27954 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO ILL -KI'
F. A lnxMn'NG. 27954
APPLICATION/PERMIT PLUMBING CT IDErTIFIC
BUILDING DIVISION BUILDING PRWF.CTIUEN'fIFICATION
BUILDING ADDRESS: SANITARY NO. APPIJCATION SUBMITTAL DATE
6 _ le U C L(J AUe'. UNIT# ATN
IiRS NAMG: PHONE: CONTRAMOR'SNA ° LIC NO: N0C2Y_1Bp4_1 4 ,44
CONIROLI
V i
C 'CI'4iNGINPJAU LIC NO: AD RS. • ❑
14 J o c us
ONI'ACI': Tae py,fn PHONF,:dp3'v71� BUILDING PERMIT INFO
c/ / QTY. ELECTRIC PERMIT FEE
PLUG ELECTPLUMB MECII
PERMIT ISSUANCE 11 X
LICENSEDCONTRACft3R'SD ofRATTON APPI.IANCES-RESIDENTIAL JOB DISCRII'..ON
I Herebyol Di thatI amlicemed,nda ptd Pref of OCct t tdmy fe.4in
WOO scctian 3an)ar DiW,ianJof the Biuire.s and Nofevivm Code,etld my license vin p,SNpyS
tint tinea not UPTO2WAMP5
Dtnm
y 0. Cowxte,a 201-1000 AMPS
ZOy— ARC]11 TECPS DECIARA'I'JON OVER IOW AMPS
SQ.Fr. R AREA S/SQ.FT.
O<.—� luakntud my plvu,IWlle usNupublic rtc,rds.
F y F W SIGNS ELECTRICAL
6Yw".4J LIttIIxH 1'nefnaianul
C y.CQ OWNER-BUILDER OFtre ComTION SPECIAL CIRCUIT/IdTSC.
row, Ing affirm that 7 sin ,Bo from the Clmtmn Co i.c:Any law for IM1c
1+1LLQH followingrtresa pecmian)0313, .1w,ialdve,c1croru C,dc:Any city memory TEMP.METEROR POLE INST.
wbirh rryuirt,a pnmil b amsl+uc4.iter,improve,demolish,m rtpir intycd vmamc
$ }5. prim td itsiasu Rocaonto alheepplicmtfthe C conivaUe'vgrc (Chlernt POWER DEVICES
dtt_0p 9(cheurocin,d quvunlbIle).fD tam of theC.«,B.,i«s U.I�w(Ch.pla
L e� 9(thw Wi.ingwith Section ven a ))of Dlvidon3uflheetl e„and.Any ichumdo) SWIMMING POOL BLECIRIC VALUATION
y _y metion731-1 by t NcrcflmnwdrIhc.Pemnfa dee.,ne eactecoom Ar,ij cm Ry of L
F7Y no,ron]0113 by emedmidlllforspmnil wbjmelM spgicmtlo.civil pemlly of OVILEIS-$WITCHES-Fl]CNRFS r(
=I Sp mm mclhanfvehundmd Jy.lmynnp. NEWRFSIDENTIALELECTR _SQ.FL eOG �G
KF ❑ I,uowrcrofNcplopcny.«myereryloymwiNwvgnude'vwkmupemetion. STORIES TYPE CONSfRUCf10
a3� willdolheo(,nsuldde he ComimeurimcMNmrfwclo,t nolelply to t4, wu of
arW I'mfev,iem,C«la:The Cmtwcbr',Limtu I�w Jan awl apply to.n swat of `
poPenY who builds a iertpmva Iherta,and wM don vcM1 wM hirmcif a Ihwu6h M1ia
nemployeo.pmvldWlhet suchimpovmenla venal inlrndN ieofferttlfmmla.IL OCC.GROUP EU'N1IMwcva,the Wilding m imgovereenl u sold within are yeo ofcompletion,the coma-
boildcr wdl havethe bmdcn ofpovm,Ow he did.WIM a imgove fm W rpo,e,f TOTAL:
wlc.).❑ QTY. PLUMBING PERMIT FEE T. D NE
coramet the pmjat(Sec.7014,Bummem end Profeviw Cale:)TM Cornm or's y PERMIT ISSUANCC
Liceme law Jon nut spay b en owns of pmRnY who builds a improves dertm,vrW
wmcufawch pmjccuwilhec,nvwta(s)Ikeosdpanwnt tithe Conuvcbr',
Lame I,.. ALTER-DRAIN&VENT-WATFR(EA) FEE SUMMARY
la
❑ Ism eacmpt umkr Sec. ,B&P C f«Thu leasan BACK FLOW PROTECT.DEVICE SANfIARY Y N
OwmcrOve RECEIPT'#
WORKMAN COMPENSATION DECLARATION / DRAINS-R.00R.ROOF.AREAO J17 SCHOOLTAX Y N
❑ Ihertby affirm lMtl Mveecmihnm,f cartenl m.elf-imum.ancmifeme of RECE.1"r
Wmtai Comfemnlim Imuruee or ccnlBM FL%'R1RFS-PER'IRAP
covmall rnt,A aPY Wermf(Scc.1800,lab C.)which PARK FEF RECEIPL'M N
I'mi,# —�`' O - D� OAS-VA.SYSTEM-1 INC.4 OUTLETS BUILDING DIVISION FEES
❑ C�enifed copy i.hcrtby fmninmG 7dls! GAS-EA.SYSLTJN-0VER4BEA) Fl-ANCHECK FEE
❑ Cenifrcdrefy is AIM with the city lmpntiun d,iioc . GRFASMNDUSTRL WASTE INTERCEPTOR GRADING FFE
CERTIFICATE OF I:%EMPTON FROM WORKERS' GREASE TRAP SOILS PEE
COMPENSATION INSURANCE
(Thi.sectim had int be mrnpMMif theprnvti.fm one huoAtd ddlan(5100) SEWER-SANITARY-STORM E.A.2001eT, ENERGY FEE
I N.y lhnt in the perfomams Mthe
so. f«which,mhjAti 1.he i,lshsll WATER FffATER w/VF)JT'/ELECfR
mal angati any w—f in any manna w u to bccorte wbjM b the Wmtn% PAID
z Appli mtiun laws of Celihmia. Dam ATTR SYSITM/LREATING Dvc Receipt0
O O O CE TO APPLICANT:If,n ,ro this Ccmircve of E,cm Q FT.
'z g qCc. Y should N W RPSIDIMIAL PLMB. S nyp�
V1 become subject to the W«h Po C Im(ermit o 11 the erred Cade,you muv
forthwith cmtply with such pmvi' ,alni,pmmil,Mll be damcd rtvokM. BUILDING ITE
1 D CO . UCTION LENDING AGENCY SEISMIC FEE
.7. z Ihvcby.ffirm Ithcrti nn,NKlilm lending agency for me Remo u c
V O de work fm whi t-pcmdl uiuuedd(Sa.309'1,Civ.C.) // TOTAL: Q ELECTRIC FEE
E
Indc/n Name .
O FV+ TcMcr's AM I MECHANICAL PERMIT FEE PLUMBING FEE
1 cestif dw 1 love lend this sppfin one Nu�h��eyyy111000vRnfom o
�+rL. L) e^nroct. MECIIANICALFEE cto rnmply hJl ci d Ji In laws mg tte Puma ISSUANCE_ In lmildin,ding vuction.urld Iwv I pm the
U z above- tis 1 onp / ALTER OR ADD TO MECII. CONSTRUCTION TAX
( ')'gree m nave, mnify m'dj�Ie'dee y of Cupenloo,gaunt
liod,di es.Judgmeou,c eapmsn h yin wyucmeegunn ssidCry AIR HANDLING UNMITO 10,000CF14)
umcc ache granfthi,permit G
AIR HANDLING UNIT(OVER 10.000 CFM)
Si re of Applicenl/Conlmt Dem E%f1AUST IIMD(W/DUCI) PAID
I ARD()VS MATERIALS DISCLOSURE HEATING UNff(101011,000 BTU) Q Dam Rcaiq If
illlhco tan«fulurc huilding«cvpenl Mort«MMI'F"'+",Jou,mMcriel fffATING UNR(OVLR 100,000 BTU) TOTAL
.dc Cupertiw Murdcipsl Code,Chep,9.12,W Ue Newt ved Ssfny
Code,Section❑ye,
/o VI, ],ATION FAN(SDOLG RFSID) b A . J4/
Will theaPgi.,or Name buildin,occu BOU-M-MMP(31fP OR 1010,00 BTU) 9SSUA CE DATE
he mow rye,%Aurt ordily whimemit
h ws sv cmmmirew u defuwl by the Bay Arn A'v t)uslhy Muutgatvn
District? BOILER-COW(OVER 100,"BTU) AUG 14 1995
❑Yet No NEW RFSTDFMIAL MECII. SQ.FT.
T have rtm Lha hazard,'.mee"a•rtywmmenet alma Cmager 6.95 err tk C�jr Lit.
Cslif«nW HeMn&Safety C«k.Sectlo s 25505.25533 W 25534. 1 oMa,lu d Thu
if tk building don not cmanly live a enen4 Out it my ocp ibilh,to Witty Ne
copom of the m,lu mmems whiiicc/hh mmusust W met it iar 1,ie\aan«,f a Cen1BOom of
Owner d-canted e t ��DW J TOTAL: ISSUED BY:
OFFICE