26180 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILD � " PERMITNO.
BUILDING DIVISION APPLICATIONIPERMIT YLUMBINJECT IDENTICAL 26180
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: ,.1^�I, I ' r}�}\rC SANITARY NO. APPLICATION SUWdMTAI.DATE
104-00 TA�1 JAU / ` • ` UNRx ,(LOT# `�� .
,OWNERS
OM � � G� UC NO: J
."V1 NtC CONTROLx
In d fENcNnr� IC NO D NL
CT al
ONTACT: PHONE BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG [tCf PLUMB MECII
PEFtMRISSUANCE A E] El El
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDPNOAL
GKZ I heebyaflinndball mlitteeaullderfaovisioruofCh.plv9(eamnlmcingwitn ..J�OBt DESCRIPTION
J40
F e,ti11 Jl
70XeffDvri,ion J of Bu,iota,ed Pmfeul.Codd mnens
Corte,ay liis in PANELS
V # IJP T02(p AMPS Jl�'
QZw Li«m
�Qd Conuactm o61� OVER
AMP
ZOOM A HITE.CPS DF-CfARAMPS
ION SQ.PI'.IJAOR AREA S/SQ.ET,
)ZF�
eretan'n7 Nvpublie rtmrdt OVER IOOO AMPS /\J►YI'�l]
_ SIGNS ELECTRICAL
gFy�J I.urnaN PrO �
"y�Q OW ER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
OW, 1 hxeby allilm the,1.m eaemp Iran the Conueear'a Licme Lew for the
W following renwn(S«Bon 7031.5,Husinua end Prcfcesim.Code:Any city or county TEMP.METER OR POLE INST.
which eeyubec a pen011 tO conwuct..11e"impove,drnwli h,or rtpid,any'"arae
poor,n ita atutune,dso«quim 0r applicant fm stub perini,lo rile asigrodstatemeat POWER DEVICES
<O that he i,licen,eE ffoari to the Pnwtuorlsnf the Cmtaaors Lkcna Lew(Chenu
m0.x o� 4(crxnmmdng with Scmim J000)of Dlvision9nfthe Hurircv tad Profeaw Code) IMMING POOL ELECTRIC VALUATION=
W_, or tha,hei,eaemq threfmm and the buffs for,he aH ec!cxvnptian.Any violetien of -SWITCHES-FlXTURFS C/—�C.
LZa Sectim]O315 by any applicw,fore pamit,ubjau thc.Pplicanno a civil petalry Of
S O nt
than fvchutld $5
0T.
01,uwrcof0popmy.mmmwiN wuutMrokmpra, NEW RISIDfhTALELECIR _SQ.IT. STORE9 TYPE__C7N_M=ON
�3� willdothew«k,edthestrtu5urti,tlmintmdd«oR«Nf«.vle(S«.]I144,Bu,i,css
ana narca.tn.ctde:Tne ennnanlM.Li«n.a law d«a nm.pMr m,n aw,Kr nr
pmputy wls0 bead.«imprtrva atemon,w,a who a«a,aelt wart w,wv«d,rwgn nu
ownmlploycgpmvidd tM„ucnimp,ov<mentsert na ime,MW marred r«,ale.If, P RES.uNns
nowevcr,the naildingor hn,wito entI,sola within oneyewofcmnMuicm.lheowrcr-
builda will Fera be bwdrn of Poring that he,did not build m Improve f«PurPme a(
,ak.y
❑ 1,uOw ofthe mpmy,cmexclumvelycmt ingwiNhc"WCons.c,anto PLUMBING PERMIT FEE 11.0010,ZONE APN
Loraouct the I r kc,(Sec.7(344,Ba,.,end Itofacdou Cni The ^
iecna Liwdoa nm y,Iy to en aw,lnoflropcny who Wild.«Ln PERM{T ISSUANCE
wnocono.for cachprojecu ithircmv.curds)liccnadW to AI,TFR-DRAIN 'f FEE SUM
W 11> ('�+ _ MARY
Litems Law. r
❑ T am eaemp umkr Sec. for NO.rea+on PACK IlOW PR TEC{, EVICP S�^� �,/J� u NITARY Y N
Ihmm Data + 1 \ / ;I�_.t� RF.CF,IPTN
DRAINS-FLOG ROOI',ARF:+,CON6 0
WORKMAN COMPENSATRI ECLARATION ^r. - r. 1100E TAX Y N
❑ Ileeby.ffmm thvl Mc.ccnifia�c of caws,msclf-insum,«.¢nif to of Fl�gPS_PEg.�P` F_ — — I RE PTP
Wohui Ctnlpauuimlcar..maccnifid copYthertof[Sa�3PAO,lsb CJwhicM1 i - � PARK E Y N
iR
covesall empbyee'•uda this permit GAS-EA YSfEM-1 ��:.'� _ _CEI N
pdLL.S.0 i / 7 BUI 1 ION FS
C—Pany GA.S-EA.SYSTHM-OOP, .. PLANCIIEC GtH at S15
❑ Cenifiedropyisherebyfami,Tted.
❑ CrnifedcwyufkdwiNt city4uBeubndivi.iasl. GREASEaNDUSIRL WASIti IMY.RCEPfOR GRADI NCA
CHRDPICA'I I'OF EXEMPTION FROM WORKERS' GREASETRAP S LS .E
COMPENSATION INSURANCE
(This rection need nut be cm,pletea ifthe pemtit i.for one hunmdddl. O10J) SEWfJt-SANITARY-STORM PA. ENERGY FEE
Delos) np��
LM
Icvtiry,hat in the prif.e.fdre work f«which III pvmi,uivud,lslWl TCR TINY RW
m,ecri any penin in any Wilmer sou to becrOal su1 to the Wmk'ea' a �• y PAID
Cmnpmw'tm Laweof Celifumiv. Dtic 7 -WATER SYSII:M/IREATiNC III Date ciptM
Q z APpli., _
z NOTICE TO APPLICANT IL after mekil,g NUCertlBcue Of Fsanpfirei you should NEW RESID64TAL \frjf��'JQ.vi17.1t T AL:
> Mwith chject to The WBi omplY with arch pcoviannwWia locr,doll be deemea,evdecd. ratan J BUILDING FEE �x
C. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE `
O I hcrchy of orn ba,Il ere it.c.f,n leMing egeo,,,for the Etas ce
U —C
the, TOTAL: ELECTRIC FEF,
ork f
wm which that er
pmit at Baud(See MYCL Civ. J
Lerd fa N.
u' F fonder',Addra, QTY. MECHANICAL PERMIT FEE PLUMBING 1`113-
u
EEU 1 codify than,1 hnv,red that eppliruion and atatc that The,above inform.non u
} caa¢t lapa,nconWly with Jl clty.d tvnry mdimrua W.44e lnwx rtlWtry to P /c MECfIANICAL FEE
PERMIT ISSUANCE
F' building Oadructcr,,and hcncby eathor rcpremcrai ofthis ciyo,enter ulmt the C CONSTRUCTION TAX
U Zvbwc-,ncntlmdlcropni for mspec,kn purpa,,a,. ALTER OR ADD TO MECU.
(We)etlrOe to save,iidamiify and keep huMcs the,Ciry of Capevimn ngainat
IldOlihm,jud,si costs and eitprneee which may in any way accrue eid Ci
gaiml said AIR I IANDLING UNIT(TO
10'"CFM)
inm1; n the granting of
AIR HANDLING UNIT(OVER 10.000 CFM)
Signe TCI Date BXHAUSPHOOD(WNUCT) PAID
DOUS MATERIALS DISCLOSURE HEATING UNfT(TO 1001 gBTUI Date Rmif4x
Will 11 de eppllaunt«futurt Wilding xcupant Wore nr hardlenvanrdaus materiel HEATING UNIT(OVER IOO,000 BTU) TOTAL
ss doh i by the Cupertino Mwicipal Code,Cltapa 9.12,and the IIu1N ed Safny
CNc.Smim 255JP(U] VENTILATION PAN(SINGLE RISID)
❑Yu
9111-0
4j
tY0 theepplc.nt«fwurt builaingo«vpvtt ua cquipnMnt mdevim whkhanit
BOILER-COMP(THE OR IM:000 BTU) ISSUANCE DATE
n.rnma,eat cntarninent,a fined by tnc Bey Area,AB Quietly Muugcmcnt BOILER-COME(OVER H)(LOO)BTU) P A 1 D
Oi,ricR
❑Ya No NEW RESIDENTIAL MECH. SQ.FT, WAR 1 have mad the horaduu,co iels I1,B,,mrnts andm Ctwpar n45 Of the n 281994
C.IUmeBIIul,hS Safety Cade,Se . 25]05.255]1 ad 25530. 1underused W, WA
if the hildingdm lid curnmtly have I.that it mY ,r,ouibh,y,o,totify the
eapa,fl n rt at pri«to isnumte a Ge iHcan,of Clll' tar I I
«m 3
0Dwnmoru 'cd agent to ISSUED BY: _ a�
OFFICE