27761APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINOAPPLICATION/PERMIT PLUMBING MECHASCA L
BUILDING DIVISION BUILDING PROJEITIDENTIFICA'UON
PERMITNO.
27761
BUILDIN Il RESS.
SANITARY NO.
APRJCATKI^N SU'B•MfI'1'AL DATC
[_
i� UNTC LOT#
, \
OW 1
CONTRACTOR'S NAME UC NO:
Nt
❑
CONTROL#
RCHITECT'/ENGlblr R: IJC NO:
ADDRGSS:
CONTACT; PHONE
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
B4De aE MUMH MECH
ISSUANCE
RATION
LICENSED CONTRACTOR'S DECLARATION
1 hereby drtnn thmt 1 un licaeed uMn pwvisiomofChaper9 (cotmroncingwith
APPLIANCES - RESIDENTIAL
JOB DESCRIPTION
PANBIS
UPT0300AMPS
Sntion2000) of Nvition 3 ofthe Bmirom mid Pmfeni.,; ,erd my Ii. iso
full farce end crfect
Lexow Class % ! Lic,# %
�xx�^
�]' J
�Q
Doo, ' Cmtrcr«
201 - 1000 AMPS
ARCIIrrECTS DECLARATION
1 usdvevud my plxw shall be uaW a public mmrd.
OVER 1000 AMT'S
SQ. PT. PLOOR AREA
$1SQ. FT.
SIGNS PJF.CIRIGkL
licrnsed PrufesavW
OWNER-BUILDI fm DECLARATION
SPECIAL CHtNR/MISC.
lT
1 FlreM1y uem Nat 1 am cxrntp frrm the Cultrmrur'a Lwcnu Isw for the
TEMP. MCIFR OR FOIE [NST.
fullowtng ormor ($action 7031.5, Buslt..a and Pmfe :Any city, or county
which rcquims.pcm r, rnn., alter, lmpmve li0. T iur my+mtcture
POWER DEVICES
priorbiuisur 'alaioryuim the mppl' urh pvmitb e. ugt islatanent
chat b, ulice 1pmumtso Ne mofJ Can oc.L Iatw(ChwWa
9(comnrtlaingwhh Sect )of Division3oftho Busint Ptafeadoau Code)
SWIMMING POOL ELECfIUC
VALUATION
het he isucm factor uthe hays for he.11[ged exempAoy viduon of
nyapTAtfinepcnnilwbjxtahcpplcm, eciviINn.11yof
OUTLETS -IXTREwSgctnim20J1n5
ctM1unrt hundred dnanm(SSLvI).
11I,umvroro Irwpxry.mmyempluyemwilh wegm mdeirw wmpvmum,
NEW RESIDENTIAL ELECIR _SQ. FT.
STORIES
TYPE CONSTRUCTION
willdo Nc wwl., tk strunure is lmtlntenhdoraH for ( 2044.Bumyn ai
rod Pwfessimu C : The Commcbr'a Ii apply u owns of
ptopctywhobuildm flolleo mfammat wrw hlvuel orthroughhis
OCC. GROUP
RS. UNITS
ownemployce, wbi mints dalrroff fma.le[L
r
howcvc,thcbulldmIr tmr
t inoncyof theownn-
huihkr will M1avc the p lhu he did rat build or (m pvpssm of
TOTAL 1
QTY- PLUMBING PERMIT FEE
❑ I,unwttnef the exclusively mntr gwilhlic�,dswtnanan to
FLOOD Lo
ppN
conavuct tyla pmjo,t ( .7W. Bumit mrd fi.imu Code:) The Canhcbr'a
Ii scl_awdoeslmt bmowtlnof wMbdld.airvpovmtlermn,md
PERMIT ISSUANCE _DO
whocaovacufmuachlw lswimxc IM(a)Hanud WlvtmOotheCmo-croia
� -DRAW&VFM-WATPR (PA) )
FEESUMMARY
Ucrncsw
❑ I am excmpl utder Sec. B & P C f r thu sawn
BACK MOW PROTECT. DI?V ICE
[Yvon Danc
DRAINS- FLOOR, ROOF, AREA. COND.
SANITARY Y N
RF.CEIPTY
WORKMANCOMPENSATIONDECLARATION
Wakm'Cmnpmrmtion lmwuce ormcenifwdrapY thacoflScu I8.00,tAb C.)whiN
SCHOOL TAX Y N
ECEIPTY❑
FlXfURCS-FERTRAP TO
PARK IF Y N
GAS -EA. SYSTEM -I INC 4 OUTLETS 0I
/
mvcta all a*oytti uMn thu permit.
Policy #
RECEIPTY
BUILDING DMSION FILS
CompmnY
GAS . EA. SYSTEM-OVIR 4 (HA)
PI.ANCI IECK FPJ;
❑ Crnihed vtpy is hneby fumiaMd.
GREASMI WASTE INTERCEPTOR
GRADING FEE
❑ Crnirted copy is pled with the city inspection divimim.
CERTH�ICATE OF EXEMPTION FROM WORKERS
COMPPNSATION WSURANCE
G TRAP
SOILS FFE
A6VITR - SANITARY - RM E\, 200Ff.
ENERGY FEE
(Ti genion rod not becmrnr, t ifthm permit to faroro hundred dolWm(SIM)
or lean.)
WATER IIIiATFR WNE 1ECTR
I crnify than in Oc perfomlmrceoftha work for which Nit, permit is iatd, Imhmll
employ mYPc*mo b Woh
PAID
WATER SYSTEMHRFATIN r
Cmnpemarthon la 'fm — _
Applicent
Oats Rcccip0
NOTICE TO APPLICANT: If, din making Mr, Caaifweo( Ex ,you should
become wbjem In chic Workc'•v W. «ratlm p.oviaimu of Code, yyoumyn
n
fahwhh corlrTAy with much pwvimiau Nis peanut dratted revoked. 1
VW RMI D RMR. SQ. PT.
TOTAL
BUILDING FEE
SI;ISMICFEE
CONSTRUCTION LINDWG AO CI'
1 hneby sol bar three is a cotturvction Icrdiog for the
Ih[ wank fm which Nu peanut it, ivsucd (Ss 7092, Civ. C.)
TOTAL
ELECTRIC FEE
LeederS N.
R_
IsNn'a Addtus
MECH ICAL PERMIT FEE
PLUMBING ME Sg. SO
1 cmify Than I love read Thu mlgliwion vd ante that IN, • .tian it,
rmmct. I.grcc to crob AY with all city mrd warty ordittmrce vleu Dwt, 'ng to
' 2. Om
PFRMITISSU C13 l V
MI:CIJANICAL IEE
' Y
huikling canuractitm,anty frac sm tionpmpmrnintivm of this city ant dre
eMva-mCitl.,t progeny
and pulp
ALTFA O ADD TO MSCI I.
CONSTRUCTION I' AX
(we) mgtee to leve, irdermlify and kap hmmlev the City of Grpc 'm.gtitw
air,moify har
Ii.bilitin,ludgmenH,cmtsudenpntme which meY in t,oy wey mcrneegei lardCiry
AIR 11 OLWG UNIT (fO IO,IXq CFM)
N
C
3—�—/
/
A HANULINGUNIT(OVFR10,000CFM)
SignatumcfAppliwnhContreclor Oua
I L% HAUSTHOOD(w/DUCT)
�'Iry
PAID
HEATING UNIT (TO Im,m; it rU)
I IAZARDOUS MAIIRIAIS DISCLOSURE
Det, Rnclp #
Will the ti licmt orfurae building occurmnt uare or hudk hxratdwa rounnd
u dartTlM by tk Cupenima Mmlicipil Codc. CTupv 9. 12. matthe HirIh and Sxfny
HEATING UNR(OVER 100,000 eT11)
TOTAL e D
Code. Smion 25533(x72
❑ Y3 ❑ No
VLE VENTILATION FAN (SINGRESIDE
Willtheepgllcmtorfmurehuildineas'cupenl us,Opnentudevi whichcmil
BOILER- COMP(3HP OR 1(I(l,fN11I BN)
G� �W
IPUp(IEE/pp TF
honwdous air nFllaminmty as Jerrod by the Bey Arca Air Quality Management
Dia"rte [IMAR
❑ Y. No
1 1995
BGILER - COMP (OVER I W,UIO BTU)
NEW RISIDENIIAL MECH. SQ. FT.
1 have read the hvardeus mmenxu regabrnrnu mdn Chatpur 6.95 of the
Ctlifomlx licehh& Smfcry Codk, Sectimu 25505, 25533 mal 55N. IuMnuud that
Cil i yr l/UrCq
if the building does.. cutmndy hove a mount. than it is my rvpnnsibi0ty to nmify the
I,IIVU
occupant of Iha Icyuircmcnts which maxi Etc and prior to iaxuunce of x Ccatificii of
(k ,xany.
ISSUED BY: 1
termer m mNonred.grnt Dana
TOTAL:
I•»uK:1