD GON APN
❑ oci tho cocci(See 7 M, ucneo, conofeo,i wlCodc) Mrontraamto
mmwcm th Project(Sec.]004,Bminev vd Pro[mian CakO TAc Cmoixlur'a
1 Iboecrtow Joamvpplytis with cMpaopcny whosed pount to rheCmmxrar'x AL.�-DRAINAt VENT-WATERER
Li.Iso. ( ) FEE SUMMARY
❑ I em exempt urda Sec. ,B&P C fertM1u rwmn BACK FLOW PROTECT.DEVICE
OMIDE 1.11-
SANITARY T N
Owns Date DRAINS-FLOOR,ROOF,AREA,GOND. RECF-IPf0
WORKMANCOMPENSATIONDECLARATION SCHOOLTAX T
� Irn'C{oMinpoc�nwi In hav acini wufRd cvpy thvrtoa f(Ss 3900.Irb C.)whkh FIXTURES.PER TRAP PARK HER YECEIPfN
Pooley Nlea_ yM�wffiv-034 `1 Pd -0f `1 GAS-EA.SYSTF,M-I INC.a OUTLETS REPT
CEI .
BUILDING DIVISIO dFS
�r�Cncnihrtby to Cc 1 GAS-EA.SYSfFlsf-OVFR4IRA) PLANCHECK FFR
❑ Caifud copy is fJdwith dre airyimpeeJmdivis{m. GREA,SFJINDUSfIeL WASTE INTRCEPTCR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS Ir GREA.SETRAP SOILS IEE
COMPENSATION INSURANCE I!
Oltu aeeJm rsW mtheanplevd fifth pvmitu (SIP"' :S - AN ARY RM ENERGY FTE
IaBifY that ion the pafamuxx oftls work fmwhich Jus partlilu lnuetl,ls WATER BEATER WIVM7
t empvy y mixon in any ro mmer w v hems est to Ito ebe lWmk -
teanI PAID
ro
CopemeJonuvo.&California. Des WATER SY �.�EA RcaeiptN
O NOTICI TO APPI,ICANT:U,agerrmking thu CerJfxwe of Envnptim.l uahmltl I WR' SQ.
t z TOTAL
rn beans.comply
Workmen Can m tam smoil"I the l�ed Code,
fmJrwaN rnmpy with£cb pmrio®mJua penroil elWl be deemed rroked BUILD E
1 [� CONSTRUCTION LENDING AGENCY SEISMIC FIE
Uz I bamy affmm thu Vert i.a emmwwetion lading agar,fm the petfmmwce a
U ft wool,fur which this'mut is iasuca(Sx 3(Iffl,Civ.C.) TOTAL: ELECTRIC FEE
t ndl N.
D"' F GeuJ sAdan.. QTY. MECHANICAL PERMIT FEE PLUMBING FEE
m U 1 certify that I bx.e rrad this appication sed stare that she above imfmmtl H
W cmeu, legrte lnwmply wiN Ml city mrd rnumy nrlinerurw andswelaws rtivong to PERMIT ISSUANCE MECHANICAL r
❑ z. nuildiogcm ,etd rtby autl,airc rcpt utivnofNu city'.sun upon th
CONSIRUCIlOTAX
ebme-menu ro inaparion PUTntts. ALTER OR ADD TO MECH.
(We)• rmBy W keep hum Js City of Cupntino egaims
liabilities.' r deapenm any way xcrve maiwsaid Cary AIR HANDLING UNIT(TO 10,000 CFM)
Inc ung of tN
AIR HANDLING UNIT(OVER 10,00I CFM)
gnanue of Appl' t/Cmuacso pate EXHAUST HOOD(WIDUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT TO 100.000 BTU) ohs ReeeipIf
Will the upplicunt or future bulling occupant note w lurdle hexardmn metmal
udcfinedbytle Cupatam MunicipMCodc,Cltelxer9.11,ard JeltWthtedS ery HEATINGUNIT(OVERiM.0o0BIV) TAL:
Gde,SttO0 Y5532(n)"
❑Yes 13 No VENTILATION PAN(SINGLE RESID)
Will tbeepplia'am o future WBdingoccuPtemusetywpmrntmdevimwl emus BOILER-COMP(311P OR 100,000 BTU) ISSDATE
M1vordoor Mr om.o ircl n,m dcfnal by the flay Arte At,Quality Mem einem -PUAN D
Diatricr'f
BOILER-COMP(OVER 100.000 BTU)
` ❑Yex ❑No NEW RESIDENTIAL MECH. SQ.IT. JUN 2 4
I Aare rend the hasardmx matuiilr r to under 6.95 of the 1994
eyutrtnm Cltryn
Calafo Ail Hgd ocxn tco Ctly haecaenum,that it is art425334. Lurderu.nd Uhe CII I Uf n-syr
ofthebuildinge onterme.whaventrnwm,et itis mymprtce o 1. tonotifythe Cf{I11VU
accupent of the rtquimreme which cons h ten prlo to imwge o(•Cmifac of
(k'avl r
t Owns mraut;toxl egcnt Oboe TOTAL: ISSUED BY: I
OFFICE