27667 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO UILD>`T-RLECI RICAU PERMIT NO.
APPLICATIONIPERMIT PLUMBWG-MECHANICAL.
BUILDING UIVLSION BUILDING PROJECT IDENTIRCATIOv 27667
BUILDING ADDRESS: SANITARY NO. AYILCA'IIONSUPMITTAL DATI;
UNIT Y LOT H /—Ll
ENS NAMIi: Gomez- FUONH: CO IRACTOR'SN LIC NO: N/C CONTROLN
� G o
RCHITECT/FNGINEER: LIC NO: A DR S:11 �, �ryY1.t4 �VA. ^` ❑
CONTACT: (("�)I UU,,� PHONE,
//���� 1 QTY ELECTRIC PERMIT ` FEE BUILDING PERMIT INFO
Obn �v-63vo BLDG ELECT' PLUMB MF.CH
1 �JJ PFRMITISSUANCE ❑ ❑ kj\ F-1LICENNT
SED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL �T
pC% Iherehy.ffim Nm tum lkev luMer pmvisioncofCh.plv9(cmmlvlcing with JOB DESCRIPTION
1400 Seclion]000)of Division i ofd,e B000m,s and Poificasions Code,am my l lc n is in PANELS
_— fun fore uWcfici
<,, Licemc Clan LcN UPT020OAMPS
,nay Dale Con,rctIX 301-LMOAMPS
O,"iaz ARCHI'TECT'S DECLARATION OVER 10W Ah/Pg SQ.FT.FLOOR AREA S/SQ.FT.
p z_0 1 uMa.wd my Plan dull h used n public recmds.
F,n C JunJ SIGNS ELECTRICAL
QyKSJ IjcensW Professional
rX c),Vc.. I brachy affirm thaWNP�c cm,a man nEJac CoA��«t I ii, a law fa Nc SPECIAL CIRCUIT'/MISC.
1+ :IL VQ, lollowin8 rman.(S ion]OILS,Busineu and Pmfe.i...Code:Any�,a., TEMP.METER OR POLE NST.
4'OJ which ria uoa pmtu,to cvnsini dw,improve,dmnlish,or repair any vmcmre
prim to lis counci rc,ire thc.pplkwt fasuch permit to flea.ipxd.0 POWER DEVICES
�K¢p ,Ml he is licenxW Tartu 1.the po,iI.,m of the Conarelo sLicerre `T 1
saXp ff 9(comntmcing with Section 7")of Division 3 uftbe Bu.int— eaiau Code) SWIMMING POOL.ELECTRIC VALUATION
WN IXdut he iaeaanPl dcrtDmn artl the basis fa Neale Any violadm of OVHETSSWITCHES-FIXTURES
FZT Sahv]OILS hY any eppiam faro Tenni the eppliunuoaewilpvWryof
not more Jen five hunN milers(
❑ L owx.ftbepop ,m , _aQ.FT.
STORIIS TYPECONSTRUCTION
d3_ notJolhawork andthe she C Li.Low
docamk(Scc]O.Buab,ns
.rd Profeuion Code:
The C rx,aa I.iceme I.w dace teat apply io en ownm of
pigmy who Wildsmimpov tl,crwn.ard who Axisuch wak himaelfa tkough bice
wn,mpWyca.pnvidW dun uchirnpmvrma,uvre oa lnudWmofferW Trate lL OCC.GROUP RES.UNITS
h t,, ,thebuildingmim venaccl N,,old wohmoncy o nmplUion.Neo TOTAL:
Ivilder will have tk beedcn f prodng Ilea be did not Wild ne efm of
sale.).
❑ Lnuwneroftte Tri y,asst cxcluxivcly Ll irig con QTY. PLUMBING PERMIT FEE FI.001 z N APN
coot Ne proy'. (Sec. (W,Basions and Prof J The C 1
Littmelawdas mtoppl o owrtaofpropenyw but uoprovn Nertan,md MIT ISSUANCE
wh.ennirvcufasuchpm wiN.c,vura:lor(a) tut
cl ALTER DRAIN&VENT-WATER FA)
Ilcenx Law, r (' FEE SUMMARY
❑ I un exemptorder 'a. ,B&P rt.nr, HACK FLOW PROTECT.DEVICE
SANITARY Y N
Owm Pont, it WONT ANC M ON DECLA TI DRAINS-FLOOR,ROOF.ARFA.GOND. SCHOULTA% YECFIPTN N
❑ lbaebyli lnntbu ve.ceni(imle comeatnrJf-i .arbi oco RECPIPI'»
PIXTIIRES-PLR TRAP
Wonkas'Ccmprna,ion lm eenir, pylhmcof(Sne.3BW.L.b C.)whi PARK FEE RECEIPI'N N
von all empgasundcrN cc miff,. GAS-EA.SYSTEM-1 INC.d OUTLETS
Policy N - BUILDING DIVISION LEES
C„mpany GAS-EA.SYSTEM-OVER C(EA) PTANCIIECK FEE
❑ cert;r�m copy i.ltaaby mml.n
❑ Ccnficelcopyls Died with the cl pecdm diviaim. GREASIVINDUSTRI.WASTE INTERCEPTOR GRADING ME
CERTIFICATE OF L%EM NMOM WORKERS' GREASE THAT, SOILS FEE
COMPENSATION N
(This s Oicn nest nun be c,mpletW iflhe pami,is fee ore huntlrW mlhus(SIM) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or I..)
I certify NU In Ne paformvre of,he work fa which this pecmi,is iasud,I"I WATER HEATER WNENT/ELECTR
not employ say Pe,xv in any numcr sa,u In bnonn subject in Ne WorkerPAID
Z Cumperudionl.waof Califomie. Dale WATER SYSTEAI/IREA'TWG Date Raeip0
zQ N CE TO APPLICANT:ILeflcr m.kin Nis Cinmfi a of E.,dan,yw should NEW RESIDENTIAL PLMIL SQ.FT. TOTAL
00 bccmrc ahjat to the Warkofs Canpenanion provision of the l.bor Code,you most
C4 5: fathwiN comply wlN such pmoatom or this Tartu,sh.11 be memed revoloL BUILDING FEE
1 O CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hachy.ffnn dome is. nuak
ion Ning agatcy fee Tho pafam.rx.of ELECTRIC FEE
V Q
be,work fm which does pmTdt is im-M(Sec.3097,Civ.C.)
[,M ,Nem,
PIctma's Adorn QTY. MECHANICAL PERMIT FEE PLUMBWGFEE
U 1 certify this I love rod this.ppiation std Mae,hu Ine.Gove Information is
W co,nmr. legrtt la cvmPY with toll ciry.nd county onlinurr.and eau laws Mae,to PERMIT ISSUANCE MECHANICALFEE
OM building cmea action.and hereby amharire,epesnulivei uflhu city to cola open Vit,
L) Z eetimad propcny,for sat ALTER OR ADD TO MECH. CONSTRUCTION TAX
dwmrn
(W.).gree,o are,iMcmru keep b.rtnleu Ne City of Cupcnuro ageimt
fahilil.o.jud IIc,nuun pen. whi maylnanywnyecertw.SsumnseidCry AIR HANDLING UNTf(T010 ofil CFMl
the go
—� AIR HANDLING UNR(OVCA 10,00( CFM)
S' mofAWlicm ,a Dam EXHAUST FOOD(WMUC7O PAID
IIATARDOUSMA'rEHIALSDISCLOSURE HEATING UNIT TO IWJM HTU) Due RarlpN
Win,he.pplle.n,or fumy Wilding occupems,ae a h.rdle lo, ileac malencl HEATING UNIT(OVPR IW,IXp BTU) TOTAL
to defircd by the Cupenion Municipal Cade,CN,p,r 9.12 aM the IIceIN end Safely /�
Cmk,Smion 25532(e7 VENTILATION FAN(SINGLE RFSID) P A
❑1 ❑No
ISSUANCE DATE
ip
Will Neeppiuuorfulure buildingaccup.ell useequipv,entadev{m whichamt BOLL.ER-COM11P(JHP OR IOO.OW BTII)
e hsu d air comooioam6 n defireA by Ne B,Area Air Quality Menugemrn, BOILER-COMP(OVER 000,000 BILI) AN
41995
Disaictl
❑Yes, ❑No NEW RESIDENTIAL MEC L SQ.FT. CI I Y Ur l.Urtt 1
I have,rod the h.- ._. mncems].rc,itca.s order
Ch ,-695 of ire IINO
California Health&Sdety Codc,Senior 25505,25533 sed 155J4. 1 tmdanmd the,
if IM Wilding da_a not currently bave.,eme ,Out it is my rePonsibiliry to omify Re
,ncopan,of Nc requiremenu which mad he mc,Prier to issuance of a Ccnificace of
Occup.rry.
Owncr or eu,harized agent 1J.¢ TOTAL ISSUED BY:
OFFICE