24935 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOILD -ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. 24935
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BUILDING PROJECT IDENTIFICATION L J
BUILDING ADDRESS: `' SANITARY NO. APPIJCATONSUBMDTALDATE
\\\ Lx, JJs SF UNIT# LOT#
OWNERS NAME: PHONE: CONTRACTOR'S NAME: LIC NO:
p icnzoinr .\ t NIC CONTROL#
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ARCHITECOENGINEER: LIC NO: ADDRESS: ❑
S.
CONTACT: puoNe:
ELECTRIC PERMIT FE BUILDING PERMIT INFO
QTY.
dLD E IiCf PLU
ERMI]'ISSUANCE J
LICENSED CONTRACTOR'S DECLARATION pPP1.lANCES-RESIDENTIAL 1013 DFSCR
p02 Ihcm10tUdby mthat l amlicensed!under Biumesmai 1'rodesions ter9(commando w
IWON
u100 Section 7000)of Divis onJof the Business and ProfcssionsC ymcenu isin pgryliLS
ca: force and effect, m
F -cenu Cloy Li c.# UPT0200AMPS
201-I000 AMPS
r o,_ Datejt;joemedici OVERIMAMP
OZNZ ARCHITECTS DF. TION OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
QQ I undcntand my Inns shall be usul us pa is records. p
<'. 3 SIGNS ELECTRICAL L C ® I N
Qy,�j LiccnsM Profeeamonal G , �0
OWNER-BUILDER DECLARATION SPECITEMP.METER
OR
n.�
�OaF 1 hereby affirm that 1 am exempt from the Cnmructor'e License Lew for the IR
Wn3 fnllnwingremm(Section0031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE IN ST.
ISy;
ADDITIONAL PERMIT FEES
BUILDING PROJECT IDENTIFICATION VALUATION
BUILDING
ADDRESS
OWNERS
NAME FEE SUMMARY
ISSQ_,� DNE
cA.E CToas
N MBUILDING
LE�./ ` 'y ��y
V `�{"- G PLAN CHECK
CONTRACTOR'S FEE
ADDRESS
PRONE SEISMIC FEE
DTV. ELECTRIC PERMIT FEE
—OUTLETS SWITCHES-RECEP ELECTRIC
LIGHTING FIXTURES
PLUMBINGf A�
APPLIANCES-RESIDENTIAL
PANELS MECHANICAL ,
SIGNS
SIGNS TRANS. TOTA
SPECIAL CIRCUIT
EMP.METER OR POLE INS. vERMIT VALIDATION
MOTORS SEE FEE SCH.
O SERVICE CHANGE
Z 2
1- o TOTAL
cc ISSUANCE DATE -
LU > OTV. PLUMBING PERMIT FEE aLoc. ELECT. vac.[[ MECN.
CL 0
Z) Z ALTER-DRAIN&VENT-WATER IEA.)
u O BACKFLOW PROTECT.DEVICE
O w DRAINS-FLOOR,ROOF,AREA,GOND.
} N FIXTURES-PER TRAP
F z GAS.EA.SYSTEM.I INC.4 OUTLETS 4%Ct.J
(� E GAS-EA.SYSTEM-OVER 4(EA.) y
INDUSTRIALWASTE INTER.
LAWN SPRINKLERS-1 INC 5 V.B. Fc'\
LAWN SPRINKLERS-OVER 5(EA.)
WSEWER-SANITARY-STORMHEATER
EA.200IE/ ('n
WATER HEATER W/VENT
WATER SYSTEM tr_ 6,y
WATER TREATING EQUIP.
TOTAL
OTV. MECHANICAL PERMIT FEE
ALTER OR ADD TO MECH.
APPLIANCE
AIR HANDLING UNIT ITO 10(AOCF.M.I
AIR HANDLING UNIT(OVER 10MCF.M.)
EXHAUST HOOD(WITH DUCT)
HEATING UNIT(TO 100,000 B.T.U.)
HEATING UNIT(OVER 100,000 B.T.U.)
VENTILATION FAN(SINGLE)
BOILER-COMP 13 H.P.Dr 100,000 B.T.U.) ,
BOILER COMP IOrr.100.000 137.1 SEE FEE SCM.
TOTAL