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26612 I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO AL PERMIT NO. BUILDING DIVISION APPLICATION(PERMIT PLUMBING-MECHANICAL 26612 BUILDING PROJECT IDE\TIFlCATION BUILDING ADDRESS: SANTfARY NO, APPLICATION SUBMMAL DATE DTN c—cc OWNER, � PITON : A aNIRA NAME: J 11c o- Z Z WC CUNROLN CTlFN F.F UC NO: '"DRESS ❑ J lez' CO ACT: PHONE: QTY. ELECTRIC PP.RMIT FEE BUILDING PERMIT INFO 3L,9, PERMIT ISSUANCECLBLL]G f� PLUMB :CH LICENSED CONTRACTOR'S DEARATION gl'%JANCFS-RI5IDEYIIAL pyo Ihertb,.ffnm Natlemlicemd rMvWs ofChWp 9(cromnereimgwith JOB DESCRIPTION F00 SeetroneyludeR«Ivision Juf lW Businessonl Profemmuse Curds.W/Smy license loin PANELSfull �( �, U 2 .Z. 'F+ UP T02KAMPS l aZUJ 1.1«rsse ti Lie.N ris6y w< Cmmector 201-1(100 AMPS F-� ARCUPTICPS DECLARATION OVER I )AMPS M.FT.FLOOR AREA $,SQ.FT. _ l undvslmd my shill be wd u public lecmds. Frn�� SIGNS ELECTRICAL Y�,'pj I.ianscd Plvfessimel ,rJ OWNIsR-BUILDER DECLARATION SPECIALCIRCUIT/MISC, 81 0 tfi u.FFFUF I hereby, nm Chom u I eseolqom frthe Co ,or's License Taw for the : UlowmSmo,son.(Section 7031.5.Businaa wd Pmfesioa Cusle:Any City or couruy TEMP.MISTER OR POLE INST. V1° which mill res a Tomtit to construct,aher,impose.demolish.to repair troy Swensen f.;!(i� pnmto lu itsuwce.,lso rtmuirm N<epplia-un rw.ucn permit to rle..ignnl stucmrnl POWER DEVICES an 0 Thu he is h«nsd qusuuu n to the provisioner or Ilse Canrrato/s littnse Law(ChWu � 9(commencingwith Section lgp)ofDi,mcs Jof the Bum.arm Rofession Cade) SWIMMING POOL ELECTRIC y�LUATI Trn or that he is exemp l tofirom end de basis f«Is,i legd exrmptian.Any volarion of t-ZQ S<clion]031.5 byturr Pplicw fm.Psnoil wbjeclslhc ggfi.amia evil perWty o/ OUTILTS-SWITCHES-Il%TURES out come tow five hudrtd"I.(s3(IOJ. O NEW RESIDEMIAI,FlECTR _SQ. s© ❑ Joe wort,, hepmpalumis n employavwiNwegamthe(Soo. �- STORIES TYPE CON51RUCf1 will doth,work,W e:Tic Clurtismli Uc,sdm sw chis«sJe(sac] ion Business ,d Pmf�imn Carle:The Cmtrecwfs license Taw docs nil apply w w ow«r M pmpeny who Wildsmiminosm thereon.erW whodm such wont himxlfm lhmugh his ,I 0 �1 employees,pnvddthnt such improvement.rweru.inlendCJ moffercd f«sale. If, _ ItOU RFS UNITS hi—rr.the Wilding or urlprovemem is sold within one yc,rofermspletion.Iheowrcr- Wilder will bsve the burden of proving tsu he dMnot Wild or ion f« M J ILMI K prove WrP«^ ❑ I,trr awresoftW popeny.umndudvdy mnlrxlingwithlicemeiJi,co me.t. QTY' MBING PERMIT usutncl Ise poJen(So c.]016.Buin,u wd ProfeThe ssions Code:) Cmmictur'• Lk,cnselaw d«amtopplytowowrerofpopertywWbuildsmr Mvmtsercan.erd PERMIT ISSUAN _ whacmtmcls f«such Iwjcns wish o cminCl«(s)liancd pursuxnl to tsc Cmtmnor'a UsnseL,w. ALTER-U NA VENT WAT IAJ FEE SUMMARY ❑ 1 am excmq ender sec. ,B R P C f«Chu rtaswl BACK FLOWRt .DEVI SANITARY Y N 0. Dmc RECEIPT'# WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF.A - COND. SCHOOLTAK Y N ❑ hereby,fBrm thatlhav<scer4fic'm,of conwtwself-inws<.«ecertificu,or lrr`ml ss -Wmken'Cmnprnutim Imuran«mettnifidcopy 0ertof(Sec.]800,fab C.)which Fl%TURPS-PER TRAP PARK FFE YN rn ell rmplaycc's undo thls pvnnit. GAS-EA.SYSTEM-I INC.6 Of1T1.fT5 RECEIPT# Policy N BUILDING UI V INION FEES Coo'fmmy GAS-EA SYSTEM-OVER a EA) PLANCHECK FEE ❑ CCnifiedcwyisherebyfumisbed. ❑ Cerumsf copy,E fled with Ile city inste,s ndivision. GREASIANDUSTRL WASTE INTERCEPTOR GRADING FFl? CERTIFICATE OF MINPTION FROM WORKERS' GREASE TRAP SOILS FEE COMPENSATION INSURANCE. (This section need not be compMd ills,Permit is far.h«dmf dollen IS IM) SEWER-SANITARY-STORM EA.]WFT. ENERGY FFR «les.) I coni ry that in Ile Permoreece of the work for which this permit is issued,l shall WATER HEATER W/VENT/ELECIIt rot employ tiny Pelson in wy.so as w hecorre subject In llre Worriment' PAID Z Comrprruatioe laws of Cdifamia. Det, WATER SYSTEA/TRTI 1EANG Duo, Rood,# Acant Z 0 NO CE TO APPLICANT I L afar making this Cmifcite ofF emption.you sMvM NEWRFSIDEMIALPLMB. SQ.FT. TOTAL: a [n boa subjectto t WM.Ya Cmoperusthis prmit"of rte Label Cvi yon mwl 7 forNwith Comply with such p,ovlsiou«Nis pdmil,IWl be dear#rtvokd. BUB.DING FEE C Q CONSTRUCTION LENDING AGENCY SEISMIC FEE V 1 hereby t ff Unit(here u•construction kdhrg,gmcy for the performance of TOTAL: FJRCIRIC FEE Q the,work for which Chu pemdl Is Iarvd 30 (Sec. 9],Civ.C.) r Lcrdels Nmre O [^ Laden.Adar,aa QTY. MECHANICAL PERMIT IEE PLUMBING FFI? lJ I aniry dmil 1 hove and tw.ppBatbo W uu<wl the.bore inforow:m is correct. l agrem comply with dl city and emou,«dimsrees wd some l,ws reWing tpPERMIT ISSUANCE MECUANICALFErE E^ r% hailb,conslruclian.mal boobyamlarle,rcPreenmwivaof Nis city w CH cmaaPon the CONSIRUONTAX U z above-mentiarld property for insp yian Purywes. ALTER OR ADD TO MECH, (We) ere,iwemory keep City of Cupcwhw sgdrvt liabiluie.ju t. crossimlex ka vihichurea, wywayxmr1/ .sorry AIRHANDLINGUNG-aOI0,"CFM) in. nof a opemit. L / V AIR HANDLING UNIT(OVER 10,"CFM) ikF 149 116 Signe ofA ca 1/Can 1 V rw EXHAUST FOOD(W/DUCD PAID BOGUS MATERIALS DISCLOSURE HEATING UNIT(T0 100.000 BTU) Ust, R�ipi N Will the applicent or future WJdirrg occupant more or handle M1nsadow mntmlel IIFATING IINIT(OVER IOO.tMp BTU7 T T u def r e 1 by the Culvemoo Municipal Code,CluPter 9.12,ede hud ilealth &for, Code,Section 25512(,)'. Ely. El No VENTILATION FAN(SINGLE RESID) ISSUANCE DATE Will OscapPlicwlor(utune Wildingorcupwlru,equiprcnt«devicewhichemit BOILER-COMP(JHPOR I0),000 B'N) lumdoui oir mntsmiwmu n defoed by Ise Bay Arta Air Quality M,rugancrd B.FR-COMPIOVFR tlTU)1 W,000 M . f115V1C11 Cl Yes ❑No BO40 NEW RESIDEKI'IAI.MECH. SQ.14. I base rod the hnsaed«ss maen,ls rtmuirtm,ms uncle,Chaper 6.95 of Ih, Cdifmmie Health&Safely CoJ<,Seen.25505,25531 and 15516.E molersoml that �`e ,9 if the building d,m not cunentimn y his,a wt,thahn t ' my respmsibil bthe y l0 notify V occupant of th �uin e emrnts which m mum be et poor b to ounce of a Cenlrru,a LL Occnpwcy. h�6a a lig Darerorwthmiutl sgemt One ISSUED BY I OFFIC