26521Fier srAAtT TO ctt t w tMFORMAT!ON WITHIN RFn I lNrq - IKE PALL POINT PEN ONLY
CUPERTINO PLUMBING -MECHANICAL
G DIVISION APPLICATION/PERMIT - Bu Inc PRo,�acg'..Inelvnl7c�nQN,SrYa3,'
PERMIT NO.
n [s C n 'I
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RESS:
SANITARYNO.
APHJGTION SIIBMFITAL DATE.
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CONTRACTORS NAME: LIC NO:GIN
OCI�A
ER:
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/LIC
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PxoNE
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ecl'nUfixeC"41'ie� r.'F1 a1RC yJ
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�A'"`'ir.BUBDA7G PF.RIaBTrWFOia,^wl
B}DG-FyEC[, PLUMB MECH
,jL1jXJ�[` Ie
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION
Ch ode, rad mmenenseisin
0 Thereby o firin of
O Section irethy of Division J of the Business aro Pmfenslone Code, and my license is d,
3 ofth Busindmpad promotions
APPLIANCES - RESIDENTIAL
PANELS
JOB DESCRJPDON
J full tome and dfecl.
y License Cl..Lie. N
UPTO 200 AMPS
201 - 1000 AMPS
1 Data Contractor
Z ARCHITECT'S DECLARATION
SQ. FT. FLOOR AREA S/SQ. FT.
OVER IOW AMPS
I underatund my plena shall be used u public records.
1r
LA o
SIGNS ELECDUCAL
JLicensed Pmfmiond
Q OWNER -BUILDER DECLARATION
U I hereby affmn that 1 am cmmpt from On Co...', License Lvw for Ne
F
Q whichfollowing ruson(Secdo. Clum 7031.5. Business epr Pdcimula,ormny city mco.
J which its iiresas. a]. tocom.the plicImprove,h permith, me a airsig any omens
0 Primoitsicensed•dmrequvontheapplian.fasmhpemtito Lice signed moment
p then he is licensed de Se ml to the ).fD ons of the Convectors License law (Chapter
9lmmmencing wide Secdon 7000)o(Divuim7of Ne Business WPrafesaimts Code)
or that he is exempt Nerefrom and the buil (a dr allegeduemg101,
rn ion, Any Victorian of
Section 7031.5 by my applkenlfix a Color,subjece, the applicant to a civil penalty o
Q then five hundred dollvs (SSW).
O ❑
nm mom fuegop
I,uownmomy,arrmycmpleymwiN waguuthevsolecompensation.
_
an
dothewmk,ande:
SPECIAL. CBtLT1IT/MISC.
TEMP, METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OUDETS. SWITCHES -FDTD1Rh'S
NEW RESIDENTIAL ELECfR _SQ. FT.
STORIES
TYP COgBS'IRUQf1ON
^V/N//IV//
camorof
Llano law doe not apply lf nt owner of
The Contractor'sLiodmo(w does net
and Code: The a
oral
erar wine, ba cols
ves f
pmperry w car bui Ids or improves thereon, end who doessuch wodt himself a duarugh his
ownemPloYees.Providd tlwsuch improventanuemnaintededao(tiered Retitle. B.
C. GROUP
M. UNITS
however. the builditi, m improvement is sold witho mic ysar of cmtpldarn, dw owner -
builder will have the burden of proving the he did as build or Improve for purpae of
le).
❑ I,uowmrof Negopetry,emuclusivelYmnvcd^8 "^�IiatssW cmvectasto
532 N
"N
»#ser
-'�„ ro-_n;;vlsa,>.pgkry.ayrli (t., s
Co..,, the project (See. 7044, Bnsimu and Pretensions Code:) The Cmvu:or's
License Lewdoes mopply in anownerofpropenywhobuildsor impreveadtetwn,and
%PERMIT ISSUANCE
who... fasuch projects wi0taconvacla(s)bansed Pursuant to theca mmora
Li.Law.
ALII'R - DRAIN h VENT. WATER (EA)
_ SU
BACK FLOW PROTECT. DEVICE
❑ 1 sm exempt under See . B @ P C for this reuen
SANITARY Y_N
RECEIPT#
Owner �e
DRAINS -FLOOR, ROOP, ANSA. GOND.
WORKMAN COMPENSATION DECLARATIO
❑ thereby WGmthulhavicecemficauofconsenitoself-i e,mea'au of
Wmken'CompensormBtsurmccaeeerdfid espy thereof ec 3800, Lab C. NcIt
m ali employee's under thus permit.
covers
SCHOOL TAX Y N_
RECEIPT'#
pIXNRRS-PEg�p �
PARK N-
RECEIPT N
L GAS - EA. SYSTEM INC.4OIITLEIS
BU 0 DIVJSW FEES
yp
Company
GAS- EA. SYSTEM -OVER (AA) 'a'isaaa,..
❑ CmifiM carp, I. hereby fmnuMd.
GREASFJINDU51TlL WASTE DffERCP R
GRADING FEE
❑ Certifid copy is fill wiN dm ' napedm divuioo.
CERTIM OFEXEMPIIONFROM R
GREASETRAP - - '-a� �-
SOBS FEE
OMPENSATIONINSURAN
(Thissecdonmden completed iflM pemdl is fa dol (
SEWER - SANITARY - STORM Ek. MFT.
ENERGY FE6
or hers)
TER HEATER W/VPNT/FIECTR' ,
-
I eere(y dm in NepMo roof the N permit'
nee ample, my perm in an roamer a Waken'
Compmaromnlaweof Caifomi
PAID
Dare Steell
WATERSYNTEM/TREATINO
Applicant
NOTICETO APPLICANT: If. 'ng thu Rests , yen sh
NEW RESIDENTIAL FILMS. SQ.awX%PT.
AL:
T hecam mbjeetmthe Warhels Cam 'm 'rev of do Leben Cody use
forthwith comply with such Provisions this [stall be danced
BUILDING FEEk
SEISMIC FEE
ION NORIO AGENCY
Ihereby df th then isaca. ImdingsmryforJ�eperfavtsvca ofNe work far which this pends is issued (Sea QT, Civ. C.)LendcfsNmr `
w;Orladles
Y
C
Address -PLP
I anify that 1 have red Nis application ad ams Thu the above infomuuon h
I correct. l agree o comply with all city and country omiw¢o and lute hwa relorng m
PERMIT ISSUANCE
CGN O AX
building mnswction. and hereby wtharism repumtstivesofdtis city tnmmupon the
above-rantimed property fm inspection purpaa.
L ALTE7l OR ADD TO MECH. l �•
AIR HANDLINO UNIT(TO TO,OW CFM)
(We) agree to save, indemnify and keep ns Ciry of CupeMo against
liabilities•judgments,mandexmemswhlchmay my aye againstsvd Ciry
AM RANDLU40 UNIT (OVER 10,000 CFM)
le ommi enc Ne gmn4ng of Nle Permit.
G
Y
EXHAUST HOOD(W/DUCD �t�
PAM
S' alum of ApplicaniContrmor Dae
HEATING UNIT (TO 100,000 BTUILL
HAZARDOUS MATER[ ISDISCLOSURE
a ReceiptY
HEA TING UNIT (OVER 100,000 BTU)
Will the applicant or future building acupant more m handle luxardeus mtedal
as defindeby the Cupmino Municipal Code, Chapter 9.124 and the HedN and Ssf ny
VENTILATION FAN (SINGLE MID)
Cale. Section 25532(.)1
❑ Yen ❑ No
I UANCE DATE
uipmentdevices whichemit
Will NeapplicmmrfNorm buildingeecupantuurya
Air Quality Management
hi mrdons air carnaminants ns dePord by the Bey Areas00
Dismal
000 BLV) BOILER - COW (3HP OR 100,
pq
1'� A D
BOILER -COW (OVER IWAON)
NEW RESIDENTIAL MECH. SQ. FT.
❑ Yes ❑ No
OCT#
have red due haaadous matmials requirements under Chapter 6.95 of the
om2550h.2557]W21onsi 1undenund Nat
GNiomieHealN&ot Currently
if the building doe not cumndy hevcamnant. the it is my responsibility to notify, the
occup im of the requirements which must be me. prior o uaume of a Certificate of
2 /�
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rs/` 0i, -
V `�T(\,`/Y/y)
G Ver
Occupancy,
ISSUED BY:
Ownern,mlmmeal agent Date
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