25348 APPLICANT TO FlLL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOING-MECHA
.,Ilse-¢L.
APPLICATION/PERMIT PLUMBNICAL
A PERMIT NO.
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 25348
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMITTALDATE
10 TLI,SCO�X\ PL . - -13ed UNIT# LOT#
WNF SNAME; PHONE CONIRACIORS NAME: WC NO: NIC ONTROL#
illlul6kElo HAIR AVOkM6 F-LfCIP-kL 49WO C-Io
RCHEFECr/FNGINFFR: LIC NO: DRESS O (A O II ❑
CONTACT: PHONE ��JJ /J BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEF.
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ❑ ❑
LICENSEDCONTRACfOR'SDECLSRATION APPLIANCES-RESIDENTIAL
Qy.y Ihemhy affi met l am licensed undo powiaionsofChaflart)(commarwingwith JOB DISCRIPI'ION
u102 Sation 7000)of Divisicn 3af the Busmen antl Prafmmu Code,W any limtx is in PANELS
FFZ�aJWF. full facCwd cRal. nn .
I<F..UU Enna Ciera C-IO C, gS0 &LC� "IT020o AMPS
y6y Dine Cmlrwtm E( "I 1000AMPS
OZNoo I Z ARCHIFECTS DECLARATION OVER I"AMPS SQ,Ff.FLOOR AREA $S�FT.
urdersurd my plain 001 be u.xd as Public recoils. D I
yr F ul SIGNS ELECTRICALA
Q,MV Li sail Rafasioml OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. }rte
W Oo. I hemby effno that 1 on exempt from the Conlmcims License Law fur the M P U 1 T E
31a-vFi following reason.(Samdon 703125,Emboss and Pmfcaiau Cade:Any city m coumy TEMP.METER OR POLE INST. ^� ��F1
F-LL'j which raryim a prrmil to cwtmcl,dla,improve,4nlull.h,ur regio any nrtxtwe 23 /3
f n'n pnortoin'1.wnance.dwr,uioa,heiipllcunt for wch panni,w nlcasigncd.Iaremcnl POWER DEVICES TE
N<0a tlut be is licensed Fortson'.the,envision orlhe Corse,«s Licemc L.w(Ch.pler SWIMMING POOL.f:LECIRIC
m omLL 9(ctmmencing wl,h Section 7000)ofdvisim 3 ofthe Business and Prvfcaions Cdk) VALUATION
y _y aJest M is exantpltherefrom ata the Basi.for Nc dlell exemption.Any vioWion of Q OUTLETS SWITCHES�Fl%IURFS Sec,i,m7031.5 by my.pplI.,for.permit wmacts me aPPlicun to a civilprmlyM
am stare than five hurdred"hers(Sfi(Xy.
NEWRESIDENTIALEECTR SQ.FT. STORIES TYPE CONSTRUCTION
4F4� ❑ Lmownaofthe all eogeny,amyempmikilm,hwgnm,hei(Sm.mmp Butt. ,
m 5., will dofevii. Castle: shut oo.ce,U draw clooffetv!forsak(Sec.7(N4,Business
W Prorealoeu Cale:the Cantor«f licrnse law docs not epp1Y In N owner of
prvpaty whobuild.dwpovntherem,erldwhodocssuchwdk himxlforthmugh his
own employm,pmvidedmo such impmvrttenls vend imrn4duofferdl for.uk.If, OCC.GR P RES.UNITS
Mwcvcr,rhe build i,g u imptOvatenl i.wd wlNln ar Ye^r M cornplaiara th ow,1n-
buildcrwill have the lurdcnofProvingthat hedidnot build errimP ve far purryte of
sale.).
❑ Iia.owrlaoftbe ltWeny,.mcacludvetyrnnvaning with licenacd cantractm to QTY. PLUMBING PERMIT FEE FLOOD ZONE AFN
gtv'Imcl the project(Ser.ITEM,Business and Proo cions Coda.)The Coalmen«s
Liemse lawdoes not apply m anoaaterofIropeny who build,in impova,haman." PERMIT ISSUANCE;
who commas forsuch Fwjat,with.mnonsecos)liccnsct] int,.Ile Cmtracrds
U.x AL'fL'R-DRAIN&VFNf WATER(FA) FEE SUMMARY
aw.
❑ l am exempt udler ser. .B h P C fa,his rearm BACK RAW PROTECT.DEVICE? '
urrm
SANITARY YN
WORKMAN COMPENSATION DECLARATION DRAINS-Fl.IpR,ROOF.AREA,COND. SCHOOL TAX RECSIFT# N
❑ IMebyofrimlltatl Mveacmirimeofmnwatioxlf-iw ,d.c ficaaof FIXTURES PER TRAP RECEIPTIs
WhenComismnation Romance m acanirwd wl0"thent(Sm.3800.Lab C)which PARK FEE Y N
covin dl employee'.;under,his Permit. GAS-EA.SYST ESI-1 INC.4 OUII.LTS REiCBIPI'#
Policy# BUILDING DIVISION FEES
Comma ny GAS-FA.SYSTEM-OVER 4(FA) PIANCHECK FEF.
❑ Cenifedcopyiahcreby Un i.hed.
❑ Coif Jcgry Hfled with IAC ci,yimpariml division. GREASFJIISDUSTRL WASTE INTERCF.ITOR GRACING FTS
CPRTIFICA'I E OF EXEMPTION FROM WORKERS' GRFASETRAP SOBS FEE
COMPENSATION INSURANCE
Missec,ion recd nut hcmmpletcd flhcprtmi,isfmcmhwdtnl ddlon($100) SEWER-SANITARY-STORM FA.200FT. ENERGY FEE
d ka.)
I canify tbot inmepc,f.,of tlawoarUk for which this1 ypanni,is issued,l stall WATER HEATER WATIST/ELECIR
nil employ uny Pav9an in any sumer w / :lMt Io Ota Wortera' PAID
0 Z ^mrynueticraL#ws CfAl ftpo� F� / \ :! WATER SYSIPSIRRPATING D.a Rraipt M
Z O NOTICETOf(AIWYPJIP ICRANTC:lff,.ferm.king, C�,.c.f Erempion,ywshould NEW RESIDENTIAL PIJAB. SQ.FT. TOTAL
V1 become whlalw,M1e Waker'sCmnrpmutian fnovi.iau of Ota l�bd Code,You onus,
� � fonhwiN comply wiOt such provislda mthu pcnrtit dtdl be 4emed revoked.
BUILDING EYE
aQ 'CONSTRUCTION LENDING AGENCY SEISMIC FTI;
U O I hereby dtum thw Otcre isacwutraalon kwing.gcnuy for to Pcrfarnweeof TOTAL ELECTRIC FFE p
me work for which this pe n it i.inucd(Ser.3(P7,Civ.C)U. V
I.rojt,Nvrc
0 Lanalms Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
U I cxnify Nit 1 have rod Ilm s Plication and"a thin Ibe.hove infomlution is MECHANICAL FEE
correct. eto comply wi0,dl city and cowry ddimrca eta Lak Hw.rtWin#to PERMIT ISSUANCE
F_ � building cdstrontion.and hereby authwine rtpruenutivn omiscity to enterupon the
U Z obovc-1tlatliatcd progeny for rogation fau ossa. ALTER OR ADD TO MECII. CONSTRUCTION TAX
(We)agree m"vs.indemmify and kap bnmdeaa the City of CuPertino namost
liobithrin,judgments,costs and al,.,which may in any way seen egaimr said Cry AIR HANDLING UNIT(TO I O,OW CFM)
in conayucn¢of the gnnOng of Ws pmmi,.
AIR IIANDLING UNIT(OVER 10,0)0 CFM)
r.&rinM
Of APplicenl/Catumc,d Dao EXHAUST HOOD(W/DUCG PAID
I IAZARUOUS MAWAIAL5 DISCLOSURE IIEAIINGUNIT(TO100,0)0BTU) Una Recefa#
l Oe appucam err future building omop.d nne nr kindle h.vrdu nummidHEATING UNIT(OVFA IW,fg0 tl11U TOTALby the Cupauno Municipd Cdk,Charter 9.12,and the Health and Safety
Code,Samot 2553200? VENTILATION FAN(504GLE RLSID) '
❑Yes �.No ISSUANCE DATE
BOILER-COMP UI IP OR 100,000 BTU)
WllltFevppli®1,m(uturtbuildingoccufwl use equipn,cntadcvlm which arm, 1� {�
40,tvsdous air contammasou,to 4fred by the Bay Arca Atr Quality Managenen, BOILER-COMP(OVER 11X).000 HI U7 R1 A
Disttid7
❑Yes /1(N. NEW RESIDENTIAL ME H SQ.ff.
I have read tlx lt.r..dmu m&tminls re,lWomenu undo+Ch.pur 6.93 of Ne JUL 2F1
Cdifamin I Icallh A Sdety Costa,Sections 25505.25533 aa1255 W. 1 uo krstud Ih o V
if the huilding does int currrndy have a lemuol fist rt is my nespanolahty to notify flue ��K
cecuaam or the mFtirtmrnb wbicit most he met prior to iatunce of a Ceni;cine of CII Y Ur
Occit'incy.'
Owner or authur,nty] st Dere TOTAL; ISSUMy BY:
OFFICE
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