24559 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - A' PERMITNO'
APPLICATION/PERMIT PLUMBING-MECHANICAL. 24559
BUILDING DIVISION BUILDING PROJECT'IDENITFICATION
BUILDINGADDRESS: SANITARY NO. AR'LICATIONSUBMITIALDATH
UND'N LOT
O N 5 NA
CONTRACTOR'S NAME LIC NO:
N/ ^CONTROL.
ARCH11ECfpNGINP.Ot: LIC NO: ADDRESS: ❑ I I
CONTACT: PHONE
QTY. ELECTRIC R T FEE BUILDING PERMIT INFO
gLD(: L' U MECIi
" O PERMIT ISSUANCC 1L��/
LICR.SIA COMPACTOR'S DECIARATION APPLIANCES- S EN IAL B DESCRIPHON
PI¢Z Ihereby af Nvisror al 3 c(tJb,Bueu ant] isim.vo CenJ .artl mmcncing with �� _
�dF0F.. Safolle�ct�)cf¢Uviaionlar IIIc Busirra.od Pmfaaiorn Cole,etd my licemeein /vvl, -�/�
FUU Litems Clan Lic.N T PS c�z) .
W
Date coetractnr I MPS
�G ARCHI'TECT'S DECLARATION SQ.FT.FLOOR AREA S,SQ.FT.
z0a,'OZ—� IundenlnM my plans shell be wed a public m¢da jSPECIAVLCIkC
F`NtW
aY j Li¢mN Pmfe siwW T
a¢�u OWNER-BUILDER DECLARATION �N.1 hereby.firm 0.1 I Nn eaempl from the Contmclera Cicada Liw fa theCQtcoPrefewainw Coda:Anyeryorc.unty T.
C aON G which rcyulrcv n pe-,inn eowpun,ollnr,roll denud'nd.m,epnir.ny etruaum
EW>7 prlur to i.i....Iso rtqily uthe appl:,an,for ry ,card,to fJe.vplalw.t POWER DE VICES
W <O lin he is Lot—Law(ClNper SWIMMING POOL.ET.ECIIRIC
o.ao�c 9(cormnaueine with S¢Iim]OOo).lDriaim Jofthe Buu,lesa.rd Pmfwimu Codc) VALUATION
_,� or lh.I he in caempl lnertfvnvr,d the nail fa lhe.11cgd eaanpim,AnYviuletice.f )ULCUS-SWITCHES-FIXTURES 1.� �
Q Section]OJT.5byuyaWlicaufmapmilsubfecddreepplirarttloacivilperultyof —1
�Z m Ihanrvcnwdrd ddl.rs(1500).
NEWRFSIOINTIALELECIR SQ.FT.I, �wncndthcpmpcny.ornrynmpinym wile w.gcasnhcirsokc¢ryenatinn, STORIES TYPE CONSTRUCTION
a3— wort.CM : The CrheroatlmlotGeldeI,aw,dr.nete(S¢.]B14,Boerof
Pmfaaions code:The Cantrenuts d bo law dln net apply if en owner of
srpcnY whobuildsarimpova dneon.ard whodoeauch w.K M1imaelfalhtwgh his
cmpoym,poviddthel.uchimpmvcmrnuvrt MiNaddwnffadfnrsele.
If, OCC.GROUP RIS.0 ITS
huddler wthebuildinge den of nenlisiedwithinorae year ofcararrove on,thema,of
builder will hart the dndm M proving that he did not build a improve!a pmlwe of
sole')
❑ I.aoworr ofthe properly,uncaclusivclyamu:ting wlln lkvialepu�t+}� Q Y. NG FEE FLOODL NE APN
rnnstmet the rola,(Sec.90,14,Burma's ed Rofeaaiuu Cerl')The Coj�lEemN.s
Lean "wd wlaMlyto owmrofpmpcnywb. ii&a i. sora .rd YERMITT j
whocmlracufm.uchp j,c swith.cmt Oorf.)licrnsdpmu.nitoiMCn —
T.iccrtsclaw. J }TER-�AI h EN - (E.A) I FEESUMMARY
OUTSIDEFEEIS❑ BAPCfaho¢ A CE SANITARY Y
N
Ow,� RECEIPT N
WORKMANCOMP[dISATIONDECIADATION ' .
SCHOOh'fAS Y N
❑ Thereby affuri�Nulh.ve•crnirate of uuum„o acB-iaurt.ae¢ru(ImleM RECIRn
Wmt¢iC In.n.ccnird ( I� RFS-PPR TRAP
mlperlwim c yltertuf See.Jg(q,I�b C.)whlch PARK LLE Y N
coyer,all empnytundenhis pemlit GAS-FA.SYSIFM-IINC.6OUTLETS
RVPIN
Palic,40 BUILDING DIIN
IFF5
Company GAS-EA.SYSTF1,F0VFR 4 DIA) PLANCHECK
❑ Cerrfkd eTpY i.hereby furnialled.
❑ Qnird ropy is Tied with the CIIy inapeer.n divisim. GREASIVINDUSTRL WA,STF,INTERCEPTOR GRADING Fl*qv ,
CERIIFICATE OF EXEMPTION FROM WORKERS' GREASETRAPM
COMPENSATION INSURANCE SOILS T VV
(Tbia inion xNtrotMcornpleadif the pcmlit isfao¢hwtltN dollen(11001 SEWER-SANITARY-STORM EA.200IFT EN GY FEE �.
T¢nify that in the,prfmnnen¢ofth,wort for which this Intent istauu.n,I"I WATER HEATER WNFMOELECIR
not ert any person in my rtuMcr an ae to bamsc sunJ¢I In Jtc Wortm' PAID
Z Calapuvution �wa
Lof Caldi..omDate WATER SYSIF.M/TRFATING Data Ree - aaaa,
Apel .n
O NOTICE TO AI'P.ICANT:It.alter muting this Cmiraur.f lhcmpion,you allond NEW RP IDENTIAL PLMR. SQ.FT. TOTAL
I--' !� become aub}cl to the Worka'e CmnpmHirn p oacaer ofthe lwhor code,yw mon
tonhwith comply with step prnvisinns or Inti p roni,ahall he den Jrevold. BUILDING FEE a.^
Q CONSTRUCTION LENDING AGENCY SEISMICFEE
Z Ihereby afrrm that lhaek a cortYrucli.n lending agcney for the of 71
U O the,wart fin-which thio Itcmlil is issued(See 3097,Cir.C.) ELECTRIC FF:E _rN
Lend N..
O TmJc's Ad1nae; QTY. MECHANICAL PERMIT FEE MUMBINGFEE cEq
T cenifY than I beva read This application ad amen tha the nMvc InoZeetee i.
>. 417 correct. Ivgrezmcwnply with all city and couay ordiwxa aM arae laws rtlerey to PERMIT ISSUANCE / MECHANICAL FEE
F' budding consutxyion,.M hereby autMriurtpexntntivnofthio city,.ente .,nr rhe CONSIRUCIION TAX
V Z ebnveRKflliimtll Prt for iwpeeiori pue,t ALTER OR ADD TO MECI I.
(Wc).gr¢to uvc,i,dcmnifY.nJ reap M1amrw J,c City of Cuptttiw.gvrtar
Iianilitia.jwlemtnanerwhichmoyinany wayarnengniwtenkCily
AIR HANDLING UNIT(TO IO,g)OCFM)
Ncryuc,ucatheugordd
'l.
- AIR HANDLI NO UNI'T(OVER I o,000 CEM)
I
g urtn Appfeanl/Cmnlrxt¢ Ie PXIIAUST H(bD(W/DUr.T) PAID
HA%AftOOIJ MATERIALS DISCLOSURE HEATINGUNTT(TOIO),"BTU) Dale Rccipa
Will Ibenpplieenl Mful buildingu upanlnomwhe ichav u.m cHal
w&fimbythe Cupeniw Nfa MICode,CTupta9.12,and Nc Health.rd S.fety HEATING UNIT(OVER 100,000 BTU)
CMe,Senior 25532(07
❑Ye 0 N VENTILATIONFAN(SINGLERESID)
ISSUANCE:DATE
Will ihe eppieantnrfu,urttvildin8occupantuae eywpmmlmdevimwhkh emit � BOILER-COMP(3111'OR I00,000 BTU) p
• n.xarJons air CmllnmiNM1 a defend by the Bay Am Air Quality M.rugemenl BOILER.COMP(OVER 100,00(1 BTU) P
) Ir W
Dislrin?
❑Yes ❑No NEW RESIDE TIAL MECIL. SQ.IT.
1 have read the h.,� ,,matedaT, under Chapter 695 a dba DEC 2 2 1992
Cs ifwti.Health A Safely code.S¢Ii.]35th,25533 2(d 25534. I rooderslruul tint /r
iftlw building doe m¢nn
cupmd non cY have a ten.nl,dun it a my¢spauibirty In noudy the II Y
ocMlhc mquatrnu ons
itwhich he ten xie,to resho c a.CanuteV
of Ur cut r , ,
Qcu a
PxnR oreullwriaei'ent Dae L ISSUEDBY.
OFFICE