25309 (2) yrya:^rspI'M 11.wra e-1.I... .v.•vr.m....v..-......u.-....r r„ �- ... ...... . �.......r. -
tt'•, CITY OF CUPERTINOPLUMBIN'- ' ERMITNO. 25309
F BUILDING DIVISION APPLICATION/PERMIT G-MECHANICAL
d I PUILDINC1,01DIRCIn IDo
IJUITOADDRESS: ,e sae SANITARY NO. APRJCATIONSUBMRTALDATI
�t I 1 f.`IW '11W..Cp.' Q
UNITM LO N
3 NAME: IONS: -79 CO R'3 I:
'IS411E 11N1 CONIAOL
1' AR /PNOI E : LIC NO: D O
I N o ►h
ONTA� PHONE: k 0 WpBRhIIT,INFO, � s�.l7!irV,'
L E1,[!Cj' ME MliCll
3) i a5 '
PERMIT ISSUANCE ��
li LICPNSe ONTRACIOR'S DECLARATION APPLIANCES-MID L TOE DPS IPfION
�`}}' Kx Iherby allMnthulem llavdunderprovidonwfChapler9lcommmdng with
Be mire 700B)of d_�Nd lRof the Lic.. end f ion .ylQ mat limos isle
PANELS O
r fullrmce eau' I 41!•F UPT0200AMP3 ��
License w Cont
7" Den Cont 201- 000 M S SQ.FT,FLOOR RHA fISQ.FT.
CHITT.CI9 DHCL TIO
CZ'3 1 understand my plane shell be used u public¢lords. I /M1
gym❑ 1 CAL JVgJ
�sdd uamd Professional
p4
OWNER-BUILDER
f� qOBUILDER OEM
S CIA N
R/MISC.
O I harsh, Hio that I ant exepfrom the Communes License Lew ler the
aLLy rtseum(Section 7031.3,Business wProfessions Code:Any dry or rmy Te METER
which rmes
pennll o construct,alter,Improve,demolish,or repairany emctua
n Y� Worohat...nco,alwmqulaethe applicant(.ouch pemdt le RleadgxdstsnmenI POWER DHV
Cpthan be 1.license punumt he the prooldwsof the Contactor.License law(ChWer
9(cmm In&with Section 7000)of Divider,3 of the Business NO Professios,Code) SWIMMING CIRIC VALUATION
y mthea he tseaempt thwefrodsed the bolt(or the dlege aemWon.Mrvldwonof 1
>^ Scolbn 7031.7 by am applicmtfaapmnit wbjecb the applluntbsdvilOmdryd ounADS;.s ES-ISXTURES IY
amort than Ave hundred dellen($300). NEW RESIDENTIALELECfit _S PT.n❑ 1,newnrk,and epm)eM.mmarilmo lad rothwegaulM1elde(Sm.70mpevwon, Q' TOR P CON 17l CIiOh
+ will dothewons Crain:
The nisreUnnnde,Law df.etaWly.70 M.Business
and Professions Crile:71se Conireclors Uaoe Law ilea net apply to an.war of
pe
."whobuildsorlmpeva thneon,end whodoeeeuch work himself.throughbts OCC.ORO PUNITS
-T ownemplryea,provlddthal.uchlmprovmientseae nothoendedooffered for We.if,
however,the bulklm,or impovemem Iseult]within.I.electrified.,then...
# builder will have the holden of psovinf that he did not build re Improve fo purpose or
h sale.6 I OODZ APN
❑ I,"moffortha property,amencludvely connecting with licensed contractorsre
4. construct the project(Ser.7041,Buttons and Profaslons Code:)The Connector's f PERMIT ISSUANCE Licence,Lewdoes not Wlyoanownerefpm
ropywho Wilde orlmpmva therand
who contracts her such projects white conmmm(e)Ilcenee pursuant to the Co eruct]. e
U.-U.. ALTER-DRAIN&VENT-WATER(HA)
❑ l.m-meopl uner Ser. ,B d P C fm tMs reason BACK FLOW PROTECT,DEVICE TSIVE FEE
SANITARY Y N
Owner Dso _
REIPr N
,..� •t �'• WORKMAN COMPENSATION DECLARATION D R SCHOOL TAX Y N
;t1 Ihereby efnrm that l have a cmi0cam ofconom m self-nsuse,me ceninate of -.. REC N
err CompenWltan Imuran.ne a awned copy,Baroof(Sm.3800,Lab C.)which Fl RPS PP.RTRAP ' waste PARK FEE Y N
rover all employee'.0 IhlStft.. GA �Y••,�,•l REC.IPfN
Company-
pny 1JlAAA d, s STEM BUILDING I IS FEESsab
. w _/e/eb1 A/ �Ii CA/ OAS-EA.SYSTEM-O PI.ANCIIP.CK FEE
.❑ CmiOd orgy b herby fudehd. DA
❑ CeniHe ropy is file with thedty lmpecflondlvidon. REASPJINDUSTR ORADINO FEEteal, b
won^
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FTP
i, COMPENSATION INSURANCE
t 'rndzseetion mad not be completed iflhe permit Is for ons hwdredoll.n(3100) SEWER-SANITARY-STORM EA.200Pr. ENERGY
i aim)
Icerdfytheindwparfmrnmvofdowmkfmwhlch Ni.permlllsluued,ldtdl WATER HRATER W/VENTA?LECIR
rad employ any Peron In any manna w u m become subject to the Workers' PAID
CompenxtlonUws of Cdlfomia. Data WATER SYSTEM/TREATING ate 8.1140
00 Applicant
y NOTICE TO APPLICANT:IL efeermding this Catlflanof RxemW.n,youdeuld NEW RESIDENTIAL PLMR. SQ.Fr. TpT
G FP become subject o mwp
the Worker.Canpem ovldom of the Uen bor Cade,ymum
fenhwiN comply with sea Frovidom o Nn permit dust he damned mvokd. UILDIND FT
0 CONSTRUCTION LENDING AGENCY SEISMIC
j Z1 hartby affirm tiw tea Is a conrmellon lending 4emY f.tha pedomaas of
0 the work Am which this pmth is bound(Sm.3097,Clv.C.) P.LP.CfR FEe .�
B O �+ Lendal theme 99
[" leder,Address N T" n PI.0 INO FEE /mm
0 ill!!! I conify thea 1 have read this application and some that tie.have infrrmealon Is
r- a cmrtct.I agree o creep? with dldry sad mmtry ddironm ae.l.n law.rtl.dngo PERMIT ISSUANCE MI
.HANICAL FEE
lLl-^Jy j bulldingaonuction,ad hereby rvdvdortparnhtivaofdd,chy omtaupon the
WSTRUCIION TAX
7 om
e-mtiend propmy for ivpee0opup..rp . ALTER OR ADDTO MECH.
F7 (We)gree an save,Inderndfy and kap heamlm the Clry of Cupertino against
IlsMdhla,judgments,evars. a whicM1 ma In any wayiere.sgdnat said City AIR HANDLING UNIT GO,10,"CFM)
I`a .can r he gr Lingo b II.
3' AIR HANDLING UNIT(OVER 10,04M CFM) -n seen I
It"
ma
Si .PAppli t/ContrMo EXHAUST HOOD(W/DUCI) PAID
HAZARDOUS MATERIALS DIS SURE HEATING UNIT(T0100,000 BTU) Dee Reaipl0
Will the anpllomm fuorebulldingaNpent. hands hazardous ensimal
u define by the Cupertino Municipal Cede,Chapter 9.12,an the Edo and Safety HEATING UNIT(OVER IN,"BTU) TOTAL:
Code,Seellon 25332(.)7
CI Ya 13 No VENTILATION PAN(SINGLE RR31D)
t r BOILER-COMPDHPOR 100100 BTU) Neu ESS,D DATE
Will 0e.Pyllnm
ntfuort m
buildingopma
luequlpmm
sntdevica ,
whichemll f {� D
1 ha ordoue.1.tudnann 4B
re md by the BayAna An Queliry Mwge rsom BOILER-COMP(OVER 100,000 BTU)
Won?
��- ❑Yea ❑No NEW RESIDENTIAL MEC1L SQ.F`L US 9 �a9 sS�
3
M
( I have reed the hnardwe materials requirements under Chapter 6.93 of the J
i - Califmnie ilalth R Safnry Cde,SaOons 23503,23333 and 23534.I understand then CII t (✓
If tie building dm tel amity have.tenent,that it Is my rtspondbility to artily the
h (:Uh'thfIIIVU
oceopanr,of Lha"id emenn which mull be and price n lax.of•Cenifiao of
Occupancy.
owner m amhodad agent Date ISSUED BY: