25826 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOI. IN -IxLhC I RICAL PERMIT NO.
APPLICATIONIPERMIT PLUMBING-MECHANICAL 25826
BUILDING DIVISION BUILDING PROJECT IDFNI'IFICATIf IN
BUILDING ADDRESS. SANITARY
SANITARY NO. APRJCATION SUBMITTAL TAL DA
Iu V� `1'7`„� �1 UNIT# LOT#
WNF SNAll : PHONE: CONTRACTOR'S NAME,: LIC NO: L
A ' j _ (�IN {C/J yv y--y. NC CONTROL#
CHf1E OINfER: /LG"li UC NO: ADD D D UIf'NGL •, VJ"v I"c.
CONTACT: PHONE: BUILDING PERMITINFO
/rfUN"IL 4 QTY. ELECTRIC PERMIT FEE
f— �I��� 1/6 � b PERMIT ISSUANCE �� PLUMB ECT,
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RFSIDGTALJOB OBB`DESCRIPTION
pyZ Ihcrtby affirm that l our liccnsm utukrprovisions of CTalua9(commennngwiN
W00 Sembn)000)of Division J of Be BuO.,rd Pmfessicr,Core,sort or,license is io PANELS
UPTOMAMPS
FL� fullcRas. Lic.N��sl
1 iD Due ContncTo�(� OVER 10 AMPS
1"'yZ ARCHITECTS DE ON SQ.FT.FLOOR S/SQ.FT.
ZOVs— Iunretsland mYp na.rhell be uaJ ux publi<rtcarJs. OVER IOW AMPS
F y t IL SIGNS ELECTRICAL
Q��Q IiccmcJ Pmfes.ismal OWNER-BUILDER DECLARATION SPECIAL CIRCUITRdISC. /�'
OWL) I hereby aErm that I sat exempt fmrn Be Cmmoctor's Liwve law f«the ,V V
Iy3LLya (allowing s®san.(Smiion'IOJI S,Business and Hofasiw Codc:AnY city�ccounlY TEMP.METERORPOLEINST.
which m mires n permit w ce1dN[I,ohs,impave,cenwlish,or repair any,ummure
prim to is ivuarcx.also requimtlse applicant(«such permit to file a times!Wormosel POWER DEVICES
0O Thuhe is Bvensed pusssnt to the povisi«u ofine Comacror's ldcave Law(Ch. y ptSWIMMING F001.ELECTRIC CLL�C 9o,Ormtsetcing with Serum17000)of TTvision 3 of the Business asld Professiars code) VALUATION
y_LLy «tM1nt 7031.5m run,tt mmam the bmunil,hjxallege exemption A civil ps adly of
FZ,Q mo more
than beenyepplitantfm 5500).Txubjettsthenpphcanuoacivil puWryOd OUTLET'S-SWIICIIFS-FlXIVRI'S
not m«ecow Eve M1wdrm Japers(55!101. NEWRESIDENTIALELECIR _SQ.Ff. RIES bTYYKFCONSTRUCION
zEz�❑ ❑ 1.¢a owns Mthc pofertY•«mycmplgbswiNwtlgesutlteirademmp�eum.
y3� will da the w«k,ud thewtctwe is.imenred moffam f«sale(Sec.]UW.Bosmb. �
and Prefcuions Code:The Contractors liana law docs rt«apply to w owner of Q
puPeny whobuil,is«impnves thermn,oud wMdoe�.such w«k himself«Through hin .GROUP RES.UNITS
cmM^Yws,puvireJ JW socio impmvememaart nd inleMCd«uReml(mule IL
bowlerwihcbve the
a rovi l'ahatbc fid otse year of improve for Theowrcrf T 0
builder will have the burdee of paving that k did MI build or improve for puryox of
,xJ`')' FEE
❑ I,as uwrtaof the pmpero
rY.am exclusively ntrlicensedm
ng with licensed nuact« QTY. PLUMBING PERMIT
sto Fl- APN
«,u met the p,ecl(.Sec.7044,Bmincts rood Protevsions Code.)'D Com uclor's
Licenx lawdocs msapply T^anawnurufproperywM bwlJamimpnves dsereon,and PERMITISSUANCH
whoeai Law.(«.nch Pt^F«+wish•rnnvacT«(s)licenem postal T to IIIC Corlh%tNs
U.Law. ALTER-DRAW SVENT-WATER(EA) FEE SUMMARY
❑ 1 am ncmp uMa Sm. B&P C for Nu reason BACK FLOW sAli Ls
SANITARY Y N
Owoe, D. FlFS_ 1 RECEIPT#
WORKMAN COMPENSATION DECLARATION DARS-1 RCHOOLTAX
N
❑
CEI
eo,m,:C«ttpclwtimolmuuTrextril.mcopy 0sereof(Su.38W,Iub C.)which AR tFTJi N
vers all rnaploycc'a utdcnhls petmiv GAS-f?n SYSTE.�K Wt}��1U RE P
Policy 1�N/tilL .0 GD DIVISION ILLS
Coopany GAS-EA. ,OVER 4(EA) - PIMOCHECK
❑ Crnifim«qy u hveby famished.
❑ Certifies]copy is film with lieciry impccdm division GRESFJINDUSIRL WASTE INIFRCFPIOR GRADIN
CERTIFICATE,OF EXEMPTION FROM WORKERS' GRHASHIRAP SOILS
COMPENSATION INSURANCE
This cation nem.be c000m,st ifthe permit is forte hundmldollen($IN) SENWElt-SANITARY-STORM EA.40(Icf.
«le )
I terrify that in the p,rf.eOfthe work for which this panus u iatref.I dull WATER HEATER WIVEIST/FJEM
fat rnq+IOy any yrs'^ in any mwocr so as to bcnxre subject to the World mPAID
z Cmo,emoriontasys of California. Use WATER SYSTE UTREATING Due Rae N
Applicator
z� NOTICE TO APPLICANT:If.after mLLJ,Rus CenBUue of Exemption,yau shouts NEW RESIDENTIAL PLNTL SQ.FT. T AL
bec«newb*l to the W«kcs Cmnpvauior govimons.flhe labor Code,you must
C4 ^ fanhwith mtttplY with such proviusms«This pennil sfuJl bedmrcdrevakM BUILDING FFE
0. ❑ CONSTRUCTION LENDING AGENCY SEISMICFEE Z
V z Ihaaby affirm thuthemuecaetruction lording egatcy r«Ibe l'af«narcTM T rAI ELECTRIC FEE
the work for which this permit is issom lScc JOff/.Civ.C.)
tr-- Lender's Nstax
Lender's AJbB QTY. MECHANICAL PERMIT FEE PLUMBING FEF,
O0 b
U 1 certify that 1 have read this application mxI sate That the above inf«meYun is MECHANICAL FEE
corm-I agree to comply with all city and aunty commrca oM sour laws releung m PERMIT ISSUANCE
F_ � bnlldin emorction,Ydhereby arobusire RpeaTY4vb Of lM1la city to eMa upJn llC
U z, ALTER OR ADD TO MECH.ebmetteuimud prsyeny f«insyztbn purposes. CONSIRUCIION TA%
(Eo11�Z.w,tfi,,m,cx
,mckonnify erd kccp harmles tM Cay of Cuperim egainn
liabilitwhichmryinnnywayaccrueneint uiJCiTy AIH HANDLING UNIT(TO IO,gM)GIM)
inclse gruoung Of this pemm.
yIf, AIRHANDLWGUNIT(OVER iL0NCFM)
S' nature ofA - tVCuntmclm Y """ I EXHAUST HOOD OVIDUCT)
PAID
HAZARDOUS MA'FERIAIS DISCLOSURE HEATING UNIT(TO W,000 BTU) Due Receipt#
Willthe applicamorfor.Imding orowl u«e«lundlc 1,rardnw vaterol BEATING UNIT(OVER 100.000 BTU)
u ref«d by the Cupenim Mtmkipal Code,Chopta 9.13,ud the Health soul Safely
Code.Section 4553401 VfM LATION PAN(SINGLE RFSLD)
❑Ycs ❑No
ISSUANCE DATE
Will the applicant mfumtr buildingoaupentusecgdpeax,t«Jevlca wtichanit BOILER-COME(JHPOR 100.(X10 BTU) 1'�qq
hnraedos uau am
comitwu ea refTnm by the Bay Area Air Qua iy Mmager em BOILER-COW(OVER IW,W0 BI's!) A 1 gak
IRsm<f! ! L/
Cl Yes ❑No NEW RFSIDFNTIAh MECH.—SQ.FT.
I have trod the hvaudous muerinls rtgoEemena order Cm,.6.95 of the 19
Califomla I Icallh S,Safety Code.Stuff..25505.2533 W 25534. I urdavud that /s 94
if the,building rhes rw cunentI,hoax atrnmu,dm it is my esportsibilhy to notify the ^�I r
occupant of the requirement which most be met Error to luuome of a Caufttale of Vr GUr
O«uponcy.
Owner«wN«sN ages Date ISSUED BY:
OFFICE