27002 (2) APPLICANT.TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOhunmissis. LmIRICAL PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 27002
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
B UILDING ADDRESS: SANITARY NO. APPLICATION SUBM(rFALDA'IE
LOT»
OWN py MF,iJ l� �C /PB:ONE: ` CONTRACTOR'S NAME: LICNO:
/ (/1df•,Q'/(� /� W fyI—SPV V NIC CONTROL» Is
CIIITE ?NGINCER: LI O: pU S: ❑
ONTACI': PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
-/ flLDU PLUhJB h1ECF1
nq/✓ G ��Z�l/ a PERMIT ISSUANCE
LICENSED CONTRA OR'Sionsof RATION APPLIANCES-RNSIDFMIAL JOB DESCRIPTION
py.Z IhembyaffDiihaO.littmrdimeas and
Code.and(commencing se with
�sd Section7000)
and affect. 3 o the Rosiness and Professions Cody and my license is in PANELS
y W full force and eff«t.
F ZV, Littnx Class Lic.p UP T02f10 AMPS
rn7 y Date Coutmcmr 201-IOIIB AMPS
Z O,z ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
CZ-0 I understand my plans shall be used a public records.
py(=kq SIONSELEC(RICAL
<y :J Licensed Professional
�ya'6 OWNER-BUILDER DECLARATION SPECIAL CIRCUTOMISC.
exLicense
s yV 1�
OyU I hereby affirm that I oro exempt from the Contractorns
's Licee Law for the
W 3 W y following center.(Section 0031.5,Business and Professions Cade:Any city or county TEMP.METER OR POLE INST.
.� which requires a perming convect,ulcer,improve,demolish,or repair any swnure
K�Q� prior its issuance,alsurequires the applicant for such Permit file a signed statement POWER DEVICES
ry K W Oo ohm rs
he is licensed puusnuo the Provisions of the Commuctola Licerue Law(Chapter
4 a 9(commencing with Section7")of Division 3 of the Business and Professions Cade) SWIMMINGPOOLF.LECTRIC VALUATION
yxf aor that he is exempnherefmm andthe basis for thealleged exemption.Any viola....of OUTLETS-SWITCHES-I1=RE ��� Q `�` —•
i Section 0031.5 by any applicant for a permit subjects the applicant to o civil penalty of J 4
nrm. than five hundred dollars(ESfq). NEWRESIDENTIALELECI'R S .FT.
❑ re I,»socone.nfineproparty,..myemployeeswithwegesasthc'vwlecompema.w. —SQ.FT. TYPECONSTRUCTION
q3� will do the work,and the structure is not intended proffered forade(See.0044,Business
and Professions Code:The Convectors License Law doea not apply in an owner of
property who buildup improves thereon,end who.«e such work himself gr mrough his
wo employees.provided that such improverrentsom not imendedoroffeml forsale.If. OCC GROUP RHS.UNITS
however.the building or improvement is sold within one yearofc.mple.oa.the owner- T
builder will have the burden of proving that he did not build or improve f«purpose of
4nl
asownergf the pmpeny,emexdusivelycanwcting with li«mWconwdmsto QTY. PLUMBING PERMIT FEE FLOOD ZONE "Nnewer the project(See.1044,Business and Professions Code:)The Convector's PERMIT ISSUANCE:
L cense Law does. .
apply to anwnercefpropeny who builds or impmvesthercan,and
won contracts forsuch projeeu with a conwcmrts)licensed pursuanuome Contractors pLTL'R-DRAIN&VENT-WATER EA
License Law. ITA) FEESUMMARY
❑ I em exempt under Sec. ,B&P C for this reason BACK ROW PROTECT.DEVICE OMID-1-MIN
SANITARY V N
Owner Data RECEIPT»
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF.AREA,COND. SCHOOL TA% YN
❑ Iherebyaffrm thetllwvnce or i rectieronummselLinsuce,m att C.)whi of RECEIPI'p
Workers C.mpeesation huumnce grucertifal copy lherrof(Sec.38IX),Lob CJ which FI%TURES-PER TRAP PARK PIiE Y N
coven all employee'.under this permit GAS-EA.SYSTEM.I INC.4 OUTLETS RECEI
Policy» B II ) s DIV ON FEES
Cany
Car GAS-EA.SYSTEM-OVER4 PA) PLANCl1ECK O Y O
Cl copy is hereby(umished. �
❑ CmifieJ copy is fled with the city insp,mian division. GRESSE/INUUSTRI,WASTE IN'I ERCBPTOR GRA
CERTIFICATES OF EXEMPTION FROM WORKERS' GRP.ASETRAP SOILS iE t
COMPENSATION INSURANCE
(Thlsumionnminmbec.mpletWifthepewit iafsrone hookedd.11.($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or Jess.)
I cenifythet itnhe performance of me work for which this pewit is issued,l shall WATER HEATER WNENT/ELECTR
not employ any person in any mummer a.u t.became mbjeet to the Wurkeri PAID
Z Compensation Lawsof Califomia. Date WATERSYSTEMITRFATING Dma Nec ' t»
Applicant
z� 2 NOTICE TO APPLICANT:ILnfter making this C.sificemof Exemption,you should NEWRESIDENTIALPLMB. SQ.FT. TOTAL:
e-i Cn become subject to the Worker's Compensation provisions of the Labor Code,you must
FKi > foMwim comply wim such provision.arms permit shell be deemed revoked. BUILDINGFE Vol
W [� CONSTRUCTION LENDING AGENCY SEISMIC
5 1 hereby offum that them is a construction lending agency forme perfomunce of
O me work for which th is pewit is issued(See3091,Civ.C.) 'IYl ELF C .E
�y Lender Name
u" F' lenders Address QTY. MECHANICAL PERMIT PEE BIN
0 V I comfy that 1 have read this application and stat,that the above infowntion is
correct.l agree to comply with all city and county ordinances and state lows relating to PERMIT ISSUANCE MV NIL IEE
LO building convection,and hereby authorize repmscnutiveso(this city to enter upon the CONS 1Cf10N TAX
U Z above-mentioned property for inspection purposes. ALTERORADDTOMECH.
TV I agree save,indemnify Wh.)a,.keepCiry of Cupmino againstliuhilities,ju ms,coaisurd.y� yuccruenguinstsaidCity AIR HANDLING UNIT(T'010,0.'NI CFM)
in cons of the gramin Pfiis AIR HANDLING UNIT(OVER 10,000 CFM)
Si .rentApplicmm/Cep nor ate EXHAUST HOCED(WMUCT) PAID
I IAZARDOUS MATERIALS D CLOSURE HEATING UNIT(TO 100.000 BTU) Dote
Will the applicant or future building occupant store or handle hezardont material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER IM.W BTU) TA
Coda,Section 25532(a)? VENTILATION PAN(SINGLE RESIDE
❑Yes ❑No
BOUXR-COMP UBW OR 1(10,000 BTU) ISSUANCE DATE
Will theupplicanmrfuwrc buildingacupam uuequipmem nrdevices whichemit ��qq pp
Emanations air contaminants as defined by he Bey Area Air Quality Management BOILER-COMP(OVER 1110,1)00 BTU) P A O
District?
❑Yes ❑No NEW RESIDENTIAL MECII. SQ.ff. /��
1 have read the Journal materials requirements under Chapter 6.95 of the DEC ,gAA
California
Hand"Safety Code,Sections 25505.25533 and 25534. I understand that aa+�l�'
buildingdocs nut cuwntly havea reram,mat it is myanEu nsibilily m notify the /a"pant of the requirements which musi Ise mer prior to issuance of a Certificate of V (JI- (,upancy.
er or
anthadeed agent Data TO ISSUED BY:
OFFICE
01/1A/90 15:35 111 431 3384 NEGATEST CORP -44 CITY CUPERTINO [a 003
R FB I
CITY IIF CUPERTINO 27002
LLL'll.l)IN/i DIVISION
AN Alt Nn, 1 ON�UBMRTALDA
amuna:.,qua: 9 cc q €
LIC
OWNf NAM '
IDN CIDB'a NAME •. , �_-
NO.-
cNna rtnD N
INSPECTIONS DATE II4SPEG INSPECTION RECORD elm +aC*
FOUNDATION/PIERSIH.D.S. - NOTE: ALL GRADING AND DRAINAGE IJP �)TDJB �BJiJ
SHAM BE INSTALLED TO COMPLY WITH
UFERGROUND THE APPROVED PLANS AND�.TIY OF ,` )�`ILI
FAD/SET BACK•CERT CUPERTINQ STANDARDS.
GARAGE SLAHS/PREGUNTTE HJSPECriONSPECIAL INSPECTION DAM aar,
POURNO CONClWM UW-ABOvE HAS B D
UNDERGROUND/SLAB
PLUMBING
ELECIRICAJ.
DON07POLIRPJ YHFII►SP!!�f
PLUMBING
MECHANICAL ��yS
ELECTRICAL
FRAMHdG VENTS
A1sUTATION / -
PLAitS - �+
ROOF SHPATH/DIAPHRAM S
PLUMBING
• TUBS&SHOWER PAN _
MECHANICAL
ELECIRICALI BOND
1 _ FRAMHJG/STAMS/E.EGRESS
\\ IuNgS •ATIONNENTHATION 3'Z
COVFRNO:.
EXTERIOR SHEAR/HOLD DOWN
IN'IERIORSHEAR/HOLDDOWN SBL
SHEETROCK/SHEEIROCKSHEAR
EXTERIOR LATIVWSCREEN .
SHOWER LATA r �
NO.TAPE.OR.. . ' :pNTJLpBOVBHAS
SCRATCH COAT
SEWERWATER
TSMPGRARY-': -
BIIIIDHYG
ELECTRIC-4L n
GAS o
r,— . , 7;i: ba h
GAS TEST
GRADE PROVED FOR OCCUPANCY \ l
FIRE GEINSPECTION IssuANCEOArs.-
HANDICAP ,
CALL DONS(12:30 2a HO[JTtS �
ELECIRICAIJFIIERGY BEFORE
INSPECTION.JOB AD- p A
• BEFORE NEQUBtED 0�NEEDED WHEN DECLUMBINGlENERGY DRESS AND PERMIT
MECHANICALJEIOY PHONING. 'T Tpd�
BUILDING/ENERGY ATT NTIONLCOpPNNFFT�RRCA� ORS: 1 1j
ON
ELECTRICAL FINAL TEST
THIS—JOB (SITEITIIOUY�ORKHR S C!r r �^-%ovp4mi ft' •, .
DVORTANTI
PLEASE READ REVERSSE�ONBEFORE mueosr:
CALLOYG FO FEr