26195 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE HALL POINT PEN ONLY
CITY OF CUPERTINO PLFmmIL .WCHANICAL P N° 26195
BUII,DINGI)MMON APPLICATION/PERNIIT Ruaow°PRo.Ecrmt.NlTncAn°N
SANI'TARYNO. MPLICATION3I6)MITTA1,DATB
D O l CO A'SNAME: LiC�f'
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CONTACT: PHONE. QTY. (Jf MYCPRLC PERMIT FEE flp, BUILDING PERMIT INFO
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PIERATT ISSUANCE ❑ ❑
LICENSED CONTRACTORS DECLARATIONAHSIDffiVTfAL
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6zVz I mf wCI wdeEaf Lind UP TO 200 AMPS
Data-cmaatm 201-1000 AMPS
[Fp.0 ARCHITECTS DECLARATION OVER 1000 AMPS SQ.Fr.FLOOR AREA SISQ.FC.
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OWNER-BUBAHR DECLARATION SPECfAL CQlCIE1'fiB9C.
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SWEIdMINIO POOL&FCPASC � VALUATION
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andPm nwor&aadrtm nhucmeieu oi.Lt.daroR'a does me apply 70an o mlcese
and Paafadoas Code:The mthe do Liana Law dabs ar apply m m owner of
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oavemyloyeee,provldedNalevchimpmvmeubmemtinmodadmoSmNBmeale.ff, OAOUP R&9.UNITS
mweva,tlmixi0Nv8mimlwvemmtiamMwitmnomY�oftampluim,Omowrcr- TOTAL
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13 PLUMBING PERMIT WE FLOOD ZONE APN
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Ilcav I". ALTER.DRAW RMIT-WATER(EA) FEE SUMMARY
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AM Owner DAT ]BRAINS.FLOOR _ ® RF.CeINIi
WORKMAN COMPIRNSATI0N DECLARATIONTAX Y N
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PaBryd ����T�..•alb Z•� HUIld)IIv'O DIVISION PEES
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❑, CaOBed copy is hWryfmdst�.
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CERTIFICATE OF IMEAUMON FROM WORKERS' OREASETRAP SOILS FEE
ODMPENSATIONINSURANCE
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LT CONSIRUCTONLERDINGAOENCY SESNUCEEE
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10 dowmkfm wbicb Mmpamtmisoed(Sca 3097,CW.G) TOTAL ELECTRIC PIEi
Leaudee. oma 6004! Lamla'BAdtlma Q'T'Y. MECHANICAL PERMIT FII: PLUMBING PIffi
I oerefy Mm I be.mead Ode appllWm and smm Mm Om ebM inloa aLLw Is N U34ANICAL FEE
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F7 alxs omodmwd propmly for iapaimpeapma. ALTHRORADDTOMECB.
(Wer)Agra m Sava baI®dy and keep 0m city of Cvpatlno e9elvd AE HANDLING UNIT('1'O 10,000 CFM)
HuWBOa, and w many amvaagetmleaNCiry
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a� AIR HANDLING UNIT(OVER 10.000 CAM)
SI PApplicenVC 4Mem EXNAUSTHOOD(WIDWI) PAID
} OUSMATERMTSDISCIASURE HEATINOUMTCrOIOUWBTW Date ROMA#
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FIEATINOUNIT(OVERIODAMUTU)
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Code,Satim 25532(a)7 VWTDIATION FAN(SINGLERESID)
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ba=d m air commmmmm a defined by the Bey Ara Air Quality Management BORER-CDW(OVER IOOA00BTT1) �I p�
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Owrcrmamituriadagmt Data TOTAL ISSU®BY:
OFFICE