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25385 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY PfAMIT ND. CITY OF CUPERTINO APPLICATION/PERMIT PLUILDIAli'MFCIRICAI BUILDING DIVISION BUILDING PROJECT IDFNTIFICATION 25385 BUILDINGADDRESS: / SANITARYNO. APPLICATION SUBMITTAL DATE UNIT N LOT I O N E: PI E: CONTRA ME LIC NO: rrO- NSC CO O1. - 41RCHfTF,CT/FITGINEFfR: O1 O A 145-01-FSe / ❑ irtw/•CJ// Q I C r. ACT: FHONF,: \T QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO BLDG ELECT .UMB MECH / PERMIT ISSUANCE El LICENSED COMIIRACTOR'S DECLARATION ppI'WANCES-RESIDIMIAL TOB OfSCRI ON yZ 17000)aDiision am of ft Butim erproWannsMCheoje.a mrm ose wiN , 00 Section]I%p)o(DiviumJofesnnBusineu and Pmfcvione Codc.ud my lkens is in ppHEIS full fomewLk.Y ' �a Date clue, Cmtowmr zm "AMPS �NZ ARCHITECTS DECLARATION OVER IMAMPS SQ.FT.FLOOR AREA S/ Q.FT. O Z—� I m,1,,,und my n e es Pla "I beJ nbi pus mc«m. SIGNS ELECTRICAL hiansN ITof imul M,W< OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMIS XOatJ 1 hwby�ff.thml l am exempt Gam the Cannectole License Lew far the w3 LLO ti< fdbving rtamw.(Salm]0313,Blvmsa arm Pofeuioro Cade:Any city or mum, TEMP.METER OR POLE INST. t b J which require,a penml to consmuct,alfa,improve,demdish,w repair my so mlmC /y © 11�' prior in isvwnce,also iei,mrm the applicant(«such pttMt to file a sipcd Wrmirnl POW�DE�� dd/I�\`S �V oS�W a �p Uw he i,licrnscA pulvunl to the pmvui«u of Lha Conuecloh Licrns law(CTepler ndo� Y(cmmsncle�wiN Seuim]OIX1)af DiWsionJof Ne Buntaa and Pmfmiau Code) SWIMMING POOL.ELECTRIC All =m «Jet he L eaemM dlvefl«n end the basis(«the alleged caanplian.Any embeom of OUTLETS.SWITCFiM-Fl%TURES tZ2 Seeliw](IJI5 by my applicant forepemYt aubjece Js eppliom too civil penalty of rZ nn more dun fivehundaM dMlars NEWRMIDENTALFLE= _SQ.FT. ct: ❑ I.uowmrof thepopmy,«myamggmwith wagn ulheiraolcwmpere¢tion, TYPE 'STRUCf10N a3� will dothewart,Cock: he Co otctotimcitlNm Law iib swtapply to an,Buvllus oM IRofessi«u CWc:The Commmto/s amt I�w Noes not apply n m ovule of INnpeary woo bride.«impnnes Itemim,and won doe,elan was Idraelrm mmagn w mwnempbyegpmvided tM1et.ach imino„emrntsme rotintmddmofferW f«.®Ie.If, OC .GR UP .UNfTS bhuwcrwill havebvueilJlltg«improverllmlia Boldwithincaasyrvolcomplvian,dsvwrer- TOTAL: sil!c.). ❑ I.aswmraDhepee.704 anesiness lymnveameas iCo,bi)Thewomctonm QTY PLUMBING PERMIT FEE FLOOD LO E APN License the not(Sec.]OW,Business and I4ofe W Culex)The Ctmlre,l License law d«snutappfy to mowmrofpoputy who ltrdmaaimprovu thaml,aatl PERMITIssUANCE S� who conlreen f«.wch projects with acocmnt s)IicensM pwswm to an,Cmmaetofs ALTER-DRAIN&VENT-WA'1'FJ((FA) Liceme Law. FEE SUMMARY ❑ 1 am c.acmq undo Sec. ,B A P C fm thio rtnsw BACK FLOW PROTECT.DEVICE ' SANITARY Y N Owmr Dale RF.CF.IPI'M DRAINS-FLOOR,ROOF,AREA.COED. WORKMAN COMPENSATION DI:CIAHATIONSCHOOL.TAX YN ❑ Ihveby affirm tM1atl lsveeanilmte of c«ucnt to slf-imine.are artifiresM RF.CF.IPI'N Wrrtai C Fl%TfIRFS-PFA TRAP wlpenasB«I hwmmec«aanificd rngthvcaf(Sa.3S00,Lsb C.)wM1ich PARK FEE YN covers all emple,ee"umkr Nis Peon t. GAS-EA.SYSTEM-I INC.C OUTLETS RECEIPT'# Polity 0 BUILDING DIVISION FFC Cmrrany GAS-EA.SYSTFld-0VFR d(11M PLANCUECK FFt ❑1:enifkJ ropy Is hoeby famished. j. Golfed copy ufkd with rls ary vupxtion divumla GREASIJINDUSTRLWA1IMM HCT IOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASF,TRAP SOILS FEE COMPENSATION INSURANCE (Hlissecliml lyd m he canplesd iflhe permit at fico.hmtlrcd dollus(S IW) SEWER-SANITARY-STORMF 2XFT. ENERGY FEE or I—) :l I cMify that in the pedormanta ofthe w«t fee which Jtis permit u la el,I mal WATER HEATER W/VPNTXF C`Dt V mI employ any person in my omrinv so u to baro¢eubjecl to the Wot),. PAID z Cmc emationlawsofCWfomla Out WATER SYSTEM/TREATING 0.s Raeipt0 Appliant z 2 NOTICE.TO APPLICJ T:If,after rooting this Cenile a aEaevlµbm yw should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: � lA haamc euomply the Wench ai Comla+neum provieianall Delsb«Cndc.yw mttu EEy2 forNwiW comply wiN smhpm.viou as ibis pclmitsMD be deened revoked. BUILDING FEE- LQ M CONSTRUCTION LENDING AGENCY SFJSMICFEE z I hmehy,e1BmI that then is a com amion lending egrncy fvr the perfortlwa of U O the wort for which this permit is iuved(See.J(19'/,Ci,C.) TOTAL a� ELECTRIC FEE 4r' Name Icndotheneams QTY. MECHANICAL PERMIT FEE PLUMBING FEE Is V ccniry that 1 M1mpl rent Inas ity"con utl Hms dw the about inramutlm H corrcinI,c eettiw."with y horst,munry«Atwncautl eq ui,esmletinghe PERMIT ISSUANCE MECHAMGLFEE F-' buil'e-me«wns! nlpw,for ymprepesenutive of this city to emerupntha CONSTRUCDON TAX V z ebnveWc)aomd popvty f«inspection ifyw puryteu ALTER OR ADD TO MF.C11. (Wc)assn<to.ave,indvmify Intl keep may in my of Cupma a�Jmt Iiabililiv,judgnwrtu,cosln and d ibi.f which may in any way avast aB+InR said City AIH HANDLING UNIT((010,000 CFM) �^y yem�o(the gaamirlg of Olis pemdl. AIR HANDLING UNIT(OVER 10,000 CFM) Siplimmof ApplianVC.emo4totD/ate EXHAUST HOOD(WIDUCII 1-51 PAID HA]ARDOUS MATERIALS DISCLOSURE HIIATING UNIT(TO I(MLII(III BTIJ) Due Rmipl Will the applicantor man,bmilin arupulu store or M1mNlk hasndos,IrwmJ I�ATNG UNR(OVFR IW,IpO BTU) TO as dehmd by IN,Cupnino Municipal Cole,Chager 9.12,and the HW Ih emit Safety Code,Section 23532(n)T ❑Yu C)No VEMILATION FAN(SINGLE RESID) Will Rhee Iicvllmrutusbuilding«cvpmlus BOILER-COMP(IHPOR IW.ODO BILI) ISSUANCE DATE PP ryulpmmlmdriaswhich mdt I hernrMua air conmminmte as defined by the Be,Ann AU Quaky Muagvmm BOILER-COMP(OVER 10),000 BTU) l 1 ❑Yyea ❑No NGW RISIDFNTIAL MECFL SQ.IT. PAB i 1 have arae tis ernnious Sectiom squirtnema unlet Ctuper Ent of lie if the his Hcelths Safety 1,ave.ti I52550h2353Jo,mi,wa. IunJerslnrld that AUG 19 g � itthe Wsidingewenalervent wihave•st be,Inasitis myrmaecs of toifican 111¢ / «,cupanl of Ile requirtmcnu which man M met prior to taslwtce of a Crnilcue of fkaapmmy. I n n Ower«mthmised agrnt flute TOTAL ISSUP.D BY: V