26042 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPER'P1N0 A PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING•MecxeNICAL 26042
'�1`:'e.:_ <!`BUdDBiC PROJECT IDENI7PICATION%ip?�+i�5vii
❑ALDING ADDRESS: SANITART NO. AllucA'DONS/U�BMHIAL DATE
I '—1 1 UNIT a LOT is
OWNERS AMFQQIICT� PHONE: CONTRA '5 AME: lh
4 _ /.I CONI'ROLa
CHI'D> /ENGINEER: LIC NO: ADDR 5: l(�s�a�"� ❑
CONTACT: PHONE: 'i-= jap3 .�i ,s 's" rvm k" saari ,Y`-x r � t .y:`H�'.:u•-
QTY.•,f„ 5 H.EC77tIC PERFllTiE
^-'�a r'FF8 7 - BUILDING PERMIT INFO -•,
es 6th -- RHIM ELECT' U B MECH
PERMIT ISSUANCE ❑ ❑
LICENSED CONTRACTOR'SDE .fCh.m 9( APPLIANCES-RESIDENTIAL JOB DESCRIPTION
t y.Z IM1erchy oBrmthaO 3 oftlicensed Buinss and rofinif(.bapde,add my become
with
JOO Section?o00)of Division 3ol the Boniness end Prolusions Code,end my liamcis in PANELS
w full(one end We 1
:Q6 Liunx (-_ CJps-�Lic.N VP T02W AMP5 s .
Dare of Convec,or 201-11100 AMPS
�Z ARCHI'IECTSD LAMTION SQ.FT.FLOOR AREA 5/SQ,FT.
1 undestvd my plans Nall be used M public records. OVER 1000 AMPS
iFal SIGNS ELECTRICAL
Licensed!Professional
of, OWNER-BUILDER DECLARATION SPECIALCIRCUITMISC { A 1\\
`i FU i hereby alfc,dust 1 am asempt from the Cmmetoes License law for Ne i1I1 L Yf 1: �I
oroa following wan(Section 70313,Businns and Profevios Code:Any city creamery TEMP.METER OR POLE INST.
.m..l which requbn a Poison.in ennsautt,alter.improve,droadiah,or repan any soumure
:}z prior b its issuance,am requires the applicant for such permit rc rile v signal swcmmt POWER DEVICES �•1 ,� L—
t<0 that he is limmM pusuanuo Ne provi.iom of Ne Conmcwe.Liunx law(Chapter SWIMMING POOL ELECTRIC
;p�' 9(cosounenemg with Section T000)of Division Jof the Buun...old Profession Code) UATION
_m or them he is a..P,thomfrsin and the luaus for the alleged namption.Any violation.(
'.Zn.• Section?0313 by my applicant for a permit subjects the applicant to a civil Penney of o1mEr5-swlTexEs-FIXNRF_S DATE ��---
Q nm mom flan five hundred dollars(5500).
.(—p ❑ I,ssowmafte, gnu persetion, NEW RESIDFN'f1AL ELECfR _S
properry.ormyemployeawithwa thevmlecom STORIES TYPE CONSIRUCI'IOM1'
will dothework,and to smmucisnotinrcndrdoroffered forvle(S .TOl4,Business
and Profeviom Code:The Commerce.Lt.law doss nm apply w an owner of
property who builds orimpova Oweon,and whodoe.such wmk himseifor dough his OCC GROUP RES.UNITS
owmemployes,pmviddthemsuchimprovemensaremlinwndcdwoffe forsue.If.
however,the building or improvemand,is mid wi thin one year of mmpleti on,the owner.
buc bm o
ildwill Wve the adf proving than he did not build or mprove for IntrIntrinsicpnof TOTAL"'
sue.). try-afc+uvaneasasa' vGy��n jsVo
❑ I.wownuofthepmpeny.amexclmivcl mnmctin Aliunsedwmanonw .� GST' �, $ 'yb BE FLOOD ZONE APN
Y Swi atA aEadH-
consmct the project(Sec.7044,Business and Professions Cade:)The Conme.oea
U.lawdoesm.applywanownnaflimpeny whobuildmimprovnteean,and I PERMIT ISSUANCE
who..Lacs for each Projects witnacmvutor(a)BmmW parsuanfwpc Conmcmr'. ALTER-DRAIN&VENT-WATER(EA) "• .'s��3"✓'"CpBC SIIIvBv1A_R.Y
Liave law. asl���h
❑ 1 am esemp undo Sec ,B&P C fu dds reason BACK FLOW PROTECT,DEVICE OUTSIDEFEES
SANITARY YN
Owner Date DRAINS-FLOOR.ROOF.AREA.GOND. RECEIPT N
WORKMAN COMPENSATION DECUBATION SCHOOLTAX YN
I hereby aft Owl have.cmilcuc of cannon,to salt-mum,ora cerufinte of RECEIPTN
d,er Compensation Inman.ora artifiedcopy thcrcaf(Sec.380),Lab C.)which I FI 71URF_S-PER TRAP PARKFEE Y N
covenul ertrc py5e�ynder tltis prnniL — f
0 C5ynf GAS-EA.SYSTEM-I INC.4 OUTLETS BUILDINGDIVISION FEES
RECEIPT
Company
Policy t-!r1 /
W fiN copy is hereby famished. GAS-FA SYSTEM-OVER 4(EA) PLANCRECK FEE
Epocadried copy is filed with she city inspection division. GRFASWUJUSTRLWASTEB.TERCEPfOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION WSURANCE
(Ibis sxtionrcdno.b mmplead ifte permits foronr hundred di.R.(SM) SEWER-SANITARY-STORM EA.2W1FT. ENERGY FEE
or lcsvJ
I unify tut in the Performance of tha.ark for which this Permit is issued.I shall WATER HEATER W/VFNT/ELECIR
not employ any person in any manner sass be become subject to the Workeri PAID
Compmunion Lawsof Califomia. Date WATER SYSTEMRREAMNG Date ReceiplN
Z Applicant
O NOTICE TO APPLICANT:If.after making this Certfiae,of Exemption,you should NEW RESIDEN 1AL PLMB. SQ.FT. TOTAL:
Ln become,subject to the Wohees Compensation pmvisiom of the Labor Code,you mus
forth comply with such provisions or this permit shut h domed revoked. BUILDING FEE
a CONSTRUCTION LENDING AGENCY SEISMIC FEE
.Z i hereby affirm that then is a caramction lending agency for the performance of
O the waft for which this Permit is issued(Su.309),Civ.C.) TOTAL: ELECTRIC FEE
Lenders Name «xB aa.++r 4e<sad-::w�a-.n't•"^.y--1 I�•.. ''<-Gjt PLUMBING FEE
F leaders Address QTY.r ,MfiCHANICAI:PER
U 1 certify that 1 have read this application and safe that dee ab.vr information is4.., T:.;Aai.»n,
W Correct.Iagme,to comply with all city and county ordinances and mine laws mining to PERMIT ISSUANCE MECHANICAL FEE
building construction,and hembv authrnme reprexnativ sa(this city inciter upon the CONSTRUCTION TAX
Z above-mantloned property for inspection puryoses. ALTER OR ADD TO MECH.
(We)ague w save,indemnify and keep harmless the City of Cupertino agum,
liabilities,judgments.rose and eaprnas which may in any way.ccrue.gssdm said City AIR HANDLING UIJIT(TO 10B0)CFM)
to c—mai.so,c of the granting of chis permit.
AIR HANDLING UNIT(OVER IU."CFM)
Signature of APplicanUConmcmr Da¢ EXHAUST HOOD(W/DUCr) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 10I.W0 BTU) Date Ncrcipta
Will the applicant or future building occupont store or handle hazardous material HEATING UNIT(OVER 100.000 BTU) TOTAL:
as ddned by.he Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Cock,Section 25532(.)? VENDUTION FAN(SINGLE RESUB as 11 W 6
❑Yes ❑No
Will thea licanmrfumre buildin Cox tordevimawhich emit BOILER-COMP(JHP OR 100.(100 RTU)
N
PP gucupan equipmcn
Vests air coaumirenu as defined by the Bay Amo Au Quality Management BOILER-COMP(OVER 100.000 BTU) APR 1 2 e
Lattice? 199 ,
❑Yes ❑N. A7.577
i sr NEW RESIDENTIAL MECH. SQ.FT.
I have mad.he h—mdous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 25574. I undersand that gtgg INSPECTION DEPARTMENT
if building doer man currently have a wont.that it is my rnponsibaity to notify Ie, CITY OF CUPERTI 0
occupant of the requirements which must be met prior to i.ssumce of a Certificate of
Occupancy,
fywrcr or vuthoriud agmen Dew TOTAL ISSUED BY-
OFFICE
Y:OF IC