24502 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING- LE ICA L PERMn NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 24502
BUILDING UIVLSION BUILDING PROJEC9'11do IFICATION
BUIL.DINGADDRISS: SANITARY NO. A�\���nAlti
O ��� //�'I/ I•V�— G✓ UNIT# LOT
OW 1'X5 ME: O PHONE: CO R'S NAFfE LIC NO:
Izz
NIC CONTROL•
pRCI ILCT/RJGINEER: LIC NO: AIJD 1; .
Ui0C G 3 Z
CONTACT PHONE QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
211_ 4137r PERMIT ISSUANCE 1111�A p.U❑MB L l
LICENSED CONTRACTORS DECLARATION ppPIJANCEs-RESllfl<N'f1AL
pyo IM1mbY.Rrmdwl.mli¢ m&rpoviueruof Clup<r9(cvnmrcmi th JOB DESCRIPTION
LO02 Seen.7000)a(Division 3ofnW Busioev MPm .0 ylic<meis in PANELS
yZF funfnnu rff ,. "r
GG U falx Lic.p UP T021111AMPS
Dow C«drrta 301-1000 AM
Zl v z ARCHITECTS DECLARATION SQ.Ff.FLOOR ARES
:;o
oz—O I undernnod my plans nhWlW ono"puNic rtcO . OVFXI A _
% dolS S RICAL
RATION
whw
if_'1 !IlOWUii gnv�soPOor descoicosol
oll 'Pao PncF vni Alul��.CMCIAny cl�orcuunly P.MEfI GU ; NST. � � � '
which myuim o pCmtin 10 conseuel,cher,Impose,chorchJt,nr wpoir tiny nnto �' Ni
��Y� prior no iu issuuee,ties myuim dun applkant fur such pemdnw Ek.sigrnlAwement POWER DEVI '
sayK p dun W is IicmxJ puw.u1.1hepovisiom of do C«atsnws U.Cow(Ch.prr /
dxax 9(cummennng with Section 7")of Disouni.1 O'dw Busi.and Pmfasitms Codd SWIMMING POOL ELECTRIC
til�—m
or That lie ix exempt thoormm not Ih<basis for the 011 excmptinn.Any violation of pUl'LEfS-SWITCIIES-FIXTURES
CoQ Seetion'/0313 by any upplkant(m a permit sccu ubjthe applicant w a civil pmwlly of � O�C
tw1 mac dun live M1UMrM dullan.(SsOo). NEW RESIDENTIAL ELECIR S FT.
off: � ❑ I,..oweeroDhe p.op«tY.mmyentploYmwith w.gnvdevhikcompcnaafion. Q' STORIES TYPE UCION
63� win Bothe work,aruDlcswcmre is non inwmlcdaoffemd for We(Sm.7044.Busirc.vs
sand PowNims Code:'Ihc Cumrneon"License Law docs not apply 10 an owner of
property wifeW ilcisaimpmm thereon,and wlmdomsuch work hinuelfatheough his
owncmplo ees,povided then sushiy OCC.GROUP RES.UNI'T'S rnpmvemmw.reo«NItMN«OR[ld fm sok lL
hil ,the Wilding a impovenCnl is hind within one ycer of com.ko for toe owner-
Wildcrwill have lWWrh of thin WAiA rut huilA«im f« f T
proving prove puNuwu
We).
❑ I.uawnan MlW pWannY,weselusivelycmv.ningwthliven imwcla.lo QTYPLUMBING PERMIT FEE ROOD ZONE APN
eOMtnw1 dr pmjecl(See.]044,Buri.antd Pmfmlw Cade:)Tire Conmchos"
Liccrnc Law d«sn«apply to.nowrcrofpnllmywW WildxmimpruvcAthcrecm.aM PERMIT ISSUANCE
t wMmtno,u,forxuchpmjects withucom PP,)Ikenrd punoenuodw Contrect«s
Licrn¢Lew. ALTER-DRAIN&VENT.WATER EA) IEE SUMMARY
C3 I oan esmtpl under See. ,B&PC fer this mavenID: ES
BACK FLOW PROTECT.DEVICE SANITARY Y N
Owner Dam RECEIPT'#
DRAINS-RCOR RIX31'.AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ IWwbYeRnn than!have.aniEcv<Memseotmslf�iwue,macmifcueof RECEIPfY
W«km'C nsanim lnuuwac a.anihN Fl%TURES-PER IIZAP
anpc copy thcoof(Sa.Jg00.leh C.7 which PARK IEP. Y N
covm uI onin oy<e'.wdcf this pmnit GAS-FA.SYSTIIM-I INC. OUTLETS RECHIPI tl
Policy# BUILDING DIVISION FEES
Cont,ony GAS-E.A.SYSTEM-0VM 4(EA) PIANCHECK ME
❑ Ccnif icopyisherebyfumisto
I gin
❑ CerdEW<myix Bled with dun city in p<cdm divisim. GREASEANDUSTRLWASTEINTTXCITTOR GRADING EEE
CERTII;ICATTO]z FRMVI'IONFROMWORKPXS' GRIASE TRAIT SOILS FEE
COMPHNISATION INSURANCE
(ITi..ionn<d nabeamplev.i JOtepemdlu fmvrc hltdrN dolWa(5100) SEWER-SANITARY-STORM EA.30(o ENERGY FEE
Prieto
Ie ify Unit in Ito perfoormse,ofthe wM Rr which thislsoit is i.as d,I shall WATER PRATER WNTINDELECIR
n« employ any Mrson in any Twoner
so
anu to be subject 1a the Workm' PAID
z Canpereationlasv.of Cuiferniu Date WATER SYSTEAI/IRFATING Rmeipl 11
Applica n
O0 NOTICE TO APPLICANT:If,anm nuking this Cerdf w of P,xanpoon,you sbuuld NEW REST DENIIAL PLMB. SQ.IT. TOTAL:
o bmmm.subi Ito the W«kch Cumpcnaion provisoT the lsWr Coo,,you mus
5 Post comply with such povixiuns-this permit shall Ne deemed revoke. But No FEF. Oar
d Q CONSTRUCIONLENDINGAGENCY S El S M IN FFE
� z IWmby am.at therem..onsnruc,ion lending'i for the pm
erforance of 'TOTAL' ELECFR 'FF.E `
U UW twod for which I his permit is Iesnod(Sec.Y)O],Co.CJ
Ietdclx Nemo
O F Leander',Addrus Q7Y. MSCI IANICAL PERMIT IEE RUMBI FFE
CJ 1 crnify the,1 hove reel this.pplie.tim end este thin th<ebove in orsomon is
.T. Isco no cnnply with All city endcuuntyndinances and mew lows relating IT PERMIT ISSUANCE .'solo MECHANNI
FFJ3
F-' Wilding cunstruTiuq and hereby authuri.<rcptvenlefives of thi.dry memm upon the CONS'IAU ON TAX
U 'Z .1,aveomenlicsi pmpenY for impcctian purymet. ALT'FX OR ADD TO MICH. ��
(we).gree 1a cave,irdrnmify and two M1mmkss the City of Cupertino.gu.
E.Mliue'y^grnwntn,time and exlynnwi,wM1lch stay in Any way were,against said City AIR HANDLING UNIT ITO 10,000 Cl
ineCr ceoflb rvntingo Ix petmi,.
�I AIR IIANDLINO UNIT(OVER 10,000 CEI,1)
Stgnanawof Appric eme" aw DE%IIAUST HOOD(W/DUM
PAID
11AZARDOUSMATERINSDISCLOSURE I VETTING UNIT(TO 100jl0 xTU) Uue Rec<ipY
Will dr 4beant co,furore huihdne oeculmnt star a handle b.ossdeas nowrial HEATING UNIT(OVFR 1010.01(s)BTU) TOTAL
n defineal by the Copantuw Municipal Code.Ch.per 9.13,.sad tM Heal cad Safety
Cade.Smi 255J3(e)1
0ye,, El No TILVENATION FAN(SINGLE RFSID)
Will dr Iicon,arfumw Wildin «cu BOILER-COMPCHPOR Iro,"BTU)waterdeISSUA CE DATE
app 8 pan toy Aoea tRM«Paity Mwhichman
Dishie uA.v mnmmirwnw a deEnW M the BeY Arm Air Qu.I11Y Mevgemem BOII.FJt-COMP LOVER 100,000 BTU) ` '
I Dlsnrlcl)
If ❑Ya ❑No NEW RPSIDIN'TIAL MECIL SQ.Ff. NOV
25 jqq�
1 have read dee watiolwu wool smitirentenm uonoChapwr 6.95 of dun y
Cuifond.Health&S.fery Code,Sec,iov 35505,25533 ca34
POT 255 . 1 uMw
< .nd this
^�
If dre building does,not ncurrently have a moon.ohm it is my wapomibility,w 11'n nify the V
Pretreat,of Its,"Por n:nie which mus W m<,prier to i.. I.Cenifaw of vr UUI-e
Occulsanwy.
l m eunharrred agent Date T ISSUED xY:
OFFICE