26312APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO , BUILD - hUhcTRICM
APPLICATION/PERMIT PLUMBING - MECHANICALRCP
BUILDING DIVISION BUILDING PROJIDRNTIF'ICATIO\
PERMIT NO.
26312
BUILDING ADDR�S: `
SANITARY NO.
APPLICATION SUBMITTAL DATE
/ UNIT♦ LOT#
E PHONE
O NA JC NO:
NC
❑
CONTROhM
CI 'Ili fNGINEFR: LIC NO:
ADDR S:
CONTACT PHONE.:
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
BLDG ELECT PLU MECII
PERMIT ISSUANCE
❑ El ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby atfmt ttw l am hommod utdsr Pmvi.ions of0tepsr 9(comntencitsgwith
APPLIANCES- RESIDENTIAL
JOB D. S R O
PANELS
]ons! fpivi.ion Jofmh Buri eM Pmfeai«nC . andmyllccmae lsin
full
full forts antic �' (
Licca ass .K. X
UPTO20)AMPS
[Gh �- Cicf`S
201 - IM) AMPS
Dr
R II'HiCFS UI:LT,ARATION
OVER 11MAMYS
SQ. FI'. FLOOR ARG
$/SQ. FT.
1 uMentad my plat a cell M1e u.al as public rads.
SIGNS ELECTRICAL
IJettaea Pmrmi^w
OWNER -BUILDER DECLARATION
SPECIAL CIRNITOAIS
I haebY of Jw 131 exmryt flan Canvwwr'n License the
TLNP. METER OR WSI'.
(Se l ity cn
ityrcawa(Scclion]U71S,B PofmabnCm itymmunty
aircmmd
%hick ryums. permit to mruwct Jttt. Improve, dvndidl, m rtpdr.ny Wsutme
m*r
F. Ne.isiine.faruchpanutb
pour miuissoust'
POWER DE -VICE/
to Uncose La (Cho'er
thus he i. li<rn 1th S,cmrto Ilepr^vuim.^f Jc Bsc Bum or'. mill Low( Cect,r
4(cOmrnencing with Sation]11DT)of DivisionJoflW Bmitrcu ud Rofeaxi«u CWe)
m lhat he iecxempltertfmm and the burin f«tW dlcgM cxmlpmbn. Any viulvtianaf
Xniim ]II3 L5 by enY ePPliwm fere a pcnnit nunjcm the aPPlicwm to n civil penally err
SWIMMING POOL ELECTRIC t/
OUD,FM-SWITCHES-FIXTURES
pIf VAI,UA^TION—
1�..� tlX.i
\4111
nmmomilan Ovebundtcd Miert($5110).
C3I,muwnaofNcpmpenY�«mY rmlJoYcawilh waeermthcirwlccomprnwtion,
NF.W RFSIDINf1A1. ELECIR _SQ.fT. n 1
T 1
T PE NSTRUCITON
willdtlhc wnrk.Wde wuclurt intw intrndcd moffmM f«vklSec. ]IU4, ButiKm
If
and Pwfdioea Cods: TTc Cumnamor'. U. Law logs rat apply 1^ N owns of
TE
PrwW Wddn«impavtt theman..tmw,am<, wen woh l>;aPeH«IEnoaghni.
own mPbyem.providcd tlutauch impmvcornueee tAsinlCtd[d«oRsrtA f«.•4 If,
IS. UNITS
TOTAL
however, tW Wilding«irvpntrcetene u wdwithin arc yr4nafattrlperian, me owtm-
W ilder will Mvc tW W Nrn of poring dw he did m buil m'vnpove for purpose. of
QTY. PLUMBING PERtvHT FEE
sale.).
❑ I,mowrcrdthe pmpeny,ameaclusiv<lycmaectingwilh licertW mmaIXlm to
Fl.000 LON
MIN
co mmct the Prajm (.Sec. ](ehl Buri. end Pwfesi«a Code:) The Conuvetm'n
(.iccars lswdocsnotepplymenuw of popcnywM Wilda «impntvm demin, erd
PERMIT ISSUANCE
whocooncn fmsuch ptojcm with.com.,mK,)IiccnsM punmmwtbe Comrscli,
Lion. Lass.
ALTER - DRAIN RVENT -WATER (G)
FEE SUMMARY
❑ I em cm.N a Sec. , B A P C fm this rta.mID
BACK FLOW PROTECT. DEVICE
fE
SANITARY YN
X
Owner
DRAINS- PLOOR. ROOF, AREA, COND.
WORKMAN COMPENSATION DECLARATION
SCHOOLTAX Y�f
N
❑ IhsrtbyaRrm thntl hevicecmifioec ofconncntmwlf-imurt.«a«nif uofI
W«kai C«npcttwion lmueuce«•atdfed mryythvmf(Ss 3800, Isb C.)wNch
RECEIPT#
FlXTLRES - PPR TRAP
PARK FEE TN
C.'eStillc.�ry' this, a
Policy# = � -r I
RECEIPT#
r OAS-EA.SYSTTJN-IINC4OULETS
BUILDING DIVISION HiS
TC P/
C«nlC f
Cj�^nni Ocd cape i.lerebyf -
GAS-EA.SYSIEM.OVFJt4(G)
PIANCHIiCKFEB
GRGSE/INDUSTRL WASTE INTERCEPTOR
GRADING WE
It❑ le,ilydmPyiaBlWwtlhlhs iIy in.Peru«division.
CPRTIRCATE OFEXHMPTION FROM WORKERS'
GREASE TRAP
SOILS IEC
COMPENSATION INSURANCE
SEWER SANITARY - STORM FA. 200FT.
ENERGY FEE
(This i -coon tuN nd be, camPlaud ifthe permit is for one hm.dml"Itin($100)
«Ica)
WATER HEATER WNENTIEJECIR
I comity that in the pafon®nceaba, w«t for which Jtig penm u inueQ l shall
not employ my fmsmi in any rmmnnm w as to became subjem to the W«km:
PAID
Campetumiest Uai fCdifonoe Data
WATER STSTEMfOUEATING
Date Reocip0
Applbuu
NOTICE TO APPLICANT: If, .Ra making this Certificate of Exenption.you Jwld
NEW RESIDENTIAL NAB, SQ. Ff.
TOTAL:
become suhjm to the Worker'. Compensvion poviv«n of the Labe Cole, you mum
Gxthw'nh comply withsuch psoelm merrthin Permit shdl be ikemed mvakol.
BUILDING IEE
SEISMIC I'CE
CONSTRUCDON LENDING AGENCY
1 hmeby affirm urban then In a aoi utim ktding agmary fat the Performance of
the work!«which thin permit 1. l..ed(Sec. 30)7, Civ. G)
T L:
ELECTRIC FEE
Irndm'. Name
1c .Adders
QTY. MSCI IANICAL PER MI FEE
PLUMBING FEE
1 cc ify that I lave read this "Plcmion at ..-,• Nm de Wove Inf«manitm is
e.g.lagrtc lommplywinh Wcity and mwmy«dinanca and uuc lawrtlWtlg to
PERMIT ISSUANCE
MECHANICAL FEE
Mdldiogmmswctian, and hemby wJwsim mI rmenutivem of thio city in sett uPm Oe
«^
edrvc-menti«eA Property finspection Pur
ALTER OR ADD TO MECH.
CONSTRUCTION TAX
(We) egrte to save, iMemni fy and keep hamkss the City ar Cupcnitn against
I'abi lines.juJg^Imts, costs end expenses which may in any way uccrve againmxsid City
NR I IANDLING UNIT(fO 10.000 CFM)
neo tic. It he gmnting of this Permit.
AIR HANDLING UNIT (OVPJt 10,0(X) CIrAI)
Sigtwurt of APplicanm/Conmmct« Deme
EXHAUSTHOOD(W(DUCI)
PAID
HEATING UNIT( TO iW,000 B
F RDOUS MATERIALS DISCLOSURE
Due Rams#
Will the applicant orIn. bikii, omImm a«e or hmdk hmmdom material
n defircd by pe Cupemioo Municipd Code, Coma 9.IZ and the Hearty std Safcry
HEATING UNIT(OVERI BTU)
'H
VFMIIA'r10N FAN WGLE RFSID)
Cadc. Section 25532(ayf
❑
❑ Ye No
Will Je npplicanl«fuwrt nuilJing occupwlaxe equipmem mdcvitta which emit
BOILER -COM ]IIP OR 100,000 BTL)
ISSU CEDATE
M
BOILER -C P(OVFR 100," BTU)
bion mom air conmmnimntn m JeMal by the Buy Arca AU Quality Mmagmant
]N,,rlc,?
APR
❑ YF` ❑ No
I have reed dx harerd^ua numcn.ls tcaryitemrnu miler Cnepc 6.95 of the
} AN
2619
C�J L J -I
I // I�
NEW RFSI LNTIAL MECH. SQ. FT.
Califfill, bui. Ranhs, Ssc Code,Smits25505,t it is sed25534. 1uMmwd Bum
rm.Hgdammmnmely Juanita 25505. 25lin myrap«u Iunimmtifythe
Vr �f(/YU
«cupans of Re requbmreau which mum be mm pi« to issuance of • Ccoiriaec of
IXcupmey, r
ISSUED BY:
Dwxr«WthonsN agent Uau
TOTAL
OFFICE