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25003APPLICANT TO FILL IN INFORMATION WITHIN pF0I Mre5 . IMM MAI I 001MT ocrJ nu! V CITY OF CUPERTINO BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL PENMITNO. ^ g. O O 25 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO. p!'PLIfATON SUBMTITAL UATE 22 UNI UNITN IAl'x -� /— -`Ti` OWN k5 NA E: PHONE TNACTO 'S NAML: LIC NO: a&dlt= A� S�.2 5i' NIL CONTROL# kCHITECpENGINFSR: LIC NO: A90R U)L-Le S�.w(,, /++:t: ❑ l(.. CONTACT : PHONE: .� n ELECTRIC PERMIT;I•.te"+'•• S f1'Yti': tn`]c IUKJIViNAn `F.,E,E n-r-t:.:try:VJ �c.:ts-s.:•o:t ✓'- _ - • :, "I. .• .. - . ..., BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ❑ ❑ PEPM Tf ISSUANCE LICENSED CONTRACTOR'S DECLARATION an 3.f Me Z s, 7").fDi Division dineir t Prichuno(Chapeh,an,m,fimm is in J I,ion]000I of Divisim3m(Ne Business end Rofoasions Code. end mYlicemeisin . full force mO effAc L) Limit ClazseL q SLIL.N ' C7 y Dau /IL3 �_r 3 Convenor Z ARCHTTECI'S DECL TION G I undersand my plans shall be rend as public records. APPLIANCES - RESIDENTIAL PANELS UP TO 200AMP5 JOB DESCRIPTION ? � � f j �L �� K (.U'v(Ti✓ �_W/,1iL/ 201 - 1000 AMPS OVER 1000 AMPS SQ. FT. FLOOR AREA SISQ. FT. SIGNS ELECTRICAL j -.o— Proi.encr J OWNER-BUDER DECLARATION IL U 1 hereby +(firm than 1 sen exempt firm de Connectors Wcenw law for Ne following n,awn. (Section 7031.5. Business and Rofessiom Code: Any city r county which requbes a permit to construct, alter, improve, demolish, or n,peir any swcturt x Poor to na issuance, ado requires the applicant fire such permit to file a signed saament 0 Oat he it licensed Porsoasn to the Provisiom of she ConuacWr's License law (Chaper i 9(commencing wish Semon]000)ofpivision 3 of Ne Basins and Prefevions Code) n rthet hit's exempt shrefsom cand Ne basis fur Me alleged exemption. Any violation of Secpen not by any applicant for a pdtsubjece, Ne applicant W a civil penury of me more Nun Eve hundred dollen (7500). n ❑ I.uowrurofdupropeny,mmYemploymwiNwegoau0earwlemmpnssauon, Will do Me work, and the smucare is not Intended or oHertd for We (Sm. 7(W4, Business and Professions Code: The Cmnnemor's License Law does not apply to an owner of pmpenywhobuildsrimpsoves Hereon,end whodrssuch workhimselfrthrough Ns ownemploycs.providd Nu such improvemenuarenot inteddro(fmd (msale. If, iidn oneyear ormmpldon, rheowner- however, thebuildingrdywvemrnt But he will have Ne budrn of proving Net he did rent build or improve fm SPECIAL CIRCUIT/hISC. TEMP. METER OR POLE INST. POWER DEVICES SWIMMING POOL ELECTRIC OUTLETS- SWITCHES- FlXTURFS j F f,�I VALUATION /� P� © � - v �']� L NEW RESIDENTIAL ELECIR _SQ. PI'. `D 1 ONSTk CDON l/ �IT7 — TOTAL: purpose of We.). We.). ❑ Las owrurof Hep ny,emexclusivelymnmacing widilicensed contrenors to crown the Mg. (Sm. 70a4, Busiress and Professions Cade_ The ConmmWr'n IianselawdoesnmapplyWmmwnarofproperrywMbuil&mi proves Harem,end who comments; (in such projaa with a conies ) licensed pursuant to Ne Contractor's U. I.W. ❑ Iamemmptund.Sm. ,B&PCfmshureswn FLOODZ NE "N FEE SUMMARY,H - - _ -,,A k (if wiaeR2RY(-�Y"TFIR,; YaY ,�y� .�.V %•I_ •.._ QTY-�'A.C'y._0 PLUM ING�PERMTTi`yC'51 —.5,i 4N ON, •� � a5-'•' u .x.+ani.-s,d..Y, s_ 1_ : Zd.s.a'.:c�'h.' PERMrr ISSUANCE �. ALTER - DRAM & VENT. WATER (EA)ft,;er_R(,<•y,a'a� BACK FLOW PROTECT, DEVICE Ownu Date SANITARY Y N WORKMAN COMPENSATION DECLARATION ❑ Ihacbya(fumthsllhaveecertificateof COPYthmof(Sm.38 o, ecatifi which cowers lCmnI re' usdandti camacenifid Dopy dureof(Sa.3g00, Lab C.) which Policy; ly�m'undm Nis pemdx Policy; _ DRAWS- FLOOR. ROOF, AREA, COND. RECE�N SCHOOLTAN Y N RECEIPT* FlJ(TURES- PER•TRAP PARK FEE Y_N_ RECEIPT# GAS -EA, SYSTEM -1 WC.40UTLETS GAS - EA. SYSTEM-0VER 4(EA) Com—��� ❑ CemfiWifmp is ere yfumnhm C".d copy is filed with Ne clry inspection division. BUILDING DIVISION FEET PLANCHECK FEE GREASEM•DUSTRL WASTE WIFRCEP DR GRADING FEE CERTffICOMPEAM OF SATIOEXEMPNWSHROM WORKERS' COMPENSATION ON MOM GREASE TRAP SOILS FEE (Duswction and yr he completed if Ne PemN is for me hmdrddollars(5100) r I..) SEWER - SANITARY - STORM EA. 2WFT. ENERGY FEE I certify Net in Ne paformmm ofNework for which this Permit is heated. I shall mot employ any Rnon N my tronoer so Or to become subject to the Wrkesn Comitant laws of Cdifomia Due Applicant WATER HEATER W/VENTELECTR ,S PAID Date RecciplN WATER SYSIEMfIR TING NOTICE TO APPLICANT: If, efor MMUdg Nu Ceniricue of Exemption, you should become subject to Ne Worker's Canpetwdm provisions of ft Labor Code, you must foMwith comply wish such Provisions r this permit shun be deenad revoked. NEW RESIDENTIAL PLMB. SQ. Fr. TOTAL: BUILDING FEE CONSTRUCTION LENDING AGENCY I hereby affirm Nat Nen, is a connotation lending agency fm Ne Parliamentof Ne work foe which this mouth is iuud (Sm. 3097, Cin C.) Lender 'sNmu TOTAL: •S L SEISMIC FEE FLECTRIC FEE laneeri Address ...- .t;Sg._wH•.. _••-:,' .n .... as ts, QTY, .� ;'� • MBCFIANICAL IsERhsGT_ y - 1 .. FEE" - - PLUMBING FEE ��•� 1 unify Nat 1 have need this application and sate that she above information is correnl agree m comply with all city and county otdinsom and state laws relating to building construction, and hereby wthodce represcnatives ofthis city Wemerupon the aboveme- a propcny for inspection purposes. f Z agnea m rave, indemnify and keep b sonless the City of Cupcninm against liabilities,judgmems,connandexperms which may in anywayacrneegainst said City nsequencc of cp Zing of Nis permit. PERMIT ISSUANCES MECHANICAL FEE ALTER OR ADD TO MECH. CONSTRUCTION TAX AIR HANDLING UNIT (TO Io.(I00 CFM) AIR HANDLING UNIT(OVER 10.10Ct CFA) gnuareofwpplicmVCanwcmr Data EXHAUSTHOOD(W/DUCq HAZARDOUS MATERIALS DISCLOSURE Will the applicant) furorebuilding ravpw Wo re or and hvudommSafin) as defined by she 32007 w Murticipu Cde, Chapin 9.12, and Ne Health roti Safny Cde. SeNon 23731(a)] PAID Data Receiptp HEATING UNIT (TO IW,WO BTU) DENTIN. UNIT (OVER I W.000 BTU) TOTAL: VENTIA'ION FAN (SINGLE RESID) - ❑Yoa 0 N Will air m icancores . behead by 'be eArae A. Quality Management ant District? e'v conamioann u defend by the Be,y Arta Au Quality Muugemem District BOILER=COMP ('"�°R 100•B°BBM BOILER -COMP (OVER 100,010 BTU) ISSUANCE DATE P. A ! D ❑ Yee ❑ No I have road du her4,dme mardua requbemma undo Chapter 6.95 of the California Health & Safety Cde, Sedom 27505, 27533 and 25534. 1 urdmeuM But if the building does nun currently have a tenant, that it is my responsibility in usably the.Coli computer R ter m(Nquhannat s which in= he met prom W Boomm mf a Co f o,n of Oxupmry. A �% APR 27 1993 ' Ur VVr Cr1111VV NEW RESIDENTUL MECH. SQ. FT. BY:I t V Owner m eutheri agrnt Date TOTAL: ISSUED WFFIVC