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27187 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BnILaTN'- ' RICAL PFRMn' o. APPLICATION/PERMIT PLUMBING'MF,CII ANICAL 27187 BUILDING DIVISION BUILDING PROJECT IDENTIFICATION BUILDING ADDRISS', '1 SANITARYNO. APPLCADON SUBMTITAI,DATE, LOTH BSC /� OWN FlIONF_ ONTRA NAME a� I C1 �f 14 L %N N/C NIROL CHITECI'/ENGINEFR: LIC NO: DRESS ❑ CY)NTAM: PHONE: QTY. ELECTRIC PERMIT PEE BUILDING PERMIT INFO BLDG ELECT PLUMB PERMIT ISSUANCE ❑ ❑ LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL PCZ Ihcreby aft that l w lianscd utdcpoviilornofCSapn 9(comoarimg with IOtl DESCRIPTION { 9 Soction 10(x11 of Dvi.ion 3 uftha Busi .and Prnfnsivn.CCo Ja.W my 1.i,In PANPds !ca-..ltl l-. roll f� mxt uc.x �O S-a UP TO I(IO AMPS I• , to 6U6U Data"C_ — Cmtmi MI-IOOOAMPS �`��--//���i.! ZOsnK ARCIITTECIS DECLARATION OVER IOOOAMPS SQ.FT.FLOOR AREA O%—❑ 1 u'/may 'elEll b�teM y�b x�°A'. S/SQ.Ff. SIGNS&F,L'IRICAL Lit n Po.f.ioml OWNFR-BUILDER DECLARATION SPECIAL CBtCUTffMLSC. aX0yU 1 heaby affirm thatomo I w uWt totM Cl ontrerLimine law f«Ce rY�+m mFi "lowing meow".(Section 70313,Bo oaoas aed Poolmiou Coda:Any city a eamty TEMP.METER OR POE INST. Ono< which te9u'o"a pcmJt to rnnsmom,alter,improve,mroolish,or oepvr wy m vure � Y� pimmlu iaruue<,alw r�woo the epplicw fa etchpmeitmUk augad amount POWER DEVICES "<0 thin Ie b liamed ptmumt to the poviaom Mole Cmvv:Om'a Licrnu law ICM1.ptc LX�K 9(c mmtcoaing with section]00(l)of Division 3 ofthe Bond.and Poofmiom Coda) SWIMMING POOL CfRIC ., 'o I'� I VALUATION IL�y or that he is cacmpl thcmfoom mJ tk Buis f«the dlepad eaemlaion.Any violation of - - S t7¢ Scnion 7031.5 by my n,lium fm.pmrtituage s the,ppfcwt on.civil pnuhy of OITfLE1S-SWITCHES-FUCDIRES nt«c thin five hwdM dollen -rol (a500). Gt ❑ I,ovowncrofthe pm,tny,ormyemployecs wills nag",utMirwkcmnprnmtion. NE RESID AL EL" STORIES TYM CONSTRUCTION will&da,woA,md thtamoctuta ie not intendei mroffatM mrsale(See.7OJ4.Busimos - .M Pwfeuipe Code:Tha Coao.nmr a 13c.law dao no apply b m own of ,manna ht build or improv"tharmn,aM wlwdoe such work M1imselfwtkwghilia employe",pmviJtd tlwlsuchimProvrntenuwaalnrentkJaoBeodf«ole If, OCC GROUP RES,UNIT, M1owevc,the bulldlnym boproremem u sdd within me yeuofrntnple4on,the owar- btil,ly will have the buodm of poring thin he did rwr hdM m inryowe fm puryoa of TOTAL k.). ❑ I.n.owarofthe lael>Rtr,weaatnlvalyemttraatmx withlice dcattt,etmam QTY. PLUMBINGPERMIT FEE ti DzoNE APN corupun ya,pmjm(Si 1(y4,Bwinev"Prof..Coda:)The Coo,o of Littnsclawdmrwt.pplytomao ofpropcnywhobuildsa'unpov"tMeon,md PERMIT ISSUANCE wlxtco umcfs fo such pnt,*t,with.coln.to(s)licensed pu amml to the Con.or'. I-icense law. ALTER-DRAW k VENT-WATER EA) FEE SUMMARY ❑ I am"crop tutda Sec. B&P C fa Bth re..m BACK FLOW PROTECT.DEVICE OUTSIDE F SANITARY Y N Owter Union, DRAINS-FLOOR,ROOF,AREA,GOND. RECEIPT♦ WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N ❑ IM1neby Jfirm thulhave•cctif to Mcunsent to rdfiwue.ae anifioteM REClilff Wtxkerw Cmnpauuiw louurenmme«ni0cd copy thneof(,Ss.3800,Fab CJwM1ich FlX'IUH['S-PFR TRAP PARK 191E Y N covm all wporoa'. �pcs,ot` G / INC. RECEIPTI %ll �r// J GAS-EA.SYSTPld-I N40lIf1Pf5 Policy. BUILDING DIVISION FFV< Cwnpmy OAS-PA.SYSTEM-OVER 4(EA) PLANCHECK FTE ❑ Ccni(dcopyishaocbyfumisMd. ❑ Crnifwl copy is Mad with the city ioupccdm dirisioo. GREASRgNDUSI'RL WASTE INTERCEPTOR GRADING FEE CTRTIFICATE OF UFMPIION FROM WORKERS GRF.ASETRAP SOILS FFE COMPENSATION INSURANCE (Thiaaatiom oxcdwtbammphla I lfthe pumit b(orae hwdml dollu.(S IW) SEWER-SANITARY-STORM EA.300FT. ENERGY FEE mlm) I cenify thin to pafarmuceafthc woek fm which thb permit is fnoed,I00 WATER HEATER W/VEW/F1-ECTR not employ my peracat N my numao ao u to btt rc subject to that,Wakm' PAID Z Cwnpewticnlawsof C.IRoml.. Due WATER SYSTEM(Ul EATING Date Reaipx Appliom O C) NOTICE TO APPLIGNT:fir,ally making this CaNfte of Exemption,you ahoultl NEW RES]DENTIAL RMB, SQ.M TOTAL: F (A bacomawhiact to tha Wmka'a Compensaim provlilan of the labor Code,you two a faNwiN comply with ouch prori.ticu or this pemdt Nall ba loved rtvokM BUILDING FFE 1 [� CONSTRUCTION LENDING AGENCY SEISMICFEE Z Ibemby e(f thin thea h.comnuctian lvtdity.gency for di'.f.of TOTAL ELECTRIC EEE U C) the wok fa which this pefam ie iswad(Scc.3091,Civ.C.) u. 5 I,cntkr'c Nome O IattJeh AJdrna QTY. MECHANICAL PERMIT FEE PLUMBING FEE I ratify then,I lura rod Ws"bution and Yue rh.,thaa above Infarmapoo is �" a evxrecL Iagta to comply with all city and emmty a-tfi.and nate lova rela4ng to PERMIT ISSUANCI: it MECHANICAL ITU? HN builthiM conurvcdon, mJ hmby nuthove repeaomives ofthis city to enter upon the CONSTRUCTION TAX U z .bora-marmoad poppy f«hm lmioo m,oaca. ALTER OR ADD TO MECH. (Wa)ago¢10 save,indennlfy aad kmP bumlaa the City of Copcnimo against limbi litin;j.d,m,ma,as artd ula+.sm'which may in my way a«rtaegvut said City AIR HANDLING UNIT TO 10,0000 CFM) cnmscyuenea o'ma ting oflhiapamJI. n AIR HANDLING UNIT(OVER 10f0(i CFM) /o-Zo 99 Signnumof Appim uCaumcto Dore ExHAUSTIIOOD(w/DUC ) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT TO 100,000 BTU) Date 1 c--pl N Will the epplicw or Intoe huilding«cupwt tore a hu0dk haaarG o,nutmel u deHEATING UNIT(OVER 1 W,LOO BTU) f nM by the Cupanino MwicipW Code,Chaps 9.13,ertl the Hulth end S.fay Coda.Notion 355311ap VENTILATION FAN(SINGIE RESID) ❑Yo ❑No WJlthc elglicw«Toru,ebullJingreenpantuseryuipnrnlmdevlaawhich unit BOILER-COW(7HPOR 100.000 BTU) ISSUANCE DATE huvdous.b cantwilmu u defml by the Bay Aro Aft Quality lvltmi nett BOILER.COMP(OVER 100,000 BTU) " G24 ❑Yes ❑No NEW RESIDENTIAL MECIL SQ.FT. I hura rod the h.audoua ntatciab oequiovnenta order Chaps 6.95 of the OCT O 1994 Cithfmmim I Ieulth&Safety",Scctbm 255(15,35533 W 255W, 1 undantwd that if rile building Jou not curramly have"cunt,that it u my ms a ibility to notify 0e ..Wt of the main nano which.be trot prim to ilio.a.Cmifiote or Occo,al "11'vUr UU_c;�u, t owoa:rm euthonwlayent Due TAL ISSUED BY: OFFICE