26815 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 'b1NirF.LMl PERMIT NO.
APPLICATION/PERMIT PLUMB ING-MKCHAN'ICAL ��o 1 JO 'I C
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
fl)ILDING ADDRESS: ,/ SANITARY NO. APPLICA'IIONSUBMH'I'ALDATH
0aft SIVE 'UNITN LOTx
ILS NAHONE: ^ )M'RI�I'OR'S NAME UC NO: lJ
6 5 b U /Y,/.V/ Nfc CONTROL x
RCHIECi"UINII3U LIC NO: ADDRESS: ❑
CONTACT: PHONE BUILDING PERMrr[NFO
QTY. ELECTRIC PERMIT FEE
- I BLDG ELECT PLUMB MEM
` PERM ♦SSU MIl 1* EJ El
LICENSED CONI'RA rPro'iiossof RATIONhW=9 APDL -�FSm AL lFJ
pyz, Thereby alRnnthat l vmlithin13 dcrpovisiomions Cons,
my 11c ucebin
4100[ fectimt,aml)sflliviaim3of Ne Ousvcm and Professions Code,arN mylmtQVto p
F�Ut� hoes,. fuss
<�
License Cl¢ss Lk.M U tMFS
vvii a� Dalt Cromer« 1- AMPS
7~Oy zARCHITECTS DECLARATION A�
IIl00AMP5 SQ.III'.FLOOR AREA ENSU.PL
I untkntmd my PlansSnell be used ua public rands_
F In L-j SIGNS ELECTRICAL
ucc.scd Ponfusional
a,cc6 OWNER-BUILDER DECI.SRATION SPECIAL CIRCURRASC.
pxx,OaF 1 hcmby alfimr th.l 1 em cxcmq from dx Cmtract&s License Lav f«rp,
W3�y followro
ing rm703L5,.(SmionBusieessaad Pmfeaaiorts Cade:Anyciryorcasvuy TEMP.METER OR PULE[NM
which rtyuirme pemnil to tanaruct,allef,impn,ve,dc,oi.sh,«r,sox any atracIum
t Y prior to ru I..,a]ao uss,. pthe"fictail fmanch panus to file.sigmolsurvrcnt POWER DEVICES
<p Out he is llcenaaL pursuant to the pmviaimo of the Contr sLiam" CQut
Lsw u
9(cummcncing with Satin 700))cf Division 3ofthc Businm end Prof.Cuda) SWIMMING POOL ELECTRIC VALUA'f�(f/
vs «Nu he is cxcmq tht,cfmn and the Buis for the alleged excin,mon. rty Avloluion of (JV
S,tiun 7031,5 by enrolgliunt fcl. :rmko.b*,,tM applkvnl me dull penalty of OUTLETS-gWTTCHFS-F'LY'IVRES / 2
SS rot mom than five hurrdred ddlua(5500). NEWRESIDENTIALELECIR _SQ.FL 7 V
g � w as awncr oftnc pnrpaty,or my employees with wages aa heir sok compensetiun, STORIES I PE D S RUMON
tfess.uldlM The Conaclor's etdelarowdt,for Wepplyt an,Busimaa
1 Rolemiom Code:The Cminaclon,Lismx law dun not apply to an owrcr is
rcnr wlwbuilds or iinprovm Ilseram,wd wnmm.a,,ntn w«k nimtlr«wwennD
.GR UP RFS.UNITS
ownrnr,ha b.,lmvided ti,oschimpovemciflhin m cur.fc oupl au dfarola.If, �.
buwIcr will
bue 1ps m impnrvemsmi a mW whnin sa,c yearm impsmvc for ha owns- T Y
Wider wJl have do buNrn Mpmvin8lhu he did mtbulb«improve f«puryme of
sal'.).
❑ I,ea owner of 0c propeny,emnclusivelyrmtracling wish liccnad tawxtmo TY. PLUMBING PERMIT FEE Fl_OODZONR APN
conn.,Inc Projm(See.1144.Buamw"Pmfeasoes CNe:)The Co.'.
Liccrae lawdrea not mlgly loan owrcrof WopcnY wltobuilds«impmvn lhawn,erd PERMIT ISSUANCE
who commas fm anon Mjccu with a contractor(s)limud puma,nt to Iht CnnrracmW&
liccmc Law. ALTER-DRAIN&VEST-WAIER(PA) FEE SUMMARY
❑ 1 am exempt undo Sec. ,B&P C fm thisrmmi I
i BACK♦TAW PROTECT.DEVICE- SANITARY Y N
O«cr tw,. DRAINS-FLOOR. F .CON RECEIPT♦
M
WORKAN COMPENSATION DECLARATION SCHOOL TAX Y N
❑ IM1crcby alRrm mnllhercn«nifitata of mricnt tocalf-inawc,«acxnifiatc ofBfimPTI
W«kcm'Connpatmtion 1.onaanif"copy lhaaaf(Stc 3800,Lab C.)which PARK PARK FEE Y N
Psila,rill employees uoc thispcirmit. GAS- STEM-1 C.4 OUTLETS RECBIPTN
ky If BUILDING DIVISION FEES
Company G -EA.SYS 4(EA) PI.ANCIIECK FEE
❑ CrniIN copy is tet Ly fumishM
❑ CrnifaW copy is filed with Ne city insprctian dlviaien. GREA$IVIND ,WA .PI'OR GRADING FEE
CERTIHCATEOFE%EMPION FROM WORKERS G E SOILS ITE
COMPENSATION INSURANCE
(Thi.ration icd no bs mmplerad Hills,pmnir is faorc hurtlrd dollars($1 S Y RM EA.2(gFT ENERGY FEF.
os le )
Icutify 0usl u me perfscnuaemfthc work for which Piapmnit is imud.l WATERH W[VEWDELECTR
rid mtploy any paraan in any rmarucr su,as to b crc subjm to Is,workm' PAID
Z Cnmlimlrw
Ecuasof C.lifomia. Data nFR SYSTh? VTR GTING e¢ipt
TING Dan, R0
caru
OO NO CE TO APPLICANT:If,efta making this Cmilime of Exemption,you should NEW R ENTIALPLMB. SQ.FT. TOTAL:
VI banme.subjm to line Worker'•Comprruauat Movisima of this Labu Cade.you must
aforthwith cormply wlm such pmvLsiona or this panus Nall 4 de<ncd mvokcul. BUILDING FEF.
1 Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hmahy affirm mut them is•construction lading egmcy for this,pmf«mana of
V O the work fm which this permit is issued(Sec.3097,CN.C.) TOTAL ELECTRIC FEE _I
t sNerve
0 kr
F 1<r. 's Addmm QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
V 1 ccnify tlut I nave mad lnia application and nue that the above information is
r�" Lia comms, l agena m comply with all city soul county mdimunccsard .•,•laws rcluing to PERMIT ISSUANCE: MECHANICAL FFM
I" y building conimcrion.std hvcby amn«im mprarnmdrn ofthis city tornta upon the CONSTRUCIlON 7'AX
U Z slwv,mculiotcsl'open'for inspscdon P.,Vats. ALTER OR ADD TO MECII.
(We)tgrta to sa,irdcnmify ass]k«P harsnlass the City of C.,Pcm w aga'vut
liabill'. dgmrnu,csnu std cx which may in anyway accmctgainn said City A IR HANDLING ON 0'(1010,000 CPM)
the gnnnng of iv AIR HANDLING UNIT(OVER 10.(W CRM)
SilPsnumo( nactm •. Ga¢ EKHAUST HOOD(WDUCT) PAID
HA%lsR0005 MAwcU test DISCLOSURE
HEATING UNIT(TO 100,000 BTU) Gate RcosigN
Will the the Cu,,mfuNmcbuildingpa «.Clua mom or nvtdle hBruNwamSctl HEATING UNIT(OVER 100.000 BTU) TOTAL
u Costs,
S by the Cupmino Municipal Calc.Chepla 9.11,artl Ik Hmlth and Safety
Csdc.Suri0 yt,' a)i VENTILATION FAN(SINGLE RISID)
❑Yo ❑No
Willft BOILER-COMP IMP OR IW.M)BTU) ISSUANCE DATE
ecmumunlofut as building by hicnBay Acca col ualityeswhichemit P A I D
ai wntaouvnu m defucd by Ile Bay Arta Au Quality Ma.agenant BOILER-COMP(OVER 100,000 RTI♦)
Punct?
❑Ym ❑Na NEW RPSIDENTAL MECH. SQ.FT. AUG -2 1994
1'hurc teed the hory materia],requirements unlet Chap.695 err the
Califomi.Health&Safery Cade,Sections 15505,75533 and 15534. 1 uodear,rd that s IlY vt V V f CIi I INV
if Ilse building Jaen not cumenlly have a lmwnl,♦het it is myr onsiilxity to nobly the a
«clrpanl of dtc rryairamrnu which m,,.t bt met prior to issuance of a Cenificuc of
cxcuTArtc'y.
pwarer«aulM1miaal agrnt Due TOTAL ISSUED HY:
OFFICE