27106 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDIA27106 APPLICATION/PERMIT PLUNIBINF-MKOFIANICITND AI. 7 g O 6
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION' L .L
BUILLDIINNGG AA/,D'aDREESSSS,�) /� ////A SANITARY NO. APPIRCATIONSUBMITMALF.
DAT
N w PI{ONE: /),., C OR'$ypMt g tI/
Lt ^'� ✓iY(•ll NIC CONTROL«
• RCHITE lEN _ LICNO:
ELECTRIC PERMIT EEE: BLS BU ELECT
PERMITPLUMBNFO WCH
PF.RMITISSUANCE ( �p .11 11
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL �I
py.Z Ihcrcby off bou l am hicen.xd tm a povisiand Chapta9(cmmrcrcingwith LOB DESCRIPTION
u100 Scctim 7")of Division SoftM Business soul Pwms fesaiCade.and my fie.is In PANELS
FYI full farce and cfhtCL
Fgj Tic.Class Lic.N UP T0200 AMPS
Date Carunnor101-ILDB AMPS
ZOyS ARCHITECTS DECLARATION OVER HIM AMPS SQ.FT.FLOOR AREA 5/SQ.FT.
OZ— IoMentard myplans.shdl be ural ns public recalls.
m SIGNS ELECTRICAL
Q Liccnxd Ptof.mroil
Tr OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
XOaU 1 Mob/aR thou 1 am escmpt from the Comracters Ucarse Isw for ths,
wit+-vFi fdlouitsg.(Sation 7031.3.Busiteu ox!Pode
rof.l.C :Any city amunty TEMP.METER OR POIF.INST.
F 4 O wEkh r,,mm,is permit to crostnct,alto,ircpwrc,damlish.or mpoor any saucturt
5_ y� prier to its issuance.dun raryues Ju applicant rm.uch pendtto Ele.dgudautemrnt POWER DEVICES
�C<O lMi he is liccnset pmonsm to the roirisioca of the Cmtrw,&,%License lsw(Chaga SWIMMING POOL ELECTRIC
a �d 9 crtmmencing with Sectim 70M)of Division 3 ofthe Buaire.an xi Profa.iem CMe) VALUATION
�jy y on lou he is c.empi tbcmfonnmcl the basis f«thc sllc,W escmgion.Any vicletimof
tKa Satim 70313 by uny applicant for n permit subjects tet applicant to a civil penalty of OUTLETS-SWITCHES-FIMURIS
mr rose$O Jun f vs,httrdret Jdlas($500). NEWRPSIDFNTIALELECTRSQ
W�� ❑ I,vowrcraf the pmperty,mmYrnNloyeewith wageastheuwkwnpamtim, .FT. STOIUFS nPECONSTRUCIION
p•-3— wII1JatM bah,edJtehu,Coreuna i,U.
m offetd fmade pPYtOad,Buaircof
and Rofesrom Code:TM Cminctors Licmu Law doe rico apply rc w owner d
popmy whobuildsmimpovntictmn,soul whodocn such wvk himxlfmthroughhu
wncmpkryce,Pingmcithesucment is old
within mvot lntrndcorcpl ac.iliso nsr- OCC R 11P RPS.UNITS
M1wxva,tet buildingmimprnvcmem is sold within urcouldofcomplvcf ,theow of A
Mtildr wJ1 M1vvc the M1UNen of Proving thm M diJ tw build a improve Ter puBxx of
da).
❑,1,as avncroftic pwpeny,am evdudvelymnuxting with lirenaedcminnon to Qom' PLUMBING PERMIT FEE Fl.00D"LONE APN
corwtct thi r j.(5«.7044,Busircas and Pwfcuims Colt,:)The Cmtrecti
license tawdaatw apply tow owrcof progeny win buildsa imporeticrwn,sod PERMIT ISSUANCE
who cocuress f«such pcty svitha con.afa)licemed quwms mtbecovict ra
I�[euc Lew ALTER-DRAIN&VET-W R(BA) FEE SUMMARY
❑ I son exemM ander Sec. ,B&P C f«this rc.sm BACK M.OW PROTECT.DE
SANITARY YN
Owner Uete — RECEIPTI
DRAINS-FLOOR,R t.ARPA
WORKMAN COMPENSATION U[CIAAATION SCHOOL TAX Y N
❑ IhaWy.fftrm thmlMve ecaufirak ofcmxntwself-itrsute,mvemi0cme of RxTUIU'S-PFR TRAPRECEIPT♦
Workm'Comprnsution lttsunrcc aecerJEcd copytMm><(Sec.J&10,1 C.)which PARKFEE Y N
coven all employee's Leta this pemit. OAS-E.A.SYSTEM-I INCA 011I1J: RECEIPT'Y
Policy, BUILDWGDIVISI NFISES
Company GAS-EA.SYSTEJN-OVESt 4(EA) PI.ANCHF,CK FEE
❑ Cmlf irnp/i.Mcby fumiahW.
❑ Cm FiM copy is flet with the city inspoction division. GREASE/INDUSIRLWASEINTERCEPTOR GRADING FFJi
CF.RTIFICAIV OF EXEMPTION FROM WORKERS' GREASE'IRAP SOILS FEE
COMPENSATION INSURANCE
(This section recd not be comphctcd ifibc lctmit is forme londrtddollan(SIM) SEWER-SANITARY-STORMF FT. ENERGY PER
or[ea)
I c,stify thw in th Par�of tic wok for which this permit is jcsouLl shoU WATER HEATER WN ' CTR
m employ suet, pmon in wy marucr so w no berme wbjca to the WorkerPAID
Ctmtperwtion Liwaof C.lifomi.. Date WATER SY TING Date Re¢iptN
O z A,pliv,m
z O NOTICE TO APPLICANT:If,aftn muMn this CrniOcom of Paan your NNW RIiSID AL PI.MB. .FT.
g pion, hmld TOTAL:
p] hcxmcsubject to the WmkRx Cumpematim prwiainw of Js,Tabor Code,ym mus
a ; fanhwith comply with such Provisions«ibis pcmut shall 6c ulcered revoked BUILDING LYE
L1-)
Q SEISMIC FEF. 2
CONSTRUCTION LENDING AGENCY
z Ihtce,affirm the there Is.cortsmeuw lctdiog.g yfoc this,pafam .1' TOTAL r].ECIRIC FEE
U O the work for which thus permi u issued lStt.3097.Civ.Of
t-- IcMir's N.
�^ LcMNs AM. QTY. MECHA LPER FEE PLUMBING I9_E
D-( 1 calif,ma 1 have read this applicatim ms,tiro!ethat the abnre inh ramion is MECI{ANICAh lTE
c.I.lagtcctocanphywilhnhlcl mdcoumymEmmiresetdsuatcmwsrchmingto PPIIIS ANCE
_ huilJing croswctim,orN hercbY'
mire teprtacnmtiru of Wer city to enter u{vm the
U z above-mcntimetyfmi minpurymca. ALTER OR AD TO MEGA CONSTRUCTION TAX
(Wc erg N etd kccp City of Cupatln,sus «
lobili' .j M. which in yway..gamesdJ ity AIRHANDLINO 0Ul M(l CF'M)
in o tk<r of pemdt. )D t AIRIIANDLINGUNR(OVERIOtMCEM)
ueof App n for / Unit, I{Xt1AUSTHOOD(W/DUCI) PAID
HAZARDOUS MATERIALS DISCLOSURE HPATING UNIT UO IM,"BTU) Dstc RasiPtN
Will the applicant m future building occupant store or hartllc huaolws meerid
as Ecfml by the Culcn'uw Municipal Cade,Outfit"9.11,surd the Halth W Safety HEATING UNIT OVER 100,000 9TUI
Code,Saticirc
0Cl No VENTILATION FAN(SINGLE.RESID)
Ya
ISSUANCE DATE
Will thcapplicwtmfuturc buBJmgoccupwtuxequipmrnt«dcvimwhichcmit BOILER-COMP(JFff OR IW,Of10BTU) :' lN, 'd
•bmnrdaus suv conlomimum,as dcfimccl by the Bay Arta Ai,Queiity Mori,., BOILER-COMP(OVER M%0M BTU)
Dtatd°7OCT - 3 1994
❑Ya 11 N. NEW KE9IDENDAL MECH. SQ.PT. /s
1 have read tic Safety
C us mefimos 5:sbL 3 t Lida Chapter ti.vs of the C11 Y !Y
Cdifarnu lbM1h 11 Safety Code.Sectipu 25SDS.23333 ed 255M.Ch 1 h,6.95 of do, 111- yyCC
if the btndmg doe na cmrrnulY Mrcatabu,utt itu wireWmnbility toms Js,
oteupwt of the requirvrcns which two h trot prig to oauance of.CW fete of
Occupsory.
Owtcr a i mhod,N agent One TOTAL: ISSUED BY:
OFFICE