25022 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILVIN.- "Mil NO.
BUILDING DIVISION _ /'APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION' 02
IILDING ADDRESS: s SANITARY NO. APPLICA'IR SUBM1IT(�4L DATE
Sy3 11 E4 � UNITY LOT#
OWNI.RS NAME: L/ PHONE W CONTRACTOR'S ME: LIC NO: NIC CONfROLN
eµ�� 14� 2 O Al ��iJ (0 Its,
RCHIT iUllF CINEEK: EJC NO: ADDRESS: i ❑
2 ( e4a/kr , 1Up
CONTACT: PHONE QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG MELD
IiTL-E�CI' UMB
PERMIT ISSUANCE L i ElLI CENSIiDCON'IRACTOR\SDECoflChn ON APPLIANCES-RESIDENTIAL I
Pry% IMmeby eff rn that tun liun�umkr povisimuofCNper9(,xrrurcncinewith
WOOF� Shcion]OW)of lTviuon Jr(the��amer,v/xl�Pmfestian Cade.ud ivy liana is in PANFIS �C
tQ U f.�cc �c Lic.N (H1 �SG UPT0I110AMIB B.
�Qy Ducnu Convecla ]LI-10130 AMPS
%OyZ ARCIIf1ECTS DECLARATION OVER IWUAMPS SQ.PT.FLOOR AREA SrQ.ET.
O%—❑ Imderound myplent short he
un lea public rtcmlf
r N C�s SIGNS ELECTRICAL
S Y f,� Licctvetl Profeai«W
C W< OWN GR BUILDCR DECLARATION SPECIAL CIRCUR/MISC.
C
OaF 1 hertby affirata Jut 1 U exempt from the Cmtrxs Co Liana.Lew for Be
W3�y< fMlmvinertasa.(Scaim]UJ13,B, Iter, odaror.d l Cade:Any city aaumy TEMP.ME'IFR OR POIL*NSI'. '
t,�OJ wM1irJr rcqubelfmNl to cm,trua,Illm,impmve,dcmnlish.a rtPwr eny Staclurt VOWIJIDEVTCTS
�f�a$ flat hmsli.wenu,also totth Nesiducats ofteuch puntilw flsirria"ls(Co'Ba
,Y0p Thal he is li.cadth See..to the)ovmsi of the Ce B.M a Licenselaw(r Cods) _
a'axo� 9(cvrmtcrcing with Scaim]O(p)ofDiviamtJofthc Buslassard Profcvrau Code) SWIMMING POOL 1D VALUATION
W 2tn «Ketole is exmmp lhcmrrmm end be pais for the.11cgul exentpion.Any vinledonof OITRETS-SWRC IU75XTURIS
tK, Seemxn7031.5 by snyeppliewt for.Parent tabje.the.pplinnl to.ewd Pendly of
nut arc then Eve hutmM,tillers(SW).
uWm
W ❑ I.u,nwnerofthe pgmetty,semycmployas withwegesestlelrwle ampnw&n, NEW RESIDENTIAL CLE RI.1 I'YPECO I ON
p,3m wmlldodfi.erd Je YmClurt ie tro,imadcd moffwlr«we(sec.]ou,Buairle, '
.rd erni wh oro Cale:The Cmunarrs w1bri law don wort Imply tort owner of
Property wM10 bullJs a inrpruvn Jmcraan,iris who don such work bimeel f a Nrouglt his
empWyee.pnviJW lha.wchimpmvemmat�rtrolinlendedmuffertd f«ole
If, OCC.GROUP RFS.UNITS
however,the building a imptovewteml Is sold within ore yeat of(IDnPlcllo(I.Ibemwrrv-
buiWer will M1eve the busdcrm of povirte flout he did ria hddd m limposefor
fpvprae of TOTAL:
ole.).
❑ I,a,owrmnofNe Property,.mexclueivelyrnnveningwithli,stated cmtr.nonm QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
Gomel the pojtO(Ser.]OW,Baia.,a arta Professoriat CoAc:)TIc Cmtr.nas
I. m.iceiLawdms trot imply to an owmternfpopmy who builds a improve therem,soundPERMIT ISSUANCE
who conlncu fm,tch Projects owemNmcloo,)liattsed PY.,m the Comvsarn
Lka.law. ALTER,DRAIN&VENT-WATER([A) FEE SUMMARY
❑ 1 em eneorp undo Sec. B&P C f«IM1Ia reemn BACK*LOW PROrECf.DEVICE OUTSIDEFFES
SANITARY Y N
WORKMAN COMP
*]war Due RECEIPT*
• DRAINS-FLOOR,ROOF,AREA,GOCOMPENSATION DECLARATION SCHOOL TAX V N
❑ Iharehy affmnhmlhuvencmifuuc of um.ant to self-imurt.maccni0cme sir RECEIPPN
Wako,'Cwnpcawinn laumae m aanlfed cFIXTURES-MR TRAP
apY JrrtsN'(Sec.JSW.Iab CJwhirh PARK FEE YN
coven Al anplo a'a uwldn this permit. GAS-EA.SYSTEM-I INC,s OUTLETS RECUITT N
Pdiry BUILDING DIVISION IE6S
y GAS-P.S.SYSTFN DVER d(EA) PIANCHECK FEE
miflad copy i,hereby,furwrtdted.
❑ llmiCiMrn isflMwffi eciiyiapcaimdivisim. GREASIUINDUSIRLWASTEINTERCGJ OR GRADING IEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE?
Ink—tion dtorl be completer iflhe Permit at for urc hundrtd dollem(E IW) SHWER-SANITARY-STORMFA.21KIFT. ENERGY FEE
a las.)
I cmify that in the p:rfamu aflae work fa which this p[nnil i,i,EI W11 WATER HEATER WNENTJF CTR
rM employ my Person in any mummer so ee to Neema subject to the Wrvkmi PAID
p Z Crrtnpn+atim Taws of Celiforrda. Date WATER SYSfEMOREATING Due RetiptN
Applicaru
p NOTICE TO APPLICANT:Jr.efler raking this Certificate of Essinpion.you should N RESIDENTIAL PLMB. SQ.FT. TOTAL:
an bacodat-meed m do Workers Canpenwiom prwi,iau of the Uaba Code.yru mow
7 farthwilM1.nmply with such pavi,iwv a this'.rust stall be dtmcd aruked. BUILDING FEE
Jai
(] CONSTRUCTION LENDING ADIJCY SIJSMIC Fl]!
z Iherebyaffirm thug Ncre is a convructiom ledariee ageruy for JK perfontunce of lD ELECTRIC FEE
Up the work ieh ohm,permit is issueSd 3097.Civ.C.)
O Irnda'a Nome
IrnJer'e Amaro., QTY. MECHANICAL PERMIT PEE PLUMBING FIE
1 urufY Thu 1 hevc ruJ flat epplicuion.rod rote Thu Ne shove mfotrwim i,
�"' 4 crrangcoraloromply wbhaBcily.rd cowtymdiiv roof ts wte l.w.rcletingw PERMIT ISSUANCE MECHANICAL FEIi
fA bumla-nbauicmodunudM1emby ctismr rtprtacm.JvnofNiacity wentcupon the CONSTRUCTION TAX
C.J z. .hove We) J;tae prpMy fm mairy rum kee,a haw ALTI-]i OR ADD TO MECIi.
^ (We)Igrcc to sere, and!ex ar sits kap hum len Ne City of Commit dd City
Iivbililiu,JuAemenls,cwU ud npaasa which mryln may way euacegeitatl veld City AIR HANDLING UNIT(TO IU,(Cp CIM)
in crnacylreoce M the grmtittg Brit pvmiL
-Q AIR FUNDLING UNIT(OVER 10,000 CFM)
Sigaluren AppOcw alWela Dote/ EXHAUST HOOD(W(DUC)
PAID
HNZARDOUS MATERIALS DISCLOSURE HEATING UNTT(TO IW,g)U BTU) Due Receipt
Will Ilia tiMlicamt or future bailding«cvpwl smre«beadle h-,..dou,materiel HEATING UNIT(OVER IW,DUDBN) TO
u dcfmnl by thanCupeuim Municipal Coda,Clue it 9.12,.rd Jac Hnith ud Safcry
Code,Saddiiarr
0Tn ❑No V ENT]LAT]ON FAN(SINGLfe RESID)
ISSUANCE DATE
NiOtoe eppliaimtafunue Wilding ucvpant u,eequipmumdevica which emir BOIIFR-COMP(JIIPOR 100,000 BTU) .
hvvdoua sir cotmnitwmt,ns defrtM by the Bay Ara Air Quality Muugrmat
DisWa) 000BOILER.COMP(OVER I01, BTU) APR 29 1993
❑Yn ❑No NFW RESIDENTIAL MECfI. SQ.FT.
1 base read the hvsrdws mancoult rafaiancn¢under ChWd 15.95 of the GI I T Ur Gurerf 1 IIVU
Califanialle &Safdy Cade.Smtioa25505,25533"25534. 1tnrdcnurd Nat
if the bwaing doe nor atremly love•Ia Vtl,Bbl it i,mY wepasdbilhy to mUfy Jac
ac
Occuupa,can of IW«quirtmcnts which muss W rrd Ino to issuuee o(a Cmifs'aBe of � /�/'��
ncy.
Owrmo-err ouNmiaW.grnt Ds¢ ]DIAL: ISSUED BY:
CITY OF CUPERTINO
INSPECTION DIVISION
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