25592 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
ITY OF CUPERTINO Int u...oxi-.1.1,1�fRWAL PERSn r NO.
APPLICATION/PURR> PLUMBING-MECHANICAL 25592
BUII,DING,DIVISION BUILDING PROJECTIMN nFICATION APPLICATION SUBMITTAL DATI
DING ADDRESS� SANITARY NO.
ICIIIII jJT�UCe41_tD 4 u4e_�.
A er R
CONJRACIOWSNAME LIC NO:
/F Iff3
F al ibil"%j NIL IlLoOkslLa
NO
0)245 111T
00�ACT'. PHONE: BUILDING PERMIT INFO
QTY. FL EAV PERMIT FEE
—MIT ISSkA�4. ILI plUME, MECH
LICENSED CON]RACTOR S DECLARKI ION APPIJAN�I IIESIDENTIA JOBDESCRUMON
C)mz IhembydCim�ciamlicen�un&Tpmvisionsof0api�,9(commencing�iih —
P100 PAN..
full force.andeflect. UP AMPS
)ate—Contractor— 1, "AMPS e,\
ARCHITECT'S DECLARATION HGOAMPS V.7 R E , $/SQ,FT.
S,
0Z IYNS EiLtFIRI�A�L
P
Licensed Pricifimsional ISPECIALCky�NEL t U T R
0 W U . k.
OWNER-BUILDER DECLARATION
race he
Wig foilrovir,resson.(Section 7031.5,Bitsmommal Proficcot...C Anysity-c...I, TEND.W%R!)�LE USST.
')< ,hich,e,,ui,v,.Nmi,o,commic,tilhc,impoi,edecolikh.o,orpair no, U."
to_3 R
�7 prior to its issuance.also requires fee oplicarral for such permit to file a signed daters"n,
c POWE DEV�k_S
floaheisliecteved,firsta......
X.F5 9(conamencing with Section 7000)of Division I of the BLNinCSS and Professions Codv) SWIMMING POOL ELECTRIC VALUATION
ad M o,, or that he is exempt flarefourn and bc onsix far he alleged imeraptim.Any viii Of
,Z� Section 7031.5 by my applicant for a Krout subjecti the a"heart to a civil Penalty of OUTLETS-SWITCHES-FIXTURES
nor me than Five handred dollas;($500), ?X
NEW RESIDENTIALELECTR —SQ.FT
C] l,aso%nerolt)icpro�ny,ormycmploy�wi�wagnutheirwlecom�ation, STORIES TYTHCONSTRUCIION
will clothe work.and the structure is not interaddioroffered Ar safe(Sec.7044,Business
and Praftc,imas Code The Contractor's License Law does not apply to an owner of
pro,vedy who buldsmarnproves thereon.and whodocs such work himselforthrough his OCC.GROUP RES.UNITS
ownemployms.pmvi�that.suchimpmvemen�=nolin�ndedoroffe�f��e.If. — Tq
however.the buildingor improvement is sold withinare yearoftompletion,themorc,
huddler will have the loarden cf,moin,dand he and no,mild or improve for por,ascof —
xi ____FTOOD_ZONF. APN
0 QTY. PLUMBING PERMIT FEE
,on,d...t the poijeo(Sce.7044,Bmac, oil Imfi,,vion,Codv�)The
...... PERM]TISSUANCE
whocontracts for such projecesits accamossfords)licensed purvicaut toReConamemar's AUTER-DRAIN&VENT-WATER HDO FEE SUMMARY
Litca'i,Law.
0 ]am sxmnpnmdb,Scv._,H&PC for this reason OUISIMMES
BACK MOW PROTECT.DEVICE SANITARY Y_N_
Owner —Daw— DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT#
WORKMAN COMPHNSAI ION DECLARA I ION SCI IOOL TAX Y_N
Hasob,affirartleal FIXTURES-PER TRAP RECHIPT 0
orkers'Cono,socution lasursocce or a cedified copy tharesaf(See.3800.Lob C.)which- PARK ME Y_N_
RECEIPT#_
covers all employees under this permit. GAS.EA.SYSTEM-1 INC.4ourLETS BUiLDINODIVISIONFE. S
Policy If
Xy OAS-EA.SYSTEM-OVER 4 EA) PLANCHECK ME
-n,fivd,o,y is thereby famished. 111
0 GREASEANDUSTRI,WASTE INTERCEPTOR GkADING THIS
CERTIFICATE OF EXEMPT[ON FROM WORKERS' GRFOSETRAP SOILS ME
COMP PSAITON INSURANCE
(Mis section need not the compichadl iffies,samit is for one hundaread dullor,($10(d SEWER-SANITARY-STORM EA.200F7. ENERGY ME
or le,,.)
I verhy that in the verficanource of the work for which this encit is issued.I shall WA I ER HEATER WNENTAiLECTR
nut employ my pervoin in my mariner ve us be became subject to the Workers" PAID
Cm,picnatuilualanovs.fCal,forrom. Dole WATER SYSTEMirl'OrATING Date Recalls N
z Applicant
z 0 NOTICE TO APPLICANT:If.after making this Conificem,of Exemption,you should NEW RMIDENTIAL PLIAB,—SQ.FT. TOTAL
00 bessame tattooed""he Worker.,Con,comfica provisions f,ha Lear,Code.......f
— fonhwith ornply with a,h orviona,or his ocroul,hall bo deconsedoevoked. BUILDING FEE
ce >
Vj F CONSTRUCTION LENDING AGENCY SEISMIC PER
z I hereby affirin[hill them is a construction lending agency for the Performance of TOTAL ELECI
C) the work for which this permit is issued(Sex.3097,Cis.C.) i
Leaders Name PLUMBING ME
Lenders Addr,i, QTY. MECHANICAL PERMIT FEE
J I mif,that I have read this dialim isrodmine hot the move informilim is MECHANICALMH
comply with all city and county candinnumas and slow laws melating to PERMIT ISSUANCE
hoildingtonstraction,and hereby milbonu representatives ofthis city menter upon the _L ;! —
01 bacce-ancrioned pro,amy for inspection m,v,cs. ECH. CONSMUCTIONTAX
U Z a k&AL D:R OR ADD TO M
(We)a,ma,to save.indemnify and kmp laccuram thice City of Caperton against
liabilities,judgments,costs and expenses which may in any way accouse against mid City AIR I ANDIANG UNIT(TO 10,000 CFM)
in c...c,u I n in , Xi"� 67—z,#- AIR HANDLING UNIT(OVER 10,MCFM)
S.,niume.dAppifearol-Cortiouroaiii Date EXHAUST HOOD(WADUCT) PAID
HA7ARDOUS MATERIALS DISCLOSURE HEATING UNIT TIO PER"BTU) Date R,,i,,#
Will the applicant or future building occupant store or handle hazard.ta,notterad HEATING UNIT(OVER 100,01M BTU) aej 19A
Code,Section 2553200� VENTILATION FAN(SINGLE RESID)
11 Yes 0 No I ISSUANCE DATE
BOILER-COMPQHP OR 100,000 BTU)
Will the ti,plicam onfuturebuildingoccu,sed maces,uiumerat ord,vices anchored —
haxiodous air contaminants aw defined by the Bay Area Air Quality Management BOILER.COMP(OVER Raff"BTU)
Di...wf? 0 Yes 0 No NEWRESID PALMECH.—SQ.Fr. PAID
I have read the Intentions materials requirements under Chapter 6.95 of the
Cablocia Health&Safety Col Sections 155115.25533 cand M534. I andetsound flot Ep '08
ifflas hatildon,does of court have. man,that it is my responsibility an mlify the '0 1947
occupant of the requirements which nand ho me, n to issuance of a Certificate of C11 �7
Occupancy. y
owner or tottloollcd spent Data RA ISSUED BY:��
OFFICE