26806 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO
BULL o, .-LL C a1 n PFJt AfI'T NO.
BUILDING DIVISION APPLICATION/PERMIT PNG FROJE MECHANICAL 2 6 p O L
(p�rq�,�jBlI1LDINC PFOIRCfBI@f17FICATION-;�?;;iY(Iy�P�� GOO
BUILDING ADDRESS: �/ � J `1 SANITARY NO. AP^%JCATIO`N/Sy}UB�/M�rI��I-fALDAi
40 �AL+KF 1 G 1✓1�o .UNITY V • LOTY � • {.6
WNFRSME: PHONE CONTRACTORS NAME: LIC NO:
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ftCHITECT/ENGINECC: LIC NO: ADDRESS: ❑
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CONTACT: PHONE 1a". "'mob=+Y'��'r°'" ,i:.s"t. iBUD:DINO PFRMIC,DiFD
Qi�'Y, '� E�CP�RMR�.I L F .,_js s. BLDG ELECT RUMS MECH
PERMIT ISSUANCE !
LICENSED CONTRACTORS DECLARATION APPLUNCFS-RESIDENTIAL
tm c�z Ihercby irm WT l un l icmeed undo povuiau daapa9(Cammmc1n➢wiih JOB DF
FOO fulllfattmd.1Dic
IiC �3 of be Bucinss end Pbfmima Cods,and my nce.,,,to PANELS
cff
FFZW cemc Wv -10 L.,1 1 28 UPTO]➢OAMPS
.
+nQa Datc 1 __Canvxvn x01.1AMPS SQ.PT.FLOOR AREA FT.
t - _
Z F N? I urdoe ARO CTS O OVER 1000 000 AMPS
T EySQ.
k
291996
x�xt OWNER-BUT DE TION SPECIAL CIC'UIT/MLSC.
kOyU I hacby aff Out 1 am cxcmp halo We Cants s Liccmc Law fm be
w3u ttQ folbwlnstenm.(Sadon7031-5,Bucheamd Pofmbm Cdr Anycirymttuaty TEMP.METER OR MU INST. - - -� t'Ur�i'j 1114()
which rc,luues a peanut to cmvn. al.,impmve,d iA.a.cpav my wuc<utc
fC�}� pior to iu ivlurce,db rtyuuv the•pP1'mtf«cab pvmit to file.JplW surtmm[ POWER DE'VICBS
ul p OK that ro D littnced mwait to Ne Pwi Toro of Ne Cmbnmds licrssic,lav(Chap.
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mmm�rvi➢wish «dm7")dUYWoo Saft urman ud Ptofctucoi CW VALUATION
POOL ELECTRIC9( VALUATION
.Zhu he u cactop tictefmmW me buil fu tie J)e➢ed oempinn.My Yiol.nuna
tK< Sc 703[Z by any a ibcmi f«.pemdt mbJecu Ne Vplictint ma civil pmJlya OUTLETS-SWITCHES-FI TUR6s
rot vlorc than Five hmW i dd W(5.500). NEW MIGENIIAI.ELECRR_SQ.FT.
n] ❑ Lnovtcofibepopery.amYwaoYeawidv.yuutheUwkcan STRU t
p _ wbl1,mf v a Cod O-mammuwa's L daoRadfonk(Sy.w al,Bmwen A ` 3'
ad Pnfesdom Code:Tic Cumu;la'a License Taw d«a not appy m m veva of i�i UNITS
eP``k 4 Y•r•—/ a
popery wro builmaimpavnthvmn,rdwrodomech wart hiwclfathlw➢h his I V I/.�� 641 etj C R TIP
owmcmpbyeo,pemlded Naaoehulpmmrntaart na9ilumded«oRad fas.k.U, lL
hvweva,be boildin➢a imp.is m W within our year amvpeboo.Nc own.- .
builds will have be Gcdeo dpm it,that M and ant dNd a impwe fa pmpou d T ...
aS:wAsa.aacING<t�wrrA.
❑)I,nowarddle paPalY,vnerelutiaRy ootramn6with lkemdaomat«sm �vT ct,1Tfr 418PYvF� ' Z AIN
cmtrvn tk peojct(Seca 7091,Bmmm toil Prof.Cede:)TM Conmrtora - .-,y
Iimuelawdmnm applybmorlerdpropmy whobwlmabnpow Naao,aJ IssuANCE
w
wLicaee law,latah pvJevvith Ccontrcmr(c)Iim.xd punumitmTe Cone<at AL -DR d VENT.WATER IEA) SUf,{MAZ�Y
❑ 1 em cxarlp mlda Sc. .B k P C fa Nit corm BACK OW PROTECT.D _ •—.
SANITARY Y N
Purer Dee DRARIS- .AO(yF, RECEfPC1 -
,., WORKMAN COMPENSATION DECIMATION SCHOOL TAX Y N
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G? _, e_ yaflom that)have.cadFlcae d«dent b alf-Wmeor.cc 5cw,,.f FD(Turwis REQ'
`.. . Wuken'Cmvpertvuon lm�aaha�o�agx«nya catiBedmpy ftma'5ec3B00,fab C)vNW PARK IEE Y_N
-�-. mrm Jlemploya'fLda 9(e L�1�/IL GAS-ES.SYSIFIA- C.1 BUBDB.'O DIVISION EEFS',;; t-
Porry
CI H�y� OAS-FA SYSTFMO 4 PI.ANCHECIC F�
CwRd copy is Bird wit the city impectian 6,,1 a GRE4SEANDUSTRL WA R GRADING FEE 7:1 5%•=.:C,�3;.
CERTIFICATE OF F.)CEMPDON FROM WORKERS' GREASE TRAP SOBS FEE
COMPENSATION INSURANCE
(This seabur rort om De com,li d ifihe pamil ufa.hwiffixddatim;(S1W) sEIVFR-SANRAR -STORM Ek ENERGY FEE
or m)
I cafify Wu in ft Pafoomaa of the v for which dus pamtru iss1,IJWI WATER HEA, W/VFM/PInC-IR
w empty my pamn in toy mats co as m bcome wbjct m de Warkat' PAID .
Z
Campmratim lawn of CJifanu Dec S
WATER
Appliracn
Q O NOTICE TO APPLICANT:IL a nmk'vy this Cemfcued Exanpim.you.Lurid NEW mENTUL PIIS. SQ.FI. _ TOTAL t.. ;t..
V) bane subjy to Re Wirkee.Qxr.W atim povtos of Labor Codc.yo,;moat
� > fmhwiih comply milt such pem anis or Jus pairyl shad be mmld mvolc4 BUB.DINO FEE
OW.. Q CONSTRUCTION LENDING AGENCY
z INNc*tiff'.dna that u.coroommon leodin➢.➢cncy fa Ucpafam d TOTAL I1F.CIRK:FILE -
V CObe^. wk fa vhch ftt paver b usoedz(s3097,Cly.C.)
:f'..
lulmla NAddtoa Y ARPLUMBM FEE
V 1 artily the L lout ivd WB gglcamo and awe Wt oe above if.it
carter la➢la btanpy wiblWtryandcolmry amm.ce uldsue Zan ml.dgm ITISSUANCE c MECHANICAL FEE
_ bwldln➢cmanocdm.and ba Ly aulhoriCe etpemubra dtlus cirybmla upm de
U Z abwc-motiarad propaay(a inyecuan pmpwo. AL ORADDTOMECH. CONSTRlICT10N TA%
(Wc)spa 10 aid mbe City of Cop—a&-
IubB1.jtal coat to aY auxue'emstasitiCity ABL HNUNG UNIT(To 10,000am) "•. .
ivc«uc4 ft
ABR HANDL- G UNIT(OVER MM CFM)
D� EXHAUST HOO /DUCT)
•
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNRTM ,o00B Due
RIAaaipY
Win be applicant«ftm hailmn➢occupm atom or handle huudolu maerial NTNG UNIT(OVPR1 BRI) TOTAL _
u dcfi by tie Cuperdw M ipl Cade,Oupa 9.13,ad tic HcJN uJ saftry, -
Calc.Saum 3.5533(.)? VENTILATION FAN(S ID)
❑Yn No
ISSUANCE DATE f... -..
Will ticeppionl«(uaue Wildlry e clumdmit
BOILER-COMP 3 RIW,000B
havdmu civmn h0eed by ft Bay Aoca Av Quality Mmal%,mml
BOILER-CO OVER 100.000 Bm
1
District?
❑Ya ( NEW RES L MECIL SQ.
I have aeW the Ict,co a wtcriJa mgCirtanmu udcr Cl. 495 d dm
CJlfomi•11eJ1h&S.fny Code.Saaimu ZS 5,25533 orN 35531. 1 ur.lusorld dw
iflhabt,ldi dor Yb 1"smy rnpotibifix,to fy de
occupant of 1 L..of.C mr..d
Once Z
Datc TOTAL- ISSUFDBY.
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