25313 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO APPLICATION/PERMIT PLU rsta"i-MECHA25313
ICAI PERMIT NO.
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. AIYLICA910NSUBMTTI'ALDATE
0 3 GL EA1 Vpl X141 A�1,� LOT# '7-1�,-q
OWNGg,S
PAAD NAS M07/I[/NI���_v3MRACTOR:S NAM LIC NO:
A S NC CON ROLM
ARCHRECF/ENGINEER: UC NO: ADDRESS: ❑
cmk—'�T AT NALLTVIdr,4 QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
(406)"79-W661: BLDG ELECT PLUMB MECH
PERT
LICENSEDCONTRACTOR'SDECLARATION APPLIANCES-RESIDENTIAL ( \
yy Itrcmby alEnn Nstl anllameJ umlerpruvi.ionmf@epter9(marcncing with JOB D6, RIPIION
00 Sation]IXp)of Division J of grc Bu.Ixu W Pmfasiorm Cade.amd my lkcm u m PANELS
y(�� full f«a ard effm. 2
�41y IJer s,Clna Lit,If UPTO200AMPS ,7
+nGd Doe, Coomaga, MI-1000AMPS
ZOv`ai— ARCHITECTS DECIA YDON OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ,FT.
O z—O I uMerstvid my plan.{toll be used as public to rols.
F'rnt SIGNS ELECTRICAL
QYE� ugerard ProfevimW
°L,ed< OWNER-BUILDER DECLARATION SPECIAL CBtNR/hRLSC.
�pp�aa..OycU I hereby ufrlrm that I un exempt frorn Bu Convu'wr's License Taw for me
u134♦n fallowing ressom.ISec4on]0315,Busi.and!Profusions Code:Rey city«c«mgy TEMP.METER OR POIE[NST.
t LL g wlixM1 requires.pemut m caamua,Jter,impove,dcrrollah,a relair any atrtcmre
�(is pri«mita iasmrce,elwrequlra tM1eappliaWf«wch pcmdtto Okavigred sletemeot POWER DEVICES
m_MO Brut he u licensed pursuant to to puvisiom of the Conmamor's Licemc Law(Ctupty
a Xoty 9(anrun fn,with Section 7000)of Division 3 aide Bnninraa and Prare.riom Code) SWIMhBNG POOL ELECTRIC vALun'll(yyS�.
y)_y «thu he is uemB#thaefrom end the basial«the elkged uermption.AM viderion or V _
t:a Smion70315 by any aWliwt for u permit subjecu the applicant to a civil pandry of OVTLEIS-SWITCHES-FXT'uRES I ` �
f S 0 ra mare gun Egc hurtlml"I.(5500). NEW RESIDENTIAL E].ECfR SQ.FT. ` -.1
K ❑ I,aaownaol,hepopcnY.«mYanpbYmwiN wagesuthdrwkcompewOm. STORES TYPE CONSTRUCTION
tai_ will do the work.mnd the smucmre is not mended oraffeml for alc(See.]0.W,Burg. � ' �f. I
and Pwfeaai«m Code:The Contractor's License Law donot apply to an eres ownof V N
,openw W bails.«impaga,beraa,a,awmdoavaen sash nimwlr«tlm«rgnw
cmpinym,pnvldM Bur such impmvcmcnaart mtintcrNM«affcmdfaraale.IL OCC.GROUP R' .UNITS
M1uweva,Be W riding«'mnpmvcmcnt it said wiihin me yea ofmmpktian,Ba owner- /1 I
Nnldcr will lure tro buNen or pwvi�,M1u ro ala rot W Ikl«vrrpove ra wrpoae or
le TY. PLUMBING PERMIT FEE F.. D oNL APN
1,a owrcrof the pwpcnY.em caclutivcly cmtracdng with Ikcnstl mnwctm m
Zonglow we rojm(Sec.701#.Businm and]Pmfeaaiau Code:)The Cmtracton.
I;ccmclawdocemapplY ter.nowrcrarpropenywrobuilrhaimleovu ticrcon.ard I PERMIT ISSUANCE
who for such prokca with•contramor(r)IicemN purrmot to Be,Con0actar'a ALTER VENT WATER(EAI
Home Law. FEE SUMMARY
❑ I aoncavopt order Ser. ,B A P C f«,his reason BACK FLOW PROTECT.DEVICE
SANITARY Y N
Owner Dare DRAWS-f1.00R,ROOF,AREA,COND. RECEIPT#
ORKMANCOMPFNSATIONDECIARATIO SCHOOLTAX -Y N
❑ Ihvchya that Ihave•cenifu¢ofe.,to.elfAwve,or.owificve of /fRECTiIPT#
Workers'Compenserion lmuwee«a earifiM copy ihertor(Sa.3801,Tab C.)which L FIXTURES-PER TRAP �� PARK PEE Y N
covers all employees uMa this pemnit GAS-HA.SYSTFM-1 P`C.<OUTLETS RECEIPT#
Polity Y BUILDING DIVISION FEES
Cograny D nlfed copy uhcrtby famished. GAS-EA.SYSTEM-001 EA
❑ Certified copy is Ekd wlN Be city lmpectim a:vi.ion. GREASEMNDUSTRL WASTE R DW
CERTIFICATE.OF EXEMPTION FROM WORKERS' GREASE TRAP r t S IS
COMPENSATION INSURANCE
ER
Iritis acmian nnrotl not Weweplered ifthe prawn,m forehtvWcd lollm(SI)0) SEWER-SANITARY-STO MPA.NIOFT. ENERGY FEIi
to,lar'.)
I ccntifY gnat In the,pert«nw¢of de wwk for which this partial is iswed,l drab WATER HEATER WIVCIA
ort employ any Person in anymamrcr w as to bccwe subjm to de Wakens' TAI PAID
Contpnse,ian law.of CaBfomia. Dare WATER SYSIPAVfREATING Data Rcaip#
Q z Applicant
z C) NOTICE TO APPLICANT:If.arta making Bus Certifae of Exam aeon,you.hauN NEW RFSIDEPITIAL PLMB. SQ.FT. TOTAL:
f, Wearre wbjm a
W the Woek 'a Cmnrn
pvm p
tiosmons oft#labor Code,You mug
a ; fumhwith comply with arch provisions or this gamut shill W deemotl revoked. BUILDING F}S
0. Q CONSTRUCTION LENDING AGENCY SEISMIC FFE
Uz I bereby.lT rao Bar Be a canueucrbn lending agency for rte perm,,m ee or
O thew«k for which this permit is iaaad(Sec 3))7.Civ.C.) AL ELECTRIC IEE ft
Iurdcfa Nutrc
O I<rdde Amnesa QTY. MECHANICAL PERMIT FEE PLUMBING FEE
1 cemiry that I nava read this application and.we the,the above Information is
CL cmcck lagrtcmconrplywi,hdiciry mdcavuy«dlruecp vN s,ve law rtla,ingb PERMIT ISSUANCE MECHANICAL FEE
I-' Wildi,can.far,and hereby aothan.repvenagves Mthudryto anter upon the CONSTRUCTION TAX
Uauras-ncnti«N PnTemY fm inspection puryosea. ALTERORADDTOMECII.
Wel agree to.save,indamify ard kap harmless the City of Cupertinoagaiw
bab11 tm,judOmanra.cmaardexp whichoayinanywyaaroeagaiwsail Cny AIR HANDLING UNIT(TONf"CFM)
uenca a, gngaf,hu 93
7 h3 AIR HANDLING UNIT(OVER IO,tK)(1CFM)
Sigw,ureor Appli OConuactm J pa,a EXHAUST HOOD(W/DUCID
PAID
IWAARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.000 BTU) Date RadpY
Will the"lic.nt or future Wilding occupant vane or handle M1arandmus material I IIrATING UNIT(OVER I W,qU BN) TAI.;
as defined!by Be Cupertino Mm ici al CMB,Christer 9.11,ard the I Ledih and!Sdety
Cede,Satin 25531(e)) VFNHLATION FAN(SLNGLE RESID)
❑Ya ❑No
Will tha mrfmure WildingO upant uw BOILER-COW(3111'OR 1011(10)BTU)
ISSUAN F-DATE
ocomagn equipmentQualit Management M1vaudom au can,a,dutarna v dcfueJ by the Bay Aru Air Quality Management
DisaicTf
BOILER-COW(OVER 100.000 BM
h
❑Yes ❑No NEW RESIDEW AL MECI1. SQ.FT. P A V
1!urge rear the Cannings materials m3uirtncnu order Cupar 6.95 of the ���
Celiromla llMthh Safny Cade.S«,bm 25505,1J533 era125536, lumdaamndthat
if the building dm tag currently have a lennL Bute it is my mpemibiliry to notify the
«cupaat a de rtquirenenty which mun W non pi«to luuana a•Certificate err
a<uwmcY. Ia
cat l l
Owner«n,KoriaN agent Dao TOTAL ISSUED BY: