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26138APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE PALL POINT PEN ONI V CITY OF CUPERTINO BUILDING - R AL BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL ' 'Yi91vR958U1LDING PROJECT IDENTIFICATION,✓,,4, -A, ::_ PERMITNO. f� L J( BUILDING ADDRESS: C ] 1 r 1q r 1 &N/� C �1_ UNITN LOTH SANITARY NO. APPLICATIONSUBMITTALDA, ��l OWNERS NAME: PHONE: -Z 16 Y CONIRACOR NAME: LIC NO: ,= Z c=L V� CONfROLN ARCHITECTIENGINEER: LIC NO: ADDR S: oS [.te O/cl+1YSSEl ONTACf: PHONE: 'm rid R. aErjzi tIPn•�-4+Y 7�.j;�' f1", ja ny" ELECTRIC PPRMMIT„se•+A•c.i��{ FEE. 4$!'•$re`".'Te iBUBDBJG PPRbBT,U1F0 P•. .s. aLOG ELECT PLUMB MECH ❑ ❑ PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm ism I amlicensedB under provisioesofCNpt e. And mmencing with 1 Section elf`eeeeSD��TivisianJatthe Business Arm Rufen -7 Code. and my license is in full Cl.aa 10 Lic.N ST3 �7�/ t License Clens i Data =1 Contractor APPLIANCES - RESIDENTIAL JO DFSCRIPTI `,y1fr/Jy`W"�w•v , PANELS M200 AMPS 201 - I W I AMPS CHITECT'S DECLARATION 1 1 understand my plana sha11 be used as public records. OVE0. 1000 AMPS SQ' FT. FLOOR AREA SIGNS ELECTRICAL Licensed Professional SPECIAL CIRCUIT/MISC. OWNER-BURDERDEION 1 hereby off Nat 1 am exempt from dre,m Con COnuacmis Lima. Law for the i following rtawn. (Section ]0713, Buainea rad Ro(aswm Cade: Any ciry m cowry I which requires a permit to construct. Misr, improve, demolish, or repur any awctum priomoiuiuumn, almeequun Ne applinnt far wch pvmitmfil<asignedsuurmnt II •� , TEMP. METER OR POLE WST. POWER DEVICES j Nan he is ittnud pursuant to Ne povisiom of die COnlemtm', Licrnu law (Cbapur • 9(Commencing with Section 7000) ofDivisiw 3 oflbe BusinessvlM Profession Cade) or that he is exempt tlurmfrom And that basis for ft Alleged exemption. My violation of Section 70313 by any applicant for a perform subjecta the applicant to a civil penalty of SWIMMING POOL ELECTRIC VALUATION 4 / OUTLETS FIXTURES�� nm mom than five hundred dollen ($503).NEW ❑ Lmowrlk.fftoperry, ormycmploye .f.adfu, hevulemmpe.e As roe, W will dothewmk, ands: tumisnon inundede, RESIDENTIAL ©•ECIR QFT STORIES TYPEC STRUCIIOf• Tla, apply of an,Bwimss and Pmtcssiotu Cada: The ConOaculs licvue Iran don Hwa apply m an Owrla of Law ' propeM whoWildsmimMvnmerton,a wMdonsuchwmk Mi lfmO ughhis dMmoeconducWe.IL owncmployxs,providMmanuchimpmvvnenumne C.GROUP RFS, UNITS however, me bate reproeresmatprevia is soldhe didnom yon or earn theawe he bur builder will have the burden a(proving that he did rot build or improve (err purpose of improve for of ' Y61 i 0TCII,uownerof QINGP E - pFRAffT ISSUANCE ]ale.). theproperry,amexclusivelycanractingwithlicen,ed cdnlimtm,m confirm, the Mimi (Sm. 7000, Busim,s W Refeuima Code:) The Consracuri Li. LAwdon not A,plytomownmofpMp M e who buddsmimpmandves thermal, e FLOOD ZONE APN whoconwcufmsuch projects wiNachoWcmt(s) licensed punimatto du Conuamors License Law. ❑ I am exemptundm Sec. , B d: P C fm this rnson �.-DRAINhVENT- ( ) WATER EA BACK FLOW PROTECT. DEVICE ` Owner Dau DRAINS- FLOOR ROOF, AREA, COND. SANITARY Y_N_ - RECEIPTM WORKMAN COMPENSATION DECLARATION ear Lal, In,'Co pen dmtlhaveceoraia ofconseMmsel(Sm38M, Wmkeri Comperwtian lruurancemacertifiedcopy tbermf(Sec 38W,lab C.)which C.) which Caves all employ e'9 a alis pefm L /l 2 Poliryn (��n--,.l. (c9 P94 -Z, -f / SCHOOL TAX. Y_N_ RECEIPT* FIXTURES-PPA TRAP PARKFEH Y "N=• - •' OAS -PA. SYSTEM -1 PIC 001171,Ef5 . BUILDINGMS10N FEES -..•ss,;.. Company G+-" / c 17,1� GAS -FA. SYSTEM-0VFA4(EA) - PLANCNECK FEE . ❑ Gasified copy is bveby furmalud. ❑ Certified copy u filed with the city itupecfion division. GREASEANDUSTRL WASTE INTERCEPTORStT+ GRADING FEE CERTIFICATE OF ExEIMPTION FROM WORKERS' COMPENSATION INSURANCE GREASE TRAP SOILS I'm SEWER- SANITARY• STORM EA. 3WPT. ENERGY FEE (This Amnion deed n0tbacompleud ifthe permit is fmaru hundreddollerv(SIW) or tear.) WATER HEATER W/VENDELECTR' Imrst thar into. pnrfmmance0f lbA woo for which this perm, is issued, l,hall not employ Any person In my More, u As M became Aubjsn t. the Workem, Compenution Laws of Cali(omia. Data Applicant _ WATER SYSfEM/IRI'ATINO pAlp' %-�•„ Date Receipt N NOTICE TO APPLICANT. If, oflen making Bd, Cadfinte of E,wnpdon, you should become subjmt M the WmMs`5 Compenuti0n provisions of the Labor Code, yeh muse NEW RESIDENTIAL PLMB. SQ. Fr. NOTAL -. faMwith comply with such Pmwilumamlhis peormahall badepnWeevoked. ... BUILDING FEE : CONSTRUCTION DMG AGENCY SEISMIC FEE I hereby affirm dist then u. ..me. heading Ag.., forth. p.fnmulce of + TOTAL. ELECTRIC FFA the work for which this permit is issued (Sm. Sr197, Civ. C.) Leadefs Name Lendefs Address 1 certify that 1 have mad this Opplic.d. too state don the above information is a ON MENiJ PLUMH[NO FEE - •.,ati •c MECHANICAL FEE . rorrmL IAgree tommply with all ciry tab mwryordinmm�And sole l.ws rtledng to building r0nlrvction, rad hereby autharim represenutivn of this city M mrer upon the above-mentioned property r impaction purposes. (We) Agra to ave ndemnify and k harmleu the City of Cupeniw agmss, PERMITISSUANCE .. ALTER OR ADD TO MECH. CONSTRUCTION TAX linbilitims,judgmems, Amaadexprnsn h' hami ywayamomAlphunsaid Chy AIR HANDLING UNIT (TO 10,000 CFM) urnro t grmntingof L AIR HANDLING UNIT (OVER 10,0W CFM) r S arc pplinnVConuac Dau EXHAUSTHOOD(WIDUC) , PAID HEATING UNIT (TO I00.000 BTU) HAZARDOUS MATERIALS DISCLOSURE DurR—ip., 'f Will the applicant or thrust building mcupmt same or handle hamdau, material. m defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code. Seen.. 25532(87 ED Y. ❑No HEATING UNIT (OVER IMM BTU) -HOT VENTILATION FAN (SINGLE MID) I �A Will she APPlicmnerr future Wildingoccepant use equipment mdevim which emit haamdous air communanb u defined by the Bay AMA Air Quality Management District'!�41 BOILER - COMP(IHP OR HII BT13) AI)PIJ C DATE , (J, ]� BOILER • COMP (OVER IW,OW BTU) ❑ Yes ❑ No 1 have rod the h Safely Chd, reuuriala 5505, 25533 under X 1 bs,un 6.95 of the Cmo, buil ing do A Safery Code, Sections 23303, 21333 And 255]0, I understand Nat -c-P-ildingisneAemcunswhicently vea Mr unLdwitiamy rt,po,oil. CeMEfy of cupana of the requircmenu which most be con prim m,suame of v Cenifinte of Occupancy. a( �. !y Uf `. r 994 (/{ff.'s ///VU , (/ Qh !/ ISSUED BY: Y+ V - V NEW RESIDENTIAL MECH. SQ. Fr. Owner or umhonzad ugem Oma TOTAL: I vrrlL.�