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IdiRNIII'No.
CITY OF CUPERTINO PLUMBING-MECHANICAL
BUILDING DIVISION APPLIAPPLICATION/PERMIT _ 25988
OUILUINC PROJECT IDENTIFICATION
111 J11.DIN;;)RESS:S SANI'I ARY NO. A114.I(:A'I II XNSORMTTI'N,DATE
V �✓ d2e 1.014 l l 1
)WNI/`NAaN: PIIONE: / CONT f.TOR:S NA ' LIC NO:
V/•<1l" a+ll NA] 1'ON'I L
ROx
tC111"If:CDLNGINVER: LIC1,10i ADDRESS:
)NIAa': PIIONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT -FEE
9LIN1 FLECIPLUMB MEOI
PERMIT ISSUANCE ElEl 0
LICENSEDCOPGRACIORI
'S DECLARATION APPLIANCES-RISIDENIAL JOB DI-SCRIVION
CTWz Iherehyalfrmlhm lmm
rlicneJ mmerpmvisiun.sef Chnpier9leommrncingwilh
jiJ00 Swtit INXBol Di,Wanlnflhe Batsiressnnd Professions Codesrndnry license is in PANELS
ttV� full force and effect. LIPT0210AMIN
'(py) Lictnsu Cbrts Lic.X
rnQy Dae Commis 201-hXaJAMI',S $(1I FI! A Si Irl.
F 'z ARCIII'II:CIS DECLARATION OVER IINNIAMPS ate �",\ �m
�'^G I r odersnnA my plum shall he used as puM1lic records. tl ii (S
Fytw SIGNS ELECTRICAL. n
S Y�J Licensed lhnfe aiowl 1`/1J prI� II '' �.I I—
K 6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIIUMISC. Y'�u U Na.�� II
O U 1 betray arfnes that I am,rental bore the Centauri Licene Law bat the
µ1'�LLy followin,nomonStation 7031.5.Business and Professions Cole:Any city or county TiMP.MEILR OR POLE INST. C
CLL j whioh reynires a panni, ,,c o mora,aher,improve,d mulish,or 1-
repair any on entre E i
ff�}� prionoiH issnnnce,olio acquireslbs nlglieam for such pennif to Rleasigned,mactent 1'OWIiR DEVICES
(ttilC apO has he is licensed innsuam to the ryuvisions.(,he COalmehrt's hicmOse law(ChaMn SWIMMING TOOL ELECTRIC VALVA
6 xixo� 9(aminencing with Scoop lWBlef Division Turin,Buxinessand Professions Cale)
C 2< or that that he is sterna uncnefrom and the basis for the alleged exemption.Any violation of Olfl'Lus-SWDCI IES-FIXT URNS
Section 7011 S by any applicant for a Mand,cubjecn the applicant m a civil penalty of
$FF0 no,mnermfive hundredd.1frs(S500). NEWRESIDENTIALELFCfR _SQ.II'. S10RIIiS 1)(PECONSIRUCHON
tYt [II.an+.neroftMprnpeny.mmyemployeeawiihwagesastheirsolccoivpiisulion,
a3--m will do the work.and the nmammhired intended mothered fonale(Sce.1644.Business
and Po4ssione Calc The Contrai License law does an apply hall owner of
prolerty whahuilds ar improve.nhercnnund whodms such work himselfonhrough his mc.GROUT RES.TENETS
employcea,providedthat improvement
Within
imertdcJmplenn,forwlc.11
builder%ill have
the
bur den of,man is hath within one yea of mpro a for Our Owner' TOTAL:
Lni1An.ill hove the burden nl Moving that he did Erol build or improve for furors of
sI] m . - PLUMBING PERMIT. FEE
Lmwner of OlOepmperty,evfm
meadusivelY tonling with liansWorQTY
fa
<
nmNam IL(n JD%(JNIi AI'N
construct the project(Sec.11114.Business and Professions Cmle:)The Comrnean.
Licrnsel.ax'Amsores,ply.oan.wnerorprepeny.hubuildfor ier,ovesthrraa..and PERMIT ISSUANCE.
whocontsaen fonnch projects with nemnmemhs)licensed pursuant mme Cormemr's AIAER-DRAIN&VENT'.WA'rUR EAT FEE SUMMARY
License i.e..
❑ I tnat eactrpt ander See. .B&P C for this tensorOU'ti JErt
BACK FLOW 1'RO'I'Iif.T.OEVICE SANITARY Y N
Owner DamRECEIIT N
WORKMAN COMPENSATION DECLARATION DRAINS-PLWR.RIX)i(APIiA,GOND. SCIIOOI-I'AX Y N
I hncM1yaffrm tbmihrvveennifivutc of eonsemmself-Inure.ora ecnilicmr of FD(TIJRES"PL'RI'RM' RECEI TI
mkeriComMrsmlon Insurance or acenifed copy thcmf(Sec.311M.Tab C.)which PARK Pili Y_N
-- or-'r,all ren tree's under this t. RECl;IPTN
P Y panni GAS TNG 4flUfLITIIS
Pq X BUILDING DIVISION ITUN
nli
fol Cen GAS-RA.SYS'I'IiM"OVIiR 411iA) FLANGEIfCK PIBi
❑ CenifieA copy is hereby famished.
❑ CenifieA copy is 0lN with the city inspeainn Jivisinn GRIiA51sJINUl151RL WASTTiINTCRC1iPfOR GRADING IIiE
CERTIFICAIF OF EXEMPTION FROM WORKERS' GREASUIRAP SOILS FEE
COMPENSATION INSURANCE
Olik,iectine me,dmaberamplefed tithe pemtit is rnionehundrMdallms(5100) SEWER-SANITARY"S'IORMEA.21N)". ENERGY FEE
less.)
I cenify that in the perfomaaeof the.+irk for which this perod,is issued,l shell WATER I IEAl ER W/VENT'PELEC IR
not enydoy airy ito any nmtsner se,as to become subject of Otte Worker: PAID
Cnmpensatimtlawsof California. Dam WA'IERSYSGiM/IREA'IINO Date R,rpuN
Z Alrylieunt
z��7z-+ 0 NOTICE 10 APPLICANT:It,after making this Certificate of Exemption,youshould NI2W RESIDENTIAL PLMI1. SQ.Fr. TO IAl,
l" V) accurate suhjecnn,he Worker'a Cot i,if,ation provisions ofthe Lahr Coale,you most BUILDING FEE.FF" forth.im comply with each Provisions milds permit sha111e Jttmed revoked.
LU (] CONSTRUCTION LENDING AGENCY SEISMIC TIRE
Z I hereby affirm firm them is a construction lending agency for the Mrbmnance of TOTAL: ELECTRIC IT!E
UO he work far which rots peme,is issued(Sec,Nall.Civ.C.)
V
0 Lender's Name
0 Lcral Andreas QTY. MECHANICAL PERMIT FEE PLUMBING air;
1 seedily that 1 have read this application arM state that the above inrommtion is MECHANICAL FEE
oonta. I agree or emnply with all eityead county ordinances mulatam laws relating to PERMIT ISSUANCE
C4 building smnamcfion.rnl ltercby aminrixe rcpresemaive f lhiscity to enter upon the CONSTRUCTION TAX
U Z aM+vnmentinnedpmpenyrorinspeetion purposes, ALTERORADDTOMECIL
(We)agree to save.indemnify- -ktt. harmless t City of Cupertino againN
'bilitin.jmlgm< costa nndespen s hien may in any wry accrue egainsO soil City AIR DANDLING UNIT(TO 10,00000,CFM)
encs gaming of i
(� AIR HANDLING UNITIOVIiR I(l.(MID CFM,
Sig store APPlieanl/C'ommgm UmE EXHAUST IIOODIWNUCTI PAID
IIA%ARDOIIS MA'IIiRIAIS DISCLOSURE 11VATING UNI I'(TO 1(XIJXNI IT I'if) U;nr Rc¢iplN
Wal Hie npplirant nr Hoare M1nik ing a',npan'tore m handle loured....material
.-Iiby the Cupertino Municipal Cole,Chadr,9,12,an I the llcalth and Safety ITTATINO UND(OVER I(XI,(XN)II TIII
rale.Seefion 255124e)7 VENTILATION PAN(SINE R.Ii RfSID)
❑Ycv ❑No
ISSUANCE DA 11:1
Will fheapplicam nrbnnrcauildingxcupanO useeryil+menmrJevices whichemll IIOIIJ!R"COMI'lJlll'lIR BOOM DIM)
•s11 alons air contaminants os defined by Ibe Day Area Air Quality Management BALER-COMPIOVER I x"flarfl Bru)
Iistri3O P /1�'1 ' D
❑Yes ❑No NEW RESIUIiNI'IAI.MECII. SQ.IT.
I have ram the haa.anloux materials requirements under Chaffer 695 of the //1 AI
California IIea11h&Safety Cale,Section 23505,25513 and 25514. 1 understand that % A Y
I he buildinl currently have a leme m,int it N my rtspnnsihili,y res.unify du,
orcupum of the requirements which must ha til prior In issuance of a Cenilicme of
Uwner ar autnorireA agent UnOe luTAh; ,SSI tiiD it,
OFFICE