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25598 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINOLDING--ELLUrRICAL PERMITNO. BUILDING,.DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 25598 BUILDING PROJECT IDENTIFICATION B LNG ADDRESS: SANITARY NO. APPI.ICATIONSUBMITTALDAM LQ,'» O FRS NAMIi: � O 'Cl0 NAME EJC NO: NtC CONTROL♦ SS / ARCF ILCT EIN [i eLIPIIONEGCNO: ADDRESS: 1'&/AJ470 AI -N93 ❑ CONTACT: PHONE QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO L ELECT PLUMB MECH PERMITISSUANCH ❑ ❑ ❑ LICENSED CONTRACTOR'S DL'CIARATION APPLIANCES-RESIDENTIAL pnZ I hcrcby affirm that l am licenserl urJ Voviv'ions ofClarnal(cmunerring wish 1 IPII N 00 Sauon]000)nf Uv'uimJaf thefludrcv end Prafeviov Code.enl mY lwxrt¢iain PANS Vfull fora sM eRaL 6Z Urensc Cuai Lic.N UP TO 200 AMPS ♦rr 6 aDun, Connector2(t1-IM AMPS 20yZ ARCHITECTLA S DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA VSQ.FG,. p/— l undemand my Plan:shell lx ascd as Public rtcads. FSIGNS FCIIU L / LicrnN PeofmicrW d'Q OWNER-BUILDER DECLARATION SPECIAL Cl 4XX'Oacp. 1 hereby,aHbm this,1 son exempt Ivo Be,Contmcte/s Lictrut Lew for the / W 3 to fo icomirtp reaaoa.(Section 7031.5,Business ud Pmfmiou Code:My my a county OR POLE IN C�'�� which trywas a Paenit m cansimw,alter,improve,JnnrlisM1,or repab eny mm�urt / fi< pee,bm,its isesoodi ursorequuestheeppliant(a,Cdn n01F'leaxigecdatattmentrEVIC�- S—Op INTI ht is li evueA puewmtto Ne povisimn of theCmmnaLireuc lawlCTtaWeL �' 9(amrttcncing with Serino](pU)ofDivisionJof the Business and Rofesions Calc) G IC/ VALUATIO to or dwthci.exciii.t cmfmmwdt�ebesisfortlrtelLgNexemp4im.Myvio =of -SW I FDLT)ftFS CZQ Smion703lS by enyapplierttfeespermit subjala tlz aPplkvu to•civil perWty.f m mare than flue lb d dollar($50(1). Sa�O ❑ I,uowturnlde PmP ,oemytmployetwlNwaguuWirsokcanlensauem. NEW RFSIDETTIAI,ELECEN SQ.tT. STORIES TYPECONSTRUCTION y3� wi0 doth.worn.,Code he CoueiartninRstlMoroaw does We(See.0 aa,Bwinexs nrk Pmfevionn Code The Contevwm's Llanse I..w dm_a not apply to an vwec of prupeny whnbuildaa imtrove thetmt,urn who Joessorh watl0etuelfa Wwghhf. / Pu,e,,J,e.a Pmvior tlw sucM1impmveneeuve rwt,or.fdv,lelio ,foe We.lf. OCC.O UP RES.UNITS however it Ihavl tinyrcien of roavingsur he aninoneyea or in,rt .for theawner- / TOTAL. huildcr will have 0a burden o(Pmving tMe he NJ not build w Improve for purpae of k.). ❑ I,nowrcrof,hc latrlcty,sm exclusively conRtwtietg wltM1fan.sM mntmetm to QN'Y PLUMBING PERMIT FEE ROOD . NB APN umwvr the pmjecl(.Re.7(aW.Husinev ern Profeisints Code:)'Ov Croundoor'a Licerue lawdas ml4TlYw miownvofpvpmy wiwddlNrcimfvoves tlrrmLWPERMR ISSUANCE w1hocron .feewch Project:witheconwnm(xl lkmsM punusnt to that CmUeclNs Llaee law. ALTER-DRAIN&VENT-WAFER(IIA) FEE SUMMARY ❑ I w exempt wtle Sec. ,B A P C fI E BACK ROW PROTECT.DEVICE SANITARY V N DRAINS-FLOOR.ROOF.ARG,COND. REMPf N WORKMAN COMPENSATION TION SCHOOLTAX Y N ElChs byaffmmtM1mlbaveacenlf tm.clf-inawe,maanifcue of RE.CTEIIT# EUCDIRES-PER TRAP Woegeri CenPtnwionl earufiedcopy therm((Sa.JN00.Isb C.)wN<h PARK FEE Y N vm Vl awtler Wa p.smiL GAS-EA.SYS1h M-IINCSOl11LEIS RECFJPPN Pdlry N BUILDING DIVISION ITES Cumpany GAS-G.SYSTE OVER 4(FA) PLANCIECK FTE ❑ Cenifudropy sherebyfumisM1N. l ❑ CrnifMttgy flW with thcciryinaPccum 'alai GRFASEANDUSTRL WASTE INTERCEPTOR GRADING FEE CFR ICATEOF OM WORKERS' //a�� RGSETRAP SOILS FEF: COMPEN. NSURANCE '/7 ' ' N/I ('Ihi.ssection not bee ,hie permit ufororteN I. 1 ) S ER-SANITARY-STORM EA.SOFT. ENERGY FEE or les.) J Icrnify thu in 0sc rftumueeo a oA furor ' this permit is ivuM.l WATER HEALER WNFM/FJ,ECfR not employ sny Perso in eny man m v t oene .abject m the W PAID z Cenps,.ion Laws of if.. Dere WATER SYSIIEM RGTING 0.,e Reailn N Alalic m C) Q NOTICE 10 APPLICA :I'."making this Crnirime of Ex ,yw should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: (/) bta,m ,ubjm a IleW cr•Cenpmation ProvuioeLLofth. Cade,youmuu x > laMwlth comply with we isimu orchis pemut shall b, te'.1sm. BUILDING FEE --N 0. CON UCTION LENDING CY SEISMIC TTP 1 U O 1lertby ef(chs,therei rarsuuction1 '.'eeryforreperformanaof thu work fur whwt this trout is i (Sec. civ.C.) TOTAL: ELECTRIC FEE V. Ix s None PLUMBING FEE O Istsdv's Andras QTY. MECHANICAL PERMIT FEE r W crn�c'nity to I have read this application e,c slate Ines the above nws mMng is MECHANICAL ITE egrtetoc ,wdhmby city udrounry wOvi rsattduar.Hwsrtlatingtn PfRMff ISSUANCE F-' y M1uildingrnnatrunion,endhmby authaire represcnu0ve of Nis cry to rntcr upon this CONMUCItONTAX U uhw(We)ionalpopenyfaeinfection keepmcs. ALTTR ORADD TOMECH. (We)agreeto ruousts and x,,efy sed kapharmlm the Cry of Cupmirw dCity u,,ilitie.jnceorus.emtsendexprux ilchmayinaty wey.eemeagutm WdCry AIR HANDLING UNIT(T010.0()0 CFM) nseyuena n[ egmnting [,his permit. AIR HANDLING UNIT(OVER 10.000 CFM) I gewtutcof Appl' on r adnVCDat. EXHAUST HOOD(W/DUCf) PAID PRIS HAZARDOUS MATIADISCLOSURE HEATING UNIT ITO 100,000 BTUI Due Racipt# Will theepplicattt a Ia,.buildingoc.w,wren,handle hvardoy.mae,ord HEATING UNIT(OVER 100,003 BTU) T def nen by tk Cuperana Muaidpal Code,Chaps 9.12.auw!the Hmlth rind Safety ode,Section 255]2(.)7 ❑Yes ❑No VfMIGTION PAN[SINGLE RISID) BOILER-COMP(3HP OR 100,000 BN) ISSUANCE DATE Will de gglicmitsrfwum building by not,Egsbtuy equipment oedevy Mdnaehemit P A I D hvudnus air ormwmiewnLL u dented by 0te Bay Area Air Quality Manegcmrnt BOILER-COMP(OVER 100,(100 BTU) IY imict7 ❑Yes 13No NEW RESIDFMIAL'MECH. SQ.Cry'. SEP °O X93 I have recd the banMan etvrosm,rtgtdrtmmLL wick Chapter 695 of the SEP California II WN A Sa(ery Code.,Sections,25505,i 533 and 25534. 1 wdvnvd thu if the building dies not cumenlly M1eve etawn(0ut i,is my tegtonsibility to notify the CIIY Ur ( Ur Ghl Iv_ oocttpant of that rtquimnmu wticM1 must be road prior b issuance of•CertifKN.of Owner or euthoriml agent Due TOTAL: ISSUED BY: OFFICE