24416APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project demmcation" P
PERMIT N2441'6
S N {1 S 41 Pr, -T EL ' 41S -mot l-1 9
nets area: one: p
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CITY OF CUPERTINO- BUILDING DIVISION
Contractor's Name: Lm. No: •
BUILDINGELECTR ICMLPLIIMBINGMECHANICAL C
CATEGORY C
CONTROL X
Archue /Engineer. B
IQti'�';�f �
�It�ELECTRIC PER MIT '�I_,� F
FEEPi '
' :1� BUILDINGPERMITINFO':
Address: P
PFRMITISSUANCE j
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. LICENSED CONTRACTOR'S DECLARATION L
'Iherebyafflrm that l am licensed under provisions of Chapter9 (cancreassee, A
APPLIANCE4RESIDENTIAL '
'JOB DCSCRETION
PANELS
• L
Date Contractor U
UP TO 2DOAMM
701- IMOAMIS
ARCHITECT`S DECLARATION 7
OVFRl"AMPS S
SQ. Fr. ELODR AREA 4
4 /SO, FT.
SIGNS ELDCTRICAIq/ ,
Licensed PdAdedo sal S
,
OWNER- BUILDER DECLARATION fflrm S
S'ECULCIRCUIT /MISC a
a n I
TEMP. MUM OR POLE SI'. ^1 1
following reason. (Section 7031.5, Business and Professions Code: Any city or
countywhich requ lresapadvttoconatrudsimpimpmve, demollah,orrepair T
1�
anystrutlnre prlorto its issuance, also requires Neappllrnt(anuch permit P
POWER DEVICES
..� I
ILL I
SWAIMING P06L LECTIRI / TE
VALUATION'
I.
NEW RESIDENTIAL ELECTR SQ.FC. S
S70HIG5 T
TYPE CONSTRUCTION
peneation, willdothe work and thestructure b not Intended or offered for
sale (Sec. 7044, Business and Profess ms Code: The Coetraciara Llcerae law
does notepplytoanownerot'property who Wilds or Improves thereon, and O
OCC.GROUI' R
RES. U
Improve.mods, are not intended oroffered for sale. It, however, the building or T
...
TOTAL: "
"
t)i9,kurden of proving that he did not build or improve for purpose o (sale.). Q
Q7y; '
'r PLUMBING PERMIT •
••FEE F
FLOOD ZONE A
ADN
The Contractor's License Law does not apply to as owner of property who A
ALTER -DRAIN & VENT WATER (EA)
BACK FLOW PROTECT. DEVICE I
,
OUTSIDE FEES
DRAINS FLUOR ROOF, AREA, COND. S
SANITARY Y N
Owner D
WORKMAN COMPENSATION DECLARATION - F
SCITOOL'1'A %, Y N_
certf(Icate o(Workeri Compessatlunlnaurance or a certified mpythemof(Sec. G
RFLEB'f X
GAS EA SYSTEM- 11NC.40UTLETS
PARR FEE YN
X
Cam n G
GAS EA. SYSTEM -OVER 4 (EA) D
DING DE X
Certified copy is had with the G
GREASE / INDUSTRL WASTE INTERCEPTOR P
PLANCHECK FEE
GREASETRAP P
CERTIFICA TE OF EXEMPTION FROM WORKERS' G
PAID
SEWER- SATARY -STORM EA. 200FI. D
(a1I cedilyth W
WATER HEATER W /VENT /ELECTR E
ENERGY FEE Y _ N
WATER SYSTEM /TRFATING
NEW RESIDENTIAL PLMB D
_
BUILDINGrEE
SEISMIC .FEE
_ '
CONSTRUCTION LENDING AGENCY S
ELECTRIC FEE
Lender's Name "
" -
- -
- P
PLUMBING FEE - ^
^'
MECHANICAL FEE
FEES PAID:
lsmrsect. l agree tocomply with all city and county ordinances and pate laws P
PERMIT ISSUANCE F
relatleg to building construction, and hereby awlimiim representatives of this '
'
city to enter upon the above-dentloned property for Inspection pu rposes. A
ALTERORADDTOMECH.
Date Receipt#
- A
AIR HANDLING UNIT( TO 10,000 CFM) $
$UBTDTAG
AIR HANDLING UNIT (OVER 10,000CFM) C
CONSTRUCTION TAX
Ignatureo( c to E
EXHAUST HOOD(W /DUC17 -
- C
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE,
IIFATING UNIT (TO 100,000 BTU) D
Will the applicant or(uture building occupant store or handle havadon I
Date RCCeI 1
HEATING UNIT (OVER 100,000 BTU) T
_
fTealth and Safety Code�+. �Sedion75532(a)t , H
VENIILATIONFAN(SINGLERESID) I
ISSUANCE DATE
Will the applicant orfumm building occupant use equipment or devices V
BOILER -COMP (3HP OR 100,0() BTU)
BOILER.COMp(OVFR ino00 BTU)
the Cellforma Health &Safety Code, Sections 25505, 25533 and 25534. I -
-
e•P D
NEW R2SIDWIAL'MECH. S'Q.FP. e
resporoibillty to notify the occupant of the requirements which most be met
prior to Issuance of a Certificate of Occupancy.
T
Owner or aulhoriud agent .. Data -
TOTAL
-
OFFICE COPY