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CITY OF CUPERTINO PLUMBING -MECHANICAL
BUILDING DIVISION APPLICATION/PERMIT
MI'TNO. O
BUIID NO ADDRESS:
SAND'ARYNO.
API'LICAIIONSUBMITI'ALDA'M
` UNIT LOTH
WN AMB: g PHONE:
CO CTOR'S AIR LIC NO: �/
N/C
CONIROLN
1CHITECfEN IC NO:
ADDRESS:
P ONE:ffanw
CONTACT:MINIMUM
ILDINO eIT"�M1,4�xAfrc.�
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE
0 ❑ O
d
)O
�y
I^
LICENSED CONTRACTOR'S DEC'URATION
a M1ye mthellunllcemd undapvvbiomofChapta9( onmesncing with
APPLIANCES - RESIDENTIAL
LOB DFSCRIP ION
/ sennewe �w . rA
lU--Tei\! exa
Salon 7000)of DivldonJ of the BWlnessend Rofwloas Cade, and myllanW lin
fuliforce do
Licence ass Llc. N
DueConuaclo
ARCHITECTS DECLARATION
1 understand my plain shall W and u public mods.
PANELS
OF TO 200 AMPS
201 . IOW AMPS
OVER 1000 AMPS
SQ. Fr. FLUOR AREA
SISQ. FT.
SIGNS ELECTRICAL
c
t
Licensed Professional
OWNER -BUILD ER DECLARATION
1 hereby .Iden Net 1 am exempt frmn the Contramis License law for then
SPECIAL CIRCUIT/MISC. y
„'
TEMP. METER OR POLE INET. d
%M
following reawn. (Sec em TRedolentS, BWirand professions Code: Any city orcounty
which requim a Permit to comme4 situ, Improve. demolish. in repair any situation
Prim m is inuwwe. alta requires theappllu i fasWh permit b file s aipadaa.1
Nal MIs licensed pursuant to [be pW indeluof the Conesude License Law (Chaps
9(commemhg with Salton 7001]) of Division 7a1 the Bullnw and Profession, Code)
1�,�+ 0 V
Pp
POWER DEVICES
SWIMMING POOL ELECTRIC
LUATION I
;y
3<
,p
a that he is exempt lheafrom and Ne basis for Hes alleged exemption. Any violellon of
Section 70315 by my applicant JimmBm
. pesubjects the applicant s civil penalty of
not mate Nm Rve hundred doll. SfW).
I.uaroflhepmpmy.mmymloywwlNwMuulhlrWlecmpwaUm,
JIT'
Of1TLBf3- SWITCHES-FIXTlIRE9 DATE
NEW RESIDENTIAL ELEI—SQ
TOR
IO
[$
writ fa TO N, camas
ode:
and It fusion. Cade: Ties ConeWtds Ucmse law mica nm apply lf rt owWr
Contractors U.Lane do in .,I,
ior
ern, h bas s
papmyloyw., mvim p l.uhied cmmuwho monsah workmoffmdfw.ithrough hi
owncmployes,provided ImpmvemenoeraofImendedmolfertd for Ne.IL
RO UP
TOTAL:
I. m -
proven
however, ngalmpnomeing Wldl did not build of completion, Neowe of
Wildest will M1ne Hro buds of provlry the M did not build m Impoe for purpose of
We.j.
❑ I.0 onuumono
N(See.744, ealY
FLOOD O
APN
the Prefoongwlthlicensed
cmaoat w Project (Sat. TUU, R.I.hesu and Profwlaa Code:) The Cee. and
HRreco, and
LswdonoRapplyWmewaumer peaywMsed
PERMIT ISSUANCE
w1mco pumimpovu
wheealLess. f4 WCM1 p0)eCla MINaCMtlal:lar(f) IlCtllad pYfNmlla Hie L•mWaCla/a
License law.
r �.fp, �} "F,PEe SSU MAR
apt''' � •. }.'
ALTER - DRAIN R GIA)
A)
[3T.m uempl undm Sac. , B k P C fm this rtewn
BACK FLOW PROTECT. DEVICE
SANITARY Y N
Ovener —thin—
BOOP. AREA. COND.
WORKMAN COMPENSATION DECLARATIONDRAMS-FLOOR,
SCHOOLTAX YECBIION N
O I hereby affirm IM11 Mve a mtlfiule ofconemm to Wlf-Wemrt, as astOWle of
Norkere'Cempcm.d. lmurano or sonified coW'Ihuaf19a. 7800, Lab C.) which
FIXTURES =PER TRAP
RECEIPTN
PARK ME Y_N
'
coves all employees under this permit.
Policy
OAS - EA. SYSTEM -I INC. OUTLETS
RECP.IPT N
BUILDING DIVISION PEPS
Company
OAS - RA. SYSTEM -OVER 4 UDO
PLANCHECK FEE
❑ CaliBed opy Is hereby fumhhed.
GREASF41NDUSTRL WASTE INTERCEPTOR
GRADING FEE
.❑ CeniEd copy, is riled with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASE TRAP
SOILS PER
SEWER - SANITARY - STORM EA. 230Fr.
ENERGY FEE
(Thio suctions hedeo becmnpletedifthepamit is forune hundred dular.(S130)
or les.)
WATER HEATER wrvRNTpJwm
I mudfy, NY In the peefamurm of the weak for which this result is issued, I shall
not employ my Pawn In my mmrcs W a W become subject in the Wakere
PAID
w
Compensation laws of Cllifmnla Date
Applicant
WATER SYEIEM/IREATINO
Tote Receipt
y
NOTICE TO APPLICANT.- If. after making this Costliest. M Exemption, you ahold
becomes subject W d. Workers Compenntion Pmvhloru of the Lahm Code, you must
NEW RESIDENTIAL PLMIL SQ. Fr.
TOTAL:
w
fmthwith comply with soh previsions in Ws permit shall be deemed rtwkox.
BUILDING IEE .-
a
CONSTRUCTION LENDING AGENCY
SEISMIC FPR
Ucorrect.
raj
I hereby sGl. Hm theme fix maeation lmdiN Racy la des Pesfornance of
tiro work for which this permit H focused (Set 3WT. Civ, C.)
Lender'. Name
Address
ELECTRIC FEE
t
PLUMBING FRT..lenders
t 53
1 salify that 1 have red this sPplic.d. sued some that the shove informed. Is
l epee a comply withall city uem county odlnmae tial este laws wising to
Wilding consovcHan,Whveby avmhorla rtpmentulvn of Nh city to ill upm mM
above-maHoresd property fa Lupeclla purpm.
(We) spam save. indemnify and keep Mmiw Ne City of CLpsnion again
M
PERMITISSUANCB
AMR OR ADD TO MECH.CONSTRUCTION
MECHANICAL FEE
TA%
Ilebilificald rossamdeapeneu whlchmsylnmyw accru.,aiml said City
AIR HANDLING UNIT(TO 10.000CFM)
In coneequeo III, pwtdn of thio 11.
9
AIR HANDLING UNIT (OVER 10,000CPM)
Sign um ofA IonDak
o
EXHAUST HOOD(W/DUCD
PAID
IIRATINO UNIT (TO 100.030 BTU)
HAZARDOUS MATERIALS DISCLOSURE
We. Receipt N
Will Hee sppllcmm in future building commercial or handle hazardous milder
in &RnM by the Cupertino Municipal Code, Chapter %12, tial the Health sued Safety
HEATING UNIT (OVER 103,000 BTU)
AL:
Code, Salto 25372(.)1
❑ Yea 13 No
VENTILATION FAN (SINGER RP$ID)
Will the applicml afumm building aeaepinl use equlpanl mdevices which emit
BOILER - COMP (7111` OR 100,011() RTU)
ISSUANCE DATE
BOILER-COM(OVER 100,000BTU)
hax dous air conumirww an derived by the Bay Am Air Quality Management
DlslduT
13 Y. ❑ No
h
r A I D
NEW RPSID! AL MECH. SQ. FT.
I have red the haadmes mtuoille requirements under Chapter 3.93 of the
California Health R Safety Coda Sections 25505,25533 and 23534. l uodmmuM Nat
If the building alms nm cumnmly Moe a Ienml. tlul II b my mponslMlity to nmlfy the
MAY 1419
occuent of the req.t.ts which moa W mil prior to Ia emec of a Cicalkate of
Oy.
Cid
r IHgy ..
ISSUED PY:
Ownerwns, or a WNmised agent Date
TOTAL: