25523 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO LUM"B M1RrF,MECHANIC ICAI. PERMIT"°.
APPLICATION/PERMIT PLUMBING�MF,CIIANICAh
f BUILDING DIVISION BUILDING PROJRCTIDF%7[PICATIO.N 25523
BUILDING ADDRESS: {� 1 Iy' SANITARY NO. APPLICATION SUBMITTAL DATE
A /
1'VWA/ UNIT# IATA C7
OWNERS NAME: PHONE CO R'S ICNNO: 11••_ n
f O •l O C � / NIC COINROL0 /�'
.�RCH Cq G[NIIFR: LIC NO: ADDR S: 11J
CONTACT: PHONE
n ccs QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
��\/ W UN (7 O n l '1 9 10 ✓ )EE?, PLUMB MECH
I V J� Jsl dJ / / PERMR ISSUANCE, /ux`
t LICENSED CONTRACTOR'S DECLARATIONAPPLIANCES-RFS AL
JOB DESCRIPTION
DyL It 70 elOmtthul em lictuW utdaancl Pslwuof Cottle 9lct mnueiny wish
FJOC, Scmiom a mot s f Divuioo J oftbc Btuittm W Pmleauort Cottle,ab my lienar u th PANELS C
full Tae Clic-Jfct. J
a<nsc Clm Lich tlP 1020.1 AX1P5
in�y Dwc Conoacmr IW AMIIS
GOtNixZ ARCHITECTS DECLARATION O SQ.FT.FLOOR AREA S/SQ.FT.
OzFp IuNmstetd mYplens.shell Ito us:,]to pudic scads. (t]
Q y�_uu�11 licen+cd Hofrniwvl IV SI CAL G O�
°C C)�u OWNER-BUm,t fA i1he Co ATION AL CDtCUff SC � �/ v
igq(O y 1 hemhy nfBms Thu 1 ER BUILD fwm the Contras«s Licrnxe taw fa Ir�,'�/�
u1 :LLy fdlowingfmran.l5cdan 1dJ13,BWIftoaWftof[vivns Cade:My dry«cam INST.
F-!!:O g which rryuirts a Etc ma to conaun,alter,iromove,do offish,or rapt'arty atscaure
5� >� pna to its ksuenco,also Noires the eppliwnftwauch permit to filensigttcdawmtont *[CkSV
t� p0 Him be ul iceouxi pursuant to the pavl.slon a the Contactor'.Littne law(GhapGl
as 9(mmrein exempt
Be
xor3a alleged ixmmtd Pm(maiomt�) SWI N LEIRCIXIC VAL AU 11pN
urthu he ixexempt thmcfrom end e bnusfm the nikgcd mcmpion.Any viduion of OVII. WITCHES-Fl%TVRBS `
CyQ Sation103L5byanyapplicantfaapemiitsubjecutleeppl tsoadvllpenalsyof
then lvc hYMSM ddlm(5X10).
KCO I,nuwnaoffM1e n ,wm em egundtoiraokcanprnaedon. NEW DFNHAL Q.ECfR _SQ.FT.
props y y ployem wiNw STORIES TVPECONSTRUC71ON
y3 will hcwork,a rd Ne h,Cmreiawxinteaccome Law
fmxt apply 1044.Bterof
ort esimo Cod,:non r ves tht Ciente law uch rot apply b so owocr of
p,apero whobuildaar ed tmvethmm�,aadwhodmashwwk M1lmsclfw th,sale.a
empinyms,pr�videdtMtsuch improvement uenot inmakd moffetW fa sale. karl y t 001:llsRO P RES.UNITS
however,de bowinS or improvetn em in WW within are ymofcompletian,daowm170
-
buiW will have the Mndcn of paving thio he did not build or imfvove for puryose of
I,n owner of the pmp,ny,am exclusively contracting with I ccfucd arra to QTY PLUMBING PERMIT FEE FlAODL APN
coronet On,Fmjecr(See.10x4.Rion.sort Profmimu Code:)The Camartola
License low dm satapply to ymownmofpfoleny w1h,bamm.orimprovnthem t,erel PFltMIT ISSUANCE
whecantmtsfomehproinowithecmn tot(e)1'tanxdpuauentwthe Cantacwr's
Luse law. AL, VJ
DRAR VENT WATER(FA) \ FEE SUMMARY
❑ I on acmq tender Sc. B A P C fa thin ruxan HACK FLOW PROTECT.DEVICEH
SANITARY Y N
dwm WORKAN COMPENSATION DECLA TION DRAINS-FLOOR,ROOF, GOND. SCHOOL1'AX YFCFIPfN
MN
1 hcmhy elf ren Nu 1 haw a crniOCuc of consort m sdf-forum,a e rcnificae of REiCF.IPI'N
® vax allCanpenmtian lawuaaxmaccni0edco,y fhamf(See.Jg00,Iab C.)wbieh F1XlU1lC5-PFR TRAP P E Y N
ampbyttl uMer Nu permit EJN-I GAS-EA.SYSTINC.4 OUTLET'S RECE 'I
Polity N BUIL G DIV EON FEES
Compmy GAS-EA.SYSTEM-OVER 4(EA) ILCK
E:) Crniftod copy u Mcby runuNtod. O
❑ Cenifed copy is fhd with me clfy lnspxUw divivan. GRFASE/INIUSTRL WASTEINTPXCEPI'OR MADING '
CERTIFlGTE OF EXEMPTION FROM WORKERS' GREASETRAP OILS FFF
COMPENSATION INSURANCE
('his accd std tlto
tion nbecompleted ifpermit u fa onto ltu &1l IS 100) SEWER SANITARY-STORM EA.200FT.
ml IINFRG FEE `
I certify that u the pelf.a Be work row which this pumit u isaef,I shall WATER HEATER W/VFM/EfECfR �/
out employ,any person in any monomer no n to become abjm to the Wakci PAID
z Canpen.uion laws of Califanin. Oetc WATER SYSTEM/IRFAIING Dae
AppR.
z0 NOIICETOAPPLICANT:If.after making flus Certificate of Exemption,you nbouW NEW RESIDEYUAL PLNH. SQ.Ff. TOTAL:
f- becamesuhjectfothe Wwko.Gmpmmtion pro Woruoffhe lrWr Code,yaumart
fardwith comply with ash prosmaru or Nis permit xball be heft 1reva eel. BUILDING FEE `
Q CONSTRUCTION LENDING AGENCY SEISMICFFR 170
z I hereby toff Nat thus u e mnbuctim tiding Mtoc y for bar performune of 1. 7
TOTAL ELECTRIC FEE
L) O doe work for which thu peafvt is instant(Sec_W.Ger.C) -Z
Orrr Erniier'nler,Nems ^ L7
V Lrnhr'nAOdtcv MECHANICAL PERMIT FEE PLUMBING FEE (_
lJ I aenih Net 1 have and m s
Nis appbeatian audw W
e above Wau mad. �a
�" WMECHANICAL FEE
correct. W comply with all asd w
county difwtm axdw
awe laws relatingto PERMIT ISSUANCE
mcity
building contraction,and busby euthaiee mpmacnutivm ofthis city w inter upon the CONSTRUCTION TAX N6
U z .1hoo,mcmioredg ary for impecdom pp,xaes. ALTER OR ADD TO MECH.
(We)apse w uw,iMcmnify asd keep lbaosn s the Cry M Cupeniao agamsi
IieMlitie,judgmcnrs,cost sod cxpcmu which may in anyway eaaeegairw said City AIR HANDLING UNIT ITO 10,000 CFM)
In Lcoce of Be'narmnguf Niipermit.
AM HANDLING UNIT(OVER 10,000 CFM)
Signnt rf Due EKHAUST HOOD(W/DUC)
PAID
I RDOUSMI MbisLS DISCLOSURE HEATING UNIT(TO 1(10,0011 BTU) Due Receipt
Willthe leant orfalum building ouvpeniumeahudlc hyaunbm metmel IIFATING UNIT(OVER 100,000 BTU) TOT
u deffwd by t Cupe Mwicipd Co ,C PW 9.12,and th llcdth W Sefcry
Code,SesbID ZS532(a)1
ID Yea EI No VENTILATION FAN(SINGLE RESIDE
Will deacootoelorfs=bu0ding ompanttae Mean it mdenimwhichem
BOH om-COMP(3HP OR 100,000 BTU) ISSUANCE DATE
haralloua air caunnivnt n definW by the Bay Arm Air Qualify Mougcrwnf BOILER-COMP(OVER 1110,(80 HN)
sot
❑Ye ❑No NEW RESIDEMIAL MECI1. SQ.EF. A � D
I hove mad the haurdous materials or oreoent under CImN,6.95 of the
isthmus 1ka1N&Safety Cady,have
a b 25505,t it is y r 255]4. I uMmwd ttw OCT 21�
if de,buil dingdamratcmrenlw which
•tefwm t itis mYseapwuibila wfwufyuse
wcupmt of the acyuirememn which mart h son poen m iuuettoe of a CrniOrnre of
OseupwcY.
Ownua sodanud agent Dote TOTAL: ISSUED BY: oI/: