25882 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUIJABNcEL [CAL PERMRNO.
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BUILDING DIVISION APPLICATION[PERMIT PLUMBING
-MECITAN']CAL 25882
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BUILDING PROJECTIDENTIFICA'DOR L J O O L
BUILDING ADDRESS: SANITARY NO. APIUCATION SU/IHMM_III PIAL
DATE
I
- LOT N
wN SN)1MG: PHONE ICONTRACTOR'S NAME LIC NO:
$ _ _ e NIC CONTROL N
ARCO I'I'I!C TING INET T:, LIC NO: ADDRESS
ut: , a�st El PHONE
l^ QTY-1ELECTRIC PERMIT FEE BUILDING PERMIT INFO
t '1 a/F Bey ELECT PLUMB ME
CH> l
t. a _ PERMIT ISSUANCE' � -/rry7`b ❑ El El
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDFNTLM.
O"Z Ihmn
ebynlEnthatlamimtcdundnprwisiaa
lofChspan9(ca.mtvcittgwith `�. JOB DESCRIPTION
�00 Semon 9000)of Divirim Ja(the Boom.aM Pmferiora Code,ud my Iw uin PANELS I1l�l/CVc CI[A j'+j y
�d0 f.11I.nmeff« 1 j
<ZUWI Iiceme Cbss Li,0 UPT020DAMPS IC(=PAba +0 jh� el4c —
ivn Dau C mhmcla 201-I"AMPS
ZOy— ARCHITECTS DE OVER1000AMPS SQ.FT.FLOOR AREA S/SQ,FT.
OZ—❑ l uncismord my plwu JVD 4 uiN as public raotda
�SSdd w SIGNS EI =ICAL
yl< uttmed PmfevtarW OWNER-BUILDER DECIARATION SPF,CIALCIRCUIT/MISC. 1 LED I N r
�p(,0es. I lamby affirm thus I om exanpi rani the Cmttmclor's License Lew By the
following remson.(Seetim 91131.5.Nosiness mJ Prof.,..Cade:Anycity a cmnly TEMP.METER OR POPE INST. p p I rr�
F'4OyQ which nNuv0a permmnmer,conse , er,improve,dennlisha, n ait my mort "\VV1`etu
}J� prim to its uswnce'eLw rtquim IN,"liwu for such permit w fileevgnM sutcment POWER DEVICES
�2 C)y dor he is licrnsed pwvuru 1.Itis Provisions M the C.nemmor's Li.L.w(CTVper gA L' LL
�•qx CW 9(camnmcingwilM1Salion7Np)ofNviaim Jofth Buslnns dPmfndonzC ) SWIMMING POOL P.IF.0 C F I
Www or that he is exempt dmmfmmin mid ibis Weis for the alkgN excmpion.Any violation of OUTLETS-SWITCHES JJ'
�ZQ S Iicvt 9031.5 by anyopplicatt for a pemtit subjects the appm lcnto a civil penally of SWITCIIFSFIX'IVRIS // S• UCJ
�zO to..Jan five hundmul"Ima PS500). (p
CC ❑ l,uownerofthe popenY.amYem b thw NEW RESIDENf _
IALELECIR SQ.FT.
p ymwi agnmBe'vmkcootpenv4m. CONSTRUCTION
TYPE
W
a3— will do the work,and the manure isrwt intent l aoffeN for sada(See.]Obd.Bmincm
and Professions Code:The Comsamor's licrnm Law d not apply to in owner of
property who buildsor improve,therms,std wdidon such work bineselfcrthreogh his
cmpnym.pmvidcddw nucM1 impmvments er<mtinladNuMiertd(mmlc.If. I OCC.GROUP RIS.UNITS
howcrn,the Wilding es impruvemen,is sold within on,sum of eampkdon,the owrcr- TOTAL
builder will love dudes udes of pmving that ha did trot Wild a impove for purpose of
ole).
❑ I,ea mvnmofdel*oPeny,em excluaivclycmvaning wish liaml ronuxtm to QTV PLUMBING PERMIT FEE Fl. U . E APN
comhmd the pnjca(Sw.9(44.Business sM Profco".Code:)no Conlrocmr's
License law docsttd apply loan n•nterafpmpcny who Wildsaimpmvn thcmn,ard PERMIT ISSUANCE
wWccimmcVforsuch projens withomnosion'(s)limbed ponumttothe Coo tan's
Liame law. ALTER-DRAIN&VENT-WATER(BA) FEE SUMMARY
❑ I am exemp uMn Scc. ,B&P C fa this trnm BACK FLOW PROTECT.DEVICEOUTS,IDE FEES
SANITARY Y N
(Tuner Date RIiCIDPT N
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WORKMAN COMPEVSA'fION DECLARADNAINS FLOOILROOF,ARL'A.COND.TION SCHOOLTAX Y N
❑ lhertby nfMntlmtl M1ave acatifiwe.fmnaem,o elf-ieaurc maanifiweof RECEIPTN
woken ContpntVtianlmwve<oraanificd copy lhaea((Sec.Jg00.lab CJwhkh Fl%TURFS-PER TRAP PARK FEE Y N
corers all atpl.yee's mtdm this permit OAS-EA.SYSTEM-1 INCA OUDJTS RECFJPT e
Polity N BUILDING DIVISION FP.FS
Cmn,ruty GAS-EA.SYSTEM-0VER 4(EA) PLANCHECK PER
❑ CamaN ropy i..hmby rumL,hea
❑ CrnifiN ropy is filth with the city impcnim division. GRFASFIINDUSI'RL WASTE INTERCEPTOR GRADING FEE
CERnF1CAT1:OF EXEMPTION FROM WORKERS GREASETRAP SOILS FEL'
COMPENSATION INSURANCE
('Unix inion re rot he cwnpletN i fihe panni,is for one hundred dollana(SI00) SEINER-SANITARY-STORM EA,2'IOFT. ENERGY FlJ?
m Ins)
Icedify that in the penfommmn of fie work for which this Pencil is issued,l shall WATER HEATER WNENTIFLECTR
to empty my pennon in my mmm it as m became subject to the Wonken' PAID
Z Comprmmionlaw'sof Cdifornh. Doreen WATER SYSIFId(IRFATING Dem Ri,c*st
Applicant
O U NOTICE I'O APPLICANT:IL nllu mal:ing this Cenifiwe of lPtemntim,yam should NEW REST DENTIA L PLMB. SQ,M. TOTAL
(Z) d:cora xubjttr to de Worker's CampenWion pmvisiom of tine Lahr Cde.ym most
forthwith evmpy with stch povisiom or tMs peom,shill W dcvtted revoked BUILDING FEE -
U z CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hereby affirm that there is a rnmwnim Perishing agency for the pvfomurcc M
U 0the work for which this lcmti,is issued(Seca J(N'I,G,C.) TOTAL: ELECTRIC INE
U.
Lender's Nu is
U PLUMBING ENE
Lada'.AM. QTY. MECHANICAL PERMIT FEE
U 1 artifY Ih01 T have nod this aPWbd^^end awe the the above infamutiat is
entries,Iagn we plywl,hdTcirymdmuntyardirwceaMrtmclewamlmittgm PEtMTi ISSUANCE MECHANICAL FEE
buildingrnirt.im,and hereby mthorim talner.nwivn ofthu city,.rots upon the
U Z abovoneminni propmy fur inspcmhn purpoxn. ALTER OR ADD TO MECIL CONSTRUCI'IONTAX
(We)agi e w mm,iidemnify and keep hamilem the City of Cupv,im agmint
IiiNlilicajWgmen¢.cora mJ operon which may in any way acme agaiml said City AIR HANDLING UNIT(TO 10,0.0 CFM)
N mnayieae W the 8*mtittg of this pcnnit.
/ AIR HANDLING UNIT(OVER 10.000 CFA1)
Signature n(ApplinnDen
UCootnsct.r e EXHAUST HOOD(W/DUCU
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT I TO 1000)00 BTU) De,e Reair N
Will the applicant or form Wilding acupmt mare or handle heardoua mmcnel HEATING UNR(OVEA 100,000 BTU) TOT L
in defitd by,he Cupeniro Municipal Code,Chanter 9.12,and the Hulth vtd Safgy
Code,Sectim 26532(a)P VENTILATION FAN(SINGLE.RFSID)
❑Ya El No
ISSUANCED E
W�Ilthaopplicm,afuwre Wilding acupanluwequipmcmmdeviccswhich emh bO11.PJi-COMP(111POR 100,00(i
hvudaus air conarommeo x as defmN by the Bey Atra Air Quality Mmagmnent
BOILER-COMP(OV[R IOO,IXp BTU)
1AwicG P1 lJ
❑Yen ❑No NEW RESIDENTIAL MECH.—SQ,FT.
1 hove mad the hvadous romenuls re,mremrtu under Con,for 6.95 of the FEB 2 �g94
California Ilaallh&Safety Code.Scetiors 255tH,25533 and 255Nf. I mdcnwtd dor
if the W ildittg dins o ,eurremly have•tewu,than it E my tvpmeidlily to tmdfY the
oavpanl of tie rtyuirtmmu which mum be me pia to esu.f a 'li a of
CITY ur cure I I , .
D""'a,ey. 9
Owncror amhonr gent Oise TOTAL: ISSUED BY:
OFFICE