27049 (2)APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINOJR7TTU=
APPLICATION/PERMIT PLUMBING - MECHANICAL
BUILDING DIVISION BUILDING PROJECT IDP.NTIFICA
LOT
E- P
SANITARY
SCHOOL TAX
PARK FEF.
BL
PIANCHECK FE?
GRADING FEF,
SOILS FEE
ENERGY FEB
FEE SUMMARY
Y -N-
PAID
D. Receipt I
BUILDING FEE
SEISMIC FTE
ELECTRIC FEE
RDMBING FEE
MECHANICAL FTE
CONSTRUCTION TAX
PAID
Date
DATE
1 q
OCT 18 +n^-
-Ou
B V U
27049
QTY. ELECTRIC PERMTT FEE
APPLICATION SUBMITTAL DATE
IWM{/ b
PERMIT ISSUANCE
Mhz
00
aF."f
r� «
F -''z
OC)r?—
LICENSED CONTRACTOR'S DECLIRATION
Ihertby grime BW lmrlicen.NUMnpwvisi«u of Ouger9(cmmcrtctng with
Section T000)af Mthc Businst f Cods,, and myh.ioln
rb (tore,
urns us,. x
Ewe Contrera«
ARCIIITECFSD
IunxmWd my plms stall he ti M as publicraurch.
APPLIANCES - RESIDENTIAL
PANFyS
IJP TO 300 AMPS
301 - 1000 AMPS
OVER 1000 AMPS
SIGNS ELECTRICAL
�wf
Ca
M. �<
Licensed Prnfa.slunel
OWNER-BUILD.,IccctN I DECLARATION
I hereby ufl inn I sun I. the Convenor's Licracse Lew f« Re
SPECIAL CTRCUITR.115C.
TEMP.METER OR POLE INST.
tNLLCh'a
h
oco
followingot uimsa(cmii�to]0315.Hunit�eed Rofesviaru Cade:Any city mcounty
.H�s
which rrymrts a Remit to cantmra, elttt, improve, deouliah, or rrytir my svuraurt
iuissuot swemem
rtyuimy the.vision ntftheuchlrrtrvOo fko"'1-a.
1'OlVE1t DEVICES _ ��
apo
a.a �
'4_',�
FZQ
zE0
d3$
the«ta purr
the -a
9(m cslicemalpnvonnoec) of Division thitB «'s W Pew baw(Ch.pter
9(nornrnnrcing with Sectim 7000) of Division Jofde BuvnesseM Rofnsiotu Code)
mdwt bees nemPrthertfmnvrW tM1e bwls f«de dkgcd <xemlgion. Any vid.don of
SectivnT0ll.3 ray any oppllcmtfar� permit.ubjav ass, y+plicmttm.civil paWty of
rot mac OW. five ti r "in,, Ps5fli
❑ I.mowmrMeepro M.mmyetnpbymwithwagn"st kcompen m.
wmxcewmk, enact wce orneseire's d«awcloo mows on moari�
w Pmrn,im., code: Ile cantr.mra'. u�ne Law don not Eppy m m aw,e of
SWIMMING POOL ELECTRIC
OUTLETS -SWTICHFS-FIXTURES _ L.
- -
NEW RESIDENTIAL ELECfR SQ. FT.
pwpvty was to i w. m i mRavn tl�nean, am wdo eon ueh sum himuH«tlaaugn n
ownmrpbyen.pwvitl iWts�cn;mprovarcnusmrotide+rdNmaffacd f«sele. If.
TOTAL:
howevn, tk W ilting or impwvcmcm u wM within orc yevofcompledm, theowoer-
W iWn will have tk dnaen of Roving Nu M ale rot build or impeove fa parpow of
QTY PLUMBING PERMIT FEE
❑ I,uowmofJe pwpcny. unucludvclycmvra;,tgwimliwcud contrectwem
coor t Ne Project (Sec. 7(3,44, Bauneu W Peo(e . Code:) The Canuenara
Reece law donna apply w or ownosofpropeny whobuiM.mimpavacvean, and
PERMIT ISSUANCE
whotmu.ms hrsuch projeeuwithaconvact.,o) bcens po..,a, wthe Ccsob ,
L icenc law.
ALTER - DRAIN & VENT - WATER (EA)
❑ I un carmM utder Sec. , B & P C fm toes r
BACK FLOW PROTECT. DEVICE
Owner Dobe
DRAINS- MOOR. ROOF, AREA, COND.
WORKMAN COMPENSATION DECLARATION
❑ lnertbyellirmtn lheveecenifuteofca itoself-insu ,or.ec "teof
Workcn'Gsm,rl`�� mwC���cdfcd entry Nnmf(Sm. 3800. Lab C.)which
FIXTURES - PER IRAP
GAS - EA. SYSIHM-I INC. 4OUILEIS
ct-irscy rill nnPl ,111 L/'D
PolC41nFa"
.
GAS- EA. SYSI'HM-OVER 4 (FA) .
❑ Hired copy is hereby famlale,L
GREA.SFJINDUSTRL WASTE INTERCEPTOR
CcrtilW a,py is filed with the city itispxtian division.
CERTIFICATIIOFEXFMPIION FROM WORKERS
GREASETRAP
COMPENSATION INSURANCE
SEWER- SANITARY � STORM EA. 200Ff.
(LTi. section red not bccomplarcl if his pernot is f«one huMreci eoloos($Uxb
orkav)
WAWA HEATER WNBM'/ELECfR
I cmtify dW in the Rrfmmuxe of this wok fm which cu Permit is rinsed. I JWI
nor empley my psest In any cr Y w bonne subject on Be Woc
w
WATER SYSTEMtTREATING
z
C 0
C«npem.tim law. orc.l;fomi.. Date
NN(MCETO APPLICANT: If, making thHCutiBrue of Fieetprlm, you slmuW
NEW RESIDENTIAL PLMB. SQ, FT.
F ^
bsc c wb,,co to the worker. ConVicr..eon novidmu ofce later code. ym man
forthwith cornply whirr web p.ovi.lonu or this perdu aa"n b<trvrd revokeG
G
CONSTRUCTION LENDING AGENCY
Z
U O
OF
W1
i'
F ,n
I hneby.fthat Jere lsac«uvunioo k but ii covey for de psef..f
the work for which this permit i. ism" (Ser. J091, Civ. C)
�Mcr's N.
TOTAL:
Iuulut Aednca
QTY. MECHANICAL PERMIT FEE
eternity that I law rend this applluslon ud state Nq the above infom.uan is
cmrera.l.grae to mmply with all ciryvd c«mty ordinmva Wswelawsmletingw
bdding r«wi end hcrtty.athoriureprnen.eBvn of this city to enternpar the
PERMIT ISSUANCE
ALTER OR ADD TO MECIL
U Z
ebovc mTc st for lmpecrion purpose..
M
(We) o to ave, imkmnlfy uM trop Iurmles. theCity of Cupcnuu eg.mn
liebilitiu,j ru uderpenmwbicbme inmyw.y ara.T„e gunn 'd Ciry
AIR II ANGLING UNIT GO I0." CFM)
n c«ucq It.
NR HANDLING UNH' (OVER 10.(M CEM)
Signature of AppliunUCunincern m
EXHAUST HOOD(WA)UCT)
HEATI NO UNIT (TO I(90.0ft HTU)
I IAYA RDOUS M AllR I AIS DISCLOSURE
Will he epplicnm«forces, building rampant pore of hanik Farmdwu meriid
civ xfimd by'hs, Cunni era Municipal CWc, Cruptn e 9.13, and t Hwth od Safmy
HEATING UNIT(OVI:R I(p,(kp HTU)
Code, Snti 25513(a)'f
0ye, ID No
VENTILATION FAN (SINGLE, RFSID)
BOILER- COMP(JHPOR IM." BTU)
Will Us, epplicvitv(wws, huildineoccupantuwequipmnt«xvlcnwhichemit
BOILER- COMP (OVER 100.000 BTU)
harnrdou. air conuminmu n dcfired by the Bey Aru Ah Qaehy Meugertent
O v U
El yrs ❑ No
NEW RFSIIX1Tf1AL MF,CTI. SQ. FT.
I have reed the M1aranlous ntic s rcc uimnmu udcr Cheptn h95 of rhe
nrmth & zs assn and 1 raw
cane
of csenit
ifIIe bYil iby to od
W ilt dWitif xisud
denmr..wnaveaI[ th bel r eridly Iof
of be 1.rnpatL
occupmr of Chs, rcgdrtnrnu which man be rtW prior to i+wenrce of a Ccrufrrete of
,
Occvparry.
Owren m ewharired.gnt Due
TOTAL
E- P
SANITARY
SCHOOL TAX
PARK FEF.
BL
PIANCHECK FE?
GRADING FEF,
SOILS FEE
ENERGY FEB
FEE SUMMARY
Y -N-
PAID
D. Receipt I
BUILDING FEE
SEISMIC FTE
ELECTRIC FEE
RDMBING FEE
MECHANICAL FTE
CONSTRUCTION TAX
PAID
Date
DATE
1 q
OCT 18 +n^-
-Ou
B V U
27049
4NITARY NO,
APPLICATION SUBMITTAL DATE
1alIPA
�k
N,C
CONTRO1-0
BUILDING PERMIT INFO
LDG
ELECT PLUMB ECIA
El
E] E:]I.rJ
E- P
SANITARY
SCHOOL TAX
PARK FEF.
BL
PIANCHECK FE?
GRADING FEF,
SOILS FEE
ENERGY FEB
FEE SUMMARY
Y -N-
PAID
D. Receipt I
BUILDING FEE
SEISMIC FTE
ELECTRIC FEE
RDMBING FEE
MECHANICAL FTE
CONSTRUCTION TAX
PAID
Date
DATE
1 q
OCT 18 +n^-
-Ou
B V U