26358 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BIL IN - .LLL RI L "MIT NO.
APPLICATION/PERMIT IMNG BING-PROJECT
26358
BUILDING DIVISION BUILDING PROJfiI'r tUEfrT61G\TION
UILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL�DAM
UNIT4 LOTCa/�`�
CONTRACfOR' MSN!)M' 4� I.IC NO NA- VV
WCONTROI,I
MtCHIIECT/FNGINLER: C NO: t0//6 ADDRESS:_ ^ 6 -n
V
ACT. PHONE: N. ELECTRIC PERMIT FE BUILDING PERMIT INFO
�^'[,Q•1i ��6J�/ BLDG ELECT PLUMB M
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION pPPL1ANCT5�RESIDENDAL
OtYZ IM1ercby.ffim
rthatlunlicrnscduMv vimof ChWp 9(c«n ingwith JOB DESCRIPTION
[ 00 Section]000)of Uvuion 3 of d Business and Pmfesdma Costa,and my license is In PANELS
zu1 ran r«re w ere«t. (TrV�
UsdaPS
Liss.N 116/S'p
201-I 00 A PS
y Q Date Ceruren« 201-1000 AMPS
ZOrroit� ARCHITECTS DEMRATION OVER 1000AMPS SQ.ET.FLOOR AREA S/SQ.Fr.
OZ�(��f Iundrnard mypl 'load be usM^public rtc«ds. ' SIGNS F.IA:CfitlCAl,
Q,7C'] I.I«nacdPod PRI _
E Oo. OWNER-BUTLDERniDECLARATION SPGCIAL CIRCUIT/MISC. UI
xx Oyca.. I lemby affirm mu 1 em exemq from the Cmtran«s Liana Law ec the
u131a.N following rcum.(Stttim]0113.Buawess.rd Rnfessimn.Code: RED
My my«roomy TEMP.MCIT"OR POLE INST.
which returner.permito,roramdoa .ser.imgove,dermlish.or rt}mir any smucmrt Po\VP"UEVICPS
;!(>� prior to its a
uwnce,auo reqre uithe"Ibcenr for such pernul to file.siu+tenr
gocdru
�ps Wt he is loaned mnuwt to de,povkimat of the Contrecwra Limue La.(Cluger
a Xom4 9(c«nmencing wiNSeciimor70W)ofDivislon 3 of the Busires.nd Pmrevsionn Code) SWIMMING POOL ELECTRIC ) VAL /\I
W_y orfloote,Sr,6-7isexemgthcrtrmmvnd the bmiaf«Nc elkgedexcmgion.Myvinleum of 1/T_�
FZ�' 8cdlm]031.3 by arty upPlicvnlr«eprnnh subJmathe apgimnuo.civil penalty of OVIIEfS-SWITCHES-FlXTURES
Sd nosmom then five humped dollars(S500).
❑ Lvowrerofdegopety,ormyemploymwith wegnudeirsokcrmpcnwion. NEWRISIDIITAL FL.ECIR _SQ.FT. STORIES TYPE CONSIRUCfION
d5— will do dcwork.end the swcirme is nos inlemdM«oRcrN for We(See.7644,Business
and rrodd ms code:Tie Gnuxl«a Lioame"w doas not apply to an owner of
proPcrty who builds«imgova dertod,.d who da.sorb work M1immelf«thraegh hu
ownempheees,goridei Jutwchimlaervemmu uewtintvdMm,dermad f«orsdar. OCC.GROUP RFS.UNfLS
hmwerer,dl have
the
urobwithin ore year o im,rrove for heowrcr- �a
Wilda wdl have the huNrn of poring than he did not build«im f« f ° lJ FTE SPRINI prmvc purpmcm
.atlas). PLUMBING PERMIT' FEE D nPN
❑ Lmawncraflhepruparty,umexduslvdyc«nructin,oa Code:)
The C.t.onm �' ROUIR
itarmact the pmject(.Sec.]1N4,Business and Prufanirna Cade:)The Cmtan«r
Liccnselrswd«rsuch mye is wnerofpnspmY w'a Wil dsoriml*oratBertmo,and PERMIT ISSUANCE.
wharote nsf«sixhpojecawith.caotmamor(Mlkerud lNuuant lode Cmtr.n«s ALE -GRAIN&VENT-WATER(HM FEE SUMMARY
Cleans I.w.
UA`
❑ I m eaemq uMer sec. .B&P C f«this rcumnCK FL O CU DEVICE OUTSIDE
FEES
SANITARY Y N
Drue
WORKMAN COMPENSATION OHCLARATLON DRAINS-Il.(UR, F.AREA. SCHOOLTAX YET» N
❑ 1hereby.ffirm that l have a certificate ofeosucnt to aalf-inere,or a comficate FIXTURES-PRT ReCe1PfP
�Wurken'C«rlpenetioa lma « compy
ance .comfier!cotherrof(Sec.3800.Lab C. ch PARK FEE Y N
1 coven all cmpbyKa unser This prtml. GAS EA.sY.SIEM-LIN 40LTLFTS RECEIPT
Miry» BUI. DTVI NFEFS
Com Y A .SYSTEM OVER (EA) PLANCIMCK FEF.
Certified cop,is hneby femuhW.
❑ GRdfiM copy is filed with the city impeclmdiviim. SPF/LNDUSTRL WASTE "CEPTOR GRADWGF
CERTIFICATE OF EXEMPDON FROM WOR S' RFASETRAP SOILS
COMPENSATION INSURANCE.
(Klin section reN nut be uiinpletcd Bras,permit it fir alt Mllars( SEWE"-sA T Sf0 ;A,ZNIFT. IltF"GY FEL
,lea")
N 41
I oenify dot in tk Padomure,ofthe work fm which this pend is issued.l a hell R t W /E1.Fc TR
m
ran employ any pmn am
in any mma e «as to bee«rc subjeet t the Wken' PAID
u
Comperlioolawaof C.lifomi.. DucSYSIP FATWG Due
Rem N
O z Applicaa
Z O NOTICE TO APPLICANT:If. rr
after ukiog dtu Cmllmu xemplar,
iof Eshould T NTIA
NEW RESL PLMB. SQ.Fr. TAL
� > becomesubject 1.me Worker's Comnpmadar mcvisiom ofthe Labor Code
w , mon BUILDING FEE �ti
forthwith comply with c « permshal
h pmviQcdathis it l adomed,evoked.
Q CONSTRUCTION LENDING AGENCY SEISMIC PER1 hereby affirm That them is a conmrumion lending nenry for IM1e performance o „
IMU p the work f«wn'rn ton pcmti ,s iasued(Se,3097.civ.C.) V ELECTRIC `
I<nd .Ntmc
OLender's Address QTY. MECHANICAL PERMIT FEE PLUMBING
I codify that I here dead this a Hod im lard sato Rat rdornat
tho.bore iior u
correct.Iairee wcomply with ell city and c«mry«di®ruv vd uvel.ws rtledng to PERMIT ISSUANCE
CL
building can+wclmn,and ltereby.adlorve reparnudvn ofthir cit,marter upon the
U above-nemorred Pmpny for inspction WTo�'. ALMRORADDTOMML CONS NTAX
(We)agmc to s.vc,indemnify end keep humleu theenin
Coy of pngainn
IiaM1ilidn,judgrrcnd.assts ualapcmer which rwyln.ny w/9 eagum id City AIR HANDLING UNIT(T010,000CI'M)
mm eyacn«cf the,mming of this permil. AI
f
G R HANDLING UNIT(OVER 10."ChM)
Sigratme or Applicant IrClmr10 Dau L EXHAUST BOUD(WJDUCD PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 1W."BTU) Due --py
Will the epplicanl or future Wilding ceto,am nom«handle hvard«a material HEATING UNR(OVF"IW,roU BTU) TOTAL
as defred by de Cupertino Municipal Code,Creon 9.12.9.13,end the Hudth and Safery
Crde,S«tion 15531(a)'! VENT]LATION PAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE DATE
t WdLthc.pplirnnt«fumrthuiWirrgoccup.nturetyuipnemuorhvtm wM1ichemit BOILER-COMPDHP OR 110,000 BTU)
a cmtmrunerus as dcfrrmd by that Bay Area Au Quilty Management BOILER-COMP(OVER 100,0()0 BTU)
aoD
L
Yes ❑No NEW RFSIDFNTIAI,MECH.—SQ.FT.
haved the ba;m materieH requiremenu under Chapter 6.95 of the JUN 8 1994
lth&Safety Crdc,Sections 25505.25533 and 25534. 1 understand!dor
dmea nml cmmmly have..,,IM1at It is my respmsibility to mfdy do
rcquimrtcnla which must be mel prim to luuaree m(.Ccrtificae of CII Y
mrredeg.a Doc 1 ISSUED RY
OF