27726 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY.
CITY OF CUPERTINOL - � A L PE tmi r NO.
BUILDING DIVISION APPLICATION/PERMIT PLUNISING-MECHANICAL ^7 ^
BUILDING PROJECT IDENTIRCATION [ L
BUILDING DRESS
`.` SANITARY NO. APPLICATION SUBMITTAL UA'IE
Z {N1 Y LOTY /2
Ni125 NAME: PHONE, C CTOR'S NAME WC NO: I•
NTC CONTROL
O RCIIIILCgENGINEE1U LIC NO: A RFSS
1
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE. ❑ El
UC SED CONTRACTOR'S DECLARATION APPLIANCES-RESIDFMIAL
WOO Section70N)oDivOl.SoftheB armAkimseJ uuurcu�ard Pmfeuiara;Curl,9ual my lincisnaeng E in P"ELS JOB DESCRIPTION
�z� full anaerca.
6U Clars—I,ic.N UP TU200AMP5
Q y Deme Coned« 201-1000 AMPS • , V
Z FN Z ARCHITECTS DECLARATION OVER 10WAMPS SQ.FT.FLUOR ARBA W.FP
Oi—E Iundc.wmf my Amax¢hall he used to public reeool,
F rn t SIGNS ELECTRICAL
—5K� Heaved Pmfcvicaal
XaX �cU. d(SarOWNER�BUILUER DECLARATION SPECIALCIRCUIT/MISC.
ul w,far the
LL:to fdlowiny breumfinat htan]03L5,Bmmimept f and Prafrom fla, ��t I.
oycilymeaomy TEMP.METER OR PULE.INST.
h which ON.ira a pemnit In construct,eller,inrpnwe, ish,nrIr any ahacturt
}$ Prior to its ivuarra.aBo squirts to epplicont f«much iHofle. praisa.in POWER DEVICES
COO thu he is IiansN pumsanm to tM1e povisl«a of the Cp-wacmis Law(Chapher
a o� 9(conmmncing with Section]000)of Di vivcsn 3 of the Burbaess.rrd l'ro .i'av Code) SWIMMING POOL ELECTRIC VALUATION
to orthu he iv cxcmpttM1eefrmo end Ne beaisf«Nc allepW cxanptim Any Isuon of OVI1P1'S-SWTTCFIFS-FlXTURFS
F-ZQ Se,ian]031.5 by any applicant for a peneikliebjeca the Winn to a civil yof
not more than five bundrW dollar,(SNC 7-'
W ❑ NEW RCSIDI'NPIAh ELECIit _SQ.PI'.
I,aaowrernfdeprtycrty.mmyemploymwiN wags utleirr9le STORIES TYMCONSTRUCTION
y3� willdothcwork,ardthcuracmtvcunm inteMM« reed r«sal Bull
mad Professions code:lJl bC�troctor.LiceB.e not to on own or
pmpcny whobulld «Improves tM1eraon,an w ink carbo GROUP RFS. Tf5
pbYee, ovided tM1uwch Improv o«incMN r fferNf If.
however,0e buil Ing«impmrmmui ml n yc+�r/{p Alai S w TOTAL:
builJerwill have heWNMof provingst ' drat WiM�jlnpto.c pvrymc of
�w
❑ Imowrcrof propMy, e vdyc t im1i< sea rnnaaa«rtn QTY. PLUMBING PERMIT' FEE UG NE qPN
e«drvet the project «.] and t«a C :)The Cmmues
LicemeLawdae not to en owner ,Jew builds vnpoverttereoe,ud PERMIT ISSUANCE T
wM mnlreCU bnweh Ara; wish atom tar(Qli«ruedporwam cath¢C«rveeem'n
Livernc law. tx & IXALT -DRAINVT-WATER(FA) FEE SUMMARY
❑ Tun exempt under Sa. B C P C f«thu mcaranSIDE
airBACK ROW PROTECT.DEVICE SANITARY Y N
Owren Date RECEIFI'Y
WORKMAN CON ATI DECLVtATION DRAINS-FLOOR ROOF, GOND. SCHOOL TAX Y N
❑ IM1ertby nfOrm t},u lM1aveacMifc0. c«ocnl to.wlf.imurt.«acenifcee of RF,CIiIPI'N
WorkmConrprmxanon huwant¢caeardFcd Wdcrtof(S .3b0., C.)which IIXTURCS-PPTRAP PARK FEE Y N
covin all employer umn this pamil GAS-FA.SYSTEMI
-I INC.INC.4OLEIS �-a RFCEIPI'N
PMi,N BUILDING DIVISION FEES
❑CurnCnmiBMc yin hereby fumlrhM. GAS-E.A.SYSTEM OVER4(EA) PLANCHECK FFE
Cl Cc ifiW copy is files with the airy inapnnim division. GRIASPIW DUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE Of EXENIPION FROM WORKERS' GREASF,TRAP SOILS FEE
COMPENSATION INSURANCE
mi.sectionneul r.n N,completed ifthe permit is form.humnevi auan(SI00) SEWER-SANITARY-STORMG.2WFT. ENERGY FEE
or leu.)
I anify that in the Pcrfarrmnce afthe work for which this Anil is issued.I shall WATER HFATI'i W/VENT/ELECTR
not employ any Perron in any manner to as in heroine rubjca to the Watkin' PAID
O ,z A�swim laws of Califaniu Due WATER SYSTEsIO`RRATING Date Receipt
Z0 NTTICI;TOAFItICAM:if,aferrtakingthis CenifiuteofExemptiomyaushoud NEW RESIDENTIAL PLMB. SQ.ET. TOTAL
fn became subject to the WMer'5 Cwnpennmiw rovisioru M the labor Code,you assn BUILDING FEE forthwith comply with such provisions err ibis permit bull me deeed revoked.
a CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z I hereby affirm that there is a consuuetion lolling egenry for the pvf«nanr<of FLFCI'RIC FIE
U C) the work for which ihurmi
pet is Issuedee,309],Cir.CJ
Lender'.N. PLUMBING FEE
0 F n
Lidcr'e Adreo QTY. MECHANICAL PERMIT FEE
U I certify met I have rend this"I ma.arta wue that the above infmmamion Is
>. LEI cwracL lagmccwcomplywiN allclmy and c«vuy«dEuxe and sac lawsrtWingm PERMIT ISSUANCE MECHANICAL FEE
F" ,4) huildingconsnunion,and hereby authodm repmxntmivea ofthis city to cntu upon the CONSTRUC110N'TAX
U Z aluve-mentimm,J property for ingcctian pttrpwa. ALTER OR ADD TO MECH.
(We)sgrte n vre.IMurwify and keep harmless da City of Cupenirw agaiw
liablitice,judgmem,cos.uW esperun which may in any weyaarueagainsm mad City AIR I IANDLING UNIT(TO 10.000 CFM)
rc4ucmc aft Brvnrin%a Nispmnit
AIR HANDLING UNIT(OVER 10,000 CFM) '
Applicvm/Convector !Dau EXHAUST HOOD(WNUCH
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date R«ciptN
Will Iner pliant Or futart building occupant ane«handle huardour monerial HEATING UNIT(OVER IN."BTU) T
err defaed by Ile Cupum mhMunicipal Codad the Chapter 9.12,athe I Iealth and Safcry
CNe,Seai 255J$q]
11Yu 11 No VENTILATION FAN(SINGLE RFSID)
❑
ISSUANG2 DAT) D
Wilhhea Tiunt«fmme huildingmcu waipmcn BOBFR-COMP(3HP OR 100,000 BTU) /'1 I
pp the
tonality which emit D
huallous air cvnwmimnu as JefinM by Ne BoY Arca An Quality Marwgerrcnt BOILER-COMP(OVER IOO,BOO BTU) run
oiamrin2 c` 4
❑Ya ❑No NEW RESIDENTIAL MITCH, SQ,In'. N94
1 here o ad the lwardan rroeri d,pe,m uas ander Claptu 6.95 of the Cl%y "'T
California Hai h Safer,Cade.Seeman,25505,11533 W us34. 1 aaaem�ard that
if the building dm nd cuncruly have a tmanl W t it a my rerponibirty to nmify de
oaupam of uctew which assn be sou prim to ars.of is Crnifwe of
Oau - 11111
or orionlis t One TOTAL ISSUED BY:
OFFICE