24756 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUILDING-ELECTRICAL PERMIT NO. 24756
CI'BU OF CUPERTINO APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING HI VISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRP :�� � 1 l f41v---- ,' SANII'ARYNO. APPIJGITION SUBMETAL DATE
,'.. r 5lti_..
is
OWNERS AME, MUSE' CONTRACTOR'S NAME: LICNO:
NIC CONTROL#
RCHITECf INFERS LIC NO: ADDRESS:
CONTACT: PHONE QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECU
PERMIT ISSUANCE �
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RUirdwrIAI.
RIVII
HmwzOC IMrcby eHirm thamlem liani uMapmrisianof Oxpto4(camnrncing wi0t Mf U C
&jdu fast
]000)of DivisionJoftM Pmirres and Pmfcasioru Calc.smrd mYlianx is in PANELS K
y fWl lora mdcRm /-/Y/Y0 p3 UPT0300 AMPS
{a..z 'arx Gass Lic,Niy 7�'I FLD
f y Datc
ne -1PS
, R TTCTSDECLARATON OVER 1001)AMP
S SQ.Pf.Fl,OOR AREA S5Q.FT.
ZO — IunnruW myplm sM1dlOuiupublic rwdvOZ—❑
Fyt; SIGNS ELECTRICAL /
Q'�U I�ttni Profcaimrul0. OWNER-BUILDER DECIARTT
AON SPECIAL CIRCUIT/MISC, I Yn I /A! L E D I p
a
�Oa 1 hereby affirm that 1 am exempt from he Convector's Li«m'e Law for the
tASv-fn following mison,(Sceawri 70313.Busi.eM Profasiom Code:Any city or scomy TEMP.METER OR POLEINST.
C��g which eo quha permit to c«wmct,alto,improve,deerolud.a repair any svucturt _-COMPUTER
n, 2 Pimm its issues.<,also sx,mes the"hamet fmruchp moan.file.ii,edsutcmrnt PD E DEVICES
"<C Rut M is liceni pmoment tothc pnvisime ofthe ConvamS,License Lew(Cnepter
aao�C it(cvmmencm,with Scenes9(J01Baf Division did he Buioeu mrd Pm&xoiom Code) SWIMM I NO POOL EL=? RIG
ce mat he is exempt thmefrom and the basis for the dleeed exemption.Any violetionaf
C:Q Smit]031.5 by any applicant for a crinit subjeeoI tM applicant to a civil pemlty of OUTLETS-SW'ITCHIS-FIXTURES
i stat tae then five hurdmd"fies SSX1jk NEW RFSIDINIIAL EI.ECR� S .PT.� ❑ I,mowrcrof tbeprgeny,army nnployecsaim wagesestMrsole c«npcnaviv i, Q STORIES TYPECONSTRUCTION
will do the work,and the ewcmne in nm inended«offerc]mrsde(Sec]OW,Busmen
and Ptofcvi«u Calc:The Canv«wm's Lircme Law does tat apply mo en owner of
prgenY who Wildsa imporomhcmn.midwMslam sucM1 wmthlmsBmtbmughmM OCC.GRO P RFS,UNITS
cmpbym',ding or Ne seri impmvcmmuart ort intended mplefrmd L gale.If,
however,the Wildingmimpmvmment is soldwithinsineyearofcompletion,thcnwnu-
bmihkr will hove me W nlen of pmving slut M1c did not build m impr^ve for purpue of
taid,k
❑ I.uowrvof the popeny,emexclyirelycotracting aim lkrnsedcrmvactanm QTY' PLUMBING PERMIT FEE FLOOD ZONE AYN
comvuct tM pojm(Sec.]OW,Bw«ss surd Poefeuiau CudeO The CommixemJa
License low doei ort aptdymanow«rafpo,I whobuilchorimpovm merenm.ard PERMIT ISSUANCE
wW crnomex f«vuh pmjccu wlmucamrunon.)femsed ummad w the Comm or',
Lt.I&w. gLTER-DRAIN&VENT-WATER(FIs) FEC SUMMARY
❑ 1 ver exemrpt umkr Sec. ,B&P C f«mix reeaveOUTSIDE FEES
BACK FLOW PROTECT.DEVICE SANITARY YN
0. DateRECEIPT#
DRAINS I1,00R,RW I,AREA,GOND.
WORKMAN COMPENSATION UECIARATION SC1100L TAX YN
❑ Thereby dfirm thvlhevcmccnilmcea of rnnmttomlf-Iraum,macamificame of RECEIPT#
Waken'Canpvuamien lmutana«ecenifiNcopy tbermf(Sa.J800,t�C.)whic{m FlXT)RES-PER TRAP PARK PEB YN
coven all emptoyee'•modest this pmnit. GAS-E.A.SYSTEM-I INC.4 OUTLETS RECEIPT'#
Miq N BUILDING DMSION PEES
Company GAS-IIA.SYSTEM-OVIR4(EA) PLANCIIF,CK FEE
❑ Cenifiod rnPY is hereby fwnivM1pl.
❑ CmifiM«py is filM aim mhc Oity inspomion Nv'.:,... GREASEJINDUSTRL WASTE INTERCEPTOR GRADING HE
CERTIFICATE 01'EXEMPTION FROM WORKERS GRFASETRAP SOILS FEE
COMPENSATION INSURANCE
Umis sectio need mothecom hereF Jmepomit is formmebunmedddlan(SIOT, SEWER SANITARY-STORM P.S.Z(X)FT. ENERGY HE
m bv)
Icrniymh�in the perfanwce^f the work fa which mispmnim is iu«d.l shall WATER EHATER WfVENTGELECR
pby any Parva in any romancer v mo becomt, subject to the WaI PAID
Q
Z m prmvrt fCnlifo to s WATER SYSTF,MITPHATING Dote Rcaipt#
O
Z ,.. TIICE TO (CANT:If.efumeWng u Cmificatc of Exemptimm,you Should NEW RESIDENTIAL PL,HL SQ.FT. TOTAL:
stn become subject mo the Wmkels Canpem-. i rovissom of the labor Code,your rmnm BUILDING FTS
fumrn
withcomplywnh.achprovinwaor pnim'hall 6e deemmed revoked.
1 CONSTRUCTION LENDING AGENCY SEISMIC HE
V
I hereby affirm mhet there is a coumrucuo lording egercy for mshe,pemfaan
mee of
th 'TOTAL ELECTRIC FEE p e work for which this permit Is IuaM(Sec.J09],Cls.C.)
r lenders Note PLUMBING HEt— Lmder.s Adm.. QTY. MECHANICAL PERMIT FEE
U I«+mify mut I Aare recd this applimmo eml serve met the above mmo amen is
cvrteee lag wmmplywithelleuyemdcamtyadiurcuuduetelawsreluingto PERMIT ISSUANCE MECHANICAL PER
(-" Wildingeanswcum.ad Meq vdhamiae rtpesrntuives ofmiscity to emer alien the
U Z above-mentioned ro SrS,for lmpctlon panpom. ALTER OR ADD TO MICA. CONSTRUCDON TAX
(We)egme w save,indemnify and keep hwrnlna the,City of Capetian.agniw
Iiebilities,judgmenes,amweeodca'merswh hmayinanywaynomeMaimisaid Cry AIR HANDLING UNIT(TO 10.000CFM)
u conv4 thegMueis
AIR HANDLING U,ET(OVER 10.000 CIM)
Igtamu App tc4maComict« Dee PXHAUSTIIOODOODUC"O PAID
IIA%ARDOUS MA IAIS DISCLOSURE HEATING UNIT(TO 1M.000 BTU) Due ReaipN
Will the applioml-I'utme had",occupant vae or M1mrdle heamdous mme, al HEATING UNIT(OVER 100,000 BTU) J
u defmrcd by the Cupertim Monicilnl Cade.Chapter 9.12,send the IIUM1b sol Sufny
Code,Siemn 25E32(a)Y VENfIIA'fION PAN(SINGLE.RISID)
❑Yes ❑Na
W Jltleappl�nt«fwumcbwdingary true BOB SR-COW(3HP OR 100,000 BTU) ISSUANCE DATE
put equipment«deviceswhicbrndt
huamdan air condominiums u defined by the Bay Arrest Air Quality Muugcmrnt BOILER-COW(OVER IW.RO BTU)
District?
1:1Elq p Pi 1 b
Ya No NF.W RESIDENTIAL MGCII. SQ.ET. Ir
1 have ted the haavdau materials raryummmu ander Chuper 6.95 M de FEB 9 ��n�
Odifornia HOAh d Safety Cade,Sections 25505.2553]and 255]4. 1 andonvrd mat
if t!r W ilding does nem camenly base.termint,tMt it as on,.,00sibility to ma'dY m0 .1
«<upril of the m,uimmrnu whkb man be mm pries to issuance of a CenlOwte of rTe
Occupancy, ,`��
OwmcmeudwrinA egmt - Dame TOTAL ISSUEDBY: wa� • 1'
OFFICE