27579 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO APPLICATION/PERMIT PLUMBING-MECHANICAL "�` ITNG 27579
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUII.DTNG ADDRESS: �`yrh` ��• A��r./�� ya �j SANITARY NO. AlL [ION SUBMDTAL DATE
�J o V� IFC.7Be t6 t o lffrf W
W BRS NAME: PHONE: CTOR'3 NAME: LIC NO: 1�
T T //rs Q�s'�rO00 ¢ riC C/O fd'28f
NT CONTROLX
SANC11171rCfIE1JGIN1URt: LIC NO: /•1 V) BXTC voo 0
CONTACT: PHONE QTY.
ii
QTY. ELECTRIC PERMIT PfiE BUILDING PERMIT INFO
D.s�P tri P G r e y 9od--73 Y-vZ V s. BLD ELECT' PLUMB ME
PWAIT ISSUANCE ra LhRf
LICENSED CONTRACTORS DECIARATION APPLIANCES-RESIDENTIAL TOB DESCRIPTION
y� Iheabyaffimlhael.limvedunderprvidonmofChapter9(rnmne cingwiN
;O Section RMD)oflliviminn3ufthe tlmime uaPMmime Craft,rand!myUanmkin PANELS \ L � �
p(U full baa and camr-1 O Fi UPTO200AMPS C
< Licens Qeu �/ Lk.N S r
rosy Uma /`-2�-e 4i Camnamr Z •G 201-100DAMPS
LL OZ ARCHrrFCP3 DEC ARATION OVER IOD AMPS � SO.FT.FLOOR AREA S/SQ.FT.
Ot? I nndmxteN my plunx shell be used or pudic records.
Fygh I SIGNS ELECTRICAL
<Y f IJard Prfmaionsl
SaaW� ' OWNIIR-BUIIJMR DECWtAT10N SPECIAL CIRCUIT/MISC
x34 I hereby affrm that 1 am acoustic from to Contractors Limen Law fa tine
ul following rearal.(Sati0e 70314.Economical Pafmiore Cod.-Any eiryormse, TEMR MEIRR OR PoLELPa T. cassaa
which require a Permit ac countercoup iter,improve,drnmliN,ne ropeir my Yrerme
PH.mit.ivanla,them mquirntoappUmeforsuchpertmfilea ipledemmmt POWER DEVICES
a:<p dm he h littnsed PuEsusEr to the Provisions a deComnelM.[.IN.LAw(Chagc
9(mmmemkgwlb Satim RDO)of Divisim3oflheBueinmud Prf..Cade) SWIMMING Pod.ELBCMIC VALUATION
or then he in exempt duordrm and the bode fordo Wit*exemption Any violation of
Zs. Section 70313 by my appliance for a permit subjects 11n applicam in a civil Pendry,of OUTLETS.SWITCHES.MMURES
Sp me more than five humped dolW(5500).
1'- [3I.anowmrof0epapary.ormyemployaewiehwageanseheiredemapereedme. NEW RESID&PMLELECfA _SO.FT. STORIES TYPECONMUchm
�3_ will drehowak.odthearms.ienul iemndalmoffemlfwank(Sere.70e4,Bush. '
ad Prfemekns Code:The Coanamfa Liame Law dm me apply,m an ww.of
Is lmtywhobuibbmimpmmeOa .adwhodaosuchwmkhimalfmthrughhie
ow ryes.gwichimptovemistevlelC OCGRWY RFS.UNITS
rm .ilmwimpmeisedwiddnfuy.dfcompkdm.dmmwner-
whorwill have to Furdm rdproving Wm he did m build or impure for pupm of
).
❑ I,aauw.Wtha popmy,MeaaludvelyermtmXingwithlkmmdconlneecam QTY. PLUMBING PERMIT FEB D NB AYN
coravun the pmiae(Star.7014.Bushles us.Rafewim Cade:)The Caricature.
Licmae Lawdmamapptywmmv 4properrywhobuiHsmimpmmtbre .and PERMITISSUANCE
wheemntmcu rraeuch inmates contramr(a)licensed preuaN mthe Creaacmh
IJcenr<IAw ALTER-DRAIN B VENT-WATER(EA) FEE SUMMARY
❑ 1 em eemp under tlm. .B deP C rar Nie realm BACK FLOW PROTECT.DEVICE
SANITARY Y N
® O°rner Came— DRAINS-FLOOR.ROOF,ARBA.COND. RI. X
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Ihmbya?umthmlhaa aamlfeAmdmmm acaafwnsue.oraeertilemeof RCRBPI'N
FlXTURES-PPR TRAP
Wickax'CkmprnmMalnsmumeaaanifidmpytherad(Sec 3g00,lAb C.)which PARK FEE Y N
einem dl enlple we'.m der6da pmrli. GAS-EA.SYSTEM-1 INC 4 OU IJM RECEIPT'#
fuliq# BUILDING DIVISION FELLS
Company GAS-EA.SYSTEM-OVER4(EA) PLANCHECK FEE
❑ OemiEcd copy is hereby famished.
43 Cctifmd copy is Bled with teat',Inspection Mvhkn. GREASF41NDUMILL WASTE INT'ERCEPT'OR GRADING FEE
CERTIFICATE OF EXEMPDON FROM WORKERS' GREASLETRAP SOILS FEF.
COMPENSATION INSURANCE
(Thin aaYimnedera becmmplrud iftim permit h fou ma handrail dollen(SIW) SEWER-SANITARY-STORM EA.200IT. ENERGY FEE
or lea)
Imedfythe in the pefammnee ufthe work for which this porde n issued,Ishall WATER HEATER W/VENI'/FJ.WM
rex employ any Peron In any man.an we at b. anbjm or,the Wekas' PAID
z CmlpmxYionlawaof Cllifanim. D. WATER SYSTAVIREATING D. Recap#
ATliwlt
Z NOTICE TO APPLJCANT.If.after making this Certificates of Exemption,you cheuld NEW RESIDENTIAL PLMIL SQ.FT.
TOTAL
E" �yi became ssubjectse m the Worhe/m Compensation fervidness of the Latta Cork,you mum
� , fmhwitha ply with such provisions or lhim permit abW Lou tic.edovaked. BUILDING FEE
y (� CON.STRUCITON LENDING AGENCY SEISMIC FEE
7 z Iforestry air=dan Orae is acanaactian budingagelay for tins portentous,or
U O the work ror which dds permit ieheated(Sm.3097.as.C.) TOTAL ELECTRIC PEE
I.erdefe Num PLUMBING FEE
O L) TAlydefm Addorxe QTY. MECHANICAL PERMIT FEE U 1 eenify that 1 have read this apdicesion aM wen that the above Information h
ameee.Iclear mcam lY with all city admuryodmuxvad mum hwsdmirg in PERMIT ISSUANCE MECHANICAL FEE
buildingcmatrmlion,and hereby aueherim refereaenmivm turtle city m mem upon ger
CONSTRUCTION TAX
U z ehw(We)stned ptopunyfm hwdly ren pupae. ALTER OR ADDTO MEC#.
(We)clew:m sea,inekma c red kali hmy In
my my
City of amCupenfuo against
encotie,judlemnte.cmuand caucuses which MylnanyweyaaumagdMmeid City AIR HANDLING UNIT(TO IO.00)CNM)
in cansry afehe M
./ AIR HANDLING UNIT(OVER IOABO CPM)
i linnt2bnaaacr Deter/ EXHAUST HOOD(W/DUCI)
PAID
11, 2ARDOU3 MATERIALS DISCLOSURE HEATNG UNIT(TO IOO,ODO BTIO Dole Raeip#
Will IM applicant or future IuildiN accupest macre or Nude humorless mamdat
uM:nned by the Cupenim Municipal Cade.Chapter 9.12,ad the Hath and Wary HEATING UNIT(OVER 100,000 BTG) TOAL:
Code,Salim 233330,)T
❑You 13 No VENTILATION PAN(SINGLLE RESID)
W ilI the upplicant a tutor bui Ming occupm um equipnvu a deviaa which reit
BOILER-COMP(3HP OR 100,1100 NTN ISSUANCE DATE
hoodoo+dr tmumiMns a defiled by the Bey AM Ab Quality Manufacturer BOILER-COMP(OVER 100,1X10 BTU) /�
District? P A ,O
❑Yu FMI
❑No NEW RPSIDAL MECH. SQ.Fr. O�
I have read the M1arrvrlDua materials wquhme ma oda Chafer 6.93 of the C 87
CelTromia health M Salary Cie,Senior 73303.25.533 and 25.534.1 understand to
if the building Moa rest currently have a mMlL that it is my responsibility to reify die
anegane of de mmuimareM which.m be met prior to because of a Cm(fwte,of
ORupOmy. Vf `rJ
Owneramthadsdegam Date TOTAL: ISSUED BY:
OFFICE