26888 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 26888
BUILDING ADDRESS: yJ /�/g��))yJ SANITARY NO. APPLICATIONSUB/Mf�/•ITrTM-DATE
2061) V&' 69�n ✓--,UNIT# LOTN Sr' s
W ' W F.' CO ACION'SN M LIC NO:
OM ahilzNIC COMAOLN
w f EEN: IC NO:O /i/Za. ADDRESS:
G I7�
NrnGr: PHONE Qom. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG LK
PLUM ME
Ppth1R IS5UANCY: Cu
LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDPNHAL JOB DESCRIPTION
mcez I bcmq aJnmt that l non licrn lunhrpmvisiwu ofOugerr)(cmtutRtxingwiN
u C)2 Section'l000)ofDivision Sof des Business]and P]ofeuiom Code,and my lit.u u PANELS ��
'dfuB forte wd eBcc t V
lla-.Zw �.] loc.0 UPTO200AMPS ��•
tn?y Date • Co. a 201.1000 AMPS
ZOtnvi� CTiT1'ECTS DECLARATION OVER 1 AMPS SQ.FT.FLOOR AR $!SQ,FT.
O7_Q lundcrstald my plen]shell be used stat public word, ^ — O I�{� •"� r
g:2 SIGN F LTRI f/X/'YN•1 (\ 11T(\ �70
�y,F Liceuucd Profasiovl
0W OWNER-BUILDER ERDECIARATION SPI;CIA RC ESC.
Sdx O a v I theng rca off.tllu 131 comp fir.u tthe P Cnufane o e:Arty Ityw for the
W3p.y following mason,(Section OBd Lsuct,Huai..unitFofeuiob .orrery city orcclure TEM . OR INST.
ON¢ which require•permit re nines the eller,impmsu h pernuW,a e.sir any almclure
E=}C, piortos issuantt,elsotequirtstheaituienlfm]uchpvnu]to file. VI
COp that heulimucd prectiotothe)ons,ioofthe he B.,incsm License I�w(Chagcr
oz Y(canmtcrcing with Sadnn]g10)uf Div�s�u�3rflM1e Husiocu.N Po4w'iau'Cods) SWIMMING LBLBCIRIC w VALUATION _
^N mtl im 703[.5by tyao and lbcbasi]fathc illeeW lino itoscivlpl yof /�/• ��
230 Smion]O31.S By any apptkvufmapmeit wbjastnd eppliunt too civil pvuhy of OOILEfS SWITCHES-Fl%'H1RF5
2 mac lnan five nuNml JNlats(f5fq).
C�p ❑ I,vownnofthc ptgeny,ormyemployen withmgeutheirsdecounpcmatim, NEW RESIDENTIAL.I?LECIit _SQ,II'. R1.' TYPE CONSTNUCI'ION
dothewars Code: soucturtisnotineudrveLawrdres..,I,in en
a]td Prufasions Cute:The Cmtmctara I.iceme Law dace ort epp1Y to w awtln M
propenY who build]minyrwea therton.atd whodoe.uch work hlm]elfur Through hie
owornplvyce,pmvidd that]uehimpmvemenui meltotimerWedmoffared forsele
If, OCC.GROUP RES.UNM
huwern,the huildinga improvement is sold within ono yearofampletiun,the owner- T
builder will have the burden of proving that he did not bsold or improve fa purPme M
uk.l.
❑ I,wow]Nxofthe propenY.emexcluslvelYcunlrneting withlicco.edcmt]rrmto Qom' PLUMBING PERMITFEE FLOOD ZO APN
construct the project(Sn.]OM,Bulirers and Ptofeviau Code:)The Contractor's
License law does not ggly in anow erofpngnuy who build]or impose thereon,old PERMIT ISSUANCE
I-jo.mcu for.uchpmjens wiN•mmxtor(s)lian]cd purwvumtheCmtrxtor>
Licasc law. ALTER-DRAIN&VENT-WATER(FA) FEE SUMMARY
❑ 1 inn exempt under Sa. ,B&P C fn tM1n rcamn OUTSIUVTmN—
BACK FLOW PROTECT.DEVICE
SANITARY YN
Owtta Datc DRAINS-FLOOR,ROOF,AR EA,COND. REL4.IP1'M
• imtUilWORKMve. MPrNteofcNDEwulf4mum.CL�VHON SCHOOL TA% Y N
❑ IMcby.fBrm thatl have.ttnif to ofcmuent bselfinsum.aacertif uiofROM".N
Fl%'NRES.PER TRAP
Wmkcur:Compeuaatiun lnsumnismottniOeJ copy ticmo(l5ec.38W,Inb C.)which PARK FEP. Y N
covers all cmpluyc2a undn this pmnit. GAS-EA.SYSTEM-]INC 4 OLHLBIS RECEIPT N
miry N BUILDING DIVISION
Cmnpany GAS-EA,SYSTEM OVER 4 IFA) PLANCHECK PER
❑ CcninM c^pY i]hcrcby fumi]hM
Cenifid copy is filed with the ityi ivi GRFASFJINDUSTRL WASTE INTERCEPTOR GRADING FTE
CERTIFICATEO' ;XE O ORKERSGREASETRAP SOI LS FEE
CO ON INS
(This section need IetWif .for mm hurArd dtl $1 SEWER-SANRARY-STORM EA.2())FT. ENERGY FEE
or Ica) V�
loceifyth.tlnthe rfmrwcwfarwhichibi tflaiesoal, WATER HEATER W/VENFOEECTR
con employ any Person 'n any as in sat to thcrs PAID
z A atian lmws of Ca'arni WATER SYSTEhVTRFATING Date RcceipN
ph
zQ NOTICE TO APPLICANT:I n tbieC 'KeleMiwu,you should NEW RESIDENTIAL HAD. SQ. ' TOTAL
per hecmte subject in the Worker's ora poviahma Mt Code, norotut
g > forthwith cemply withsuch Pm siau or this'rirmt dccmcd mvoked. I BU II.DWG FEF.
a (] CONSTR ON LEND AGENCY SHISMIC IEE
ZD Z
Ihaeby eRrm shat there i.e ending agen%for the perform.nce of
U p Be wort for which dJs pevrrdn is i .309].Cir.C.) TO' ELECTRIC FEE
Lerukr'a Nems O PLUMBING IEE F lender's AJdma QTY. MECHANICAL PERMIT FEE
U I certify t h,t I hese read that aHdiruwn and suite thin the above Infam.]im is
mrtttL I.,.In omply with all city and county oNlrorca and s.laws mlatingtaFIJiMITISSUANCE MECHANICAL FEE
building castrunim,enJ therebyuutlwrire Rpcecnlnlira ofthie city menta upnthe
U Z above-mcmiorxd property for insyectron purposes. ALTER OR ADD TO h4ECH. CONSTRUCTION TAX
.. (We)agree to save.IndemrJly and keep ha.mleas the City of Cupesirm ag.iw
77
1' il'uim' nta,cmle and expense which may In wy way eccmm rpumu viJ City AIR HANDLING UNIT(TO 10.000 CFM)
01 MtLeg Ni it
AIR HANDLING UNIT OVER 10,000 CFM)
S' .16 of pgicmuUCaZtscta D.tc ENIIAUST'I IWD(W/DUCrt
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dese Re¢ipi#
Will the st,diant or future building occupant atom or M1Wle huardaus mstcrial HEATING UNIT l00,pp BTU) IO TOTAL
as def rod q ilk Cupertino Municipal Code,Chapter 9.12,vud nd the Health. Safery
Cole,Section 25632(e)7
Ya No
VENTILATION FAN(SINGLE RESIDE
❑ ❑
Will thcapplicantaocc
futusebuildingupantuucquipment orAcvice whn
ich wt BOILER-COWQILPOR 100,000BTU) IS6pjy(;EDA 199
hvaMws air contaminants its defined by line Buy Ara Air Quam
Quality Magcr
eent CC�r I .7T
ER
DisuinT BOIL -COMP(OVER I WIMIO, BTU)
❑Ye ❑No NEWRFSIDEMIAL MECIf. SQ.FT. CIlY ur L;uf,tliI INU
1 love rtad the hvardoua metni.l,tryuiner encs under Ch.ger&95 M Ile -
Crrhfomu Health h Safety Code-Sectiw 25505.25533 and 25534. 1 uMnaurM that
lithe building Joe not curmmly Itasca recant,that ii is my uesgtnsibnhy to notify the
occupant of the requbcmcntx which m v he nun Prior to Issuance of.Cnwcue of
Ocvupaa
OwnnmauthoriaN agent DatcNSUEDBY:
OFFICE