25850APPLICANT TO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OF CUPERTINOBUILDING - ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL
BUILDING PROJECT IDEN'FIFTC,ATION
PERMIT NO,
25850
BUILDING RESSG
SANITARY NO.
A/PftlGTIpN SI(BMTITAL UATG
/Ik/V''f6D UNIT ♦ LOT N
�
12
W iRS NA PHONE,
CO ;S 'A
J
N/C
COMROLN
R HITEC"DIENGINPEIt: LIC NO:
ADDRESS:
CONTACT : PHONE;
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
BLDG PLUMB MECH
PERMIT ISSUANCE
❑
LICENSED CONTRACTOR'S DECLARATION
rest I un Noosed uada
1 h7(XMt
a4 (cvnmcno se in
APPLIANCES -RFSID I-
1 BDLSCRIL'fl
�\� A� \z
of Di and
SeaI iiri l of Division 3 o ted llminca mO Profwiav Cade..ad my licaue is In
Putiau iess Co is
[m¢cud effect
PANELS
U
U. Clan I.ic.N
UPTO2110AMPS
Date Contractor
X11 - 100f)AMPS
ARCHITECTS DECLARATION
I understood my Plans dtnlladused n Wblic vrd..
OVER IJ00 AMPS
SQ.Rs71 MAR
1�VA9
IN
USE. F1'.
SIGNSELECTRICAL
LI¢wed Pmfessiowl
OWNER -BUILDER DECLARATION
SPECIAL CIRCUIT/MISC.
fi
1 hachy e1 (Se that 131 caanP satin rhe Cess a is Laine Ire fa the
ewu Cade: Anycirymwunty
O
TEMP. METER OR P)IJi INST. DATE
,ehi,hntoot— ani m,o715,Bwueautive, de
wnicn reyaire, a Permit m.ttnamuet inti. lmpmrva Jermlieh, a mP.v ear .tmtattm
_
Prime its icamedl ehomgoth thovismanoftiwchpenme.
POWER DEVICES
Li.ti Low(ChWet
Juthuareacassdth Scout 7000) or s ti of th the Busacce end Lew (CCodc)
Saeon 7000) or
9( chat
m 3oflhLBWhern ed Pm[asionmen
SWIMMING POOL ELECTRIC
VALUATION
he iaingwird
Icer,
aclotkh 1 ebPaacfmmudra the badsinrtheilkgdexmaara in diy IReuion of
of
any applimllen, emtit nuM1jttts the npplicanunaavil pewly of
OUTLETS-SWITCHES-PDCDIRFS
aSection t dau, ere
rot macaw Ev<hurdrd dellen (5300).
❑ wathwdl
lteirwkca4,
NEW RESIDENTIAL ELECTR _SQ. IT.
PIIS
TYPI. CONSTRUCTION
onow�MJcpeereny,«myarrybyen
will Mr be w(rk, seJ,Co the it na iniad cd for Ned. 70,44,
for B
Buri eta
he Com as, Law a sm
.nil Rofusi VN Cods: The Conmacer', licenx Ire doer not .pply b m Decca Of
oce, of
peapmy who buJde a improver thvnm, ud wed dao Bach wah M1im,elf a Jomugh hie
wn rmployccr,pmvtdthntntchimpovercencsem mrimadedaoReredfmnle If.
OF ROUP
RLS. UNITS
1,:
however,thebaitingaimpmvamth.at ae)�Mca ower.
sofin,Joc
builds will Inv, the burden of proving Nn he did rot build a impwve for puryuw of
he
QTY PLUMBING PERMIT FEE
silt.).
❑ I.uow�OftM lt.operty,em exclusivHy caarurJog wird licrosctlmwxcaeco
IT- ZONE
APN
ortemet the Imjcet (Sec. 7044, Stine and Preheat— Coded The C.ano tm's
active Lew daemanpply co.n owrcraf pmpeny whobuild,aimpmvn thcrron,W
PERMIT ISSUANCE
who contrera forsuch Pmjens aeith.conn.aorH) licensed pn,u.nt eche ContnetWe
Licenm Lew.
AI; PER VEt4'T-WATER LA)
(
FEE SUMMARY
❑ 1 em esempcorder Sec. . H R P C far this .
BACK FLOW PROTECT. DEVICE.
OUTSIDE
Owrer
DRAINS - FLOOR, ROOF. GOND.
SANITARY Y N
WORKMAN COMPENSATION DECLARATION
❑ Thereby affirm thvtllmvcvani0aac nfamscmmself-ireum,meccniBtste of
Worken'Compemuaion lnsmmeem a certified copy chemnf(See. 380(1, L.b C.) which
SCIIOOL TAX YECELPTN N
RECEIITY
FIXTURES -PER TRAP
PARK FEE Y N
GAS - EA. SYSTEM-] INC. 4 OUTLETS
coven ill pnpbyceY undo chi. permit'
Pat,, Y
RECEIPT' M
BUILDING DIVISION FEES
y
GAS - E.A. SYSTEM -OVER 4 (ES)
P.ANCIIECK FTE
Cemiftd rnq is herby famished.
GRE\SFJLNDUSTRL WASTE INTERCEPTOR
GRADING FEE
Cemified copy is fled wird the city inspection division.
CERTTFICATIi OF ECE4PION FROM WORKERS
COMPENSATION INSURANCE
GRFASETRAP
SOILS FEE
SF,WER- SANITARY - STORM IA. MAT.
ENERGY F -ER
(Tis section need me be cmnpleted ifthe permit is sof arc hundred dellen(5100)
WATER HEATER Wf%F DELECIR
I cerJychuinthe pert«nonce of Je work fuwhich chispvmitisivu l,isad)
nor anploY tiny pawn an any manna m n to heconse subject to the Warkai
PAID
Con"asatinnlnw—f Cdifonie. [)Me
Appllo t
WATER SYSTEWMEATING
Due RadpN
NOTICE TO APPLICANT:If, after making his Certificate ofFen,mon, you should
hecaane subject co tie Werke, ComlenvtiOn p dvi,iods of the Isbcr Code, You met
NEW RESIDENTIAL PLMB. _SQ, FT.
TOTAL:
faJawith comply with each pmdshau m this permit shadl M deemed revoked.
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirm the them is. amstrteaon krding.gaeY fee tie performaJ of
TOTAL:
ELECTRIC FEE
the wok for which thin ,cmtil is issued Oke—30J7, Ge. Cd
Lender', N.
Lender',Addrex,
QTY. MECHANICAL PERMIT FEE
MUMBINGITE
I certify Man 1 have mail Joh.,licetion erd,tetc thoa Js.bove informed. is
C. I.gmc to camply with Hl city.nd cotmty mdi. nil ave law, rel.errg a
PERMITISSUANCE
MECHANICAL FEE
budding conmadon, end nemby.mMnte acpsmaddi i yes of this city toenteruPm the
steve-mrnm=
ed nursery for inspectlssn purq u..
ALTERORADDTOMECH.
CONSTRUCTION TAX
(We) agac to n, indeneify and keep hannlu. the Cary of Cupcomeo vgvaua
I abilitic, judgnscme.;�2reel epcnirri vv Ir yinunyweyaccrucv,suretsald Cly
AIR HANDLING UNIT (TO 10.UWCFM)
I Of the gMJn, O this permto
AIR HANDLING UNIT (OVER I0.000 CFM)
EXHAUST HOOD (W/DUC17
PAID
Si,RadaJ,eofApj04 VConmxtu —ac
HEATING UNIT (TO IW." BTU)
HAZARDOUS MATERIALS DISCLOSURE
Date Receipt M
Will the Jr,,liessim m Tamm hoarding Ocarp.nt same or Insects, hnsalloue mina mil
as defectl bythe Cupcnim M araci,?Cde, Cheper 9.12, udthe I leelth aM Safety
HEATING UNIT (OVER IOf'"B,E)
TOT
Code, Sae. 1553200?
❑Yes 0 N
VENTILATION PAsl(SINGIE RESID)
WIIIJe appllurctafutWe WitingocmrpwttsYequiprcntidevica which emit
BOILER -COMP(3HP OR IW.000 BTU)
ISSUANCE DATE
PA
BOILER - COMP(OVER IoLod0 BN)
taeudma sstarmi
comurru ed nn defmby he Bay Amo At, Quehty Me
utagrnnt
Ulsmnl
' Y
Po
❑Yes 0 N
DPA
NEW RFSIDENFAL MECH. SQ. ff.
1 hove read ale M1avrdoes m.rci.h mquiamenc, cads, Cher 695 of the
19
California IRadth A Safety Code, Smiau 155(15,V533 steel 25534. 1 undmwid that
hI 3
Ch1
if the building rWtet taunt.
er t cumcery have u thu it ie my res,malNlity to etaaify the
rccup.m c f tie nquimrren,s which mus, d ma'rear to at of. C Rant a!
Cese '.
% (/J-
QVr�rIl IIVI r
ISSUED BY:
Owmer or.uJtmiwl it,ed Date
TOTAL_
OFFICE