26896 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOm ` - AL PERMITNO.
APPLICATION/PERMIT
PLUMB;
NO
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 26896
BUILDING ADDRESS: SANITARY NO, APPIJCATIONSUBMFDALDATE
UNITa LOT V^,
OWNS S A E PHONE CONTRACTOR'S NAµE LIC NO: LJ l
/I- N/C CONTROL
V v�
RC DECIESIGINEER: LIC NO: ADDRESS Z../J {
✓f C Ifav,
CONTACT: PHONE
Ql'Y. ELECTRIC PERMIT PEE BUILDING PERMIT INFO
JJ BLIIG IiLf:ClPLUMB MECH
1'EtMI'f ISSUANCE
LICENSED CONIRACfOR'S giCIARATION APPLIANCES-RESIDENTIAL
M1z I hereby affirm Nut lrn licensed under provisions of ChWer 9(emossxingwith 1 { I
100
Seed.? )ofDivlslon3oflheBusineu ud l4o/euimo Code,rd my liana is in PANELS
full F
FZa Liave o"eeC�4a�contra�;`Sf UP TO 2ro AMPS
,y<y Uea—tl—P Canurw c! ]01-I(100AMP5
ZOyZ ARCHf1ECrS DECIARATlQ OVER LOBO AMPS SQ.FT.FLOOR AREA S/SQ.FT.
O<.—D ladrrvrd mY para JWlbeusW upublic r¢vrds -
F:L t w SIGNS ELECTRICAL ,
<y m j IiMsW Profrniaal
zy¢< OWNER-BUILDER DECLARATION SPECIAL CIRCUR/MTSC.
d /�
Oi FUF I hRm a
cehy arro than I aeanpt from the Cmtrectors Liana Lew Tor Ile /"LUG 3
t+13 LLya fulluwin¢reason.(Seeman 7031 S,Husilxv rd Plofevions Code:Any city or county TEMP.METER OR POLE INST. 1996
V,Oy.I which ox,nou a merit to uanstruct,alter,improve,demolish,or repair any stranure
aa9 mhx In its ioannee,also reel lbeulplicent fw,.1h —it to fileasiBMdatetemenl POWER DEVICES
cat n, C) Nrs
Nal he is licensed puuant to the povisions ofthe ms
e Ctnol( LIa' na Law(Chapc ` UI- VUI-L..I DFkJ
a Xe4¢ 9(con.croeng with Sec6on]000)of Division 3.1'16,Husitxv and Prof..Code) SWIMMING POOL ELECTRIC VALUATION
mthat he is eaempl l Thom eM de basis fmthe allcgcd caallpllgl.Any vialstionof OVI'IJ:-IS-SWITCI{yS.pl S
F'La Sstkm 7031.5 by uryappliMlfor a m
peiilsubjeem,la,spplkant too civil penalty of
. e Oban live hurx4ed dellen 0500).z� CW RESIDFNUAI.FIECIR _SQ.PT.0 ClClI,uowlxr MlheTnoperty.amyr�loy¢swiN wa�csu Oxirwkcampaaanw. R TYPECONSTRUCTION
a3� will dnlhcw.Coalk he Cyn
,or',L •-,saw to frost Wl,.,. Bunleef
W Hofessian Coale:The Contrsl9ls Lialssc law don not grply to m owns of
mummy who builds a impova dxm9n,and wlw d¢s.ucF xork hilruelf u NTooyh his
empbym.pnwided Nr suN impovemelus art not intadcdmoffei(asele.
If. OCC GROUP
howcv¢,the building a bnprownent Is sold wiNinwx yearofampeliab,ux owner- TOTAL
builder will Tuve the burden of moving That he del rot build m impose for pvpose of
k).
❑ I.u.uwrcrnrme prupaly,emeaclmivdy rnnuxlinywiNlicrnaedamtmclrasm QTY. PLUMBING PERMIT EEE Ft UZ. N APN
Rntroel the Project(.S¢.1014,Busitxv and Pmfeviuu CMeJ The Contractor's _
LianrcLaw&..a,apply to an ownerof gory oy who hat hlorimpmves Ncrrnn,and PERMITIS N )L O
wMl cononas fm weh mn)ecla whh a emtrM:nw(a)ficenKd wr]nartt 10IIF COnIRCI«s V VV
Lccnalaw. ALTER-D kWATER(HA) FEE SUMMARY
❑ 1 em camp unJcr 5¢. B&P C fm Nice reason BACK FLO VICE, SANITARY Y N
OwnerSANITARY
COMPENSATION DI;CIARATION DRAINS-FLOOR A ND. O SCHOOLTAX YECBIPI'g
N
❑ Ihcmbyef0mllbrl NvcacenlRcue of conamlln adf-Nwm,macvtifinm of Fl]CNNES-PFR TRAP CEIPTY
Workrn Compwti9n lmuv¢c¢aceNlxd ropy Nvcof(S¢.JI1W.lab C)xhkh PARK FEE Y N
Lrovm Wl u,0 �b L RF.CFIPI'Y
Polo ell) ,ate Qi°• ing-oi GAS-FA.SYSTEM-I INC.<0fI11.[:TS
y BUILDING DIVISION FEES
IY CmiTied co%ulxrtAby! aM1ai C GAS-EA.SYSTEM-OVER 4(EA) PLANCf{ECK FEE
❑ Cmi0ed copy is fkd wiN the city'"r don Jivisim. GRFASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXFMPHON MOM WORKERS' GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
('nisr:cction txcd tetbecomplotttif Ncpenna is fmmwhmo idollvs(SI00) SEWER-SANITARY-STORM EA.21)()FT, ENERGY FII!
a leu.)
I certify Nat in the fxrfmmarbce of the cork forwhlch Nispermit is iswcd,1001 WATER HEATER W/VF /EI.ECIR
net employ any Terson in any m u to bcema wbje I to the WMai PAID
z Crmbp:urion laws of Glifomia. Due m WATER SYSTEM/IREATING Due Rcaip♦
Al"liM1
z O NOTICE:TO APPLICANT:lf.after malt,this CaroF le of Earnrpion.yon ahauW NEW BUT DFN'HAL PLMIL SQ.FT. TOTAL
C � fbmc
nnnbjm Nc to WmkKs Connpcnuuon pnwi6orn dx of Lala Coda.Codwn
a.you o
arbw
mnfrly wiN each Provisions;or Nu per Jt shrl ed dmnxd rooked. BUILDING FEE
1 Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
O Z I lxaM a f Nat there is a ewovenon lending aletxy for Ne pafmmrxe of
U Ox work fm which this p¢mil is issued(S¢.3091,Civ,C.) TOTAL: O ELECTRIC FEE
L<ndc/e N.
F^ lame:,Adchess QTY. MECHANICAL PERMIT FEE PLUMBING FEE
>" 0.CJ 1 cmify that I have mad this application and sure that the above information is MECHANICAL Il!E
carWl.Ingres Inamply with all city uM cnunuy aJinancn wJaNlc law,relating l9 PHRMIT ISSUANCE. O Q
N huildinpmnnwction.andhereby authrtmarepeaenallvn of Niaoilymenter rpm the CONSTRUCTION TAX Z ubrvcnxnlioned Psremy for inspection pupom. ALTER OR ADD TO MECH.
(We)ngtee to ave,us emnify sold trey 1mmJw the City of Cupmino&,vitro
liabiliaac nn,-V•.and eaperues which mey in any way xmueagniw saW Cily AIR HANDLING UNUFG7010,000CFM)
�inralurn e of Ne 6mnndrb{,yf this penmil.
I __ � , 'fes' AIR HANDLING UNR(0sl RIO,00C0H
`—� EXHAUST HOOD OVIDUCT)
b y�eat_ OVIDUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BLV) Dare Raripl0
Will the algliMlafbuwc buBding occuplm rue m brdle hoar los mrenal
as defined by Ox Cupatim MuniciplCade,Chapter 9.12,snd the Hullh rd Safety HEATING UNIT(OVER 100,0W BTU) TOTAL
Calc,Sectiab 25532(a)t
11 ye, [YNo TLE VENLATION FAN(SINGRPSID)
ISSUANCE DATE
Will Iheappleantmfumm WildinB uxupa^tumW uiprxntudcvisawhich snit BOILER-C0MP(3HP0R 100,000 BTU)
hmnNbwa air contrninan¢as deftnat by the Bay Area Air Quality Manegmenl BOILER-COMP(OVER 1 W."k BTU)
Dinncll I��.k��
CI Ye, Do. NEW RESIDENTIAL MECH. SQ.FT.
1 lave read Ibe huallous mreridt reeUh ems ulda Chepa 6.95 of the ,a O
California IIea1N h Safety Cade.Scotian 25505,25533 and]3534. 1 aderrrd Thu
if,he b�niWi,d r..1 umcndy base a lair,Nat it is my o spnsibilily to roufy Jx
acclipant of the rTqui u w 'idun be rnel Prior to issuance of a Coral c of
'Alones 'aJ eQnll Date TOTAL MUM BY:
OFFIC