26517 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINONO C C
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL vJ
BUILDING PROJECT'IDENTIFICATION
17
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMfITALDATF.
NIT LOT♦
WNFRSN y. PHONE CONTRACTOR'S NAME LIC NO:
la.`/ to C COMRul-,
ARCHITECT?NGINEER: LIC NO: ADDRESS: ' ❑
CONTACT. PHONE' QTy ELECTRIC PERMIT FEE BUILDING P
INFO
O 6 �V,,may ON'1—oy�� LDO Pi FcT PL� MECII
IC. ��L� PNAMIf ISSUANCE LICENSED CONTRACTOR'S DECLARATION APPWANCES-RESIDENTIAL
C)CZ IherebyoThnnthetlmnlicm. underpmvisionsofaap(w9(cm,u ngwiN JOB DESCRIPTION
pl001— Ssction 7M).t Division 3 of de 13 , c cold Pmlealao,Code,and my Baine u in1 PANT
a y�I
m V tJ full torso,and elms t
cc<--ZUty Canoe Clad Lk.N ` UPTO200AMPS
to<ti Due C... 201-1000 AMPS
F y Z ARCHITECTS DECLARATION SQ,FT.F]-COR AREA M.FT.
ZO.i,— IVM«vW my PlmsshsllMu.MU Wblictmxds. OVER 101)0 AMPS ���`• _� y
�ZCI SIGNS PJECTRICAL �.{ r, 1
QY�j LiccmM Profcdionel `
Xm m m Q On I.s.0 I DECLARATION SPECIAL CIRCHIIT/h1ISC.
O c-V I hacby.litm Jut 1.m excmp I.the Convamor,Name U.for the
w3 tia fAltwing,cuon(S¢von]031.5.BusiM and Pmfesdotn Code:My city or county TEMP.METFA OR POE INST.
�.J which rtyuim a pcnnh to cml,vun,Jin,intpovc,d=moh,h,or qtr my mumme
Y� pnor to its isruarama1w)eyvita the upplicvnt f«such pmniHo file.sigoM...,anmt POWER DEVICES
w d00 that the is liamed punu.nt to the provivions of 0e Ca draw'.Limne I�w(C11apn gWIMMRiG POOL ELECTRIC
d 9(mmrcteing with Sation]000)ofDiv'tiooJ or Oe Budoed.od Pofeai«u Cade) VALUATION
y «tlw he hexemp thncftam.M tie but,f«Oe JlcgM cxanp' vblMma 0) �.r• - ts
F_Za Sntian]0113 by mY epplian f«.pdtnit,abjav the.ppl tw.ci a( z5a MEETS-SWITCIffS-FD(TURES L '\J r
C 0 oat.Into five hwdmd ddlm/55(10). NEW RFSTDENTIAL EIECIR SQ.FT.
Wm ❑ I,uownnofJeptvpcnY.mmye„rybycca withw tMb,ok pmm ftl PL NSTRU O
o. will do Ne wa,k,nntl the strmum is n«imrnded role fm die(SwA ,b
and Pmfessinn,Code:The conl,vctm'�;-R
Lia x dm nm eppl t�a�
pmpcMy who Wild.«Wpmva suchwarthi iTlluwtonalnmded« fm If, 6ffC .UNITS
howevmfleWildingar Wpvv ucyeuo(((c000mnnnylctian,builder will h tse the burden n ing rot buil �ppave for of Wu
°'I=')' \ QTY, PLUMBING PERMIT FEE
❑ I,.,awnnofthe nY.em cv ¢v uY mnoxJng con.onto P1,00D ZO 1. APN
cunWct W projat .] d Pr fcssi J Cmtreomr,
Liansc l�wdou tw vppl «- vu thetmOmd PERMIT ISSUANCE
wmaelv.cn f«wch po ) to Jecaoo-.nor. M.�y-DRAIN&VENT-WATER(EA7 FEESUMMARY
Liame Lew.
❑ 1 em cscmpt a Scc. &P C f«this taws BACK F W PROTECT.DEVICE SANITARY OUTSY E N
FCFIPfN
0. WORKAN COMP ATION DECLARATION DRAINS-FLOOFA
OOR,RF,AR ,COND. �, SCHOOLTAX Y
MN
❑ Thereby eft thmlhe.e acmi0ate cm.cmt If-Wort.ars anilute of .pIJt TRAP /� ETN
W«tm'Contpvwtian l,awrce a.artif (Sec.3g(0.UbC.)whicb PARK FEE N
na Jlcmpbyc ttadnthupe t- GAS-EA.SYSTIN-1 INC 4 OUTI= N
po.N BI 1 SION FEES
Cmnpmy GAS-EA.JYSIHN-OVER 4IFA) PANCA 0
❑ CcnifMcop othsoobyfumi,hvd.
Cenitied copy is fled with the city impaction division. GREASEIINDUSIRI.WASTE INTERCEPTOR GRAD G
CERTIFICATE OF EKEN[PTION FROM WORKERSGREASETRAP SOI
COMPENSATION INSURANCE
(Thi,saotton, no,be mmplucd ifthe pmmit is for mchmldnd ddlm.($100) SEWER-SANITARY-STORM FA.HAFT. tt, PNI:RGY E
or kd.) —
Ianifythin inNc miaon•cce ofthewort for which Ni.petit i,issued,I•bell WATER HEATER WNEFEJELLCIR
not mploy my perm in my manner eo u to becme subjm,o the Wort PAID
z Cae�patvnon law of Glifami.. D.tc WATERSYSIEMIREATING Dee RxJ N
Applicros
z 0 NOTICETO APPLICANT:If,efts m.ting M.Cmdlcueof Exi, on,You.hould NEW RESIDFN71AL PLAfB. SQ.PT. TOTAL
r+ � haamc.ubjectmthe W«ter'.Cvmpmmtion pmvui«u of Ne lsbar Cade,Yw rrv�
..``�'' + fanhwith comply withsuch pvvi,imsar Nupermit.AeB be dxmW rtvotW. BUIIDINGPFL r�
(] CONSTRUCTION LENDING AGENCY SEISMIC FEE
7 z I hneby.fMo tb.t thme u.co u union ims itry.gency fm Jle perfantlmKe of L FEECIRIC FEE
U O the wort for which thi,pmtti,i,i--,M(S¢.309],Cs.Cd
Lt ID
I '.Nmte
I<ndcr',AJdtvs QTY. MECHANICAL PERMIT FEE PLUMBING FEE
O V 1 anify That 1 he teed this appI a d Mate tM mmetim i, MECHANICAL FEE
r�
�^ W caned.Ivgrta me IY wilh ell city ud m,y in.rc a to WIN,rtluingm PERMIT ISSUANCE
F_ y dJMingronvmc' trodyw
drymmmrupontie
V z .bwc-mcnuored (m ALTERORADDTOMECH. CONSTRUCTION TAX
(We). — veiMumof Cupadw nsmst
atjn t mdcj .ts,awaddCity AIR HANDLING UNIT(TO IQ000 LTM)
1nc«ucytingo
AIR HANDLING UNIT(OVER I0,gM)CIN
7.
Sign.w,e of Appl' t« !19:v
EXHAUST'HOOD �� PAID
US MATFpIpt g DISCLOSURE HEATING UNIT(TO 100,000 BTLB
W ll tle.pplitunt at Ed..building occupant Mate or bmdle h.rndouv muni) AL
u&FpnN by the Cupp o M IcINI Code,Cb,,a r 9.12,md Oc limith and S•fey HEATING UNIT(OVER 100.0(10 BTU)
Calc.Scotian 25532(a)' VENTH-ATION PAN(SINGLE RMID)
❑
Yu T..
BOLER-COMP CHP OR 100,0))BTU) ISSUANCE DA7
Will thc.pplimnt«fumrt WtWingomp.mueeyulp,em mdeny whichmJt
ervdvu,.h commd u Hted by Ne Ray Nu Air Quality Mugs, int BOILER-COMP(OVER 100,000 BTU)
m ] 9411
❑Yn NEW RFSIDFNUAL MECH. SQ.IT
I hese h.v.,d.n antis, u rc.a,tt a Cha,w 6.95 of the OCT $8
filiform.tics 5•fetyC«Ie. 'e tions 505.25533 and 25534. 1 uMenarmd w,
if the buidin • tw<utrmJY eat LNu it i,my aapvmidOrymndifY the
«oryan,o c c ucmrnu kt mu be M prior m idueme of•CeniOo,c of /. 1��/���
Ocm C1 q {/f�Ji{�'I'�NV
Owns orauJu M Ihte ISSUED BY: /� � !
OFFI