27939 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
3 ;¢�,BUILDI{G PRIOJE-T NANx�,3.r5"1,uLwT,?> PERMITNO.OF CUPERTINO AFPLICATION/PERMIT PLUMBNG-MECHANICAL
BUILDING DIVISION
2 Z 9 J c
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAT
,^`
2 Dp UNIT N LOT N 1 ~
O F E: P ON� O LTOR'BNAME: UC NO: N/C CONTROL#
o(j_
RCHDECT/FNGINEER: LICNO: AD RESS: ❑ -7;62.1 2. 1
C NTACT: PHONE: -`wt' 4 alas. R*" -' / 1
Q'fP BL;BCfRI ` I .. ,�. _.t.. BUB.DPfO PHRMIT,INFO�
6 1� C_ 1"x — en.�ci .aEt!'0. '1p S-'7P.+W, c.s .::9i"-;� 'm. gLDf; Cf Pty ME
S I8 ' S 33 PERMIT ISSUANCE —, �!R{
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
Metz I hemby affirmthatl am licensed under pavisionsofChaprs9(commemingwith JOB DESCRIPTION
�00 Section 7M)of Division 3 of the Business and Professions Code,and my license is in PANELS ,�1 N—
CUF fullforcelass—I'
pQ_Z W Licenu Class Lic.M
y6yj1paii, Con"wessar IMAMPS
ZO`y ARCHITECTS DECLARATION jwaC. \\rstOVER IOOOAMPS SQ.Ff.nOOR AREA $/SQ.FT.
C Z ❑ I undeand maty y plshell he used w public recoNs.
F4 11,�j SIGNS ELECTRICAL
Licensed Professional !�
z \
Ky rc6 OWNER-BUILDERp,from Cons TION SPECW.CBtCl1ITBASC. I� L"�
w 2 O y cU. 1 ng Mas off that 1 em exempt from the Casaimm Co e:My Lew forco the
� e0.454' following massa.(Section custom r,mar, ed Profesaiotu Code:My city orcomry TEMP.M161FR OR FOIE BUST.
CE 2 which its issea a pemdm m consmscL ages,impose,demolish.Et aasiig ed stmc.e
M<, Priormiiissuanc.aartquthernoinrimtfasuch pemdUofileamLaw(ChapCa POWER DEVICES
tyM�p that 9(cona misaigwimaround eed.7 epovisions Busimts"Proftaw(Chaps
e pet 9(<ommcrtcine wia Section]000)af Di ' .3af Bwinwad Profineioru Cade) SWIMAING POOL ELECTRIC VALUATION
❑y
or Nathe is
Pt therefrom ad aforNell memorial.Any,
.af
Section 70
31.5by mYepplic apenauubjttu pdicaturarnilpeciaryof -SWITCH- /v�
a mom tan 11c.Is llu50). RSNETIALQELTR _SQ.PI. �
M I,u thepeoperty,ormyeployttswithwa sutheirwleompauedn
M
�
TYPECONSTRUCTIOt
e odahmak,udthemasurri,ecoinaMedm.B fmsale(Sec.7014,13usimu
Profis sums Code:The Corrosive's Lomas law d nor apply m an chatter of
nywhobuildaorimprovea Nemm,atdwhodmm wohhimselforNmughhu
employes,po,ki tharamhim vap.uatemti eddoroRaeciforsale.I, OCC.GROUP RES.UNITS
his ever,Lhebuildingor'unprovemmt' aldd ' oche vfcompledm,theowner-
bui will have burden m [ ha orimproveforpupoaea(
We
❑ ,sown the e- ,a NY FLOOD ZONE APN
Yscrmecda with licensadcmtncrosto
row a W uaweu"rod Profmi C C.bum/r ,
Liana
aLaw yeomowiwofpropeny wbo orimpova rhemon.ed PERMfffISSUANCB
wh,ca wtifm tie, jecu withitimmamr(s uanmthe'ran . SA _ _ -
Licen ALTER-DRAIN A VENT-WATER(EA)
e i _ ..
❑ 1 sm xempt du Sec. .B#:P C ler this won BACK FLAW PROTECT.DEVICE UTS _
NITARY Y N
Owner
WORK COMPENSATION DECLARATION 5 DRAINS•FLOOR,ROOF,AREA.COND. SCHOOLTAX YECE�7'N N "
l ❑ Ihemby umn Ihaveacanifisuofousatmeelf-ims as rerdfisu of d-PER TRAP RECEIPT'#
Workera'Com 'on baunaeoracutifirdcapy Mereof(Sea3800.L bCJwhich PARK FEE Y N
Consent all e skiYeea uder lhu Petmil GAS.EA.SYSTEM-I INC.4 OUTLETS - RECEIP #
T'
Policy# - BUILDING DIVISION
Company GAS-EA SYSTEM-OVER 4(EA) PIANCHECK FEE
❑ CatifiedcopyiahertbylhmishN. Ilstiltli
❑ Cerdfid copy is fdd wiN da city Wpedm diviei.. GREASIBINDUSOII,WASTE INTERCEPTORGRADINGFEE FEE .?I'�'`�qi"•.
CERTIFICATE OFEKEb1P1IONFROM WORKERS' GREASE TRAP
COMPENSATION INSURANCE
('misucdmud.tbacomplemdi(thepemitu formeb.mddollas(5100) SEWN-SANITARY-SfORMEA.200PT. ENERGY FEE
or les.)
I cenify that in Ne performance of da wank few which obis permit is issued,I shall ATFR HEATER WNENT/ELBCIR --
not employ my pna.in mf Banns on u m moa a subjm m the Workers _
Z Compensarim Laweof Celifamie. Due WATER SYSIENVTREATINO MAN
Applicant pea Rtteip Ml
Q O
Z NOTICE TO APPLICANT.5.aPoer musical,a.Cadficate of Exemption,You slmdd NEW RESIDENTIAL PLMB. SQ.Fr. TOTAL:
FN become subject to the Waheh Comperwum povitimu of Na labor Cade.you Bun
� > fmhwn,comply with such proviaiou car this annual"be Assessed rooked. BUIDINGFEEUj
e<,;
CL, A CONSTRUCTION LENDING AGENCY SEISMIC FEE -
D Z Ithereby affirm that there is e coutruNon lading alae,for the performance of
UO tha wank far,which rids permit Is ie d(Sec.3097.Civ.C.) ELECTRIC FEE
handers Name PLUMHINOFFE >%'
O Lendds Addw }
I certify the I hese meed Od usppBM.as sum dud the above informed.u
0. correct.Iayectocomply , Try ad esexchius—mlmalmnindadngm 7R�
111eCHANICAI,FEC
Vy buildingconmucdon,and uthorim repmaarudva of this city anater upon lb
U Z above-mendoned Property for' d n pumpsn. - ECH. CONSTRUCTION TAX -
Meri ngme m save.. fy sad keep harmless Ne City of Nperdm agehut -
liabilics,judgmrnu..aumd uawhkh mus ' egamatuiciCity AM HANDLING UNIT M H,00o CFM)
n.nastumee of the
AIR HANDLING UNIT(OVER 10,000 CPM)
S' mmmofA UCm Deu EXHAUST HOOD(W/DUCT) '
PAN
HAZA MATPRISL S DISCLOSURE HEATING UNIT(TO 100,000 BTU) Due Receipt N
Will Ne applicla[or fumm Tiding occupmwmomwhmdle hesadous material HEATING UNIT(OVER 100,0008TI1)
w deflnd by the Cupearm Mai'pal Code,Chant,9.12,and the HnIN used Safety
qnnt
Cade,Section
13 Yes 13 No VENTILATION FAN(SINGLE REBID) Wit lk VN
ISSUANCE DATE .
Will thea licentorfuhuebuildin eccu muss ui BOIR,R-COMP(SHP OR 100.0008711) ;
PP B Pe^ W pmrntQualit Management
heradous air conuminanu u deFiwd by the Bey Amus A'v Quality Management BOILER-COMP(OVER 100.000 BTU) PAI
1
District] T W '
❑Yea ❑No NEW RESIDENTIAL MECH. SQ.Fr.
Rhesus red he heradou nweriats maltur arra ands Chapter 6.93 of du MAY 719
California Health d Safety C Semou25505,MSllmd23334.1uders, Wt
ifthe building can not current veamnmt,tlutit ismyrnponsibilirymnodfy,g
setup.[of the requimrnmes ich a prior m intunce a CeniOcusu of
Occupancy.
J I T,
Owner or oath ag<m au ISSUED BY:
OFFICE