26099 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO °ILI I�;i- ' PERMIT NO,
PIANHMECHANICAL BUILDING DIVISION APPLICATION/PERMIT tlU1LDING PROJECT IDUNIFJCATION
26099 609J
BUILDING ADDRESS: �Y a SANITARY NO. A141.ICATI^ON SUBMHTAL DATE
Ki aY UNIT LOTH
OWNER A � YT14NB CO R'S NAME: UC NO: NtC CONIROLN
ARCHI'ItiCI' GINEh LIC NO: A=_ESS ❑
CONTACT: PHONE
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
PFJHATT ISSUANCEr B_ LpO BLECf PLUMB M
LICENSED CONT'RACTOR'S DECLARATION APPLIANCES-RESWEMIAL
OTZ JOB DESCRIPTION
1200 Seclicm'IOW)oflT,,si 2of NeBwlrcoand Profuaiwu Cade.std my limta U in PANELS
Poll face and-Recta 2�0�—►��Q�..�/T1
QZ, Liana Clan Ix.M UP T0300 AI.1P5
yZ� Done Contramm MI, A
FyZ ARCHITECTS DECLARATION OVERT .� SQ.Mr.FLOOR ARG $,SQ.IT.
oOZN� IundrnueN my plan,.,hell hewWuryblicruv,de �—
I=r?I_WJ SIGNS CII.CAL` n
�'7 Ll rinsed Pmfevalonal �J�
'w< OWNER-BUILDER DECGRATION SPECIAL CUR/MIJtiV
µ(0a tU. I hereby.fins.But I em ucmp fran Ne Contranal.Tiame law for the
t+r31r-in following reawn.(Scmim 70315,Ba,tne,and Profeasim.Cade:Any city an ttunty .MBT1��.E INST.
t_� which mquim a perroh m emwuet,da.,itapwve,demolish,or repair my muerse,
PMO� pri¢nad ior..:.i.....Way n,.ire,iheeppliunt Mauchpermi,to fk.,lgne J awenent
ICES
0 that he i,lpurswm the e lrovi.w iof the a
Contractor's ucue law(Chaps — -
ao� 9(cra.rcar,wish Seth-70(o
Division Joftbe Business aul Ptofeviau Code) SWIMMING POOL EJUECIRIC VALUAII
ns_, mNat he is exempt lletefrom atW the basis her tJte aMVd exemption.Any violation of
FZ�' Sectim7031S by any aypltcent for apemtitaubjects une applicant to.civil penalty of OUIItT'S-SWITCHES-PLKNJRFS
< not tome then five hundtM dulHn SSW). NEW RESmFNIIAL PJ.F.CTR 5 FT.
nl' � ❑ T,vowrcrof thepopesty.mmyanploy,awith wagn astMrwkcampauation, Q' TORIES TYP ONSIRUCf10N
L3� wlidothework,endihci iumi,nminindedmoffemdforMe(Sa7] .Bwircv
aid Pm(ea,im.Calc:The Coarse is Licenu Law does not apply to an owrcr of
pmpcftY wMhuildemitnpoves mcrcm,nrW wMdoes swh wo-khlmuJfo-through his
wn cmploym,povidcd ttitattchimpovrnenu amnm lmcMW mMfacd fm mica If, OCC.GROLTP RE. ITS
however,ill baitingmlen 4 proving
arcyearofiampluim,theowrar-
buikler will have the bmdrn M proving that he did rot.wild m improve for pury.0 of
Wet].
❑ I,uvwrcrMthe Pntpmy,am excladvclycano,ciingwith licxn,cd c.ntrnctasm Qom' PLUMBING PERMIT FEE 775TE ppN
.m.Wct the ptoject(Sec 704L Bwircu arta Profeeiuu Cade:)TM Conuaclar's
Mccnulawdacsnmapply to unowncrnfpwprny wlto buildao-impmvea tlnam,arW PERMIT ISSUANCE
who conur4�for.hpmjaro with econuactor(,)licensed! mthe Conuwter's ALTER-DRAIN&VENT-WATEi(G)
Lii,.law. FEE SUMMARY
❑ 1 am exemp under Sec. ,B A P C fm this mown OUTSIDE
BACK FLOW PROTECT.DEVICE SANTTARY YN
Owrcr D`e DRAINS-FG,LOOR,ROOF,AREA,COND. RF,CEIP .
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
�Iheahy alarm thmlhevicettniBrvte nlcananr to alf-irwue,oraanifiraaeof FLXIlJRFS-PER TRAP �� REMn4
W'orkeri Catycm,swan hnunrreem•eenlfed coq dercof(See.31M.Tab C.)which PARK TEE Y N
h ell empinyec's under this prnnit. GAS-G.SYSTEM-I INC 4 0UTLE S RECEIPT g
Policy 0 BUILDING DIVISION MiES
CmnWnY� OAS-EA.SYSTEM-OVER 4(G) NANO IECK FEE
❑ CmifMcoq is herebyfrrnish .
�Cenihmlenpyl,filet]with the city inspection division. GRGSE/INDUSIRL WASTE INTERCEPTOR
GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS GRGSETIOP SOILS I'EH
COMPENSATION INSURANCE
This action rrwd td be cunplwd ifthe permit a fosoe hNtAad duTWa(SIM) SEWER-SANITARY-STORM FA.3WF7. ENERGY FEE
m Ion.)
I terrify Rut in thepMmnurre offt wwk fm which thisptrmf is Raved.I shall WATER HGTT:R W/VLNT/EI.ECTR
not entploy any pans in any mvmcr,o u.bonne aubjxt to the Warkci PAID
Cmnprnotion laws of C.lifo-rda Dam WAR SYSTEM/fREANNG Date MceiptN .
z TEC, NO CE TO APPLICANT:If,after making this Certif to of Exemption,you should NEW REST DENTIAL PLMB. SQ.FT. T 94AL,
F r^ bcc
f ,ubjectyivit Wohd,ucCampcnvtim povkimofthe tabor Coh,Ym man
mhwith comply withh pmvisiaromthi,pmNt shall be deerrN revokM BUILDING FYEAu
1 Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z IhesWyaf(thntthve isecon,mctiwi lvkine aecnry fm De perfo-mercc of
U C) the workfm which thi,permit I,:sated(Sec.109],Civ.C.) IL ELECTRIC FjE
IerWer's Name O PLUMB[
F Imler'a Amtreat QTY. MECHANICAL PER M IT FEE r`
r Cwt] e I ceniry thn i have mad Nis eppTiwtlm anti.are t>bt de abase thrmmatim I,
.nect.Iagree mcmryly with alldryarW munry mdlemsea opt sum laws mluing to PFJtMIT ISSUANCE MEC :E I
F' EuiMing mtuuunion."hereby autlwrim representtives ofthia city tornter upon the CO ONT
U above-mrntiaoN prgeny fmirgationpurport ALTER OR ADD TO MECN.
(We)agree to save,indemnify atW keep barrnles,the City of Cir enirio agaiw
Iia " ,.dg.,n.,cos.3pd expew_,wMrh may in my way aceruea .nest nay—c, AIR HANDLING UNIT(TO If,"CFM)
m ofth M
AIR HANULINO UNIT(OVER 10,000 CFM)
u nn .actor rbai, EXHAUSTHOOD(WJ)UCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HGTING UNIT(f01 0,000 BTU) Date Rtteipt N
Will the ap,licaot or future building. pent owe or handle M1vmdotu materiel
a,defined by the Cuperwto Municipal Code,Chap'-9.12 arrd the Ilealth and Safety HEATING UNIT(OVER 1 LMP RTU) U
Code,5uv 0 ye,2(a)1 ❑N. VFNTIGTIONFAN(SINGLERFSID) _
Will the apphema orfuture buiWingoem ma use equipnentmdcvites which emit BOILER-COMP CHP OR 100.000 BTU) ISISSU[{ANCE DATE
M1vurdtw air cmar
tniwa rc
nk dcfJ Be
by the y Area Air Quality Meragentenr • ^ ' O
Diku,k l BOILER-COMP(OVER 100,000 BM
❑Yes ❑No NEW RESIDENHAL MECIL SQ.FT. LIAR 7 ,1994
1 have tmd rite M1ssudow m-,_:sirs t iremems strider Chapter 6_95 M the .,
California Ileoth A,Safety Code,Sections 255(15,25513 and 25514. I uwlmtnrtd that
i ,,tebuildingaaofla,"rotca.a.m Iha.eatearttaria i-my m-,wn,iof.Cerrocareof CITY Ut IiUYCM�
if the dithe Tea niremrnuwhich ale Iremeipito miatuentt.fa Cenifaue ofy f
aenp ey.
Owrero-autMrcird agent Date 1 L: ISSUED BY: