25449 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO PERMIT NO.
APPLICATION/PERMIT ,PLUMBING-MECHANICAL 25449
BULLRING DIVISION BUILDING PROJECT IDFCUF'ICAIIOS
Bll LDING ADDRESS: ww SANITARY NO. APPLICATION SUBMITTAL DATE
r .UNIT♦ LOT♦
N
PHONE COV
1_
PW7
Eo NAMELIC NOSIC CONTROL
LI� i
. RCHRECT(FNG1N WC NO: ADDRESS: ❑
CONTACT: PHONE QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLI3G ELECT PLUW MELIi
PERMIT ISSUANCE ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENML JOB DFSC$(
cwz Ihcrehy aR Ilia,l son licensed aoJerlroviaiau of Clapter9(cmnaancfltp with l� ST/`Trl-+N`�
LL 00 S,,.7").f Division 3 of the B�..,and Profeasiau'Cade,andmy lisrue u in PANELS S^
Fty V full force ud effect. UP TO 200 AMPS
FZyt License Cleo Lie♦
en« Date C..Irr 201.1000 AMPS
FyZ ARCfIITECPS DECLARATION SQ,PT.FLOOR AREA $/SQ.FT.
ZOOZti- I udcluaod my plmu shall be ucd.Public rawda. OVER 1000 AMPS
rry w SIGNS ELECTRICAL
g ticcvM Professional
"y OWNER-BUILDER DECLARATION SPECIAL CIRC(TIMSC.
XdOaU 1 hereby.m.thu 1 un ncmp from h,Contrrtor,t Ucente lbw for Hi,
ul3 oy f(slluwing fetool(Swain 7031.5,Bu.anm and Profdsiotu Code:Any city m,aunty TEdP.METER OR POLE INST.
�LL1J<] which rtgaird.omni,10 4rucl,idler,improve,dcmolinh,a nebur.ny boo.
f�YS Prior to iu law.rce,also reclaim du.ppliont for.ait pumit to filt,ii clad u.rrnam POWER DEVICES / 1
E5 QC I a1 he n licdved pcnwet to the Iaavn..of the Camadar.Licence Liow(Chapter It, Ill
In,
o(Cy 9(mmmciciny with 5atian]Btp)af Divinion3of tM1ctldircs ud Pmfcssiaru Codc) SWIMMING POOL ELECIItIC I B ON
_y mthu h7031 sby anmefmmud Ne,.buiinable.11egM,,bo,ia.Anyviduian of OUTLETS-SWITCHES-FIKNRFS On. mP V T R
FZ_a Section]BJ1S s uonclod untfarepermit eubjecu the.pglicmlto.civ0prnaity of
�0 than fivchwdrtd dWlua(5500). NEWRESID0, 1ALELEC)k SQ. J / I ECONSTRUCTION
o ,a.ownerofdtepsperry,amycmploym wiN wv,dioheirwle.,ewllon, 4V
a3_ will wor5."the.nnidtao, inmemaa a dInitials,(sa.]w4.BntinciaDATE
soul Profnssiau Code:The Conatido ,U.Law don am.poly b N owner of
pmperty wtaabaildsaimymvd Inman,anal h.d,.such wak himselforthmugh his
mvnempbyed,povidd dw auch impovrnelLLtuelrotiNrnhduofiemlfm.ule.lf, C R IIP RFS.UNITS
however.dtc buildin�ainpmvemcm is sold wimittarc year ofcomplctian,deawtn- TOTAL:
Fwlder will M1.vc IM1e M1uNrn of proving that he did rid luild a imPmve far puryme of
cote.).
❑ I,mownerNthe Pope^Y,mncaclusivelycortueniltgwithliccmd cwv.ctasw N' PLUMBING PERMIT FEE FLOOR%ONE AM
anrun the project(Sec.7044,Busirw-u and Pmfeuiw Cade)The Cmtradors
Licwelaw Nod na apply loan owneraf propcny wha huildsaimpmvdthcrtan,old PERMIT ISSUANCE
who c.oracufaruuh proj"sith.con4acuv(a)litt�pa. ,an da Conaanoc's
Licaec Lw, ALTER-DRAINA VENT-WATER(FAj FEE SUMMARY
❑ I.m cx mpt ander Sc. ,B R P C fa this rt.san BACK FLOW PROTECT.DI;VICF,
SANITARY Y N
DRAINS-FLOOR,ROOF.AREA,COND. RE.CEIPI'a
WORKMAN COMPPNSATION DECLARATION SCHOOLTA% Y N
❑ Ihcrchy aff vhnlhavc a<rnificatc of come.,to ulLinwre,a.cmificue of Fl RFS PERIRAP RECEIPTY
Wohm'CtrnpmaOun Bnwarlcaa•ccnifidcopythcrmf(Sc.3g00.lab CJ which PARK FTE YN
ovrn all emploYd'•ceder dw peaeir. GAS-EA.SYSTEM-]NC_4 OUTLETS RECEIPT I
Policy X BUILDING DIVISION FEES
Co nPanY GAS-EA.SYSTEM-OVER 4(EA) PIANCIIECK FEE
- ❑ Cmifidcopyi,heeebyfami+
❑ CerOBd ropy is filed with the city iropcctim divl.iom GREASIONDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EJ(t NIT10N FROM WORKERS' GREASETRAP SOILS HE
COMPENSATION WSURANCE
(This..rcA rot be coni lflM permit is faaoe hunAd dollma(S M) SEWER-SANITARY-STORM EA.21X)l ENERGY FEF-
or lace.)
I mtifyth.t in do perfomur[e ofd,work for whkb thla permit it issued.i shidl WATER HEATER W/VENT/ELEC11t
not employ any Pusan in any numtd w u to became wbj,xt to Lha Worker.' PAID
z C000nwlortLswsof Cdifcso. Due WATER SYSTEA/IRFATING Dstc RceiPN
AMI rot
QO NOTICE TO APPLICANT:If.sifter euking thu Cenificate of Eacmption,you ahoold NEW RESIDENTIAL PLMB. SQ.FT. TOTAL,;
Cl) become object to da Worker'.Compnt®dan proviaim.M the lam
labor Code.you au
fathwilh comply wish wpr
ch vl.uons or this pcnoil drill be drd
cenmvAM. BUILDING FEF.
CONSIRUCfION IJ]NDING AGENCY SEISMIC FF£
173 z Ihereby aff th.t there u.Courtrai ladirtg.gduy for thepuforcerr of(Sec, TOTAL: ELECTRIC ItiE
O wort for which this permit is inucd er.3(19],Civ.CJ
1<ldcr's Nemo
(L PLUMBING FEE
Q Leder'.gddrm QTY. MECHANICAL PERMIT FEE
I cenify that I hevc red Nice.ppliation and uste than His,ebwe infamauon is
MECHANICAL FEF,
W mnecc l.gnz b
comply w,Jt idad as
l dry unry trace uc law relnPERMIT inLg to PMISSUANCE
ybaiWlegermttntctiory ud haebY.udtais represenwivdof Niaairy to wnupon the CONSTRUCTION TAX
U Z aMwe-rnentiamtl Progeny for inspxian purpo.a. ALTER OR ADD TO MECIi.
(We)ugnc to cove,iMrnmiry W kap h.rmlm da Cuy of Cap iooagvnt
li.bilihd.lu u,cmu.m expelw_r which nay in troy way sttrae., irw mass City AIR HANDLING UNIT ITO III,"CFM)
m �"`
l.�Irto ��a-93 AIRHANDLWGUNIT(OVF.R10J(OCFM)
si wart or Appliunt/Cmtrxra One Exxqusr xOOD(w/Due)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING HEATING UNIT TO I W,IXp HTU) Doti, Receipt M
Will be applicantor future buildingocCh .tme2,h.rdle Iu:.Auunwdi.I BEATING UNIT DOVER 100.000 BTU) TOTAL
n Jefircd by the CupcnE,a Mtmicipal Cade,.Chapter 9.1;W the Hdth.d Safety
Cade,S,,f 25532(.)] VENTILATION FAN(SINGLE RES1D)
❑Yes ❑No
ISSUANCE DATE
Ntll Ne.pplidruafuturtbuildingrlccupma use cquiprmtadevicawNchertut BOILER-COMP(JHPOR 100.000 BTU)
hvnNous air nmtaom,ind to,defined by the Bay Area Air Quality Menagement BOILER-COMP(OVER I(p."BTU) n
AI D
uv n7
❑ye,, ❑No NEW RESIDENTIAL MECH. SQ.FT. P
LI avc nerd the Fared.,.dVe iels leyairen eau macs Chapter 6,95 of the /111.Health ff SefnY Code.Section,25505,;5533 ud i5d34. I tWeruvd dw pVunofthe rcquircnumu which moat be met prier to issuance of n C"6r,ate of
cy.rsuhorr d'w Date TOTAL ISSUER tlY: