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26237 (2)_Fe r_ APPLICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO` - BUILDINDIVISION. APPLICATIONIPERMIT PLUMBING-MECHANICALb G 3'R.}y}Y1fl`ASY; BURMIN P8010IDEWUPICATION4,$x^PiJ,$i; s'L - PERMITNP. 237 BUILDING ADDRESS /( I'I'/A�) z/ ' J c UN'a 1^' L01 SANI'1'ARYNO. APPLICATION SUBMITTAL DAIS J O%V ti NAN I I ONE: CONT ACT'OR'S NAM N/C CON I'ROLu t1lr.:m1,C1/ENGIN :'T, LIC NO: ADDRESS: ❑ CONTACT: PHONE:w„•.var• �F i T :4r vl QTY J^EL8C7RIC P8RMIT.a"r+FtF88a"?BUILDING u � roti .a kat }1t • ... xc t ro PERMIT INFO BLOC EC PLUMB MECH PFRNfIT IgSUANCE �3B 4 LICENSED CON1RACfOR'S )ECLARATION 1 hcrchy affirm that I stn licenmdunder provis onsof Chepter9 (commencing with ppPWANCES-RESIDENTIAL JOB DESCRIPTION Section 7") of Division 3.f the Business and Professions Code, and my lie. is m PANELS �1 full force and effect. \ License Class Lic.M UPT0200AMR5 �` / 201 - LOUD AMPS Data Contractor ARCHITECTS DECLARATION 1 undemm�d my plans shall be used es public rccmda. OVER IU00 � SQ. FT. FLOOR'jR - . S/SQ. FT. SIGNS ELF.CDtICAL �1 ui `IVL.I` Licensed Profcaional OWNER -BUILDER SPECIAL CIRCl1IT/ADSC. 1 hereby affirm that I for. me exempt from the Cussima is Lianas law farco Ne 1 Cade: My my cowry following reason (Section ]0315, Business andove, TEMP. METER OR POLE MST. douonz which rtquira n permit o cons; the alta, improve, demolish, fi repair ed seedcase s priorwits Issuance,rrore9utro the applicantfarsuch fileee Lx zurcment POWER DEVICES Contrtmitto that (commencing is liavd purtumt to Roc provisions of thethe Badness License Lew (Chaeta or met heisxemithheeuon]andthe basisnn3ofthe Badness mad Rofasioa Code) or Nm Wei31.5 bytmerefrommdthebaank s Neallegedeacmpi to Myvioldonof Section ]03).5 by any applicant for a permit subjects the applicant w a civil penally of SWIMMING POOLELECTRIC �� VVALU!(�ryON OR69 C.J V UTLETS-SWITCHES-FL\TURE9 not mom Nen five hundred dollen ($500). ❑ I.uowetaofthe properry,mmyemployea colon wegaathe'uwleromperwtion. NEW RESIDENTIAL ELF.CRt _SQ. FT. STORIES TYPE CONSTRUCITON will do the work, and the zwctur s i s not intended of o!fared for sale (Sco. 7f 104, Rosiness and Professinsts Cole: The Contractors License Law does not apply to son owner of � r,i n II A 1 r. •7 II property, wholmIdsorimprovu thnean, and whodoas such work hdmselforthroughhk a ownemploye,providdar thsuchimpmvementzmenot intandedmoffaed fmale.If. however, the building or improvement u said within one year ofcompletion. the owner- C. UROUP" --P"N 5� f�a '^ 1 \ / I✓ I h I� builder will have the burden of proving Nat he did not build or improve for purpose of nnasst as'.:n[.J•.�vn{Rv'ac;.wix.xswttc@^y�N�r . fa ? 'Jxrt'.vwiG x�r. 1'S.+�'.`vial at `.�e "♦ Wi ❑ I.m w afthepmpmy.=n clusivelyeontns Zwith =) ac= romraee the project (Sec. 7044, Resines and Profusions Cade:) The Conpacem'e license law doer not spar y ct an owner of proPmy who bud Ids m improve tlteeon, ad DiiTE Dz PERMIT ISSUANCE whoc acafmwch pwjau with acontrazPoKs)licensed punuantwthe Conoactors L U. Law. ALTER - DRAM & VENT -WATER (EA) _wr�}"tj°�17",„c7•"_.FEE SUMMAR_Y,C'gy>,�.r-'Pei ❑. 1 am exempt under Sm. , B & P C far this sawnD BACK FLOW PROTECT. DEVICE SANITARY YN RECEIPfM Owner Dae DRAMS -FLOOR, ROOF.AREA, CONI. WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN _P Ihembyaffimnwlbaveaandfiuuofwttacntwwlf-inm¢,oracandflcateof W'mkesi Compcmation Lssurmwmeanifidcopy thucof(Su.7B00,lab C.) which RECEI a FIXTURES - FEB. TRAP FIXTURES FEE Y N coovers all employer's under this pemdt. Pulicy.N GAS - EA. SYSTEM.I WC.4 OUTLETS RECF PTR BUILDING DIVISION FEES Company GAS - EA. SYSTEM -OVER 4(EA) PLANCHECK FEE [ICcrtiftd copy is hereby famished GREASEANDUSTRL WASTE INTERCEPTOR GRADING FEE ❑ Certified copy is filed with the riryinspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FE COMPENSATION INSURANCE SEWER.SANITARY - STORM EA. Jul ENERGY (This section need notbecompletd ifhe permit is fossa handraddollars(SI00) edeas.) WATER HEATER W/VEM'/ELECM I certify that in the pafamunceoftbe work fm which this pcmm is issued,I shell are emplay my person in any mmner ao as to became rubjece m the Workers' PAR) Compenaoonlawsof Calif rad. Data ATERS IEMRREATING Date Receipt# Applicant NOTICE TO APPLICANT: If. affect, making thus Certificate of Emerilmon, you should NEW RESIDENTIAL PLMIL SQ. FT. TOTAL: become mbjaa m the Worker Compmation provinom of Rose later Cde, You must forthwith comply with such provisions or this Permit shall be demand revoked. BUILDING FEE SEISMIC FEE CONSTRUCTION LENDING AGENCY 1 hereby affirm that then is a contraction lending agency for the pmfmmence of the work for which thus Permit is issued (Ser. 3097. Civ. C) ELECTRIC FEE �. Lenders Name Tameerm Address 1 certify mat 1 have read this mpldcafion and mute mat be above information is correct. I r,om to comply with all city it county ordnances and sort laws reladngto --se.' crass .••. .^..v^:.-• ::_e,<f,"tL 'Na'^"� QTY.?rv' 1MECHAMCAL PERMIT.;",.«;�: y�:; FEES;: :"ode AT�,4a.1w ere:. we,•s,.....:nv..e,Rv.•> r *.. a. ... . PLUMBING FEE PERMIT ISSUANCE MECHANICAL FEF building construction. and hereby authority mpreanutivcs of thus eery m enter upon the move -renamed progeny for inspection purposes. ALTER OR ADD TO NIECE. CONSTRUCTION JAX t W e) uprec m save, indemnify and keep harnlesm me City of CuNmr..'mou limit jufroicon.costsvndupens swhich may inmyway wcrueagdnstsvd City AIR HANDLING UNIT(TO 10,0(IOGFMI in to at mace . c ing fthis it tAA AIR HANDLING UNIT(OVER MOB() CFM) Signmure of AppbeonVConnaaor Date EXHAUST HOOD(W/DUCf) PAID HEATING UNIT (TO MWO RTUi II AZAR000S MATERIALS DISCLOSURE Dmx Hcccipta Will the uppbeem err lumre builJmg necupunuume or handle humrJnm on art, ul as defined bythe Cupenoo Municipal Code, Chapter 9.12. and the Health and Safely HEATING UNIT (OVER 100,M) BTU) TR'I'AL: Cde. Section 25532(v)7 ❑. 13 No Will the applicant or Brute building occup5nmw Nuipmcmordevice, which emit ISSUA DATE VENTILATION FAN (SINGLE RESID) BOLER-COMP(3HPOR IM." B7D) BOILER - COMP (OVER IDp,fgD BTU) . Instructions Dtqair conuminants as defined by the Bay Area Air Quality Management ❑Yu ❑No I. '♦ .. p ^' N' b - NEW RESIDENLNIECH. SQ. FT. M I hove teed the haurdous materiels requirements under Chapter 6.95 of the California Hrdth&Safely Code, Sections 25505,25533 and 25534. 1 understand the if the building doe nm cormfly have • extant. that it is my rapmoubili y to notify the APR �, ii r1W _ . wcupmt of the rcqudremenu which must m met prim in m umce of a Cendfiure of Occupancy. Coy ISSUEDBY: t\ Ilia • a'IIryV Ownermeuthmird agent Dau OFFICE .