24497 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO24497
'E AL PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: ��J.yJ SANITARY NO. APfl.ICATOONNSUB//MITTALDATG
7� l l7•�- c UNIT♦ LOT# I 1 -A'I�
OW VERS NAM[: PHONB: CONTRACTOR'S NAME LIC NO: `
NIC CONIROLM
CIII'IECI'/FNGINEIiR: LIC NO: ADDRESS: ❑
CONTACT: PHONE BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG ELECT PLUMB MECH
PH RMIT ISSUANCE: � El 11cf, ❑
I.ICENSEDCOY'I under 'S IlEC1ARAT1ON APPLIANCES-RGSIDENIIAI, RI�(I
py% Ihertby affirm thin liCONURACTOR'S DE Of RAMO (ammencing withJOB
1+100 Sectiml]WO)ofDivision3af the Busuru.rd Hvfatlans Cole,nM my liame tilm PANELS
C W fall tone aM affect.E<.j LLl Liccn.ve Class' Lic.# UP TO 2W AMPS
trDue Com or 1-IfNp AMPS
%O viay z ARCHITECT'S DECLARATION 2(1OVER 1000 AMPS SQ.FT.FLOOR AREA "Q1 FT.
0z_0 I urden Wed my pun sBtll b,urit,!u wNic records.
Fh L9 SIGNS ELECTRICAL
QySJ LovmedPmfcssiarlel
OWNER-BUILDER DECLARATION SPECIAL CIRCUIOMISC.
OyFV- 1 M1ertby efi m ttut 1 em exem,from the ConnectNc Ixerue Itw fa the
W3LLy followingaawm.(,e m703l.5,fluinms.nd Profewit)n%Gde:Anyciryorcoanry TEMP.MET ROR POLF,INST.
4ED
which ra,ires.pcmut bCon4ruCt,Ylter.Inprove,demoBeh,or«,alr tarry strvctun
aS WYE prior to its iewma,.Iw requires theri'licam for such pemnit to file.signed sntemm POWER DEVICES
p C¢0 that hon is liaised Pursuant to the I.Ymauoftie Contractor'.License L<w(Clupe, UT
SWIMMING POOL ELECTRIC
aaXO� 9(cannmtcing with Station 7")of Divisim 3 ofrhe Bu.siaS vtl Professaca,Code) � VA�'11ON
W n or Chu he is exempt thmefrom and the hasis fa the alleged exemi Any violetim of
LZY Scaim]0313 by wy.Pplicnt fm.permit abject,the.pplicmt to.civil prniltyof OVfLETS-SWHCIIPS-FlXTURFS E
z�Q mx true then five hondml dollars(5500).
n ❑ I,uowmafthe NEW RESIDENIIAL ELECIIi
ttiil1 prlinjGumm otimenycawithwngesurheirwlm cmnpctwtian[, SQ,ET, ST RIES CONSTRUCTION
p,�� will drthe wimk,erldthe he Covi is not inmrdlde nlTeredfa We(Sm 9016.Basun of
yd eny wino bin Code:The Cas lie 's License I�w docs not apply to, ami of
prgeny who huildsaimprovm them r end which,such wded M1imcelfur fara dh his
wnmttploY�RovlJed thin such imlrovrmewve wtinaded mortaed fa We.IL OCC UP .UNTIS
hnwcver,the building es imprarov.,is sold within aw yemofcomplerirn,the nation- TOTAL:
buil) will have the burden of proving thin to did Mt build or improve for puryoi of
n.Rhm lvgeny,tim exclusively cormacting with licensed convector to QTY. PLUMBING PERMIT FEE FI.00DZ E ANN
t therPokeO(Sa.'l066,Business anti Profeasiorn Cade:)The Cor ms,tars
rucluw iYv nth apply to.owrc.flaopcnY wM boildsaimpmve thvcon,ICM PERMIT ISSUANCE
whomnR.cnforwch pojcatswithecmtr.nm(a)licenxedpono.G.hcConu.ctala AL ISSUN&VI:VT-WATER IIA)
I.Iccnw Inw. FEE SUMMARY
❑ 1 t=eacmq uMm Sec. ,B&P C fm Chia won BACK FLOW PROTIiCT.DEVICE SANITARY t Y N
Owner D.4 DRAINS-FLOOR.ROOF.AREA.GOND. RECF,IITI
WORKMAN COMPENSATION DECLARATION SCIIOOLTAX Y N
❑ IherebY affirm thulheve.¢nifkae Mamw.ru to self-imurt,m.cenlfcy<of RECEIPT.
WakeriC tion lnsutmnxmeccnificdc FlXNRI'S-PER TRAP
tmycnse qty Otnrn((Sec.JBW,LaM1 C.)wM1im PARKHE Y N
era all empbYee's Cutler thio persist. GAS-FA.SYSTEM-1 LNC.S LETS OUTRECEIPT A
lity
Po # BUILDING DIVISION FEES
Compton, GAS-EA.SYSTEM-0VER 6([A) PIANCHFEK HE
❑ C=iTicdcopyi.herebyfumished.
❑ Ccnified copy is filed with the city iupecuon dis'aiml. GRLASEINDUSTRL WASTE INPERCFPTOR GRADING HE
CER'I'[MCA TE OF EXEMPTION FROM WORKERS' GRFASEI'RAP SOILS FEE
COMPENSATION INSURANCE
(ITix scetit(1 real not he COmNlctod fine permit is for one hadml Mllon(S Hp) SEWER-SANH'ARY-STORM EA.2WFT. ENERGY FEE
m I¢.)
Iam,ify that in he perfamwnoe of the work for which this prmtit is issued,l shall WATER HEATER WIVE1,'1'ELECTR
ort empby any person in tiny sumer so u to ba:aTr wbjcct to the WhenPAID
Compemat�m laws of California. Dote WATER SYSTEMORIATING Dye RaeiptA
Q z Applicant
2 C) NOMCETO APPLICANT:IT.fur making this CcniBCae oflAcmpim,you should NEW RESIDENTIAI,NAB. SQ.FT. TOTAL:
I" h hremrc subject to the Wnrler's Com,mastion povisiors of We La W,Code,you twin
forthwith comply with such provision m this lrnnk slWl be deemed Tevokcd. ' BUILDING MM
1 D CONSTRUCTION LENDING AGENCY l.J,t/6 Toh,6O SESMICPEE
Z Ihetcbyornmt Chu there isaamtructim landing.gcncy fa the psim—e.,
U
C) the worts for which this .wed
pmerit is i (Sec.3 C
09], v.C.) TOL' ELECTRIC FEE
uLender's Nene
0 L<.dee'.Adtheas QTY. MECHANICAL PERMIT FEE PLUMBING HE
I certify that 1 have rend tHiv appllWion and store thin the above hJamation is� MECFIAMCAL FEF." a cotat. l.ene to comply with stilldry and county aduuraesW sone laws reWing b PERMIT ISSUANCE
F' building construction,and hembYaothmim rtpreunutiva of this lily to enter upon the CONSTRUCTION TAX
U Z above-menuoral" fni in ALTER OR ADD TO MECH.
Ove)'o, mmify enJ keep hmm�less iry Culscrtino egviror
Iiabilides,'W col hrrsyim= rue.gumtW ily AIR HANDLING IINIT(TO I),ODOCFM)
me fthc got Chi
7 AIR HANDLING UNIT(OVER Ig000CFM)
SiBt un d pplimn EXHAUST HOOD(W/DUC13
PAID
IIAl RDOUS MATERIALS DISCLOSURE I IPAI'ING UNIT(TO 1(10.000 BTU) Dau RacipY
Will the epplic.nt or foram Wilding oacupium stone a h.rdle haandotn wmW IIFATING UNIT(OVER IW3NIU 0'TU) TO A
m definnl by du Cupcnim Municipd Cdc.Cbagcr 9.12,and Clic Ileelth and Safety
Code.Section 25532(.)? No 11 Yes VENIlLAT1ON PAN(SINGLE RIISID)
❑
BOILER-COMP(3HP OR 1 W,00f1 BTU) ISSUANCE DATE
Will tidir iomorfm rabulldidi by thenmm eq AirltarblyIswal,ren It {'� 0
hmudrus ilr aronramiwnn u dcfmd by the Bey Ara Air(]utility Mvugorent BOILER-COMP(OVCR 100.000 BTU)
Itisrrim?
J ❑Yes ❑No NEW RESIDENTIAL MECH.—SQ,FT.
1 have rerJ the hawfJws matenal,reyui.la order @aper 6.95 of the Cif �� 79,2?1 Califomi.Hulth&S. de,fery CoSead.25505,25533 inti 25536. 1 uedtv
c .nd that City �s
,rr
if thwsd currently
e building thnhave a tell=[,that it is my rapnniMlity m aglfy the 4aV
oaap.mt of the rtquimoeTlu whim mar be mct prig to i.uama of.CeniDote of <n 11fYV
Occupancy.
Ownurortuthun�egcmt DeOFFICE TOTAL¢ ISSUEDBY:
yM' •1