25473 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITY OF CUPERTINO .-f:-I... PERMITNO.
BUILDING DIVISION APPLICATIONIPERMIT
PLUMB
BUILDING
25473
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS SANITARY
„« «'T L SANITARY NO. APPIJCATRJNSUHMFITI
/� ALDATI
7 � Aa / � UNIT» LOT
O"M NAME: PII)NE: CONTRACTOME: UC NO: _(�
e-1 G e G 7--4077 7 N'S NAa s .n OuN
r NIC GOxa..
ARCHIIECHFNGINEER: LIC NO: AD ❑
CONTACT: RIONE QTY. PIRCFRIC PERMIT PEE BU ILDINGPERMITINFO
B- LEGPLUMB MECH
Mrf
PERISSUANCE LT1`L��.T ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
py.Z Ihertbyafrm NU lam licmcal uMspovuiovofClupss9(convrtensing wit TOB DESCRIPTION
)100q Servos 70(b)of Division 3 of the Emmett mal Professions Code,artd my ficenu u in PANELS
TUU full f«cc and CRCs.
<L License Clav Uc.N UPTO200AMPS
"ii flare Convactar 201-Itp0AMP5
l” zARCHITECPS DECLARATION SQ.FT.FLOOR AREA SSQ.IT.
—0 I wderswd my plus"I ba a W as ptlic records. OVER 1000 AMI'S
07O
OZ
QYf,,j LicrnsW Rofeaimul SIGNS ELECTRICAL
CC G OWNER-BUIIDHR DECLARATION SPECIAL CIRCUR/fASC.
qxOe,U I hereby affirm tat I.m sang fmm the Contracvn's Liwnee Use for the
W 3G�y following memn.(Section 70315,Bwi n<s mal Professors Code:Any dry or tracery TEMP.METER OR POLE INST.
p<J which tcquim tit w a pcmconvect,alter.initiative,demolish.«rtpir my mixrart
E YE pane to its iswurac.elso mry'un the.pplicvn forsuxh permit m fikvsiaread uuvrcot POWER DEVICES
K<p that he is lief eud pursuuu m to pwidoru Ute,Coa aCIor s Licerene law(Ch.prc
aa0 9mmrtertcin SWIMMING POOL ELECTRIC
xe� ( gwit Sauon]D00)of DividonJoftle Businm and PtNnnoru Coale) VALUATION
W SWim7 31x ram bym a,fli amfthe Wramtfor teelleged esempMlicis ion.Myvidanon of OUTLET SWI'T'CHES-FICHE A M-- —�
{{{---�,Q M.ron](IJISby anyapplic.ntf«$permit whjaUtlrc applicant macivil lxaully of V
n«mote tan fvehwdred dollar.($5110). NEW RESIDENTIAL EI.ECIR SQ.FI'.
❑ I.esowturof the propeny,mmycmploymwit wgnutheirsokceetpens.rive, TTPHCONSTRUCTION
G ad Br woh,Core: he,CormicoarmeMedoraw ildIiarm so are Bushes
are s,ny whi«u Clams The es hee ar.U.Law moa rot apply b e owner of
pompt ybuild.aimpmvathermhardwumd iini himffBf We.N.
vnpbym,pwNd tntsuch impmvcmrnumeta iearrIcdoroffvedf«sde.IL OCC.GROUP NITS
Wwcva,the building improvement Is sold whin one yevo improve for tome of
W ilda will M1nvc the reorient of prnving tion he did not Wild to improve for pmpn.c of
sale.). QTY. PLUMBING PERMIT FEE D ENE APN
❑ INC,
anject(Smc7 amusines arnel treginewiCde:) heCommento �v
cotwrvct pojat(Sec]094.Business and Rofe..:..,.Code:)The Comrectear's
Umuel«whwerof paposs)wWWLldaacimpmvn, mi.urd PERMITISSUANCE
ialarneasomers for
votprojeresitti<on..ctrts)Isc.cd pursu.eUO On,Cormgncr'.
U.Law. ALTER-DRAIN&VENT-WATER(EM FEE SUMMARY
❑ I am exempt utWcr Sec. B&P C fm tie ensan BACK FT.O W PROTECT.DEVICE OUTSME to
SANITARY Y N
()weer Dau REM'.
-FLOOR A,ROOF,ARECON). R
WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N
❑ m'Cor afR thatlbareaarscarte McvmrnrtnanA( nwrt,«.ar i.)wMof RECEIPT'.
Worem'CamperiWion lrwvvacm•ttrdfudcWYtltsmflScc 3800,1�C)whiN FIXTURES-PER TRAP PARK FEE Y N
m all atWkryee'.order to permit. GAS-FA.SYSTEM-I INC.4 OU`F1_ fS ghchl"f
IElicy N BUILDING DIVISION PEES
Company GAS-PA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cenifedagylshertbyfumlted.
❑ CttnOcd orgy ie TIMI wiN to city intgxLon divldon. GRP.ASFJINDUSTRL WASH?INTERCEnOR GRADING FEE
CERTIFICATE OF ECEl,IPION FROM WORKERS' GREASF.TTtAP SOILS FEE
COMPENSATION INSURANCE
(This section nadm be completed lfthepmeit of«orc htvdmd"Ims(SIM) SEWER-SANITARY-STORM EA.2(X)FT. ENERGY FEE
err I..)
I certify tat in Opeffw ,,.fOa weak for which this merit is iswd.I"I WATTR HEATER WNFMJELECIR
not employ any peron in my mamar ao as or become subjxr to the WokenPAID
Z Comatr
pentre".of Califau nDue WATER SYSfE!vhc F TING Dau Receipt#
A,b.
0QNOTICE TO APPLICANT:If,al making to Certifne of Eamgtuon.you.should W FNI
NERESIDIAL PLNIB. SQ.FT. TOTAL
to he Wos�i CM�ProVillratel of be Labor Castle,Fail
� > fo�Mwit.,Ay WhInsuch po'hei«n�m this,permit 001 be hrntcd rooked. men BUILDING FEE
Ail SIJSMICFFE O
[� CONSTRUCTION LIl.mill AGENCY
I&achy hick the Cert i.a noel(See. AO.Cig C.) for to performance of
U O the wok for which this permit u iswd(Sec.309].Civ.C.) TOTAL: ELECTRIC FEE L �
I<Mn'a N.
Cs F Lends'.Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
U 1 ccrtiy tat 1 have rad IN.appintion ab sue tat to above itdmnanon i.
I agree to avnPy with all city val matey es chmetce,and mare laws rely le,u, PPRMITISSUANCE MECIMal ICAL FEE
&miming mneuaction,anal hereby authonrc rcpraatt,nva of his city m rnururym the CONSTRUCTION TAX
U Z above-meminmel pmpcny f«inspectitm purparm ALTER OR ADD TO MECI I.
(WC agrte to soros,indemnify aM keep haemlm to City of Cupcnnv against
liabiftin,judgmenu,Coses utder,min which may in any only sane agaieu said City AIR HANDLING UNIT(TO 10,0)0 CFM)
of the of or",permit.
/ AIR HANDLING UNIT(OVER 10,000 CFM)
Si tcof A,Ia,anUConmm, Date EXHAUST HOOD OVIDUCH PAID
I IAZARUOUS MA"n,oC1A1S DISCLOSURE
HEATING UNIT(TO 10(1.(1)(IBTIp One Receipt#
Will de it,be liCant or Co,smino .iCiM Carle,Ch erore ea9.12,heMlehavfdou.mSafety HEATING UNIT(OVER 100.(10)BTII) TOTAL:
rl
as de,See by Be Cuperiro Mtnicipd Cade,(-Teta 9.12,and the HeaBh and Sefery
Code,Savor,255324)T
11 Ya ❑No NTVEILATION FAN(SINGLE RFSID)
/�.ISkA�16 DATE
ap
Will theplicentttr fameholding ttaupwt use equips<nt which emit
BOILER-LOW(3HP OR I W.000 BTU) fH� IL�J
m device
bsra mous air ummmitmnD as deOn d by the Bey Ata Air Quality Maoagement BOILER-MW(OVFA W.001)B'I'D)
Dismal 11 Yes ❑No NEW RESIDENTIAL MECII. SQ.Ff. AUG 2 31993
1 have read tk baardatu mumeB tayttitrntenu abler Chaps 6.M of the Ci I Y
California herd&&Safety snot,umenly Seel b 2550g,255JIutd23g34.Linux nosy that Ur Vurtl'1llry
Ifthebuildingdoesmcurrentlyhaveatenant,Cantos mymarw,ofa mratify to
cupwa of Inc reyuiremrnu which nmsi h ms prior w Isunna of•Cmifau of
Ikcuparxy.
tmcr«.ulheraad.grnt Due TOTAL ISSUEDBY: