27093 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO An, -REetTRICA PERMUTING.
Buu,DINr.DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 27093�O
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: 1 II II �, I (� SANITARY NO, APPIACATIONSUBMITTALDATE
0( 2_ {.'V.0[ iv�r UNIT. 2— ` LOT. y
OWN:RS'NAME: PHONE: CO AC OR'S NAME' LIC NO: N/C CON'TROI.a
S P6 '11T".—&/ Tx eTa
�IARCIII . GINEER: LIC NO: AM SS:
S bob S+- SW W o• : N:. ❑
CONl'ACI': PHONE: // Sp�// Q'TY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
/3 ��G Jb� PERMIT ISSUANCE L U ME It
LICENSED CONTRACTOR'. ECLARA'I']ON APPLIANCES-RLSIDENTIAL
C=Z I hereby am ffirthat l am licensed under previsions of Chapter 9(commencing with 10 ESCRIPTI N
00 Section 70000.1'Division 3 of the Business and Professions Cade,and my license is in PANELS Y '
QVF (incase and effen. I—�15���/� (T
ZU full
and Lic.p IIP T0200 AMPS `T k[D'
N Q dDate Contractor 201-1000 AMPS
F-y{ ARCHITECTS DECLARATION OVER 1000 AMPS SQ.Ff.FLOOR ARCA S/SQ.IT.
Z O vr— I understand my plans shill be used as Public records.
OZ-0
Fytly SIGNS ELECTRICAL
jLicensed Professional
X 0 Q OWN HR-B U ILDF-R DECLARATION SPECIAL CIRCUIT/MISC.
U I hemby affirm that I um exempt from the Convacmr's License law for the
13131'-tFis following as .(Seen. Business and Profusions Code:Any city.,..my TEMP.METIER OR POLE MST.
Ho Q which requires a permit to crabs.,alter,improve,demolish,or.,an any structure '
}7 prior to its issuance,also requires the applicant for such Permit o file asigned aoteme.m POWER DEVICES
QO that he islicensed pursuant to the provisions of the Contractor's License Law(Chapter
000WIMMING POOL ELECTRIC
d%o 9(commencing with Section] )of Division 3 ufthe Business and Professions Code)
or that he isexempttherefrom and the basis for the alleged Gumption.Any violation of UTLETS-SWITCHES-FIXTURES % /q VALUATION v�
FZQ Section 1031.5 by any applicant(orapermitsobjects theapplicaa
nuocivil penultyof / JJJ C/
M 0 not marcthun fivehundreddollars(SSW). NEW RCSIDENTIALELECTR _SQ.Fr. 5l'O ES l'YPECONS'I'RUM ON
eLm ❑ I,:nnnd OeprapewnenY.na
rmyempinyswilir we6esas theirsolecompensati.n,
W3— will do the wark.and the structure is not intendialmoffined fn sale(Sec.11144.Business
and Professions Code:The Contractor's License law does not apply m an owner of
pmpenywho builds or improves thereon,and whodas such work hl forthor is
employees,provided that.mch improvements ore not rote orofne forsalu If, OCC.GROUP RES.UNITS
however.Ne buildingorimprovemenlis sold withinon ol'cnmplctim
builder will have the burden of preying Nat he did om a udd or improve for pts awn of
sale.). QTY. PLUMBING PERMIT FEE FTOODZONE APN
❑ its owner of the property,amexclusively nhacmingwithlicensrdeantract to
e.nuruct the project(Sec.1(44,Business A Proksaions Cod.:)The Contract 's
License Law does not apply to m ownero ropenywhobuildsorimproves thereon. PERMIT ISSUANCE
whocontmcssforeochpmjectswitha mtrarodsHiccnsedpursnanmm the Contmctoh ALTER-DRAIN&VFM-WATER(EA) FEE SUMMARY
License law.
❑ I oro exempt underSec. .B&P C far this mown BACK FLOW PROTIiCT.DEVICE O l: TiES
SANITARY YN
Owner Data DRAINS-FLOOR,ROOF,AREA,COND. RIiCGIPfp
WOR)) 1AN COMPLNSATION DECLARATION SCHOOLTAX YN
❑ Thereby affirm 6etlhave acenificate of conxm rax 'is etifiwte of XTURE6-PER TRAP RECEIPT
®Wveksu Cmnpen ion lnsumncemecenifcA copy mheie.f 3.l.eb )which PARK FEE Y N
11 cm In dcnhis tmM1
RECEIPT p
p ye'.a un pc GA .SVSI'IiM-I INC.INC40UfLETS BUILDING DIVISION FEES
Policy X
Company G -UA.SYSTEM-OVER4(EA) PLANCHECK FEE 33oabc
❑ Cenifrd cup' hereby famished.
❑ CmiOed copy is led with Ne city ins c ,vision. \ GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FF.F.
CIiRTIFIC TE OF EXE O OM ER GR BASE TRAP SOILS HE
PENSATION INS NCC
(Thisuctionnadnotbe mpletedifthepe 'ti notion ndreddoll (SI SEWER-SANITARY-STORM FA.201 ENERGY FEE
no less.)
Ivenifythatialhcperfornw of1hewnrkforwhsh,hisFmr�i sue shall WATERHEATERW/VLNT/ELECIR
not employ,any person in any as m become subject to a Workers' PAID e7
C.mpensationlaws.f California. Deis WATER SYSTEM/IRGTING Date ReceiptX
O Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. TOT
O NOTICI?TOAPPLICANT:ILintermakin this Crnifcate of Eae tirm,youshould O. ;
breine.mbjecno the Worker's Compcnsemio sons of mel or Code,you must BUILDING IIiF
a > forthwith comply with such provisions or this p nwit shall be no revoked.
CONSTRUCTION LENDINGY SKIS
IPJ- Z I hereby affirm that there is u construction lending agency for the perfonc
rnae of
U O the work for which this permit is isaued(See 3091,Civ.CJ IiI,HCW'li am
Lender's Name PLUMB FT,
U' F lender's AMess QTY. MECI IANICAL PERMIT FEE
O U I certify that 1 have read this application and some that the above information is
>"' W correct.l agree In comply with all city and county ordinances and slate laws existing to PERMIT ISSUANCE
MCCIIANIC .FEF,
1" ol, building construction,and hereby authoixerepmscnoeves ofthiscity to enter upon the CONSTRU TION TAX
C.1 Z abnvomentionrd property,for inspection purposes. ALTER OR ADD TO MECH.
(We)agree m save,indemnify and kap harmless she City of Cupertino against
hibil'aics,jallar ,costs and expanses which may in any way theme again said City AIR HANDLING UNIT(TO 10.000 CFM)
/(y��o� o�f�tbj/I graining ofLhis pemni,
' / GI �'1(/t! Ser C.C.% II Q,3f AIR HANDLING UNIT(OVGRIU,lI00 CFM)
newrc.f App cat C.mmctor >a, EXHAUSTHOOD(W/DUCry
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT('1'0 100.000 BTU) Dine Receipt.
Will the applicant or future building occupant some or handle hazardous material HEA'T'ING UNIT(OVER IW.OW BTU) TOI'N.:
as delmadi by the Cupertino Municipal Code,Chapter 9.12,and Ne Health and Safety
Craft.Section 25532(a)' WILATION FAN(SINGLE RPSBB
❑Yes ❑No �F
BOILER-COMP(3HP OR 100,003 BTU) ISSU9 a^ A
IT—
Will Isour oc iconl.orfumex defined by he ay AAs Air Quality esanagement
�hera,dous av conlamironss ax Jdmd by the Bey Area Air Quality Management BOILER-COMP(OVER IW.UW BTU)
District? JAN 231995
❑Yea ❑No NEW RESLDENTIAI,MECH.—SQ.IT.
I have read the hazardous materials requirements under Chapter 6.95.f the -rb �QYCHIINU
f California Health&Safery Calc,Section,2 505,25533 end 25534. l eadersmnd Nat C11 1 Ut
if the building dna not comically have a tenant,that it is my responsibility to notify the
occupant of the requirements which must he met prior m issuance of a Certificate of /—
Occup�ncy. 7
Ownamsuthorsdigenl Date lb'A ISSUED BY.
OFFICE-