25083 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLYBUIL 1 CITY OF CUPERTINO APPLICATION/PERMIT PLUMBING-MRCHAN'"'-
ICAL
25083
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPJCATRJNSUBMDTA1.DATF.
ZrA a LOT N
OWNERS NAME PHONE CO CIOR'SNA LICNO: NIC CONTROL#
(3/Ac — 806 Cor oo F srtti�c P 2v7
• ARCHITF.0 IENGINEFR ICNO: ADDRESS:
51423 Cel✓TRAI Akf. 0 ra qui a ElCONTACT: PHONE, QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG H.F.CT PLUMB MECH
PERMIT ISSUANCE ❑ ❑ ❑
LJIZENSEDCONTRACTOR'SDECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
�Z l hereby afrirm that l am licensed under pnvisionsaf Oupu 9(ona
cmaing with
OC Satin 7")of Division 3 of the Buisets.rd Pmfmios Cade,.rd my bacame u in PANELS
p(�U full rortc W cffcn. ,�J 1
Qc. yl Liccmu Class Lis.# UPTOMAMI3 V�
to d
Date-con.ro 201.10(s AMPS �a c-a
Fye ARCIIfTECI'S DECLARATION SQ.FT.FL AR &SQ,IT.
OO,O L O 1 understand my plans shall be used u pubik recoM. OVER 1000 AMPS
F L F ly SIGNS ELECTRICAL
3,-aj Licrn.ad lrofrasiond
¢ OWNER-RUILDER DECLARATION SPECIAL CIRNRWc.
j�OaU 1 bartby affirm data I an Caemp from the ConOactals Licwe I vs for the
w3LLy following renson.(SeNon7031.5.Business and Rofasiwu Cade,Any any or country TEMP.METER OR POLE INST.
F to—'O'5 which nquioe•permit to cmbuct,alta,improve,demolish,m oep.dr my mottos,
S YS pri«to its lssumnL,also rcyuim the appliwt for such permit to File a signed cltaemcm POWER DEVICES
w K O Thu he is licensed ryusumu w rhe owmioen of the Caurecla'a Lic,mm"w(Ch.tu SWIMMING POOL ELECTRIC
aaxo� 9(cvmt ing with Section 70311E. Divisian3 ofth,Busincv old Pmfeulas Code) VALUATION
«tti
W=N t he is exempt therefrom tad the Wsned for ma dlegexemption.Any violuim of _2$00 DO
�ZQ Secrso703"by.nyapplicand for.,crowtrtjectsthe. Imortmu.clvll pnsiryof
M more than rive hulloed dollars WWI.
Y�O ❑ I,uowmofthe RopnY.«mycroplaymwithwymutle'vsokmmpcwtion, NEN' D STORIES T"VisE CONSTRUCTION
ew.3� windo the worn,tawth<aweturti.t.«mtewma.arrer,d rm®la(ssu.'f 'rsdsa'
and Pmrc.,i n s C«k:The conlmcmra 1,iaauc law doe.,na.pply m en owner of
progeny wlnbwid.aimprovm theran.tad whodmsuch wort lhms,lfatamugh his OCC.GROUP RES.UNI'I5
cmploycu.pravideddhet Sucaimpmvttrrnlsm intcN offctcdfmsale.If, ATE
however,the building«Improvement or sold within oe yea of c«apksion,the owm-
buiWer will lod
ve the bw ,n a proving lined h,did sod m t heriimpove fm purpose of TOTAL
sale.).
p I,uawnaofthc popcuy.uocxclusivcy<vnuectingwithlkwedemnuarmro QTY. PLUMBING PERMIT FEE F t nE APN
mnuruct the project(Sec.I014,Busire.s tad Pmfausiom Code:)Tha Cmmr.ctmh PERMIT ISSUANCE
License Lewdoee ear apply mm nwrernl popny who bdldsa impmv,s dertan,W
who coouacn for such ryr jars with.coms.c c D)lieesned pmsvux m Use,Conurcter's
Lkense low. AUDIII-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ I.m eaermpt amda$a. ,B&P C f«this ream OUTSIDE
BACK FLOW PROTECT.DEVICE SANITARY YN
Cr Duc DRAINS-FLOOR.ROOF.AREA.COND. RECEIPT'.
WORKMANCOMPENSATIONDECLARATION SCHOOLTAK Y N
❑ ers'Co .frrmthtalhnvee,oc ifetaeedico,y thm,of(Sm.3800, c«C.)whiof RECEIITM
W«km ContpensnlbnlutvnaeoacarifiedwpY lh,omf(Ss 3800,1«b C.)which fIXTlIRES�PER TRAP PARK FEE Y N
insets ell mrployKg undcT this pnmit. GAS-EA.SY.S E-M-I M.4 0ITDETS RECEIPT N
Policy# BUILDING DIVISION Il:'
C—purry GAS-EA.SYSTEM-OVER 4 MA) PILANCHECK FEE
❑ CcnBiM copy a lwreM famished.
[} Cenir"copy is Elcl with ma city inspection division. GRFASEANDUSTRI.WASTE INTERCEPTOR GRADING FEE.
L CPRTIFICATE OF"EM!'FION FROM WORKERS' GREASETRAP SOILS FEE
CQMPFNSATION INSURANCE
(Ibis section mdrm bemmplaed ifthe permit is f«one hundred dollsrs($100) SEWER-SANITARY-STORM FA.300FT. ENERGY FEL
or lila)
Icertify lbs in the perfonmoee M the,wok fo watch this Pamir n lssued,I uull WATER HEATER W/VENfJFJECIR
not anploy any lemur in my manner so as to beevmm subject to tk Wokai PAID
C«npen..ionl<wsof Cdifomic Dare WATER SYSTEMfl"REATING Due Reccip#
O Z A,liam
2 NOTICE TO APPLICANT:If,.On making tads Carofinte o(Eaentpmxn,you.Faold NEW RPSI DENTIAL PLMB. SQ,FI'. TOTAL:
V1 baorcsubjecl b the Wahv'.C«nprnmrion provisions a the,LW«Code,You on.
fuNwlta Comply with such lnovimn+a this permit oast be dcnmad revoked. BUILDING IIS
a Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
I herby dorm Bandthyo is•am.I.lendle,henry for the parfoorn.a of Sy
U O the wookfm which rho permit is ivsed(Sec.3VJI,CIv.C.) TOTAL ELECTRIC IEE
U. W .Num
F loer.Adlmu QTY. MECHANICAL PERMIT FEE, PLUMBING ME
U I asmify this 1 have real Mu.Pplivaian tad sue that de,.bv.e id.lm is
UL7 .1.1.gre roc MEOIANICALME
earmp1ywith all city end moody adineaa tad nu<lawa oelnding to PERMIT ISSUANCE.
E-' DO building comlsoctic ,road hoeby uothoriac rtpesewtim of Ws city to enter upon We
U Z .buve-nennaoeL popery far me'tha bn purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX
IWa)agree to save,irelamnify and kap hwmkss the City of Cuperrino Wimt
Ii Wilitiu.jodWnm,nrs.cousud ex,cme which easy in my w.y axrvc.g.Iw sad City AIR HANDLING U!,UT CFO 10.0)0CFM)
in carved.of de gtenung of this partum. AM HANDLING UNIT(OVER 10,000 CFM)
Sigwam of AppliC tlCmtmn« Duc EKIIAUSTHOOD(W/DUCTI PAID
IWARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dares sip M !-
Willthe eppliwnl or forme building ocu,um u«eur bm.11e a.zmdaua mmerlN HEATING UNIT(OVER ID),"tlTU) l 'NTALJ SU
as dfue
cd by the Cu senum MmocdpJ Code,Ch tpc,9.13,uld de Hutad d S.fcry
Cotl,.Section8TI
532(.)? VENTILATION FAN(SINGLE RESID)
11 MAY C1 Nu
BOILIR-COMP(31IP OR 100,000 BTU) S1JA
Will the applimsnt m fummblefding by me,
A uipntrnd oath ca watch acrm GI I 1
h .udau 0 rontrmiwnu a delocd by Ne Bay Arca Air Queliry M.nsgertment BOILER-COMP(OVER 1001)(10 BTU)
DisulnP ....-
I ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT.
1 have¢sed rhe havCr de.mctimot rt05.rt 5nd3 uedn 4. I 6.93 aT the
California d Hedth&of cru Cody.have
a to 8505.SSsJ tad 8334. 1 urden notify
tut
if red building dm not cwrtmlY brut.Icawnt.rMt it is my ruponubility to mti(Y mac
�� ch nluy'hem`ct poli«l-u I.uudnu:uf.Certificate of
[hvnn«ruthmued.gent o�/f"' ~ Wrc TOTAL ISSUED BY:aTrJnL r9 A-P i.'MwC