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25472 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO B ILULNG- LL RI AL PERMIT NO. PLUMBING BUILDING DIVISION APPLICATIONIPERMIT BUILDING PRADJKCT IDENOFICkT1ON 25472 BUILDING ADDRESS: I SANITARY NO. APPLICATION SUBMIITAL DATE G/ I/''etJ V UNIT» LOT» ' SNAME: —1y 'Y L M{ONE.: CONTH ISSCG /N}:&0. T '/ NIC COMAOLN • RCH1IEC'OHNGINFER: LIC NO: ADU ,s El CONTACT 11: PBONE:ui✓ QTY. ELECTRIC PERMIT FEF: BUILDING PERMIT INFO S77—S OOw I PPRMIT ISSUANCE ' BLPLUMB 1 LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENDAL pyrz Ibecebyaffimdonmlkevd dl aurhpmvisi.of Cb.,mo9(Ionmrnring with JOB DESCRIPTION �N =o FpSection F f If moil and eRU vlsiun3uf de Bminns al Rofn.ions Code,ad mYlRrn,uin PANELS <1Z Lian.a Cle Lie � l3 UPTO2MAMI'S �i - t, a Conu;mc 201-IOW AMPS /Im ARCUITECTSDE ARATION O IOoOA SQ.FT. REA $/SQ.FT pZ_,) Imdaslarl my PIw.IWl be usd®pubic recwda. �yFJ S E ICA C '1_1 PPLRcruM Profess eand aa'MM=< OWNER-BUILDER DECLARATION S ,CIRCU 1 pXxoiF 1 hereby affirm that 1 an exempt fear the Contract(.lictttse I�w fa the 70 % � W3�y fdlowiny meso, Section 7031.5,Baer.-al Prof.ions Code:Any city acounry P.M IN Cv-O<, which mquim a pmmit w rnmtrvct,alcor,impmvc,dewlit,a mlmir anY smwtwe J� priamiu iswmwe.vim rtquim lM1c yglimm rm sucM1 pemulio filevugrcd'ad i POWIM DEV �a p that M u licem�pursuant to the co, donsof the Contract Liems,Lew(Chaµer �X��0 9(commercing with Sectim7o00)or Divition 3 M the Bu.ir,aa and Profmaimis CMSWIMMING LELECTRIC c) 1 VALUATION twt,t he kr enemq tereltmn ul d,M.isfa the allegd enemMion.Any vidai,n of 2 I.Z,a Sectimn'l031.5 by any aWlinru for eeubj a peen sects tMm crW .ppBcsto civil pty of OUTLETS-SWITCHES-FUTURES not mom Than fvc hu dm l"Imm($ND). egF� ❑ Lmowtmr,(tepropnty,amyempla itw .0,6-50 ampemaian. NEW RESIDENTIAL ELECIR SQ.FT. STORIES TYPE CONSTRCiCTION 1'3— willd.1he-A.iMBenimn"'it n.i.endmotofr dm,.1e Sec.7 .B.ite. and Pere,,'.Cook:Thc Comfacwls Lb c mm clam not apply w an mer of pngctywhnhuildnaimpmvcxtcmm,ad who ws otch,orkbimsefocth -his own,mployegpmved dta anch wpovunen aerwtduendedoroRetedfam If. C R s P RES.UNITS howwcr,debuildingmimlnovememinwld thin a,yeerofcanplelia,teo Wily will have tc drnlco of proving that didtd bdldaimPmve fa purymeo mle.). ❑ LmowrcrMte pmpcny.ane ivelyccd w,wit nmd mnu.ctaam PLUMBING PERMIT FEE D�oN APN ,semen the pojen(Sec.7060,B aca.W Ptofesums C 1111,Contract , !/ I.ic-1-awduesman' lyman ofprnpurywlMWil v der grid RMIT ISSUANCEt IL wlmc,h.fusuchpnjec dbsmwcmr(s)lie nmhe Cas acmla ALIY:R-URAINA VP.Yf-WAI1iR(IRA) SUMMARY IJccno,Low. ❑ 1 am exempt udc P C f BACK R,OW PROTECT.DEICE SANITARY Y N Dats DRAINS-ITOOR,ROOF,AREA,COND. RLCCIPTN WORKMAN 'OM A ECIARATI ��� SCIIOOLTAX YN ❑ IFembyaffvmtalltsvea 'R tm.N aamuf of PUCIIJRPS P[R TRAP RF,CT:IPTN Wurkers'CmnPemmim lmuru,e pyter ( 39W.UbCJ hi,h PARK FEE T N / cavrn ell employee's leder W.pmna GAS-PIs.SYSTEM-I INCAOUTLETS RECF,IPTN Pulicy0 BUILDING DIVISION fFFC Co Y GAS-EA.SYSTEM-OVER 4(EA) PLANCHIiCK FEE rad copy i.hemby fuml.hed. Ir Ccnifid copy i.fled with dm city an dlvtdon GREASFJINDUSTRL WASTE INTERCEPTOR GRADING FEE �» CERTIIICATEOFEXEMP-1 MOM WZ ORENSETRAP SOILS FEE COMPENSATION IN RANCE ('LTi.xn'wnnaJ ax be,uniplmdl(the i.foran $Hp) SEWER-SANrTARY-STORMEA.20DIT. PNFRGY IEEa less.) Icrnify taint,perfommnaofihc wakfawid,l.w" WATER HEATER WNENOELF,CTR on crtmplay any Wcrkm' PAID Z Cmmrpmsou w Cdif via Dote WATER SYSTEMOItEATNG Dare Remy,» Appli w Q NfYI'ICT?I CANE:IL etwki n8his Cent fiche M Exemption,yuo duwld NEW RESIDENTIAL.PIM B. SQ.IT. TOTAL: V1 become.ubjen w the Wockc'c Cmopauadm pr.vWcm of the lab,e Coda"am m,,. fatwit comMy wit loch provisions a this pemut.hnll bc dccned rtvokd. BUILDING FEE 4 CONSTRUCTION LENDING AGENCY SEISMTCIE,E D U .2 1 hereby effrm 11 tem u.artsauNan kndinp egecy for the pafomm�a of O the wmk for which ti.R.mit is issued(Sm.3(97,Civ.C.) / FJ,ECIi11C FEE Lender'.'Nem, L ,Addms QTY. MECHANICAL PERMIT FEE PLUMBING FEE 1,miry dud 1 have rend this appli,vaai and awe that Use above infamepoa is corrin. I w It all cit ad,amt atmomices and one laws rel MECHANICAL FRE agree emplyw y y • fit PFRh1IT ISSUANCE UZ abovboliin nfihonat no,em fie,by maeato, srcose,i, auvm of tit aitymentcr tsps the L) 2 above.znoor,d prq,nyfmimpccum pce,ban. ,U.TERORADD TOMECII. CONSTRUCTION TAX .- (We)egmm m eve,indemnify and trop hamlets the City of Cuperdro againn Ilabilidm prmeu,ewvdexpemm which rosy In any way acture sal City AM HANDLING IINff CTO 10,000 CFM) inc an putting of ti AIR HANDLING UNIT(OVER 10,000 CFM) arc of ApplicenUCmmtncmIf G c MIAUSf HOOD(W/DUCI) PAID HAZARDOUS MATERIALS DISCLOSURIi HEATING UNI'T(TO 100,)00 BTU) Die RuoipN Will the applicentor intoM uebu0dingar Cm no9e2.balk b.mdautmreril HEATING UNIT(OVER 100,000 BTU) 'TOTAL: es defined!eSec by to 32,.)?m Municipal Calc,Cnepmr 9.12,ul the Health ed safety Code,Section 25332(a)T C3 Yes ❑No VENTILATION FAN(SINGLE RF.S1D) 00TH thea coaamaams.belocal by ft awequ Ant Quality mwhich emn BOILER-COMP(3HPOR I00,O)OBTU) IS C ARE 4 bvsrddu av rnuanuwnts m dcfmd by to BeY Ata An Qmliry Manegvsnt DisRin2 BOB"-COMP(OVER 100,000 BN) AUG 23 1993 ❑Ya ❑No NEW RESIDENTIAL MMI.—SQ.FT. , 1 have read to Mvnlws material,rtyuimnrnts undo Chains,6.95 of the CITY Ut 1/UIstn i nu Celifania 11mdh&Safety Code,S e ate 2 t,5.25.533 ad 25530. 1 undnan if to Irtchuilditeon,motcurrentlyloveamtlb ,edW IIis myrnpmniofa codify the cuipm of the rrylmmets shah mats be nte5 prig w Rause,of•Ccnifcue U oaayan,y. Owneraamlwrircdnget Data ISSUEDBY: ✓V l 1