7100 4'flP4_ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
t PERMIT NUMBER
``,RU1LDINQ PROJECT.IDENTI F I CATION APPLICATION & PERMIT
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7100
PLAN CHECK VALIDATION
EkEC'7'LifCIPRMIT FEE
tr✓ r + 't,ti Y` r y. +• b: b rAi /A y /iSd 7"
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*t !.' sl': jZt'v ^7?1s K y P ,� _LIG11l`'INGyP1�T1JRES9rtJre ' 5.00/1.00
4 ONTRACT
rn AFORE �,Y rsylfy�a2' "i y;Yq / i{'r`f}�rr':`yQr��rr }t[t�k�r7PnPLIANCE$;".RESIPENTIAL{s 4.00
~. � 1V `F`{KYi roCGn',.. Ptx) @u.�a�'� r`>5."4 bi r{N k�.$ t� {� . .- :t :."� 5.00 DATE OF APPLICATION
ARCI IT Cr ,.T�yy (¢ i:• J f S 't I n v] t 1 v j J PLAN CHECK FEE P.C.NO.
1tt on t " vr��, ,/[ f 1 v1'*ttt4Y'ir yr L 1 Sl,fi St1 ,N �rr Y; �' >. 6.00
ENGINEER Y/. M1}ry :W {,
.. I l{rap trta"Fi 4Y L'°is* $6NSyTRAN$ 3.00
AArocoo ORING 1 �1 )
PERMIT VJr ATION
flLs 5.00
{
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10.00
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ay
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.s �' 7 ,_\ri2�w1 INFORMATION
ra4 4 r I hLr by 1� IR If�r[11�40L gxempl k r17te:Con iu[gnF l,icj rtC ,'j'.r( M1rb'MISCtw§ -K�J, t(t u•F i1 flral.Fj FxF RTO ORD
$ { 1 VALUATION $/FT.
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r� ', Ilia we 1 nNhth <rrelap nrtdrpro lGltwssuauC i 1 C p 4NT 11t;J3 4rC)NO A b CLEC.
1"iS7 rE1P Wt i 1 tares Ih Y u 1 r1.�tlmrt 1{fIIL a a Holl LgmncntahJl `4 Lr 1 4, i> ' n a�iOTAL
J pl1 I rl} *' ]f 'n :/`` ., PERMIT TO
s I `4l d�1 s andte(Il igtp Oy INh+ yl the. Intl¢W t t,liulsy
jµ•� �`1t I w(Calt ib lr�, mltbtnuntgurmh.}yy)rnn 70 ofU(vvI r Nr J'lw
H,1} �' Nuund' � n14rfL�.nd oI h`ti hh 1"q" a?tn�1"they l(glnnnJ (ITV r, '" ia; 'PLUMBING PERMIT a FEE l/
"K 1Ci' lMi 6 s Ih Ihj pll t, ekmyza.I!, Yr io tld(_{+fSy(y)r f131 1''i 4 STORIES rvnE CONSTR.
rrt,h1r`§r' L t yarytipglicalLt+,tlrel3�igtq`tS recy,SrdtKl{PpIILSnonN vupliiy d4 t F;LTER'-GRAIN& VENT
-WATER (EA.) 4,00
$}ttintmi Ihi{jfrv�l+tmd rtt,ii1N�ars' Q0„�)� yy _ isP /V
�rs4'/• R ❑ I wli r I th}r prifp$tt} br rn} fii,_pia>tts wvh wagrlw3 ' 6ACK FLOW.PROT ECT. DEVICE 2.00 OCC.GROUP REs.0"rts
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�j °�'YC t7 a(m ,d d Graft eJ fdt i'al .lt b7 gliusiH rt, m I mf ss ns .Y' DRAINS''FLOOR,ROOF,AREA,COND. 4.00 }�
'/CoA lh l{idy+lr mlorg 4fi i�L
W. anp apply toy'ar,x of IS r
•\4 r pulY wlrb hmlds onnipr$vv& rh rebn a wlsq does toeh`uyd ;FIXTURES i PER TRAP 4.00 SO.FL FLOOR AREA TOTAL ACREAGE
N l' li nsell or tltlaio,h hlpv,WrpSn(lilb}ees pravl iFA Ulu ufell m+prdvv f II 1�OD
'y At til JirA not;inl nJed gl h2iltl.fik vyale It Lowe Lt tb4 buihllny rx GAS El�SYSTEM 1 INC.4 OUTLETS 4.00
Z xtry
t Dru Ilp s sohi'ua Jiarb omp4ponl the owner
t� qi ( S'y GAS EA SYSTEM OVER 4 (EA.1 1.00 BUILDING USE
P' f bu 1111 III 1!Ace O�hui2f pFjrr +n[S tirpt ht;;ll IITorDwld of m r
.fl,f,4j.� jr Ierlul(.fy'e of iTl'n1{flrr{ RJE ty'rA�' '� �' IfVDUSTRIgi WAST E INTER. 20.00 Es IND CON PB om��r
�� yeD I a r n fll LP!{pyr7 �taClpsr'ey.c.m.aing with ' ❑ ❑ ❑ ❑
r ")ry}m I +SrrT,mn to aVdtjL;( Bfr praltf�f5ec 704n Itas,nLss LAWN SPRINKLERS 1 INC 5 V.B. 5.00 ASSESSOHSPARCELNO.
t✓ '�s {• pu411ro1 sI 'FC de lh Coi1tn14brY'Lleknle laµ• toesnnnpl ly j
ly{yPj'y v7ft Iqt?tan nrfll' +I rtyt�syfilitl;6JJs or nnproycs lNyecn slid who :.LAWN SPRINKLERS-OVER S(EA.) 1.00 .pis/z'�('-Q
n dt t, 1 mull.. µrf Ojlt4p + .FTo,LiorfOligenkL Puriant to
ai1�I + Ir for I ei kNv,, ilflI IN
,-*r a SEWER SANItTAR Y.STORM EA.200ft/8.00 TRACT NO. PARCEL No.
' u I m •xpnl1 ndud ti' `rr Is+- B kl (i.F this, yyATER HEA`I�ERrW/VENT„1 4.00
1 .f3a'3 Uiv r n...,',c""^"
rlJ,vit 'k" ---y"-`-PI, ,n ,-11". '- "S } r WATERS5YSTEMI it 4.00 ACC.DATE! ACC.FILE No.
r�wl «I'at c(IUL,L'�v ION U .ARATh v `I tWATERjR EATINGEQU IP. 4.00
ti5tp, t : I 6y"�i'7NI PI S'pi:lyfl i oP ,nint,a IC Ips,I Yrti rr yJ{ v°. i
4rhr' stir 'irt�111 ; I ^ 1r , ° it •'f' ZONING ENG.SITE NO.
„I,tiv� p,1r rr Illin (/(Wirkers.Conppdt a l loP In O,e.
gr] 1
;py lh&yol($ y 3800Lsb f:Tti
a }.� rl y4 �, Ct mpanYy t`��� � 1A// ,f r=A CC
l [] (1 .110•.JPyp} l n.by fgnhed ,y 1 Y lu( FIRE SEE INK ENERGY L24
.�}`�M11'+ fPrnli r fy k Lie dh tH Eit)Ylo.Sf tiI nlyi5lon} i^6 AMSC rrY .r'L }t ,REFER TO ORD.
A Iiiy! Vt., \p IIC' IJ. A Yt ^ Y ❑ N❑ Y ❑ "❑
'SjiV kiL" N� c I:N'I'I fk'J�CA-[1V1I'1\I:VP�j'10\Fpltkl k$ r „RERMiT ISSUANCE 6.00 FLOOD ZONE A.L.u.c.
,IgyoLU > tv CU\II(`1$Aji(�♦:Il$ORANCr[ PLC.MrON,Tp y rtf.... LICNO. PLG. V N V N
j'y r"� t Ilhl tier I tint.be�'.compfrted if thekrinit Is I(nr n 9• .{ !Y 5y y ;'_ i. TOTAL ❑ ❑ ❑ ❑
Jl* Zy� 1 Id 11+11�rv((41 If Jrssa Y 5 r
�� U Q.q I car(ly t11'.µ In Ih pr.rfgrrn\ante�Pm work(yr hrch III r CITY. MECHANICAL PERMIT FEE FEE SUMMARY
f- a nn1� 1 ul hsh II nm empluY a Y Person in any mapnersovs I _
U b m+ whyyl lu the tYO kus'Comp nsal bli Laws of Cul ti rnJ
BUILDING
ALTER OR AODTO MECH. 4.00
(+-pAy m1 NU1C1 IOdjould ec. Irl Nytma4ubth e,,'C t +fl
t �Z Int t y 1(r I b '.Co sl byes.t Ot Works o C,c tip Isamu APPLIANUEr'''E s' 4.00 PLAN CHECK
fl' I p +af 7 ih lab+ Code Y.I. most forth tl e 1 I ly with f FEE
`fU� -
,I'll 1 w sum" rr tlus pL mit shall be tleemad fi k d q/r )y 'AIA(HANDLING'UNIT(T0 10,000QF.M.1 3.00
ft]r,veuC11QN 11yrIDNr nGLNCv �"r ` fti AIRHAND INGUNIT(OVER 10fMC.F.M.) 5.00 SEISMIC FEE / 349tg'3 e 1y 1 { by II til th I t. a ec ktrl Y hslenAme aLrr y F OD"t EXHAUST'HOOD (WITH DUCT) 2.00
lY ti 1p, 3 F rel na til t_Irk P wh�l.Llµlll.,ls�,p. rl It 1 y ucd•1iS yd ry r yjEATING•UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
!.end,,',ta tic Aslf AA-14 /71✓Cau-hY" G. -
lers Address Tj '19EATING:UIVIT.IOVER 100,000 B.T.U.17.50 ELECTRIC
9 BOILER-COMP(3 H.P.or 100,000 Iffy0 111 Jibes ppl Yq+anA state tH uh bl V ENT;ILATION FAN '(( INGLE), 3.00
d "� Y In( Ni In 1 a, al act. 1 agreeto omply 'ilh II city Sivl of my v B.T.U.) 4.00 PLUMBING 3
lila *, and nate I Ilan 6 t building constriction. and
f t � h vby anallorivc representatives of this city to enter upon the BOILER-COMP (Over 100.00 BTU)SEE FEE SCH. MECHANICAL I
'St above-mentioned property for inspection purposes.
(We) agree to save. indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cuperlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 300 ' CONST.TAX
may in any way accrue against said City in consequence f the . _1 I
gran( sof lhis.enml y MECH.CONT. LIG NO. MECN
yr TOTAL
/ TOTAL
d9igatufa of Applicant/Contractor Date 11.
INSPECTOR COPY