26437 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Runt,"'NisF.fECINTCM. 1'I;RMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL, 264/�
BUILDING DIVISION - - BUILDING PROJECT WENT IFICATION G 1•I
37
BUILDING ADDRESS: �Iati1 SANITARY NO. APPLICATION SUBMI'FTALDATE'
T Tp LOT
OWNERSNAME: PHONE: CONT ACTOR'S NAME: I LIC NO: NIC CONK p
YA C
RCHITE /ENGINEER: LEC NO: ADDRESS: AT, ❑
s
CONTACT: PHONE: 6Y][',
E s I. ?
Q71Y�syrbs E6ECTRIC PERMIT i. (EI? NOILDING PERMIT INFO
l J BLDG ELECT PLUMB MECH
p^] ` PERMIT ISSUANCE
LICENSED CONTRACT'OR'S DECLARATION PLIANCES-RESIDENTIAL IDB DESCRIPTION
aZ I hereby norm that l an licensed underprmisions ofattoor9(commencing with
00 Smrion]000)of Div4um3of the tlusinesa and ProPossionsCWe,and my liccnu is in p S w.a_
F I1d�E full force and effect.
-VZ,od Licenu Class I.ic.Is d UP TOV AMPS
ns6� Dau Convector 201-1 MPS V
,z8O R, ARCHITECTSV.CI.ARtlGON OVER 1000 PS SQ.FE FLOOR AREA $/SQ.ET.
OZ-0 lunderstwd my Plans shall Muud public Tec ds.
w SIGNS
Q,�< Licensed Professionnl OWNER- IIAER DECIARAT10 SPECIAL
CL
IRCUITC.
i0.0�4a1 I Imrchy uffimt that I a umpt from the Conuacmrs 1. se Law for the
W 3u.m following reason.(Section 7 .5,Business sad professions Code: ity or county TEMP.METER OR POLE
-� which requires a permit t mormact,Ater,improve.demolish,or ni strucram
or
priormitsissusnee, requires the applicant for such permn mf asigneA ancient POWER DEVICES
uull 0 p thin he is license ursuant m the provisions of the Comracmt t Law( Ter
m o�' 9(commen ' with Scetim7000)of DIvlslon3of the Bu' ProfessiumC SWIMMING POOL ECTRIC VALUATION
,_y m0mlh exemp llormfromand the basis for the alleged a tiun.Anyviolatione OUTLET'S-SW HES-PI%'NRES
Serdon 315byanyapplicamforn pnmit xuM1jtt¢the 'ma to u civil penalty of
actuaries five hundred dollars 15500).
p perry,ormyempAw'
as Beirsolec inamr. NEWRESI ALELECIR _SQ.
m ❑ I,asaw rot the ro STORIES 'TYPE CONSTR CTION
y3_ willdmhewor , rid thcswemreisnotin�efor sale(Sec. no mess f
and Pndasioms c:The Contractor's Ls nm apply t wrier o
pmpenywhomildao' provathereum, werkhimsel(6 through sOCC.GROUT' RFS.UNITS
wnemployms,provide atsuchimprovetended feo farsalhowever,Nebtildingnri sement isAof p n,the ner- TOTALbuilder will have the burden ving thadoriryp rforp ..of
sale.). /��/ rt,.. f Y F ,
❑ I,mownerofthcpmpmy, xclusivelycomroctingwith ceased mvannsto QsTY, % PLUMBING PERMIT } 'PEE' ELooD ZONE APN
construct the project(Sec.7044,Bu'ness and Professions Code:) Contractor's
License Law does not apply memowner ropenywhobuildsorimp es Nerean,and PERMIT ISSUANCE
who contracts forsuch pmjeas with action tor(sUlcenudpumuon tithe Contractor's ALTER-IlRA1N&VEM'-WATER jr
,N)Law. ) x FEE SUMMARY
❑ 1 am exempt under Sec. P C for this mason NC K FLOW PROTECT.DHVICE SANITARY OUT.SIDE FEL:.—N
-
Owner Date RECEIPT p
WORKMAN COMPENSATION DECLARATION DRAS-FLOOR.RUE,AREA,COND. SCHOOL'I'AX YN
❑ Iherthy affirm lLmlhaveaceni0cnne ofcentum molt-in sum,mitermfiestrof RECEIPT Is
PIXTUR -PER TRAP
WorkerlCmpla, minnler this permit. ified copy mcuof(Sec.3gW,Lab C.)which PARK FIiIi Y N
en Nl<mployces under this permit. GAS-EA.$ TEM-I INC.40IITL S R[CEIPI'p
PolicyM BUILDING DIVISION FEES
Company GAS-EA.SYS .M-OVER4( PLANCHHCK PEE
finished❑ Certified copy is hereby finished
61� Certified copy is filed with Ne city inspersion division. GREASFJINDUST WA " :INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS EF.
COMPENSATION INSURANCE
('I his section need not be cmmpleted ifthe permit is forome hundred dollars($100) SEWER-SANIT Y-S' RM EA.200111'. ENERGY FER
or less.)
I certify thea in the performance of the work for which this mmit is issued,l shall WATER i0ER W/VENT - CTR
not employ any person in any towner so as m b>ecoTq syhl'ect m the Worker% PAID
Compensation Laws o(Celiiow is Dm�e1 � � I (L( `f/gf WAT gYSTP.M/IRGTING Dau Receiptp
FZ NOTICEtTO APPLICANT:If,afiermki this of Exert SQ.g pion,you should RESIDENTIAL PLMB. 5 TOTAL:
(q
become withcoattothe Worker's Compensation ermiaitinsof theemed yoked. must
a ? forthwith comply with such provisions or permit shall be deemed revoked. BUILDING EF. /�
a (� CONSTRUCTION LENDING AGENCY SEISMIC THE
Uz I hereby affirm thea there is s construction lending agency for Na e perforom of
Q the work for which this permit is issued(Sec.3097,Civ.C.) TOTAL: ELECTRIC FEE
L4 ULance,'.Name - PLUMBING FEE
LcndeEs Address T,Y.'',i7 t- MECHANICAL PERMIT FEP-
U 1 certify that 1 have read this application cod slate that the above information is i.L
correct. I agree to comply with all city and county ordimwca and auto laws relating to PERMIT ISSUANCE MECHANICALEE.
I-' N building construction,and hereby ambonce repuunblivesofthiscity to enterupon the
U abarve-mentioned property for inspection putpous, p TER OR ADD TO ME.CII. CONSTRUCTION TAX
(We)agree to cove,Indemnify and keep harmer,the City of Cupertino against
Iiahilitia,judgmentmcosts and expenses which may in any way accrueagainsuuid City AIR DLING UNITT 010.000 CFM)
in consequence of the granting of this permit.
AIR HAN LNG UNIT(OVER 10,000 CI:M
Signature of Applican4Cornractnr Date EXHAUST TIND W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT 10oVIO BTU Dau ReceiptI
Will the applicant or future building occupant store or handle hseallous maternal HEATING UNIT(ONIlp, BTU) l'
as defined by the Cupertino Municipal Cede,Chapter 9.12,and the Health and Safety
Code,Section 25532(u)?
0Yes ❑No VENTILATION FAN(SI I.I,RESID)
Willtheapplicwt orfnum huildinoccuwmsc BOILER-COMP(3 ORI BM) ISSUANCE DATE
g p equipmentmdevices whichema RSf A `1 V
hu mutts.air conmmimwu as defined by the Bay Area At,Quality Management BOILER-COM OVER IB0,OD0 TU) If�
District?
❑Yea ❑Nti NEW RESID TIAL MECII------ SQ.FI'. 'JUL _6 4994
1 have read the husrdons malmals requianments under Chapter 6.95 of the
California ITedda&Safety Code.Sections 25505,23533 and 25534. 1 understand that
if the building dsi currently havcarenant that it is my responsibility to notify the CIIY Ur "rCh1IINV {a�T
occupant of the yuircmwts which must he i prior m issmnw of u ciffi.a of
occupancy. Q
f
Ownerorumhonzed dent ���� Date TOTAL: ISSUED BY: `J