24932 APPLICANT TO MILIA INMAMATION WITHIN REb LINES-USE BALL POINT PEN ONLY
"1 'i CITY OF CUPERTINO', BUILDING- . .CT ICA PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL
;y BUILDING DIVISION I I y
' 24932
BUILDINGADDRESS:_;�
�7, 44 p ��{{ � �/ I/ SANITARY NO. APPLICATION SUBMfITA1.DATE
;t.`. /3 b r+Y� J'. 4TECUN6 (ZA.y wrIIND UNIT0 (~ LOT# 31"
i, JJ
O ERS NAME; r1 - / OTN6:: CONT)IpCI'OR' N LIC NO:
�— C!Y \ 'J 3—YJ-3�1 N COKIRO g
ADECT/BNOINEER: WC NO: ADDRESS: ❑
. a'.,+ -, Nrncr: � PxoNe: � '� CTRIU�p •r t ',tt"rijUII.UI CI'PPRMIT ItiPOYI �`r?k:>'s:'t'
�f}LInI/F weQ— S.f3—ys� QLD seer P.uAe MECH
' PERMIT ISSUANCE '1�
LICENSED CONTRACTOR'S DECLARATION AMLANCES:RRWDENTIAL TOB DESCRIPTION
yx m, 7").f Division
un1'the
uMerpwvlsleiuicam Cade,
mu any licensraring e
00 9eclin eraby of on tim I3 of the so dncu endvidera (C Cada,end my raenu Is In pprypl-g
y b full fora and effect. +/�.�'
OF. RLlmme Oau Lie.# UPT020DAMM ^�
N� eoilmto
0 Dau Comme 201.1000 AMPS as
ARCHITECTS DECLARATION OVER IOOIIAMPg .. ;ZSQ. RA !A S .PT.
x fJ/ l understand my plans.hall W used u public records. 1`l
MENU
SIGNS ELECTRICAL
u Licensed Professional
a that
I am camps fa DCC Contractor's
'PECIAL CIRCUIT/MISC.
O F. 1 ng mu aiRrrn mel 1 am camps from the Cntracl Co License Lew forco the -
awy following dyes. eanion cammot.her, end Professional Code: my city or county TEMP.MPTI?R OR POLE INET.
I'JyJf whkhlIt. aremittoions.the eller,Improve,h permit. mmpdrmyeWcturt
>•� Buume I,Ilewentt, mend to telh rovidmnsfine Co permit file.License IA.
POWER DEVICES
— j
9( he Is.I.gMpununitothed.f MIlli of the Convectors Lia nu Lewcc Codm
6,the W mingwimSrefrom0W)of basis rn 3oftheed exere and ProreulnaCMo) SWIMMING POOL CLECIAIC VpI Up'fMa,
w orlhat 7031.5 by yapplinndthe PerHfmlhe allegedaxmcant 0 civil ny violation
of OUTLETS-SWITCHES-FIXTURES O �r
i Section than iv anydle doll fm.Permit subjects the applicant medull realty of ,
ml rove Nen floe hundred dollen($500)..
❑ I,uowmroGhepopersy,mmyemployhsawhh omega i+Iheirwlewmpauellon, NEW RESID('NiIAL P.LECIR —SQ.Fr.. STORIES TYPE CONSTR 0110
willdothewmk,endthe he CarelenmIntended Lawdefmnue(Sec.7050, wn,of
.and Rofeulone Code:The va theclor a newho Lew dohs not apply I.n awnn of
property who bui ld.m improve durtm,and w W aloe Inch work h imwl f m through his
ownemployee,pooideal Improvement
rImpmvld whitaeseimendedarofrernd fornue.Ir.
OCC,GROUP
howeverWilder ,Ihbve manmclanof lruntiewld wdidamuyeuan Napo eran sAeowmr- TOTAL
Wilder will have the Wrdn of paving that budldM Wildmlmpove fa WtPrre of
ule,l. ?' pap
❑ I,nownerorthepapeny.mexclusivelyaonvaningwlshllcmudc "et moa ngq;M FLOODZO AIN
w n
comtmd the popiecl(Sec.7050,Business tad Profee.lns Cock:)The convenor. '
Llcenu Lewdasnnnpplylonowatt.(Borenywhobvildaorlinpwvnlhertan,wd PERMIT ISSUANCE
tMuenoecu r.achpwl la.with arontmethr e)littued punuanlwth.Cmdowelar. 'Y
• Lic nes (H
LA.. ALTER-DRAIN&VENT-WATER A) :ABB•SIJ.. M A RYe 1i1 .. .. ,f
❑ I w mcmpl underSec. ,B&P C fm Thus amum -
- - --ii' •, BACK FLOW PROTECT.DEVICE SANITARY YN
• OOman- Dale DRAINS-FLOOR.ROOF,AREA,COND. R_EC EIPT#
WORKMAHCOMPHNSATTONDEMRATION SCIIWLTAX Y N
Ihenq eMMitn thetl MesttnlMeu afemieent to self-inmu.orecenlBcsle of FIXTURESPH0.UiAP RECEIPT#
�"• 'Campeimmanence,immanence, m
tim immanence,ar• utinM nab Py thmser(See.3800,LC.)which PARKFEH Y N
- "then dl wllptoyede vMs Nh pmnll. RECEIPT#
r yg OAS-EA.SYSTRM-IINC.000TLEI.: BUILDING DIVISION FEES
eYan
❑ C<ms"lfiM call b hertby famished.. OAS-HA.SYSTEM-0VER 0(EA) - v PLANCIIECK FF.P.
❑ Cenlfledcopy le Bled with the city le pecdndlvl.Ion. GREASIVINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' ORHASETRAP SOILS FP.R
COMPENSATION INSURANCE
(Tld.wed.mad not W completed lithe pemdl is froom hundreddollara(5100) SEWER.SANITARY-STORM EA.21101T. BllCNOY FEE I
orlon.) '
I cenlry that In the Betfomince of the wells rat which this permit a issued,l shell WATER HEATER WNEKDELECfR
M employ any preen In any manna w as u Wane mdjort to the Work.' PAID
Zi Cmnpndallon Laws0fCalifamlL Date WATER SYSTEaUTRPATINO Dau Reccip# r
O Applicant 1
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ,IT. TOTAL:
� f%2 becarmsbJect to the Warker.Compwhsdn pnvidmuaf Ne Lmmm Cade,yon mum !
E: forthwith comply w0heuch pmvialna or this permit shall be deemed rooked. - BUILDNG ME rs
4in CONSTRUCTION LENDING AGENCY SEISMIC FEE �w
3Z IWmby.Mm that them In awmouclion lending agency fmthe pedolmemeof TOTAL: EI.ECIRICTAB
) {0{—! the wmk rat which this permit Is issued See.3097,Civ,C.) yy�.�.�yy
Cl' Leaders Name
LbNd �❑Ft
rAdd.. t sWMA
+ apgg! PLUMBING PER 1�
VV I certify that I have mad this application end auto that the shove Infmmmin ie p
correct 11.to comply with all city and..at,otdirt.and naw law.relatlnpa' PERMIT ISSUANCE MECHANICAL FEE
y paj2 building nnnunin,and hereby authorise nprtwnutivn orad.city toenim upon the
above-memlmed CONSTRUCOON TAX
7 TnaBenY for Innpeclln purposes. AI.TP.R OR ADD TO MEC11.
L7 1 We)egm m sever Indemnify mW keep hermke.the ChY of Npemitro egeimt i
IlsMlities.jndgmen rots nrnv which may in any wyaamevgelnatnW Ciry AIR IIANDLINO UNIT TO I0,000 CM)
Inc uentt of ng of 344 permll..
3 AIR fIANDLINO UNIT(OVER 10,000 CFM)
Became of ApplRarAlCoulassetor Data RXIIAUSTHOOD(WIDUCT)
PAID
HAZARDOUS MATERIALS DISLTAS E IIEATING UNIT(TU IW,11fM1 BTU) Data Receipt#
Will thempllcnt orfuture building mnrnulan or handle hmmdous materiel BEATING UNIT(OVER 100i"BTU), 'O'AI
b deflned by 0u Carmine Municipal Cade,Chapin 9.12,and the Health and Sale,
Code,gestin 25532(q] VENTILATION FAN(SINGLE,RESID)
❑Yhs ❑No
BOILER-COMP(]UP OR lial"BTU) ISSUANCE ATE
a WIII dunP
. ph'w
llanfutme building accupnl use equipment an devices which emit
rodour W I cmmumm,u defined by the Bay Asa Air Quality Management RGg.F,R-COMP(OVER 100.0110 BN)
dlcH k,, .
'41 13Ya 11 No NEW RESIDENTIAL MECIL SQ,FT. P A I I] {
,I him ied the hatum oo.materials requiremcnta under Chapter 6.95 of the 1
( -ifom6 Hallh&Safety CMe,Seclin.25505,23533 and 25334.1 understand that �I�1 e 3o
;,`. the Wilding dean not mno
ncurllly have a tenant,that it le my tpneibllity to notify the PdAR
•s urns of Ne requirements which mut be met prim to inunce of•Ceniflnu of
A I Lau
f J7sl romfladeed.,ml Data TOTAL: ISSUEDBY:
OFFICE j