26948 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY \
ECPCrRICAI PERMIT 26948
CITY OF CUPERTINO APPLICATION/PERMTT PLUMBING.MECHANICAL.
BUILDING DIVISION BUILDING PROJECT IDENFIPICATION
BUILDING ADDRESS: SANITARY NO. APPIJCATIMSUBMTITALDATE
/ NITR LOT♦
�� WN' PHO CO M O%-JJ/ NfC CIJMR,OLk y
ARCHI 'CT/ENGIN IJC NO: ADDRESS/
7
r" '`AVL ❑
ONTACT: PHONE:
QTY. ELECTRIC PERMIT EEE .BUILDING PERMIT
BLDG ELECT PLUMV MECII
PERMIT ISSUANCE
LICF.NSP.D CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL
ny.Z I hereby a0irea that l am li.dunderProvisimsofChapter9(camtencingwi,h BDFSC
aOFOSpenem F fullfam(w,d)Ef Dlv'uionJofthe Business ard!/Prrofessis.Code,and mY lkmmis in PANELS
QTu".1 Li �� Lic.N `�V UP TO 2(a)AMPS
yQy Da¢��- Gmtrac '/'�f/ 201-1000 AMPS
Z Or`a'irz ARCURTCTS DECLARATION 1/ OVER 1000 AMPS SQ.TT FLOOR AREA E/SQ.FT.
oz-7 I uan.nlmad my puns,hall be,usdl.e obbcrtcadv
F so t W SIGNS H.ECTRICAL
Licemad R.[c.uimal
pyOWNER-BUILDER DECLARATION SPECIALCIRCUIT C.
K 0w�6U I hereby a0irm that 1 am excmpl from de Crammer..'.L'.se Law for the
vrfolloveingtasou.(Seemat7031.5,Busimv anal Prefer...Code:Anycitywcounry TEMP.METER POLE INST.
1-'0.5 which re,mo,s a Pfrmil to<unsuttcl,otter,imlunve,dcmnlisb,or rtptir say socclure
5�}2 prion.iisisuvee,.lso tcyuima the vp,l.I fineuch peoplam[Iee signed emterarm POWER D CES
ol,<o IM1m he is liruas-edparawml to the ProvlslaccUle,Convector's Liave Law(Chapta
ddo� 9(mmmercing with Seclim 9gq)of Division 3 ofthe Brimers aM Professions Code) SWI GPOOL,ELECTRIC U
mlhmi bcia excmpl lM1 emor,and hap basis for the ellegW escmgion.Ap vialevon of O .SWITCHESFIXll1RF5
,TaT Scctmm70315 by sayupplicant Rua permit aubjxu Oe epPliwntloa civil pemem,of - /
Cmmort lM1nn five hulxhcd dalton(5500). NEW RESIDENTIAL ELECIit SQ.FT.
_p ❑ I,as.wnerof0eprupeny,amy empinyeeswiNweBcs¢slM1eirsolecampe wxn, STORIES TYPECONSTRUMION
y3°�° will Ju the wnh,and0m wuaure ismimendulomffcrtA fm Bale(Sec.I044,Bmlress
sod rofesnwu Cale The CmlmClai»Licasse law docs not.pply to.n owrcr of
Property who buildsmimpnva theram,end whlodorasuch weak hdmsclfmlM1rargM1 his
employees.pmvidNthnl suchimprovmarnls ofm Wendedmuffercd fm s.le
If, OCC.GROUP RFS.IINI'IS
however,the building or Improvement is sold within one year of awpledon,the owner- TOTAL'
builder will have the burden of proving fled ne did rot build or impmee for W rpn'e or
'`ale'). TY. PLUMBING PERMIT FEE FLOODZONE APN
❑ Tut oe project
Sea.70 . exclusively rurodessnewith liaruedcontracvmlo Q
uM19NKl he pmjml(Ser.20M,Busirco and Nofcssi.ns C.dc:)Ibc Conveclm's
Lt.",nolapply to witharnfpropemy whnsed pumimpovw,hmrom,and PERMIT ISSUANCE
wnaaeltaw. such pmjncu with econlrenor(e)IiccruM Wrsuenl to theCmvMor'n ALTER FA
uccn=<Law. ( > FEE SUMMARY
❑ 1 mn exemp uMer S¢. B&P C far IM1u m="n
BACK FLOW PROTECT.DEVICE SANITARY Y N
Owner —Deme RECFBTM
DRAMS-FLOOR.ROOF.AREA,COND.
r WORKMAN COMPENSATION DECLARTI
AON SCIOOLTAX Y N
❑ Ihcreby alfinn lhallhavcsunifiw¢ofc.nYnl msdf-insure,ore cerditcete of RECEIPT#
Worker,Compensation Imurenw or a petrified FlK'TfIRFS-PER TRAY
ropylMrcof(Sec.3800,lab CJ which PARK FEE Y N
crs all this RF,CEIPTM
GAS-EA.SYSTEM-I INC.d OUTLETS
Palley L � Z BUILDING DIVISION ttCs
Comp try GAS-EA SYSTEM-0VPR4(EA) PLANCHECK FEE
CcnlOfd copy abed.
rifled copy is filed with the city irepecdun divii GREASEffNDUSTRL WASTE INITRCEPTOR GRADING FEF.
CERTIFICATEOFE)TW91O OM WORKERS' GREASE TRAP SOILS FIJI
COMPENSATIO OM
(nisseclionrladmbscomplclM- Pram;,isfamehmdrcd dopers(5100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEF.
.rlfs)
1 Iceni(ytnalimlm Wif mace fdeworkforwhech this permit isiVated,I shaD WATER HEATER W/VENT/ELE.CIR
not employ any p. in say as to became 8LINT to,k Wcall PAID
z Compvswtwn Lewsuf Coh I.. Deem ATER SYSTF,M/ITEATING Dale Receiplp
A,li.
z NOTICE TO APPLICANT ILehcr making lhk Coni( c primaar�.r��$yys'''' Id NE ftCSIDENTIALPLMB. SQ.FT. TOTAL
Cot)
becanfsubjectlothe Wa 's Coon salian provisions mrC n
� , foMwilM1 cmnPlY wiN
se
pmvisi.nsalhB pennil II do/mNed rr BUILDING FEE
0. Q CO STRUCUON LEND ENCY�N SEISMIC FEE
� z Ibend+yaffmnlhvI isac I 1 IngaenryfyrL /^. peon
U O me wak Per widen ria ❑i.iaaaed ,Cm TOTAL: ELECTRIC FEE
Larder's Nvmf
F Lenders Addrtv QTY. MECHANICAL PER MIT FEE PLUMBING FEE
U 1 parity tent 1 have rad i..pplicai stale IDs,0ac oho infmmaum is
rd's w mrtpCl. Iegrce,a canply wish and mu yotdin.accs hole ¢hews rtl.lingto PERMIT ISSUANCE, MECHANICAL FEE
F-' 9' building mndmedmn,ural hereby eulMx aosmWivesof Thi lYtocmleru"fle CONSTRUCTION TAX
U 2 move- enhorcd PropertY for impedim pu ALTER OR ADD TO MECH.
(We)ir' e m save,inaenmify and kap ,Ices, try of Cupcnmo.gaunt
IiaAditics,j Wgmenu,msu and es,-which ma y way accrue egawt said Gly AIR HANDLING UNIT(D)IQ000 CFM)
im ucmee of the 8raating of Thi.Ispromt,
AIR HANDLING UNIT(OVER 10,000 CFM)
Signawm
of Applicant/Cmwclor De¢ EXHAUST HOOD(W/DUM)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date RaeiX#
Will Ihf eppliw,t.T future building ocwp.a,num m M1uWle M1vudtws material 1{EATING UNIT(OVER 100, TOTAL:
v refined!by OC Cupnino MumS4 Code,Chapter 9.12,oral the Heeldr anal S.fny
Crclq Senior 25532(.)? v 1.0v
ID Yea Nu VENTILATION PAN(SIN ERFSID) O
IHSS IANDCE DATE
app
Will 1M1cli�rna(uwmbuildingaxuPlusc pecquipnlcr,tmdEvicaMP wM1ich prim BOILER-CO (JI Wp B /1
RI ,g
TU)
,rassNoes air coramnim mis as dclired by the Bay Area,Air Quality ManeBeneat BOILER-COMP VER 100,000 BTU)
DistncC ❑Ya l
aka NEW RE.SID� LMECH. SQ,M, JAN 11 1995
I have read the hareNous materials ac clop ems under Chepler 6.95 of the,
'tl i
Califanio I Iwl,h&Safely Code,Se marcs 25505,25533 and 255W. 1 understood floor
;floe balding doe.act earEna a.cate,Ianl,that it is my reaponsibilm miry iry the �rr Uf WYC11111VO
fCCapWI ofthEr Ylrf is mubo m,p�or,.i arra of.CSn1Ec9,e of
amt ��_7!i '
Owmcnnauthai.cd.gcnl Date TOTAL: I ISSUED BY:
OFFICE