25447 (2)APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINOi- L., FRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL.
BUILDING PROJECT IDENTIF'ICAT'ION
PERMIT NO.
25 /1 /17
J 4 `t 1
BUIL NG ADDRESS t
ti (� UNRM LOT#
SANITARY NO.
APPLICATI S1UBMMIITTALDATE
OWNERS k4UH, PHONE:
CO BSN
ME: 1 NO:
r A,9,423SONIC
CONTROL#
ARCHITECT/ENGINEER: LIC NO:
A (O� 2 A 1 O
cdclk
CONTACT: PHONE:
"I''wk�''9+kfd " "
7T Cd r �'�`ECE Rf PERMIT FEE
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BUILDING PERMIT INFO
B ELECT PLUMB MECH
PERMIT ISSUANCE
El ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
Ihere)(hof mthetlem licrnsed underprovisiomefCTepar9(commrncingwith
APPLIANCES -RESIDENTIAL
1 BD DUILR
4
PANELS
Serion 7000)of Division3of she Bmmnsend Pmfasiov Code. and my li«me is in
`�
�
U farce end offer. /t
License Cle Lic.#_�jF ��
ITP -030) AMPS
301-1000AMPB
Dose Convector 'A4
ARCHITECTS DECLA T
1 under d my plans shall be used n public records.
SQ. FT. FLOOR AREA
$/SQ. FT.
OVER 1000 AMPS
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER -
SPECIAL CIRCTIIT/MISC.
from License Law for the
m the Connector's
I hereby taco I rn exempt from the Contrnm
TEMP. METER OR POLE INST.
Co
n. (Se rumness and Code: Any city or county
following renes.. (Sermon
deco l
which its isssnpermit towns the alter,improve,demolish, ore a sig anyawcture
remover. improve.
poortoits issuance, theapplicantfor gmedsuwnenr
POWER DEVICES
beuchpemtiuo Lt...
purwarn wrth ss License Lew (Chapter
that he is licensed pursuarn w the provisions of be Ce Business
or that he is (commencing with a) ofndthe Division Sof theedexemptiand .Any vilaCode)
Snhm h7031.5 by any ae(mmnndthe Perbasis fmthe asegedexlicant erivil meson of
Section 7031.5 by any applicant for a permit subjects she applicant We rivil perWty of
SWIMMING POOL ELECTRIC
VAL✓V
OUTLETS - SWITCHES - FIXTURES
not more than Roe hundred dy,l ($SW).
❑ Lmownrk,and epmpery,mmy emplmyeciorofwagesmtheinolecom,
NEW RESIDENTIAL ELECTR _SQ. FT.
STORIES
TYPF.CONSTRUCHON
will doshework, and thea Basin.
offendforsale(Sec. 7014. B
oCoremanotintendede
and Rvfeviona Code: The Contrscwr's License Law dos not apply b an owner of
and nerof
propertywyces.pdvidedtha" itimph,andwho wesmctendWomffenedhroughhis
hofferedforsale. If,
OCC. ROUP
TOTAL:
however, the buildingor improvement is sold within oneyearofcompledon.theuvoer-
builder will have the burden of proving that he did not build m improve for purpose of
sale.).❑ I,mowmrofdhopmpeny,amexclusivelyconnacnngwMlicemedc t=tonm
construct the project (Sec. 7004, Business and Profeniom Code:) The Contrecwra
License Lawdoesmi apply wanownerofpropertywhobuilds orimpowes damson, and
JMDINGPERMIT FEC
QTY.EAL�R.
FLOOD ZONE
EUN1:TS::honemployes,pmvidNthatsuchmearnvcmeoumenotmhanded
NCE
whocmvucts forsuch projects with.comrnctorts) licensed punuunt to the Contractors
Law.I
N&VENT-WATER(EA)
FEE SUMMLicense
am exempt under Sec. , B & P C for this «von
ROTECT. DEVICE
S
SANITARY V N
RECEIPT#
Owner Deo
DRAINS- FLOOR, ROOF, AREA. COND.
WORKMAN COMPENSATION DECLARATION
SCHOOL TAX YN
❑ Thereby affirm shatlhave acenificate ofconsrntwxlf-Insure, ore«rtificaa of
Wodesi Compensation Imuran«hu«nified copy therco((Sec 3800, Lab CJ which
coven all employer's under this permit.
Policy #
Fl%TT1RE5-PER TRAP
PARK
PARK FEE Y N
x RECEIPT #
GAS - EA. SYSTFJIi1 1
ir
BUILDING DIVISION FEES
Company
GAS - EA. SYSTEM -OV 4 ( )
IPLA
ECK FEE
❑ CertiOed copy b iameby famished.
GREASEANDUSTRI, W4BIt23y30ifKJF
1 FEE
❑ Certified copy is fled with the city inspection division.
CERTTFlCATE OF EXEMPTION FROM WORKERS'
GREASETRAP
FEE
COMPENSATION INSURANCE
SEWER-SANITA Y -STOR
_ GYM
(This when need notbecompleted ifthe pembtis for one hundred dollars (SIM)
or less.)
WATER HEATER W/VENT/ELECTR
I certify that in the performance of the words for which this permit is iaued, l shall
nm employ any persona arY r ser ho c m j� w the Workers'
Compema of J DeII�`
WATER SYSTF.M/IREATING
PAID
Date Receipt 0,
NOTiCF-r�A PPI]j[� — E71PA
NOTICE TO APPLICANT:If,e(to making this Ce uficete of 8vemption. you shhuld
NEW RESIDENTIAL PLMB. SQ. FT.
TOTAL:
becomesubjectto the WnrPr Cmnprnnon piaiamofthelabor Cade,you must
forthwith comply with ouchh provisions or this permit shall be deemed revoked.
BUILDING HE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for the performance of
for which this Permit is issued (Sec. 30)7, Civ. C.)
TOTAL:
ELECTRIC FEEthe..
" ^"
QTY- ;'I; MEQ'HANICAL PERMIT - FEE
" S°
PLUMBING FEE
Lenders Name
Leodue. Address -
above Info ul. is
1 cenify that 1 have read this application and sus that the m
correct. I agae to complyW with dl city mcounty ordinances and sus laws relating In
PERMIT ISSUANCE
MECHANICAL FEE
building construction, and hereby authorize representatives of this city w emerupomhe
above-mcotioned ponanty for inspection purposes. -
ALTERORADDTOMECH.
CONSTRUCTIONTAX
-
(We) ague w save, indemnify and kern harmless the City of Cupertino against
finibilinionijudgmats, crouts aniqatnamsnwhlch may'. ayecerueag'naI eeid City
AIR HANDLING UNIT (TO 10,000 CFM)
AIR HANDLING UNIT (OVER 10," CFMI
the grantin Nis t.
[Date
EXHAUST HOOD(W/DUCT)
,
PAID
Siu m l PP'1`^^VConvec
HEATING UNIT (TO 100.000 BTU)
HAZARDOUS MATERIALS DISCLOSURE
Date Receipt#
HEATING UNIT (OVER 100.110 BTU)
Will the applicant or fawn building«cupent shore or handle heruNons material
m defined by the Cupertino Municipal Codo, Chapter 9.12, and the Health and Safety
VENTILATION FAN (SINGL E RF.SID)
Code, Section 25532(a)7
13 Yes
ISSUANCE DATE
Willthe applicantmfumrt building«cupnnl use equipmenturdevicnwhichemit
BOILER - COMP (311P OR IM." BTU)
BOILER - COW (OVER 100,000 BTU)
hayerdous air contaminants as defined by the Bay Area Air Quality Management
District!
pppp
P A , Y1.
NEW RESIDENTIAL MECH. SQ. FT,
'
❑Yea No
6!
1 have read the hazardous materials requmremenu under Chapter 6.95 of the
Califomia Health & Safety Code, Sections 25505, 25533 and 25334. I understood! Nes
AUG 11 ,
if tae building does not currently ve arrnent, that it is my msponsibility to notify the
cecupant m i r .I. oats w 1 h mus he met n issuance of C ofic a of
b
Cf 1
V�
iXcuPmcy
1 f' I VL/
ISSUED BY'
Owner oruuh Axed agent Dao
TOTAL:
OFFICE