25342 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL PUIN 1 ren UNLT
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT No.
BUILDING DIVISION
APPLICA11DMV11MMIT PLUMBING-MECHANICAL 25342
.n1Vrs^yY M>;#: O O T TION-i S ! ,e
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMIT]Al-DATE
/0 796 �QO� ✓� L�UNITN LOT. /Ayl
9WNIiRS
IF: e&
p C PHONNNE: CONI>i&CfOft'S NA s ! N/C CONTROLe 1
C (� 1:/V / /L / /
4 CNITECf/F,NGINF.R: LIC NO: ADDRESS: - ❑
\`•/ ONTACT: PHONE: +, )s'w c s� - , �l Tet->vyXlv :;:i 5'^.r:•EUILDINO PERMIT INFO
..bELECIR�C PERh�fYi4, y ,)i2J�r xT? Pi
�/� 9 { 7 N BLDG ELECT PLUMB MECII
✓ ,0 _/? v . 3/ PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
ppeZ I hereby eRrm that l am licensed underpmvinions ofCopter9(commencing with TOB DESCRIPII N
00 Seniors 700(prf Division I mite Busmen d Profeasl...Cede,anJmylimnaelsin PANELS
RUE full faceend eBab-3C 6a e-'� •7 Q7' UP T0300 AMi'S
QZ, Licence Claa CC.- Lice •/ •.1�� I r _ .•
�¢a onto 7- L - C.ntru GL
py /S00AMP$yZ ARCllll'ECTS OVER I000
AMPS ff.SQ. .Fl.WRARFA S/SQ.FI'.
OVER
72'!t I understand mY plans shall he used as public ramELECTRICAL J
y SIGNS ELECTRICAL
Licenced Professional 7
1' On I mr, BUILDER pEbe Cron ION SPECIAL CIRCUIT/MISC.
O 1 hereby n.(Se that 1 em exempt Tran the faction Co Limn law far the
—Y.Oy Ldlnwing reason. 0011.5,Business and Pmfueiom Code:Any city acounsy TEMP.METER OR POLE INST.
,y which requires a permit to condnat,dor.Improve,demolish,an,ropdr any museum
<n Prim m its issuance,also requires the applicant for such permit to file uigned„emmt POWER DEVICES
L OO that he in licensed P-11...I m the prwinio o of the Copra dro.License Lew(Chapter
L��u44��' 9(commencing with Section 70)(Tof Division J ofthe Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
y)_y in"a'M is encm(w lhetelmm and the tors"for the alk8ed exemption.Any violation of
Y Section 703 1.5 by any applicant for a Permit subjects the appn
licano a civil penalty of OUTLETS-SWITCI ITS-FIXTURES
t....him five hundred dollar.(55M)
3$ ❑ Ln.wnttollhepmpcny,mmyemplaymewish wegesantheirwlecmmpensetion. NEW RESIDENTIAL F.LECIR _SQ.n'. Sl' . � 'lyPECONSTRUCIN
windmthewmrk.aMit swnurenrnmimenddmoffrornie(S«.TM4.Bunimsa `\SV�\ IO
and Pmfend min Cale:The Comncmis License law dura Inst apply to an owner of
property who builds or imanveuhernm,and who doessuch work himself or Nrough his
own<mpl.Ym.p.aviJed theuuch lmanvenntsart nsntlmendedor.!fared fouls.If. (MC.GROUT' RES.UNI TS
hnwever,the building.,improvement in sold withinone ywafcmm,subm,the owner- TOTAL:
will have the burden of Proving that he did not build or improve for purpose of
triol.
❑ T,nownerofinepm y.amexclunlvelycontnciinRwlUllc"n caaraaonmJli+`,�.,y FLOOD70NI: AI'N
cmtnrmm the project(See.7044,Business end Profeanime,Cale:)The Contrenoin
Licerulawdmen.tnpplymamowarnfprnpemywhnbuild.o,impmvn Hereon,end PERMIT ISSUANCR
who contra r for such projecls wi th a emmeso,(d I icnnsed porton.thanContram«i
\ License Lew. ALTER-DRAIN&VENT-WATER(PAT ;�.+-yv�i..zr.���,FEE SUMMARY
❑ 1 em exempt older Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE OUISIDEpliff
SANITARY Y N
-Tuner Data RECEIPT as
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR.ROOF,AREA,GOND. SCHOOLTAX Y N
IMrebyaffitm lhatlhrvcattnifimm ofcmsenno selLinrc.ora mmi0cale ofFl%lVRC4- RECEIITe
Workers Cmmpensnsionlmumnceaaamified copy lherrof(Sro.1g00,Lab C.)which PER TRAP —se PARK FEE YN
sew^all empl.yee'n underIbis penniL RF.CE1I7e
1: . _N OAS-EA.SYSTEM-1 INC.4 OUTLETS
_ BUILDING DIVISION Iti1S
Cump,.y GAS-EA.SYSTEM OVER 4(EA) PLANCHECK ME
❑ Certified copy in hereby fuminhed.
❑ Certified copy is Ned with the city inspection division. GREASFJINDUSI RL WASTE INTERCEPTOR GRADING FEE
CERI'IfICAI E OF EXEMPTION FROM WORKERS' GREASETRAP SOILS IEE
COMPENSATION INSURANCE
(Our section need-1 be completed lfthe 1.111.forme hundred dollen(5100) SEWER-SANITARY-STORM EA.2001T. FNP,ROY FEE
en lea.)
I certify that in she perfommnce.f lire work for which this permit in Issued,I shell I.A.Za H FATER W/VEITT/EI.ECTR
not employ any person in any mars«,m u to become mijm to the Wmkm' PAID
O Z ApplicantCmnpenani.n laws.f Cellan.. Date WATER STEM/IRFATINO Use Receipte
z2 NOT ICE DO APPLICANT.IL.Aa, king thin cenircam of ExemNlon,ynu should MW RE91DEN'TIAI.PLM". SQ. T. TOIAI:
P+ L2 becn.enuhject to flue Worker.CmmFemution pordnismof.he Labor Cade,ym mon
s 7 lmhwith comply with such prelim.,or this pnmiuha0 he decmednooked. BUILDINO FEE
y O CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z Ihereby.ffimFdvnthem inaconnmcnon leadingagency fortheperfamaaeof
O theworkforwhichthinper,nisis Umbd,Stt.J097,iiv.CT TO' ELECTRIC FEE
Tender's Name 11
L 'v,'I',�, 4F:kTkIdBCFIAtJtCAL" B�Ik�IT�y} W1 (+88-, °,.
Tender's AJJrrn fir'u 1y (:)� PLUMBING ITE
I coldly that I have reed this application end stns that the shove Information in e7s's i.wv -s. t.':....r r...Vca r i! ;!- l�.
)" acorrect,l agree socomplY with all city AM county colinanceamd stale laws relining to PERMIT ISSUANCE - MI';CUANICAL FEE.
r (A huildimgconxbuctinal herebyamberfs repreaenutivnoOhiadry mmmrupmthe
,J 7 ahone-mr-Imbed pr luny for impectian pulp., ALTER OR ADD TO MECII. CONSTRUCTION TAX
F7 (We).gree m Hove,indnnnify and keep bermlees the City Of CupeAm again,
Ii.bilities.JnJgmenu,cmIS.McxMnwswhichonyinayy ecc,uyyyaae(((eimousid City AIR HANDLING UNIT(to 10.1100 CFM)
in cmse9imc !the granting of lhi ,mit. // / /
AIR HANDLING UNIT(OVER I0,01I1)CUM)
Simadress,of Appliaem/Cmrncta 'Date EXIIAUSTIIOOD(WNUCD
PAID
DA2'AR000S MATERIALS DISCLOSURE iiFATING UNIT(1010(1,IXp pill) Dam Receipt#
Will the applicant a future building Occupant arm OF handle hanrdms materiel
As IIPAl1N0 UNIT(OVER Iq),glp RTU))
corned by she Cupertino Municipal Code.Chapter 9.12,and the I health and Safely
Cole,Senium 255320)9
❑Yen ❑No VENTILATION PAN(SINGLE RESID)
Will sheeNplicnmmfmumhuilJingacuNem uneegnipmemmrlevicen which emir 8011-F.R-COMPpIiPOR 100,(g10 BTI))
ISSUANCE U 1'-
haaardous air contaminants as defiaued by the Bey Arc.Air Quality Management BOILER IRD,gIO BTU)
District? P A ! p
❑Yen ❑No NEW RFSIDCNfIAI.MECII. SQ.IT.
`_
1 have rad she hamdo Code,materiels 5505,2 533 undo 34.Chapterm 6.95.f the ��� O
it the uildingdo s SafelyetlySections23505,25511 and 25534. Idler name the 199
if the building J�uen not currently have a tenant,that It in my rcspnnsihility m notify the
smOriulnm of the rryuircmemn which moot be met pda m ivanco of a Cenipcine of CII Y ur
Ownpaay.
Owner nr au1lmrisaJ agent Data TOTAL: ISSUEDBY:
OFFICE