27626 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDI G-ELhCTRICAL PERMIT NO.
APPLICATION/PERMIT . PING PROJECT ICDANIFIC 27626
BUILDING DIVISION BUILDING U.'—MECHANIRICA'1'IUN
BUILDING ADDR] SAN]rARY NO. APPLICA'HON SUBMITTAL.DAT-
# IAT# I�t" v
NERS NAME - PONE: CONI'RACI' R'S NAME: LIC NO:
NIC fl�CONTROL#
ARC 1'1'IiCI'/I?NGINIii? ; LIC NO ADIRESS ❑ � ! �T
is CPJ2 7 v
CONTAC'D PHONE:. v BUILDING PERMIT INFO
I� QTY. ELECTRIC PERMIT' PEE
B PI.0 MI'S,FF
sa
Aq 7>9S-Z.�86 PERMIT ISSUANCE?
LICENSED pPP1.lANCES-RI3SIDENTIAI- �Q ) D� CRJMION �
py2, Thereby af-rLICENSE CONTRACTORS
(commencing witM1
F100 See,",7n(defl Di " n 3 oflhe gmincss end�,RoQfessiom Code,and my lions is in PANELS
<Z UC crnxe Class Lic# �LL'• � UPT02MAMPS
h d Data - Camwmor 201-10ID AMPS
7,O z - ARCIHTIC'TS DECLARATION OVER I"AMPS SQ.FI'.FLOOR AREA � E/SQ.Ff.
O Z O I unJersmnd my plans shall be used as public records. Atm
y
SIGNS ELECTRICAL Ile"xcf, Licensed Professional
WOa�,Mowou OWNER-BUILDERDEChCRATION SPIiC1A1.CIRCUIT/MISC.
FVF I ngrtby affirm that 1 on exempt Toon the Casions C's License Law far the
Watt r� following irec. (Seniors 703 L5.Business and we,denolh Code:Any city or county TEMP.MFI'ER OR POIJ3INST.
wbiCM1 reyuirer u pencil to nmslrucl,alteq improve,demolish.nr repair ,uny svucture
,WY7 no its kwanem.bo re ire,the licem forsuch Oo fileasincdsmmmenr POWER DEVICES
prig tt app panni g
µajC�� thea hCinnlicensed with Section
n7 )ol'provisionsof the the Ba,emh and
nse Prof.umrs Co ter
°'Ko 9(commondng with Sectlon]tXgp of Divislon3 of the Buxinces and wofcsrinns Code) SWIMMING POOL P.LIeCTRIC _ #�VALUATION
1y My or he is exempnhcrefrnm and the basis bathe alleged exempion.Anyviomalli.f 1'LE$-SWITCHES-
FZQ not mom in.fiy anodised cunt fn r$500).tsubjeetethe npplieammeulvilpanultyof PIXTIIRP,9 .J
�F0 not mLatrwmrofce hunJopcny,mmycm).
Cm ❑ I,avowncndthc pmlwdy,ormycm loyces with wugesastheirsolecompensmion, NEW RESIDENTIAL F.1.13C1R —SQ.FT. STORIES TYPE CONSTRUCTION
a3— willdothework,endthe avucmrei dad arnfrerW tar cele(sec.]two,I3uainaaa
and Prafcasions Cale:The C actor's Lic se Law does not apply to an owner of
property who bulldsor lin eamereon,andw doeasuch work himself onhroughhis -
wnemployces,provi that such improvemen re not intendedorof(ned forsale.If, OCC.GROUT' RCS.UNITS
however,rhehnll ' gor improvement lssold with one year ofcnmpletion,the owner- .for
buildcrwill eche lordenofpraving that he did. tbuildorimproveforpurpottaf
awe. - .� QTY. PLUMBING PERMIT FEE ILOOD ZONE APN
Lu curio,nRhe pen . 4 elycont, 'ngwil 'censnlcomracmrsn,
c man the P jeer( ass and w s Cud The Convectors
I,is sr,Luwdo wucrefpmpe ulldmimp vestherum,and PERMIT ISSUANCE
who Roc )acts
o; _L becrosedpursunnuo eContmno(x
Licen awi,x,a ••/ ALTER-DRAIN&VENT-WATER(G FEE SUMMARY
❑ in
xenip m ci Sec. B&P C for is retmm BACK FLOW PROTECT.DEVICE. OIIT,IDE MR
SANITARY YN
Owner Date RECEIPT'#
DRAINS-FLOOR.ROOF,ARBA,COND.
WO TAN CO F.NSATION '. RATION SC1100LTAX YN
❑ Iherehy fr thmlhuvea coficatanfco. a self-insure r cenifica of FIXTURES-PERTRAP RECEIPT'#
Wmkere'Com overt')n Insure enracenilie r thereof(Sec.3 W.a-ab JwM1ieh PARK IEH- Y
eoveraallemployx'eanden permit. GAS-EA.SYS'D3M-I INC.4011'ILI?I'S •C-11#
Policy p BUILDI I 10 I'ELS
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Certified copy is cmhyf
❑ Ceinfiedcopyi filed with inxpection`\divan. GRIAS'IJINDUSI'RL WASTE INTERCEPT OR GRADING F13I3 _�
CER1'1 CA'I'E OPV TION.kItFIM IORKI7R GREASE]RAP SOILS I'
OMPENSATION INS.�yfCE
(This section need no ecompletedifrhepemtirisforonehun eddollan(EI00) SEWER-SANITARY-STORM G.20017. 13NF.ROY
Iscrifythotiotheperfon a ofthe work forwhichmis pe it is issued,l shall WATER HEATER W/VENTELICTIR
not employ any pemon in any nnncr so as it) become sub'et m the Workers' - PND �y
Compensation Lawaof Califtmin. ate WATER SYSTEM/rRHA'rING Date N, feW �./
O O NOTICETOAPPLICANT:IL eller ma ' gthis Cenificme of 3aem i you should NEW RESIDEN'I'1AL PLMB. SQ.FT,
p ton,Y TOTAL..
r In bmamesubjentorhe War kers Campers npmvisionsoft clabor Cade,you mon -
Pi , forthwith comply will,such moswons or thi nnil shall JcmncJ rcvokeA, RI111.DIN0113E OIsm
r�
0. Q WNSTRUCf10N hENDIN TINCT SEISMIC
zI hereby affirm that there is a construction lending agency for the performance of
V O the work fur which this permit is issued(Sec.309],Civ.C.) '< A -1.EGT
Lender's Nm
ae Is-
0 F lomders Address QTY. MECHANICAL PERMIT FEE
V certify 0' I hove reuA 0is npplicntinn andawm Ititil the shove infomswion ie
,T 0. correct.Iagree//,(('�,,comp lywithalleityana counlynNinances and state laws relining In PERMIT ISSUANCE l IC 1'FLP'
F' Cl) buildingo, a coon,and hereby nwho"-.e scmativei of Chia ciry to coin,urym@e CONSTR ION TAX
V Z above-memin it yruperty for inspel i It dnes. / ALTER OR ADD I'O MIiCIf.
(We)ag to suv inJemnify p T le the City of Caperton against
l iabbiti s,jw n la., sand expert hie11}}tgyfe�p,'in nywa accrueugnical said City AIR HANDLING UNIT(TO IO,WO CFM)
in car equc ce fth ting a(rh' i / AIR HANDLING UNIT(OVER 10,IXXI CFM)
t)
gnaw o pylic Corrmcror.S `� Dam EA EXHAUST HOOD(W/DUC
k. n PAID
IAZARDOMATERIALS DISCLOSURE 11 TINGING LINE 100,M)Is TO) 2 Um Receipt#
Will the applicant or boom buildingoreupnd store'),handle hazardous material HEATING UNI'1'(OVI3R 100,1100 BTII) T AL:
as definal by the Co,smina Municipal Code,Chapter 9.12,and the Health and Safety
Cade.Section 25532(e)? VENTILATION FAN(SINGLE RESID)
s
❑Yas ❑No
BOILER-COMPLIHPORIfIf1,"BUD
fluctuationsIS UA E ATE
Will thcupplicam or Emote huilding«capon,uscequipmcm nrdevittswhichemit LIQ [�QQfluctuationsu
ons air coin minams us defined by the Buy Arca Air Quality Management BOILER-COMP(OVER 100,0000 TB) AR 9Dd
Diablo?
❑Yes ❑Na NEWRESIDEN"PIALMEC11. SQ.FT. LI
1 have,cad rhe hanodaus materials mtpiremems under Chapter 6.95 of the On Ur W'EH FIND
California Health&Safety Cade,Senior 25505.25533 and 25534. 1 understand that
if the building does nm cunemly hove a tensor,that it is my responsibility m notify the
uselatioun of the mignacmcnts which const he met prior It,issuance of a Clod ficine of
Occupancy.
Owner m saWadzed agent Dale ISSUHD BY:
OFFICE