25239 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
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APPLICATION/PERMIT PLUSIBING-MKCIIANICAL [ [ 9
BUILDING DIVISION +.h£?.'Pki4 T.•:�UILDING PROJECT I5PNTB1CATION7lh;4f mXk(i TtJ
ULLDING ADDRESS: '7` SANITARYNO. APPLICA]IONSUBMMALDAM
1030 MALvep-v a UNRN LOT#
�JJjPIRS NAyM1fL': n PHONE: ^CTO 'S NAME: LIC NO: N� CON—TR-O—L# l,/
piss t So3
/ENGINEER:
LIC NO: DDRESS:
;t 9M,GUucPy LJ .
NTACT: PHONE sflh >^'f " ys- yr_.
.I+ ° aaP .���,` .y ,..1 -BUII:DWOPERMTf�A1POi'.';�ti}:: :
Cl c• F BLDG PLUMB /MECH
L*
' — PERMITIssuANCE
fICENSEDmnN un pmviORS DECLARATIONdamr9 APPLIANCES-RESIDENTIAL JOB
Qs.V� full form atd,(fire lunlianudun�viuo:uo(Q epur9(cawsencing witLADESCRIPTION �
00 Sauon]000)of Division 3 of the Busiow W Profession Code.md my license u in PANELS
License
y0 D� TIECTS OECIMATIS OVER 1000 AMP$ SQ.FT.FLOOR AREA S/sQ
Z—p IuMvsuM my plays alWl be ttsW uspublic oavnds. ■ D
CAL
. liccnacd Professional OWNER-BUHAERDECLARATION SIGNS
GPECIALL CHRCUTTMSC bb� IN��
.OaU 1 hereby aff Oats I w exempt from Ox Contactors IJarnze Law f«the
:3UTE
0 rFit following Human.(Sadm]031.5.Business and Rofesvau Cade An,city car county TEh1P.METIER OR POE NST. ��
rugLLnj which«gavu a motor m c«utun,alter,improve.demolish,«repu any anucme /C_l
>2 pdmmiu ususottt.siao rtquiocs the appliusnlfm amh permitmfileedgttM setemcnt POWER DEVICES f
CO that be is Turned parceson he the provisions of the Contsemrs liana Law((]epic _�I
'4u, 9(cmmmcing with SmOm T000)of Division 3 ofthe Business aM
Prof
Bu SWBNhIB4GPOOLFIECIRH7 VALUATION
W=co «tMl hcu,wnpt thveGwnaM the 6asisf«the allegM ezmµilim.MYviolsum of -
FZQSmtion]0313 by any Whitman for.perenilmbjecs the applcent on. penalty �
vil penalty of tS'SWTI'CHES-FIXTURES
Wnus more than five hundml down(s500).. .�,—SQ
nem ❑ 1,uowrcofthepropery,«myemployctlwith wagcu0c'vwlcc«npvwtim, STORIES TYPE CONSTRUCIIUN
y3— willdothw«k,aodthimucmrtisnd inmdcd«affeoN f«We(Sce]114/,Busiau
anti Noftlsims Coo:The Cmtrmtars limue law datl twl yPly to an owns of
pmpcnywhobuildsmimpova0rsm,v whodonmchw him lfwhtmghMs OCCGROUP RES.UNITS
ownempbymMvideddulsuchimpmvemmumnminund oroffc fm We.V,
nowevc.tic building«improvensent u nld wi W n one ren or conrylcdon,the own-
builds wBl have the burden of provirog thus be dice not bulla«improve f«emcee«,of
sale). •0 aa:to }G'P H1 H FLOOD ZONE' APN
❑ I,tl own jaa(Sm.7 uneacluz;and vng with liiemedwntan«sm 1y �- �
couswm six projml(Ste.]004.Bushmtiv and professions Cade)The Commeters
U.lawdassim pPlyman owrvofpoperrywhobuilda«imptmtl Naeon.W PERMRISSUANCE
wlrocmtzamfasvchprtrjectswiNacantenor(a)UcmrMpusumte UeContractola
ALTER (FA)
Limnlar.- FIE SUAAJARY.
❑ IweseoWtuWa Ste. ,B@PCT«dda rumn p �I
-n BACK FLAW PROTECT.DEVICE SANITARY Y N
Owner DRAWS-FLOOR,ROOF,AREA,COND. RECEIPT'#
A,�' --WORKMANCOMPENSATIONDECLARATION� SCHOOL TAX Y N
KIhemsysr;n that l bavea carefcamdcontrol a self-iiwrt,as carificueof I FIXTURES-PER TRAP. �w RECEIPT#
C®prention Luurmmor a carufied copy Nertof(Son.3800,tab C.)which PARKFEE Y N_
covin Wmplayal uMC Nix peomit. GAS-EA.SYSTEM-1 INC.4 OUTLETS � RECEIPT#
Policy if BUILDING DIVISION FEES
Ca#�Y GAS-EA.SYSTEM-0VER 4 rEA) PLANCHECK FEE
CI Cadfd es,is hereby fumichM
Cesdfie,copy is filed with to city inspection division. GREASONDUSfRL WASTE INTERCEPTOR GRADING FEE
CERTITI ATEOFEXEMPf10NFROMWORKERS' GREASETRAP SOILS FEE
CVn1PFNSATION WSURANCE
(fhiscomen mM mlbewnpletdi(the marmots f«mehummthzd dollan(SIM) SEWER-SANITARY-STORM EA.20017T. ENERGY FEE
«Ina.)
I anify that hi th"arfimmencedds,wort for wldch this permit iz issued.I shall WATER HEATER WIVFNI]ELECIR
nus employ any pmon in any manner m as to M e subject as the Wwteri PAID
. z Comp.onlawsof .Cafifomia. Du WATERSYSfEhVfREATWG Due Receipt#
Applicant
j NOTICE TO APPLICANT-.if,after among this Cardfiwe of Exempum,you should NEW RESIDENTIAL PIMB. SQ.PT. TOTAL:
became subject m the W« s Campers dm envision olds labof Code.yon muss
> forthwith comply with meth powisions or this permit"I be clamed mvaa BUILDING FEE
/a
(] CONSTRUCTION LENDING AGENCY SEISMIC FEE D
D Z Ihereby aR that then u a construction lmding agency for the pcfozmana of
the wok it which this haemo is issued(Sm.3097,Ci,C) ELECTW C FEE
� � as Name �I_VJ7 lc y,�,la•atc:.s;T�•s;;.:rr+u tg..:eyrnx
r.AddressQTy,• rMEC�H"A_MCA-LSrP&R-hIIT., ..' ) gr+"i PLumewc FEE r.
I artily thus 1 have rad misapplication andl Ince.thu the.bows information iz
commu Infirm,b comply with ell city cad coamy ortmocceand some lawarelaung as PERMITISSUANCE MECHANICALFEE
buildingm« cuon,mdhenbyeuNminnpa mfivuofNscitymmtaupon Ne
Z above-mmdond proper,for inspcctim purport. ALTER OR ADD TO MECH. CONSTRUCTION TAX
(We)spm He ssz<,indemnify aW keep buMess the City of Cupertino against
nu,coau arMa
ccpenzwhich may many waysecrueagsinat said City ABR HANULNG UNIT(TO 10.000 CFM)
core9usnceogomunB of this permit.
2z-)3 AIR HANDLING UNIT(OVER 10.000 CFM)
c-
Sij{plmrt o(Applicant/Cantran« Date EXHAUST HOOD(W/DUCn PAID 6
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO IM."BTU) Date Rc g V
Will the applicant«form
occ,upant re«bWle Beat,sol Safety
HEATING UNIT(OVER 100.000 BTU) TOTAL:
u defined by de CLpenim Mwicipsi Calc,Chaeta 9.13.eM the HW th orb Safcy
Code,Section 255J](a)//,��ma-... VENI]LATION FAN(SINGLE RESID)
ISSUANCE DATE
❑Yes C:UN.
Will theappliuntafuoue building acupmtuuryuipme««devicaim
whchJt ROLLER- COMPOHP OR 11X4000BN7
haent auoonumina/nTu,�in defirm by de,Bay Arta Air Quality Management BOILER-COMP(OVER 100,"BTU) P Q D
District?
13 Y. yrtmo
NEW RESIDENTIAL MECIL SQ.FT. JUN
UN
I h.wc read the hicardouc materials rm.item,mt under Chapter 6.95 of the 1993
California HWth S Safety Cade.Sauons 35505,853]and 25534. 1 understood that Cil
if the building dust not curremly haverteram.do it is no,rtapumibility to notify the I Ur
occupant of the ne,uimmena which must be met pnar to issuance of a Certificate of VUrCfI I
Occupancy.
Gunerar..tmim,l.gmH Dane ItITAK ISSUMBY:
® 6 >
E L e a r Il
-Fie dd Mew rxert F rmat emrds Dols Window Nelp '- r
16, IF,Fm11,- wIle1I11 irk
W=nML (j{ jj U%"M 6 D Tk= Input Permit Number: 0
PERMIT#. 2523 ARCHITECT: VALUATION: 229
APN. LICENSE It ISSDATE: 6/2219
SITUS STREET: MALVERN COURT SUBDATE: 6/22/93 PLCHKDONE:
SITUS NO#: 10381 TYPE: RSX TATE CODE:
AVE,CT,ST,RD: BLDGDEPT:
N,S.E.W. DESCRIPTION: KIT/8TH/SKYLT ENGDEPT:
NO#: PLANDEPT:
CITY. PLCHKRED. N CMA:
ZIP' CATEGORY CTRFIRE:
LOT#: D DATEDUE: SANDIST:
ID: NOLD Commercial HLTHDEPT:
OWNER: NOLD CQsq#fl#: STRCTENL
OWNER CEsq#fl# TOTAL'
ADDRESS: CN'sq#lt#: INSPHOLD:
CITY,STREET2IP: Residential �I�
PHONE: RNaq#II#: P
CONTRACTOR.' RE sq#ft#:
LIC# RUSaq### Search by Address
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