24908 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO
h HUILDINI;-ELECTRICAL PERMIT NO.
UN -NE.cxANICA],
BIJSDING DIVISION APPLICATION/PERMTT 24908 4JOH
BUILDING PROJF.CTIDENTIEICAT10N
BUILDING ADDRESS: SANITARY NO. AMIICA11ON SUBMITTAL DATE
UNIT# LOT#
OWNPRSNA F.: PHONE CONTRACIOR'S NAME' LIC NO:
.� ,_SCS+ Rpt NIC MR 1,0
�ARCIIIIFCT/IIJGINEER: LIC NO: / ADIVS;
CONTACT: PHONE: s.
Ay ELECTRIC PERMIT FEE BUILDING PERMIT INFO
III OCT PLUMB MECH
PERMIT ISSUANCE YV El El
LICENSED CONTRACTOR'S DECf.ARATION AP1'LIANCCS-ftISIDFMIAI. f-'f�o+.�rvnON
qCZ Itcrthy ofE mUtu11.m CONTACTORv lsimsoARAaUrY( igwith ,`JOWv'r\Gr'-.��
�cc Smlim]000)or Mvision3ofW Bofi�"Nofmaiao Cade.aedmylcncuin PANELS
yV6 full face and elect.
< A
Limns Clue Lie.M200 MPS P d.
y y Date — ^ CmtranZURI4PA1 UPT0201.l(M AMPS 1Tr v
ZOso ARCHITECTS DECLARATION / OVER 1000 AMPS SQ.FT,FLOOR AREA $/SQ.FT.
O Z_0 1 ursdvsswtd my Alms shill be lved u public rtcards.
F� w SIGNS ELECTRICAL
< Q licensed l4ofcssitxml OWNLR-BUILDER DECLARATION SPECIAL CRCUUUMISC.
1 hi.firm that 1 wn cscmp Tran Nc Conor lila licmac law for the
31+-In following reuml.(Section 7031.5,Business W Pmfeasions Code:Any city or mwty TEMP.MFTF]t OR POLE.INST.
which mattes a Permit to construct,alter,improve,demolish,a mpir tiny structure
He,to its isvuura,olso maim the epplicenl for such perrnh to fls.sigllcd rincmenl POWER DEVICES
W__n o lbw lie is Bosom.]p• •..• l0 he Provisional the Gmtrenu'a IJcrose Law(Choper
dp, z y msronrcN SWIAIMINGPOOL EI -CIRIG
KOLL ( 8wi therern]IXp)of bass ao Sof the Hufilw WRofcaiao Codr,) VALUA�ys_
L_,� or that hr,31.55 letyT mmurd the hwrnnitlfor theellegN exemplim.Any IK nam of (fir
LZY $mlinn]031.3 by tiny applicant(wspmnit subjccb the epplisannoacivil penally of OUIl,ITS-SWITCHES-I9XTURFS I
w_< rW ours than five M1uacrod dollen(53(10).
� ❑ I.asowlvsktM pofcrtY•amycmpbyaawithwagnaadeirsdemmperu.tioo, NEWRISIDFMIALELECHt _SO.Ff. STORIES TYPE CONSTRUCTION
y _ will du the work,and lhessructurt is.imcndr,d efoltcled far.vk(Sec.]OaN,Bunn. I
sial Pmfcasions Gds:Thr,Cmlmcmr's Licenm law coxa non agcy to an owner of I'
Psopny,lbob.ildsampr
improves lhanione utlwMdoafuelt hleroa forlhlot hhis
own employmm,pmvidM Nw sixhimpmverxnsartrxsl ilueodcdaolfertd fmsak.IL UP UNITS
Icwescr,llchuJdingaimpmvemanisaoWwithinacyeafol dem,the Ownv- ) I nn
huikler will twvc IhC burden of pnwing Ihw he did rnl buildor inn,,evmpnwe for puExme of 4 v I
ho,
'S°1c')' QTY. PLUMBING PERMIT FEE Y APN
❑ I,mowncofthepo71),lam exclualvelyconlnNywiC Oc Tnrnetacto t
m mmt m po;c1(sur..IB .Bnai a d Pm u on cos:) <co l a tea TE
Lian,e Lawdre,nm vpplymen owncndpnprrly wMl Wildamimpruvo lM1vmn,aM ---
PERMITISSUANCE
'Iowa =forsuch"ccuwilheconnantot(s)i.,o,ipufuamlolnr,ConnxlNs
Licnx law. MAINALTER- h VFM-WAWA(EA) FEE SUMMARY
❑ 1 urn r,xerept undo Sec. ,B A P C fa Nim reason BACK FLOW PROTECT.DEVICE— UT.I L
SANTI'ARY Y N
0,ner Date DRAINS-FLOOR,ROOF,AREA,GOND. RECFIPT#
WORKMAN COhfPFNSATION DECLARATION SCHOOLTAX YN
E] IlncbY efBnn lbw lhavr,aanRoc of catYet to elf-inurt.a aanif col RECEIPT#
Wakm'Comprn.vlion lrsamnec or a ceni0cd copy thcrtof(Sec Mx),lab C.)which FlXTUHFS-YER TRAP PARK FEE V N
c,oscr,till employee',uMm this pmdt. GAS-IA.SYSTEM-I INC.Y 0U`UEMi RE�CEIPI'N
Policy# BUILDING DIVISION FEES
CarroAll ❑ plan, ird rnpy is M1erchy famish 1. GAS-FA SYSIFIA-OVER4(IA) MNCHECK FEE
❑ Ccnifsd copy is tiled wllM1 lhr,city inrpcaim division GREASIONDUSIRLWASIEIN"PERCEPTOR GRADING FEE
CMTIFlCATE OF EXENIMON FROM WORKERS, GREASI!TRAP SOILS FEF.
COMPENSATION INSURANCE
(nil secthmnaT not he armpldcd i(the whirl Ls fame hvalrtd dollen($INE) SEWER-SANITARY-STORM P.A.2tt ENERGY FEE
or Irv.)
I ecody Out in the,pcolormarce oohs wak for which this Person It Latest,I rtW1 WATER METER W/VEM/ELE!
rtw M toy any femur in any mn T so es to Eccentric subject to Etc Waken' PAID
Compnmtion laws of Celililmia. Date WATER SYti TF.M/IRFATING Date Reacip#
O Z Applicant
Z 0 NOTICE TO APPLICANT:If.e(Icr tmkin#the Cenifutcof Esempion,you ilwW NEW RESIDEN'DAL PIMB. SQ.FI'. TOTAL
F-' cn became subject subject 101hr,Waters Cone ionerim Ivovi;icnofthe L.horde,Coyou nun
forthwith rnmVy with such roeivans orlhia Prioilshall be deemedrevoket! BUILDING PER
1 Q CONSTRUCTION LENDING AGENCY SEISMICFEE ,
I nccby affirm IT Nert Is a cofenuctioe Irndiy alEacy for t1N,'
erfmtwre of
U O the wmk fm which this pmnil is ivual(Sec.309],Civ.CJ TOTAL: ELECTRIC PER
Fr I<nler's Nome
0 [(r� IsNcr'a Addmaa QTY. MECHANICAL PERMIT FEE PLUMBING FEE
1 certJy Out I Tuve 1d ink a,icarion our slue that the.have information u MECI IANICAL FEB
�-' correct. Ieprtc to Conroy with all lily and axmty mdionat and mule laws mhting to PERMIT'ISSUANCE
�' building cowrvclinn.eM nertby aullWiec rtprtsentmiva of Nis city menta uryxt the
U Z above- E.d properly far impeclion pulPosu. ALMORADDTOMECH. CONSTRUCTION TAX
1rc
(We)egrte m save.inkmmify and Imp hurnolm tle City M Capenim yew
abililit:%jldgrlcles.coos and sapencs which my in any way scene agslnu old City AIR HANDLING UNIT CFO 10,000 CFM)
o .yucnw nflhcg tingMNi.pcmtit.
_ AIR HANDLING UNIT(OVER 10.(X)0 CTM)
(
SI ort of ApplsAlllCm11M1a Dae EXHAUST HOOD(W/DUCI)
PAID
Ian-far.
MATIoccu,s DISCLOSURE
HHATINC,UNIT(TO 100,000 BEV) Due Rmr".#
Will be asp u scan Mu buildingoc Clertportof hvdkharahlin mSafictl
a+delltd by the Cupmilro Municipal Cue.Chagm Y.l2.aM lhr,HNlh and S.fny HEATING UNIT(OVFR 1W,000 BTU) TOT
CaY,Section 25532(0)1 VENTILATION FAN(SINGLE RESID)
❑Vee ❑ No
ISSUANCE DATE
Will the aTylicantahwrt boildiya itis,llmeequ A 0 malum "cos oit
BOILER-COMP(311P OR 100,000 BTU)
loatocour air amtwnin.nu v defied by the Bey Am An Quality Manyrmrnl BOILER-COMP(OVER IDtIMg)BTU)
�DlnriI h
❑Ya' ❑No NEW RESIDENTIAL MECIi SQ.FT. 'D
Yl
1 love rW the Mrmdau+vutenals rtGu1rt11Cn1s undx Chapter 6.95 of the
Glifomia Ilmhh k Safny CMe,Sedimm 25#13.23333 tied 23334. I urdmslerd Ihvt ,�O
if the buikBng Docs tp1 cuncnlly hevc o taunt,IMt it is my rtspxuibility m ltdify the
acceptor of the mitimoorta which mm�hr,lest pia to:a,nwter,of a cmirr, lr,or Will`
Oecepwmy. f
Owrcratiulhmieadycnl Date TOTAL ISSUED BY:
OFFICE
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