26049 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO PERMITNO.
APPLICATION/PERMIT PLUMBING—MECHANICAL26049
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BUILDING DIVISION BUILDING PROJECT IDEsCHFICATION G^/
49
BUILDING ADDRESS: SANITARY NO. APPIUCATIONN'.SUBsirmALDATE
UNITY IAT#
N AN] HONG •��� CO R'S NAME LIC NO: NC Cv—OVAL
I yENGINEPR: UC NO: ADDRESS: ❑
S
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT R tAttl MECH
PERMITISSUANCE
El El
LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL
py, Itbshy ufrirm Out l.mli«mxJUMmlbnriaiannf Cluptc9(cmmrcruingwith 30BDFSCRIPION
WOO Secuon]000)uf Divlsion3ortlre Busirrms end Pwfuakm Cads.uW my lie®lam PANELS
FF�1 11— full forte vul a t. S
<zw Liams r`�'�]'y�-s Lie• UPTOMAMPS I
�<y Duce C«urxt S ]➢1-1000 AFffS w
ZOyZ ARCIIfIELTSD A O OVER III00 AMPS SQ.FT.ILOOR AREA f/SQ.FT.
OZ'C�y� Iur.Icrswnd my plans still he used to public ncoNs. n
QNS�S] Lkenacd Profa.iaul SIGNS FIECIitlCtit F7 I
L sl in L 1� y til
�ya< OWNER-BUILDER DECLARATION SPECIAL CIRCUR/MLSC. •\ I'.� L.✓'
XXdOa VF. 1 hereby.firm tiu 1 ms exempt from the Cometwo's Uddei f«the 0/',7I � ,�1I
W 3 a y following sevum.(Sative 1031.5,Rosins.W Dofesiost Cade:Any city a coolly TESIP.METER OR POLE MST.
) �'�/+ v
C`S�g which teyairexe permit to conwmd,Wtm,improve,JemWiN,a"evr my.trocNrt Al /�
Q$ pricertoits i.arum ,also oumotsthe.phmufor such peuumfile asignedimpermesp, POWER DEVICES I TE
y) 00 that h<uliccrssal P,mumtto to pwviaou oftu Cmmcta's Li«ruc Lew(CT.pter
a 9(—us with Section](100)of Divisive 3 of the Busisidesi rd Prefessiau Cade) SWIMMING POOL FJF,CIRIC VALUATION
y m thu he is exemp Drcefmn and the baysfor the,.IkVd corruption.Any.idmmr of
=Q Section]031.5 by my eppliunt for a permit subjceu the tipplimrt ee•civil peetily a OUTLETS-SWI'CIiES-FIXTURES 560- r1ti
m more the fire hundred dmller.(5500). NEW RESIDENTAL ELECIR /
� p [II,vowiu•rofthepropsny,ormyemployeawilhwegwmB irwlecomp adam, _gQ.FP. STORIES TYPECONSTRUCIION
a tem domewmk,ude: she Con 1c".Lies a.wclefmwle(Sec.1044,muser as
tiro property
au code:Llx Caurwmr'.Liceue law docs nal.pplY to m owrbr of
rnrperty w bo ba i a.a impmre.tlsercar,w was da,obn wort mttuel r«daaagn na
ow,,er.beq,ldin idedllwwchimprovemwithin rot imerdcdmorfard the comer-
OCC.GROUP .0 Tis
however,the buildings imt of porting
is veld within orb yetio i m rove for the vwr a
hailderwill hnsx the Wnkn of petering that he did seer bwld«im f« ol TOTAL:
prove puryswe
0
❑ I,as my«roftupwpcny.msxdusivdycvetravng withllanxdcmtrctonb QTY. PLUMBING PERMIT FEE FLWU' NE pPN
answer be project(SCC.7B44,Business ud Pwfunwu Cade:)The Comort«a Law. .^
Licmclawdae+mtippymmowrterofleopmy whobuildsa irnpvve thveab tiro PERMIT ISSUANCE Q'(J
Licerue law.
whocw such laojatswithecmtrrctm(a)IicrnsM grrwenttotlb Caeuriora ALTER.-DRAW&VENT-WATER(EA) FEE SUMMARY
❑ I em excmp under Sec. ,B&P C f«ehu mamas BACK FLOW PROTECT.DEVICE: SANITARY Y OUTSIDE J N
(Teter Dete RECEIPT Y
DRAINS-FLOOR,ROOF,ARFA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N
Lie llveby.ff tivtlliev..certlRs.,•ofcwsenebrl(-imus.aecarurrcete of RECEIPfI
Cexnperwtiom lmur.vcc orticcrrfierl ropy thereof lSx 3800,Isis C.)which FlXIlIRES-P[R TRAP PARK FEE Y N
m.Ild mlaµmmit. GAS-EA.SYSTEM-I INC.4 OU _E RECEIPTY
Polley#� � BUILDING DIVISION FEES
Compmy GAS-E.A.SYSTEM OVER 4(IA) PfANCIiECK FEF.
Certif d)copy is hereby f rmshed.
Certified copy Is riled with else dry aapnmm drvuroa. GRFASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTFlCATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
TDik secom recd rot be completer]lieu permit is for one hurdrdi dollus($1 W) SEWER-SANITARY-STORM F.A.3(Vl ENERGY FRE
«lets.)
I certify rut N rhe Pursuum of the vest for which this parent u ameeL l shell WATER HEALER W/VENT/ELECIZ
not doe be,my perm m my meaner w e w became wbjeci to the Wertera' PAID
Compdessaim awsof"iforrim Due WAT9t SYSfEAV1REA'IING pre Receipt;#
Q Z Applrcun
2 NOTICE TO APPLICANT:If.liter outing this Cdsifr ms MEamption,you should NEW RESIDENTIAL PCMB. SQ.FT. TOTAL:
ybaame subject a the Worker's Conprnstim proyboorei of the labor Code.you must
3' > forthwith comply with wish pmvLstrns a this permit stall be coserN revokel. BUILDING ITT..
G Q CONSTRUCTION LENDING AGENCY SEISMIC FFE
I hereby.r�tut shoe u;e vusumctlan Ivrd .
inggarsy f«the pMmrunce of c
V O the work for which this pvnsit is isuM(See.31197,Civ.C.) TOTAL ave„/ ELECTRIC FEE
W. �r Leckrse
e No
0 [U• Iendrs's AWrca QTY. MECHANICAL PERMIT FEE PLUMBING 12E ,S
1 certify Not I uve reed this.pplicivion vol issue that the above iNarrmtirve ot
coned.I a gree to comply with till city errd county sdin.rb i".sum l.ws rehtm,,to PERMIT ISSUANCE MECHANICAL FEE
building catstructioo,W meby miliens rerdsmew,n oftlJticity m suer upon the
above-memtionesl property for i CONSLRUCIION TAX
L1 mpf,mil keep
p lbsmr ALTER OR ADD TO MECH.
(We)eget m.tivgs rom e.ify and tech harries the City of Cupertino tCity
Ilehilitla.jmlgmcngrowamJeapmarawhe:h may mmy way eccrvcegainnuid City AIR HANDLING UNIT(TO 11,000 CFM)
onsyuen«M gtvn'ng of this permie
_ AIR HANDLING UNR(OVER IO.OW CFM)
ipwum of meso- 11
Date EXHAUST HOOD
PAID
TO 100,000 BTU
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT( ) Dims Recelpt#
Will the upplicmt or future building cecupent store«handle hurnru s maeriol aa��
as dcfnecl by the Cupmm Munielpol Code Chapter 9.13,tinct the llealth vol sumay HEATING UNIT(OVER 100,000 BTU) TOTAL: J."T
Code,Satim25]J3(a)� VENTILATION FAN(SINGLE RRSID)
[:I Yu ❑No
Will theepplicmt mfumorbulldingoccupmi uaryuiprmn mdevim which ends
BOILER-COMP(311P OR 100,000 BTU) ISSUANCE DATE
doe sir comamtr inanm deEned ry by the PAra m
Air Quality Mmugeem BOILER-COMP(OVER 1011,"BTU)
iblesP P A 'I 'D
❑Yu 11 No NEW RPSIDP.NI'IAL MECfI. SQ.PT.
I lure iced to ety Conus Seetio.ls regssirtmrno under C. I u 6.95 of the FEB — 9 1994,
Kilif«ni.Ik.lth s Safety Cods.Scctioer 25505,25533.y r 25534. 1 anderstvif tut
ifthebuild 11 t, ,moutrms ly which r.nim,wM1lutititi myruprice of ty toroify the
«vupem M the mquismenu which must be mel prig to iuumce of.•Cenifisete of
Occu{mrcy. C
Owrbr a euthmiud>grnt Date TOTAL: ISSUED BY: