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25323µ❑A00 'aha ZCy— CZ—❑ P4 W OC u�'0< I=��j I li6�g0 000Moo 1 4 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY RICAL CITY OF CUPERTINO APPLICATION/PERMIT PLUMBING - MECHANICAL BUILDING DIVISION BUILDING PROJECT IDENTIFICATION Z PERMIT NO. 25323 BUILDING ADDRESS ae 11^�/p VV I I I I UNIT# LOTH SANITARY NO. APPLICATIIONSUB//BMMfITALDATE ^` :RS A I PHONE: ` �T ♦ 1 tel. JJ66 ONTRA R'S NAM LIC NO: N/C ❑ CONTROLp CIIIMCf/ENG R: LIC ADDRESS: CONTA(�P:- PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO BLDG ELECT PLUMB MECH PERMIT ISSUANCE El LICENSED CONTRACTOR'S DECLARATION Thereby ofrmthst l 3 ofthe Business and rioruoons Core.acommencing wish Section a and e f Division J of to Business and Professions Code. end my license is in full free end -Hath. APPLIANCES - RESIDENTIAL 100 DESCRI N i�, _ ^ I I 1✓,/�j/'/�/�`/�` we PANELS License Clws Lic.p UP T0200AMPS Dame Convector mt - 1000 AMPS ARCHITECTS DECLARATION 1 understand my plans shin] be used as public records. OVER 1000 AMPS SQ. FT. FLOOR AREA 1;/SQ. FT. SIGNS ELECTRICAL Licensed Professional OWNER -BUILDER DECLARATION SPECIAL CIRCUIT/MISC. 1 hereby r. Se Net 1 am exempt from the eoo Professions Co e: Any law for to following reason.(Section Ir um ,Busmcu andeCoract Code: Anycity or county r! I NJ I TEMP. METER OR POLE DIST, r which requires a Permit to construct, alter, improve, demolish, or repair any structure prior o its issuance, also requires the applicant forsuch Permit o file asigned statement POWER DEVICES that he is licensed pursuant o to Provisions ofthe Contractor's License Low (Chapter 9(commencing with Section J000) of Division 3 ofthe Business and Professions Code) 117 - LU TI SWIMMINGPOOLELECRIC Setetheis1.5 by terefromandthe hssmfarteasegedexempuon. Mylpenaon of Section by anydreddantfarapermit subjects the applicant acivil penalty of ATE OUTLETS - SWITCHES- FIXTURES not more than Roe hundred dollar ($500). than ❑ NEW RESIDENTIAL ELECfR 5 . FT. Q STORIES TYPE CO CDON will dothework, Coag isnm is a .thewrk,.deproperty,ormyeraptadedoduhcand hostile Business 7044. Business Tonalapply Code: The van The Contractor's ont License w do License Lew does not apply m rt owner to ran and Proproperty whiarra iof ves n, s maperywyres. dsorimpmvestereo,mdwhodeessuchwcradc tendedimseered fusible. Ia wnemp. impmvcmenthinenot intendedmoffered fusible. If, OCC. GROUP -RES. UNITS + thebupingori prove howevice to have of improvement is soldhe within one yam ofcnloose on, thrower the burden will have the buNen of proving that he did not build m improve for purpose of TOTAL: QTY. PLUMBING PERMIT FEE ale.). s.1"). ❑ Le,owner.Flhe pmpcny,act esdmivNyconunetingwitlicenscdcmammnm FLOOD ZONE APN construct the project (Sm. 7044, Business end Pro(essiona Cade:) The Canbanors License Lawdoesnmapply manownerofMm nywhobuildaorimprovesthereon,end PERMIT ISSUANCE /� whocummcts forsuch projects with acomramor(s) licensed pursuanUmhe Contractor's LicenseLew. ALTER (EA) FEE SUMMARY ❑ 1 am exempt under Sec. , B & P C for this rcasan BACK FLOW PROTECT. DEVICE OUTSIDE PER Owner Dam—INS- 0., ROOFAREAGOND F. , . SANITARY YN RECEIPT# WORKMAN COMPENSATION DECLARATION I hereby affirm that l have acertificale nfcomenttoself-asure,ors cenificamof Je .'ri Compensation lnsumuceme certified copy thereof(Sec. 3800, Lab C.) which SC140OLTAX Y N RECEIPTN FlXTURI?S - PER TRAP PARK FEE V N coven all employee's under this permit. Policy N GAS - EA. SYSTEM -I INC.4OUTLETS RF.CF.IPT N BUILDING DIVISION FEES Company GAS - EA, SYSTEM -OVER 4 (EA) PLANCHECK FEE ❑ Cenified copy is hereby famished. ❑ Ccrtilied copy is Rled wit Ne city inspersion division. GREASIVINDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASE TRAP SOILS FEE SEWER - SANITARY - STORM EA. 200PT. ENERGY FEE (This section need not be completed ifthe permit is farone hundred dollars($IM) or less.) WATER HEATER W/VENT/ELECTR I certify thatin to performance ofthe work for which this permit is issued,I shell not employ my pcuon in any manner so m to become subject in Its, Worker% PAID Compenvtionlawsof Caiifomia. Dam Applicant WATER SYSTEM/IREATIN Dote Raeiptp NOTICE TO APPLICANT: If, afier making this Cerifieam of Exemption, you should become subject to the Workers Compensation provisions ofthe Labor Cade, you must NEW RESIDENTIAL PLN SQ. FT. TOTAL: forthwith comply wit each provisions or Nis Peanut shall be deemed revoked, BUILDING FEE CONSTRUCTION LENDING AGENCY ai—sas SEISMIC FEE 1 hereby affirm that hem is a mmwcuon lending agency for to performance of work for which this permit is issued (Sec. 3091, Civ, C.) Lenders Namc ,. TO AL: �"� ELECTRIC FEE Landers Add.. QTY, MECHANICAL PERMIT FEE PLUMBING FEB I cmify that I have read Ws epplicuim end asst- that the above information is correct. ]agree m comply with A city and county ofdiromea and state laws sel.a". PERMIT ISSUANCE MECHANICAL FEE building construction. and hereby authorise mpresentadvesof Nis city to enter upon to above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX (Wej agree to rove, indemnify and keep hmmless to Ci ry of Cu Wino against Imb itics,judgmmm,c amcxNnseswhich yinmywayec me imnaid City AIRHANDLING UNIT(TO 10,000CFM) me arm. of to ting.(this permit. \ AIR HANDLING UNIT (OVER 10,0 CFM) 1X1EXHAUST Sig nwrc of APPlicunUComractm Dam HOOD PAID HEATING UNIT (TO 100,000 BTU) HAZARDOUS MATERIALS DISCLOSURE Us. Receipt# Will the applicant or future building occupant store or handle huaadous material m defined by to Coimbra, Municipal Cod, Chapter 9.12, and to Health and Safety HEATING UNIT (OVER 100,000 BTU) TOT Code, Section 25532(e)'i ❑ Yes 11No VENTILATION FAN (SINGLE RESIDI Will tea licanmrfuture buildin accts pp g pmmseequipmemmdevittswhichcmit BOILER- COMP(3IIPOR IW.. BTU) ISSUANCE DATE sodium air contaminants u defined by the Bay Area Air Quality Mansgm eem strict? BOILER- COMP (OVER 101000 BTU) B1 Q Y" 13 Yea ❑ No K p NEW RESIDENTIAL MECH. SQ. FT. 1 have read the hewdous materials requirements under Choicer 6.95 of the . n�Ptlj California Health &Safety Code, Sections 25505,25533 and 25534. 1 understand that �•�U (S if the building does not currently have a tenant, that it is my responsibility to notify the occupon of the requirements which must M1e met prior to issuance of a Certificate of Ixeawaay. ihY• pf� ISSUED BY: Own r od mfi daed agem Dem TOTAL: µ❑A00 'aha ZCy— CZ—❑ P4 W OC u�'0< I=��j I li6�g0 000Moo 1 4 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY RICAL CITY OF CUPERTINO APPLICATION/PERMIT PLUMBING - MECHANICAL BUILDING DIVISION BUILDING PROJECT IDENTIFICATION Z PERMIT NO. 25323 BUILDING ADDRESS ae 11^�/p VV I I I I UNIT# LOTH SANITARY NO. APPLICATIIONSUB//BMMfITALDATE ^` :RS A I PHONE: ` �T ♦ 1 tel. JJ66 ONTRA R'S NAM LIC NO: N/C ❑ CONTROLp CIIIMCf/ENG R: LIC ADDRESS: CONTA(�P:- PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO BLDG ELECT PLUMB MECH PERMIT ISSUANCE El LICENSED CONTRACTOR'S DECLARATION Thereby ofrmthst l 3 ofthe Business and rioruoons Core.acommencing wish Section a and e f Division J of to Business and Professions Code. end my license is in full free end -Hath. APPLIANCES - RESIDENTIAL 100 DESCRI N i�, _ ^ I I 1✓,/�j/'/�/�`/�` we PANELS License Clws Lic.p UP T0200AMPS Dame Convector mt - 1000 AMPS ARCHITECTS DECLARATION 1 understand my plans shin] be used as public records. OVER 1000 AMPS SQ. FT. FLOOR AREA 1;/SQ. FT. SIGNS ELECTRICAL Licensed Professional OWNER -BUILDER DECLARATION SPECIAL CIRCUIT/MISC. 1 hereby r. Se Net 1 am exempt from the eoo Professions Co e: Any law for to following reason.(Section Ir um ,Busmcu andeCoract Code: Anycity or county r! I NJ I TEMP. METER OR POLE DIST, r which requires a Permit to construct, alter, improve, demolish, or repair any structure prior o its issuance, also requires the applicant forsuch Permit o file asigned statement POWER DEVICES that he is licensed pursuant o to Provisions ofthe Contractor's License Low (Chapter 9(commencing with Section J000) of Division 3 ofthe Business and Professions Code) 117 - LU TI SWIMMINGPOOLELECRIC Setetheis1.5 by terefromandthe hssmfarteasegedexempuon. Mylpenaon of Section by anydreddantfarapermit subjects the applicant acivil penalty of ATE OUTLETS - SWITCHES- FIXTURES not more than Roe hundred dollar ($500). than ❑ NEW RESIDENTIAL ELECfR 5 . FT. Q STORIES TYPE CO CDON will dothework, Coag isnm is a .thewrk,.deproperty,ormyeraptadedoduhcand hostile Business 7044. Business Tonalapply Code: The van The Contractor's ont License w do License Lew does not apply m rt owner to ran and Proproperty whiarra iof ves n, s maperywyres. dsorimpmvestereo,mdwhodeessuchwcradc tendedimseered fusible. Ia wnemp. impmvcmenthinenot intendedmoffered fusible. If, OCC. GROUP -RES. UNITS + thebupingori prove howevice to have of improvement is soldhe within one yam ofcnloose on, thrower the burden will have the buNen of proving that he did not build m improve for purpose of TOTAL: QTY. PLUMBING PERMIT FEE ale.). s.1"). ❑ Le,owner.Flhe pmpcny,act esdmivNyconunetingwitlicenscdcmammnm FLOOD ZONE APN construct the project (Sm. 7044, Business end Pro(essiona Cade:) The Canbanors License Lawdoesnmapply manownerofMm nywhobuildaorimprovesthereon,end PERMIT ISSUANCE /� whocummcts forsuch projects with acomramor(s) licensed pursuanUmhe Contractor's LicenseLew. ALTER (EA) FEE SUMMARY ❑ 1 am exempt under Sec. , B & P C for this rcasan BACK FLOW PROTECT. DEVICE OUTSIDE PER Owner Dam—INS- 0., ROOFAREAGOND F. , . SANITARY YN RECEIPT# WORKMAN COMPENSATION DECLARATION I hereby affirm that l have acertificale nfcomenttoself-asure,ors cenificamof Je .'ri Compensation lnsumuceme certified copy thereof(Sec. 3800, Lab C.) which SC140OLTAX Y N RECEIPTN FlXTURI?S - PER TRAP PARK FEE V N coven all employee's under this permit. Policy N GAS - EA. SYSTEM -I INC.4OUTLETS RF.CF.IPT N BUILDING DIVISION FEES Company GAS - EA, SYSTEM -OVER 4 (EA) PLANCHECK FEE ❑ Cenified copy is hereby famished. ❑ Ccrtilied copy is Rled wit Ne city inspersion division. GREASIVINDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASE TRAP SOILS FEE SEWER - SANITARY - STORM EA. 200PT. ENERGY FEE (This section need not be completed ifthe permit is farone hundred dollars($IM) or less.) WATER HEATER W/VENT/ELECTR I certify thatin to performance ofthe work for which this permit is issued,I shell not employ my pcuon in any manner so m to become subject in Its, Worker% PAID Compenvtionlawsof Caiifomia. Dam Applicant WATER SYSTEM/IREATIN Dote Raeiptp NOTICE TO APPLICANT: If, afier making this Cerifieam of Exemption, you should become subject to the Workers Compensation provisions ofthe Labor Cade, you must NEW RESIDENTIAL PLN SQ. FT. TOTAL: forthwith comply wit each provisions or Nis Peanut shall be deemed revoked, BUILDING FEE CONSTRUCTION LENDING AGENCY ai—sas SEISMIC FEE 1 hereby affirm that hem is a mmwcuon lending agency for to performance of work for which this permit is issued (Sec. 3091, Civ, C.) Lenders Namc ,. TO AL: �"� ELECTRIC FEE Landers Add.. QTY, MECHANICAL PERMIT FEE PLUMBING FEB I cmify that I have read Ws epplicuim end asst- that the above information is correct. ]agree m comply with A city and county ofdiromea and state laws sel.a". PERMIT ISSUANCE MECHANICAL FEE building construction. and hereby authorise mpresentadvesof Nis city to enter upon to above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX (Wej agree to rove, indemnify and keep hmmless to Ci ry of Cu Wino against Imb itics,judgmmm,c amcxNnseswhich yinmywayec me imnaid City AIRHANDLING UNIT(TO 10,000CFM) me arm. of to ting.(this permit. \ AIR HANDLING UNIT (OVER 10,0 CFM) 1X1EXHAUST Sig nwrc of APPlicunUComractm Dam HOOD PAID HEATING UNIT (TO 100,000 BTU) HAZARDOUS MATERIALS DISCLOSURE Us. Receipt# Will the applicant or future building occupant store or handle huaadous material m defined by to Coimbra, Municipal Cod, Chapter 9.12, and to Health and Safety HEATING UNIT (OVER 100,000 BTU) TOT Code, Section 25532(e)'i ❑ Yes 11No VENTILATION FAN (SINGLE RESIDI Will tea licanmrfuture buildin accts pp g pmmseequipmemmdevittswhichcmit BOILER- COMP(3IIPOR IW.. BTU) ISSUANCE DATE sodium air contaminants u defined by the Bay Area Air Quality Mansgm eem strict? BOILER- COMP (OVER 101000 BTU) B1 Q Y" 13 Yea ❑ No K p NEW RESIDENTIAL MECH. SQ. FT. 1 have read the hewdous materials requirements under Choicer 6.95 of the . n�Ptlj California Health &Safety Code, Sections 25505,25533 and 25534. 1 understand that �•�U (S if the building does not currently have a tenant, that it is my responsibility to notify the occupon of the requirements which must M1e met prior to issuance of a Certificate of Ixeawaay. ihY• pf� ISSUED BY: Own r od mfi daed agem Dem TOTAL: