26397 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO APPLICATION/PERMIT PLUMBING-MECHA'N'ICAL PiRMIT NO.
BUILDING DIVISION BUILDING PROIECIIDENTIFICATION 26397
BUILDING ADDRESS: /1 )/J SANITARY NO. AFPIJH
CATIONSUBMTALDATE
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/G�d UNIT# IATN C `
INE
R' AMECO C-IY)R'S NAM LICN NIC CON OLi
ARCHITE`CTTfEN✓•GINFER: LIC NO: ADDRESS: ❑
CONTACT: PHONE
QTY. ELECTRIC PERMIT PEE BUILDING PERMIT INFO
VhW ELECT PLUMB MECII
PERMIT ISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL TOB DESCRIPTION
�00 SSarfon,Tl�)`'Dih,ianl3oflhcBusineisam ficenscil rsnd I'ofi,toou C'dc,9end my Iio-crnseg N PANELS �J.f�rf y '�x
Q7 Lia<vc UP T03W AMPS
rFitQ Date CnnlrecJ��" WI.I000AMPS ~j
Z ARCHITECT'S DECLARATION OOVER 1000 AMPS SQ,FT,FLOOR AREA 5/SQ.IT.'N
1 undclvand mY Plaie sM1,tl h need as wblk I mi.v
Q In SIGNS F1ECfRIGL -
Licertaed P.ofxsrvnol �
OWNER BUILDER DECLARATION SPECIALCIRCUR/MISC.
OEtVa.. I Mcby ef!that I uo eac..N flan Nc Cammnde Liamse Law for pc u w A
�Qtan following ncaxm.(Seclion T031.5,Bmirca srd Prefealaru Code:Any city o-county, TEMP.METER OR POLE UN
C—y.l which rtyuircxepnnil to rannrtla,.11tt,improve.dcmAieh,urcgir.nY aWclure POWER DEVICES
f ay Prior to iu mmorc..lso mquun the 4rlicam fawch fvnutm file a eigml wemrnl I uv^ I�
_�p NeI h iv licctucd pnsuml to Ne pwNtlom of the Caovaad.I�ccnsc law(I]upla
axc p�- 9(anmencing wiN SKtlw 9fgp)of Dlvidwt3o[Nc Butinm erld Pmfnslmu Cade) SWIMMINGPOOL C Ts VALUATION
WM, caft,le is exempt lhcrefmm unit B,,,look fo-the elkged enrupton.Any--u., OIITLETS-SWITCH
tKQ Seed.n 10313 by wy epplicuv for.paintwbj.tleri picmu m a civil Pei ty of
$ not more Nan nvehwdnm Joll.n(s3od).
�C� ❑ I,esowncrnflM1epopcnY•temyrntpin eeawithw NEW RESIDENTIAL ELECIR SQ.FT.
y agu¢sJevwkmmpens.Jon, STOR ESTYPECONSTRUCTION
d3— w0l do Ncomms and th he Coreienor's Lkense odic(not apply
to
alar Pn w1holu Code:The Cattr.clde ral Taw don rrot apply 10 N owar of
progenyloyms, Oila orlod mveschemm,V txxonwehwoh hitmeercd fmalh hu
Wnrmployas,pmvided NmeucM1impmveranuarena inlcrdNwofferttlfmsele If. OCC.GROUP R .UNITS
hrvwcvcr,dna W IkNg a impnovernem Is wM wiNin ae ywr o(canPlaim,Nc owrcr-
W iWa W 01 have Ne dvdcn of prwing Wt h did ore MdM a impms fa puryose of TOTAL
sulc.).
❑ Las ownerofNcpupny..m cxclusivcly cmursclingwiN littmsN Wnbxlm to Qom' PLUMBING PERMIT FEE IL D E AM
cor comm the pojal(Sec.10,4,Busircu arM Professiao Corte)Thc Conuectds
Licrnselswdmnw.PPlywmounerofproputywlrobuildsaimpmventharm,W PERMIT ISSUANCE
who cmtans forsuch prajau with a ommammU)IicauM purswnt n the Corw.ctar's
U.Law. ALTER-DRAIN&VENT-WATER E,G FEE SUMMARY
❑ 1.m eaanpt umla Sec. ,B&P C for Nie re.sao BACK FLOW PROTECT.DEVICE SANITARY Y N
Owren Due RFCETPI'#
rn DRAINS-FLOOR.ROOP.ARFA.COND.
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Ihereby,mear N.lima.
imor.ccocaf conemmxl(See.3e,m aamc.)ue of FlX'NRFS-PER TRAP RECEIPT'#
'.Vorkers'Compenutiun ltuumraco-ecenificdcWY Jerea((Seo.3B0),Lamc.) PARK FEE Y N
/ v aJco'Ployco'uMathis Permit. GAS-EA.SYSTEM-1 INC.4OULETS RECEIPT#
pOicy Y BUILDING DIVISION FEES
CanwnY GAS-FA.SY=.M-0VM 4(PA) PLANCIIECK FEE
❑ Csniriet...is Mxby fummocal.
❑ Cmified eaPY ie filW wiN Ne city lnspeetlan division. GREASFIINDUSTRL WASTE INTERCEPTOR GRADING FET:
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILSILE
COMPENSATION INSURANCE
g1m.action ad rot h complaW ifthepcmut is for one hurdled dall.rs(SIM) SEWER-SANITARY-STORM EA.MIFF. ENERGY FEE
o-lea)
I certify thus in Nc wHonrwa MJe wort fo-which thu pcmiituivuM,lehnll WATER HEATER WfVENT/ELECIR
nm employ any person in any roamer w m In became .subject to the Wortm' PAID
Canpwtienlawsaf Coproma Date WATER SYSTEM/IREATING
O z Applicont D+re Receipt N
z0 NOTICE TO APPLICANT:If,alto-making Nu Certifiuteof&.,it.,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL
V) baome subject to the Watch Com enation poorumaru of Ne labor Codc,you mw
f«NwlN comply wiN such povitiam or Jus pemdt NW be dared revoked. BUILDING FEE
aQ CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z Ihereby.frrm Jut Jere u.construction biting agency fu lfa'm1amencc of
O th wart for which tht permit is hued(Sec.3091,C.,C.) TOTAL: ELECTRIC FEE.
Tender's Nems PLUMBING FEE
O F Irndcr's Address QTY. MECHANICAL PERMIT FEE
CJ I ccoify Jut I Nve rnd Ni.appimmien mM cote N.t the above infmoam.t.
0. ectad. I.grcem comply withallclty at cammmM
ty ooiiamae lawstel.tingto PERMIT ISSUANCE MECHANICAL FEE
I, huiking cnnstm,tion,and M1crehynuJxxiO,reperntetiveo(this city toenterupou th CONSTRUCf10N TAX
agree U Z abovc mrntimed propcoy fa inNeaiou Purposes. ALTER OR ADD TO MECH.
We) to sore.iMrnmify.rd tap the City M Cupenitio against
li.hililin,j ..cmotaidex Ommyw.y ,aaumac id City AIR HANDLING UNIT(TO 10,000 CFM)
it cOn aft 07yoI /d
5 AIR HANDLING UNIT(OVER I0.000 CFM)
L
SiXurc of Applicvnt/�RIUSIOATERIALS
Date EXHAUST HOOD(W/DUCFl
PAID
HADISCLOSUREHEATING UNIT(TO I)1"BII) Lute Racipla
Willtbc applicew lding cecupant stare a h.rdk hermdoui nmterim
n dcfad by Je Cu ipal Cock,Chapter 9.12,atd th Hu1N W Safety HEATING UNIT(OVER 100.000 BTU) T AL:
Cade, two ja-
Swum 2.3332(.)1 VENTILATION FAN(SINGIE RESID)
Clye,, ❑No ELI
ISSUANCE DO.
Will lhcepplipmER 000
l-lamre Wildingacupanluece4uipmentadevlm Whlchemlt BOIL -COMP 108, BTU)
h.vr3ws air contemirunu u dcfinal by the Bey Area Air Quuluy Marmgemrnl
BOFLFJR-COMP(OVER 100,000 BTU)
Disnin'1
❑Yn ❑No NI- RESIDENTIAL MECII. S).IT. 1p a D
I h.vc reed Ile houtdwe mammate nc aincmrnts uMcr Chapter 6.95 of the
V
Calilomle Health&Safety Code,Se m ns 23505.23533 mM 25534. 1 uMcntaml that
if Ncbuil of
Jocemu currently lhammmenonwich to be
10 Maumee
Ceificimo rolif,the
f
cc p nt err�h rcgaianena which mnW h tat pNor m�.waaace ora cenirwa or pp BY V
oaalm y. {Ytf1
Ownnnriumhori¢d ngcnlDmc TOTAL ISSUED BY' 'GIIIIIVU
OFFICE