S2456APPLICANT TO FILL IN INFORMATION WITHIN RED LINES=VSE-BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILDING -ELECTRICAL
P(11LDING DIVISION APPLICATION/1"ERMIT PING PRODING CT ]DEN]IFIC
nuu,mac rktkdh:cr mF:rv'rurlcnrwry
PERM]I SO.
S 2456
BUILDING ADDRESS:
21 30 V A
SANI I'ARY NO.
APPLICAI ION SUBMIT-Dil. DATE
OWNERSNAME PHONE:
rtCHIT1iC1'/LNGINEIiR: LIC NO:
CONTRACI'ON:S AMIE LIC NO
M Q-5 5 L I A 11 k fl,/
ADDRESS. C6 ( 6 C_ �/"f N�� V
NIC
Ll
C.'ONTROL k
3
CONTACT: PHONE:
PUII,UING PERMIT INFO
M AI a
Ave
❑ Consultant Fees Paid by Applicant (Initial)
1il�r:(/T 111 UNI MECII
BLDG 17
i - 4D �/
I •'L �C. ��l I♦ tati Vl/
�A 1 (Wia
1� LJJ
LICENSED CONTRACT OR'S DECLARATION
I hereby anion than 1 .,it heenxed ander pro vistoo, of chapter 9ld rtmem ing
QTY. ELECTRIC PERMIT FEE
_
JOB DESCRIPTION
PF,RMI'1' ISSUANCE.
with Section taro) on),klua3 nnhe nueincxa and Prodcsshm. Codc, and aty lice"., is
in full fora and effcn. c
�i % � (�
RESIDENTIAL
O SPD ❑ KI I REMODEL
APPLIANCES -RESIUEN'l1AL
0 J
License Clan. Cobtr �,-_—�
Hale/�-�•�p � Com
PLUMBING
❑ADDITION ❑PIAMBING kLI'IPF,
ITL
❑ MULTI -UNIT ❑ MODIFfURAL
MODIFICATION
INTERIOR ❑ CIE IMNEY RIiPAIk
IM OVEMEN'I' EjSW IMM I NG POOLS
ARCHll Lie S DECLARATION
ECL
1 undecsmnd my plain shall he mol m public recnJn
UP TO 200 AMPS
UP TOS
LlccnuM 11 ..imal
201-I000AMPS
OWm NER-BUILDER DECLARAI]ON
1 hereby affirm than 1 am exempt frothe Contractor's License Law for the
following reassm. (Section ](131.5. Business and Professions Casae: Any city or county
ATH REMODIIIJREPAIR ❑DEMDLITIGN
❑OTHER
OVER RNIDAMPS
SIGNS ELECTRICAL
which or,aile, . twouitt ball, all" m1m,c,dam, l:1 11' Y't uurc
SPECIAL CIRCUIT/MISC.
prior)I, br,lalkprantt hie It 6 Ia e I'm
thatlie Jp .,,,an, thepvolimen,ofll C I Law (Chape,9
(tomo n e bwiNSee 90000fD e 1 of the - B s dP f C RGw
that he rup, Ihemfn m d th h : for he .11,ed ,cropficat. Any violation of
TGIF MITI IdO OR PULP I NST.
COMMERCIAL;
❑ NEW BLDG/ADDITION ❑ DEMOLITION
Section 7031.5 by any uppbcant for a peon I sudojects the app) cant In a civil penalty of
POWER DEVICES
C TENANT ❑ FOOD SERVICE
not more Than Five hundred dollars (55a).
I,;tr owner o[fhe pmperly army rnepinyccs with wager tax their so le eompcnsalum.
will do the work. and the rai is not in,ank,derof� l ie sale (See. Business
and Profe.sions Code: The Conlmdors License Law does not apply a an owner o
IMPROVEMENT
❑OTHER
SWIMMING Of ELECIRIC
OUTLh TCHES-IBXTURES 2 d -0
NEW RP eN SQ FT.
pmpeny who builds or improves thereon, and who does such work himself or IM1mug
his own employees, provided that such itn,,,uncnts arc not m ended m ol'esed for
sale. It, however. the huilding er9mpmvuninu is roti wE1,i,,me year ofmmplvlion,the
SQ.ITI'. I1.00k AREA
$ISQ. 1•f.
v
enhuilder will 11:11c,la, bunter nr proing Ibal Leib nut hui W nr Impnrvo for pur-
po,ormle.)'
L as owner of the propeny, am exclusively corn etia, with licensed camracmrs to
'1')TAE'
r
tnvam t 11 project (S c 10a4 B: d Prafe,ions C ci) 'He C tr t. L-
wos I t o pI ly I f p pt ty h h Id - improves Ih d
n f cls tnraaxhp. t,wn:.u. I Oke-lda in to Inc f: endmoT e
Li,,,, law.
❑ 1 am exempt under See. . B d P C for Ibis reawm
QT'Y. PLUMPING PER T FEE
-
PBR,k111ISSUANCE r J
ALTER- DRAIN & VENT- WATER (BAI
Owner - Ume
VALUATION
1
WOkKEk:S COMP1iNSN'ION DIiCLARATION
I bn1bY afrrn, mein penmty ofneUnty mer (d the Ibdnwmg ckdan
PACK PLOW PROTEf,I'. UIiV ICE
/
❑Ih til all 'int CnTot ,IL II scit-mx f W La',Crnpen-
DRAINS- FLOOR, ROOF. AREA, CON D.
STCIRnes
IYPECONS9 Rl1CTION
ratio p ,d,d far by Section 31 W of R WDo Code, for ashe pe f conte tic be
work far hchflu len I d.
-
FIXTURES PER TRAP �
❑Ih and will cit N'k :Copt:( I: gired bySection
Jot t, perfranekr titan,{ fN work
3]0X1 tQI.j1)p�l��
h Inon
FICC. GROUP
NEW
`TS ;^SYstEm IWC.JOUTI.ETS
//-Mm]'Ce I`':ueJ
Wo,C.nm a+I. l xMin -//N!/ 1'oIJY Na� /'j
non
3
CERTIFICAIEOFF-XENIPf10N FROM WORKERS'
COMPE,NSAI'[ON INSURANCE;
GREASE %I
L :RCT:I'O
BUILDING DIVISION FEES
(Thi ,cumentsaloot becompleted iRhe permit it loroachmadeeddonnas 01001
or lese.)
1,enifythal in lheperronnmcaof the III kf which Nis pennllls issued, lehall
employ any persan in any manner as to become su of to the Worker%Compen-
GRP.ngL'I
n
SEWER-' NITAR -. R 1 .21 J
PLANCHECK Hili 16 IF
r Lf r
IiNIHiGY IBiF:
Lj
W'ATF.RL iATERN'NEM'rELE,CTR
GRADINGFifi
smion Laws of Califm m. Hate
Applicant
NOTICE TO APPLICANT: IL aftn making Ihlr Cerlificale of Exemption, you should
bnomc object ase the Warkcr's Cnmpen,adi 0 Prov ions 111, LnborCode, you must
WNIER, - "LNG
SOILS FE
fndbwith comply wilM1 sucM1 provisions onhiv pemeit shall he lcemN revoked.
WATER SI?RVICF.
NEW RBSIDENUNAL PLMB SQ. FE
CONSTRUCTION LENDING AGENCY
I herehyaffinn lharthereleaconstruction lending ap,ncy m,,he perfnmmnceof
PAID
Eine Renipnp
,he work for which Nie perneit Ix i..ued (S,c. 31899. Clv. C)
Lcmita, Name
Ixoolve,Address
H . IN r PEE
I certify that I have read this applicaion and stale Ibal the aNnc infatuation is
tet, l agree mcampdy with all city:md county ordirunee.. and sure laws relating to
builJing cnn.vlmetion. and hereby authoriec representation of this city mercer upon the
above-nentioned property fa ins(rocnoa purytxwc
(We) agrac,, save. aaccmnhy and 1,1111 hannlcea the Chy of Cuponlnu uguina
QTY. MECHANICAL PERMIT FEL
SIiISMI FEE
PERMIT' ISSUANCE. t
I!LIiC IC FICIC
ALTER OR ADDTO MECII. .Z-�
I'ID ItING FEF
IiaM1ilitice.ludglnen¢.cu.dsanJ expenses w9 ch m:ey iei any way accrveagain.l suit Cil}'
' m,,uence of the graining of Nis permit.
APPLICANT UNDERSTANDSA�' C PLY WITH ALI.}ION-POINT
AIR HANDLING UNIT (TO If" CFM)
MOCHA. AL PLL
60UkCli
AIR HANDLING UNI f (OVER 10.0011 ONE
CONSTRUCTION LAX
ignmure of ApplicantiCunracmr Dae
BXHAUSTHOOD(W/DHC)
IIOUSINGM11lGAOON FEF,
HALSRDOUS MATERIALS DISCLOSURE
HEATING UNIT (TO HED.00II BTU)
Will the applicant or future building occupant store or handle haeardnm material
us defined by the Cupcnim, Municipal Code. Chapter 9.13, and the Hcallh unit Safety
Codc. Section 2553280'1
[D YO, ){No
HEATING UNIT (OVER IIro1Mro BTU)
PAID Dam Rcmiplp
VENT] LAT ION FAN (SINGLE BESIDE
Will be applicant or f num huilding occupant use equipment or dn'ices whichto
mit hvardcus air comantitmnk as defined by the Buy Arca Air Quality Management
BOILER- COMPCHPOR IW.ap BTU)
2/ O
Dena l
El Ycx vas
BOILER - COMP (OV CR I IHI,000 BTU)
AIR C(INUI'DONHR
I base rend the hoe:Won, materials requiremems under Chapter 6.95 of the Cnli-
ISSUANCE DATE
NEW RESIDENTIAL MECH. SQ. FC
forma Iiwllh A, Safely Cade. Sections 25505. 25533 and 25534.1 understand] thin if the
Q 9
P
building Anes not currently havemm�ya�1Luw mibl lily m minty theoc.,nnl
(
of the ralanceran. is ynx" f a Cenlficate of( Occupancy.
'gent ����
BY.
CISSUED
rul Due
OFFICE
m
�.e. V
ADDITIONAL PERMIT FEES
BUILDING PROJECT IDENTIFICATION
VALUATION
� a o.o
DIL.PE Z r 43 o Y�' `� �''`�
ADDRESS
CARE. S
^ E'1'i
J PwoNE
FEE SUMMARY
BUILDINGoM
cEnacTaRs
ULpC07
S R.
PLAN CHECK CKCAM=TSMCA
DZ
(J
coxrnncTons !/ C ����e �4 7FEE
AOOEEss' iy ir/lf� J -fV?-A f- V(2'
V/ P..NE
SEISMIC FEE s
DTV. ELECTRIC PERMIT
ELECTRIC
JODUTLETS -SWITCHES-
LIGHTING FIXTURES
PLUMBING r Q
PPLIANCES- RESIDENTIAL
MECHANICAL
PANELS
SIGNS
ED
TOTAL
SIGNS TRANS.
SPECIAL CIRCUIT
E
EMP. METER OR POLE INS.
PERMIT VALIDATION
(� r
)SSV/NCE DATEDTV.
MOTORS SEE FEE SCH.
SERVICE CHANGE'
TOTA
PLUMBING PERMIT FEE
eLoe.
[:1
ELECT.
0
PLG,
❑
mecu.
El
ALTER -DRAIN & VENT -WATER IEA.)
BACKFLOW PROTECT. DEVICE
L J.
' c
,I
/1
/ Il
DRAINS -FLOOR, ROOF, AREA.COND.
FIXTURES - PER TRAP
GAS- EA.SYSTEM-11NC.40UTLETS
GAS - EA. SYSTEM - OVER 4IEA.)
INDUSTRIAL WASTE INTER.
LAWN SPRINKLERS- 1 INC 5 V.B.
LAWNSPRINKLERS OVER5MAJ
SEWER -SANITARY -STORM EA. 200ft/
WATER HEATER W/VENT
WATER SYSTEM
WATER TREATING EQUIP.
c i E.
TOTAi
GTY. MECHANICAL PERMIT FEE
ALTER OR ADD TO MECH. o
APPLIANCE
AIR HANDLING UNIT (TO 10,000CF.M.)
AIR HANDLING UNIT(OVER IO,000CF.M.) -
EXHAUST HOOD (WITH DUCT)
HEATING UNIT (TO 100,000 B T.U.1 2
HEATING UNIT (OVER 100.000 B.T. .)
VENTILATION FAN (SINGLE) ZD
BOILER - CONIP (3 H.P. or 100,000 B.T.U.)
BOILER COMP 10— lw OoO Rrul ses FS E SCR.
TOTAf9l CQ