Loading...
30498r F oz �3 FLL APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CITY.OF CUPERTINO BUILDING- ELECTR BUILDING DIVISION APPLICATION/PERMIT _ PLUMBING_ MECHAI CONTACT: , LICENSED CONTRACTOR'S DECLARAT 1 herebgaffirm that 1 me licensed under provisions of ( afloan ]IX(bufDivision 3.f are Bus' dP fssions rc tl •�" Clan - La X1 N'S Dt Cormana— ARCHI)is, use UFCLARAD )N 1 understand my plans shell h used as public records I OWNER - BUILDER DECLARATION' I hereby affirm that I are excng+t from the Convalaor'x License Low ran the following reason. (Section 7031.5, nosiness and Professions Code: Any city.r county which requires a permit to construct, alley, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuanuo the provisions of me Contractors License Law (Chapter 9 (commencing with Section ]000) of Division of she East new end Professions Code) in that he is exempt merefom and the basis I.r the alleged esmr,tinra Any violation of Section 90316 by any applicant for it pennil subjeels tam applicant to a civil penalty of not mom than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees wtm wages as their sole compensation, will do the work, and the structure is net intended or offered forsole (Sec. 70414, Business and Professions Code: The Contractors License tow does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements ate not intended or offered for sale. If. however, Ilse ho tiding or i allato men, is sold as iakin one year of completion, the owner - builder, will hove the burden oI proving that he did stn hu ild or imprrne fin Pur- Prior ofsale^). ❑ 1, as r of the prapsmy. am exclusively contmning with licensed transitions m cmrs construct the Project (Sec. TWy Business and Professions Code:) TTe Contrrme, Li- u Law does not apply to an owner of property who builds or improves thereon, and who contract far such projects will) a contracons) licensed pursuant to the Contractor's License Law. . ❑ I am eantnptunder Sec. ,Ii &PC }or lhisralem Owner Dam ' WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury aneof the following declarations: ❑ I have and will maintain a Certificate of Consent to selfdnsare for Worker's Compen- eatl e. ar prnvidM for by Section 37110 of the Labor Code, for the performance of the all for which Ibis permit is issued. 11 have and will maintain Workers Compensation Insurance as required by Section W of she Labor Code, for the performance of me work for which this permit is issued. IT his seaien need net be contorted i fill pennil is fin- line hundred not has f$1of or less.) - 1 certify than in the nabsuarma. of the work far which,his permit is issued, I shall rs m not employ any peon in any manner as to favors, subject m me Worker' Cnmpen- O,Z smio. Ldwsof California. Date 7 Applicant NOTICE TO APPLICANT: If. after making this Cenificam of Exemption, you should (~ became suhjaO to the Worker's Compensation provisions tit the Labor Code, you mail W forthwith manply with SUCK provisions or,hisp,air shall hederned revoked. 0 U 0 CONSTRUCTION LENDING AGENCY 1 hereby affirm thin (hem is s construction d (See lending agency for the Performance of � � � the work for which this permit is issued (Sec. l(19], Civ. C.) U Lender's Name fenders Address as I unify (hut I Tree read do. nppliculin i and sore Iho she above itfornmlion is V] correct. 1 agree Ili comply with all city and county collimators and &late laws ratming ni QTY V building construction, and hereby vulb Us, representmivcs of mis chytn enter urym me anew- mentnoned Pmpeny for inspection pm s as. y(We) agree m save, indemnify and keep hmmlcns the City of Capital. against liabilities, judgments, costs and expenses which may in any way name against said City in consequence of the granting of this permit. - APPLICANT UNDERSTANDS AND L MPLY WITH ALL NON - POINT, ' SOU CG RGGU IONS. ' SC Sign reef Applican-dConvcti n HAZAR SMATERIALSn store OSUR Will the applicant urfmure ipalCooccupantstemor handle hazardous material m to, S,, by the Cupertino A1unIelryLl Gdc, Chapter & 12, Imdl the Health are Safety Cade, Elves 25572(a)p ,i]Yes C] No . 'Will the applicant or future building occupant use equipment or devices which mil hazardous air accountants as defined by the Bay Area Air Quality Management District? ❑Yee _7 No I rate end (he ImamA e, arroadahrectmements under Chapter fi 95 of the Call- foraiiii Health & Safety Code Sections 25505 8533 and 25534 1 understood that if the handling d I currently h arrant. mat it is my maDarasibility to notify the occupant of the regmrements which mml be mar prior to issuance ofa Ccnaficare of Qc psmal,. OVER 1000AMPS _ SIGNS ELECTRICAL . SPECIAL CIRCUIT/MISC. TEMP. METER OR POLE INST. I POWER DEVICES, 41 SWIMMING POOL ELECTRIC OUTLETS —SWITCHES — FIXTURES NEW RESIDENTIAL. EI.ECTR SQ Fr. TOTAL: PLUMBING PERMIT' ALTER— DRAIN & VENT — WATER (EA) HACK FLOW PROTECT. DEVICE DRAINS — FLOOR, ROOF, AREA, COND, PINT OBIS - PERIRAI' GAS — EA. SYSTEM -1 INC. 4 OUTLETS GAS — EA. SYSTEM OVER 4 (EA) GREASMNDUSTRL WASTE INTERCEPTOR GREASE [RAP SEWER— SANITARY —STORM F.A. 200 Er. WATER HEATER W /VENT/ELECTR WATER SYSTENUTREANNG WATER SERVICE NEW RESIDENTIAL PLMB. SQ.-FT. It MECHANICAL PERMIT PERMIT ISSUANCE ALTER OR ADD TO MECH. AIR HANDLING UNIT (1'010,00TCFM) AIR HANDLING UNIT (OVER town CPM) EXHAUST HOOD (W/DUCf) HEATING UNIT (10 100,000 BTU) IIRAfINGUNIT(OVER 1(X),O(X)BTU) VENTILATION FAN (SINGLE RESIDE BOILER —COMP IJHP OR 1(1(1,000 BTU) BOILER —COMP (OVER 100,(X10 BTU), AIR CONDITIONER I NEW RISIDENf1AL MECH. SQ, OFFICE SAND'AI ' N/C El BLDG FEE BUILDING PERMIT INFO RESIDENTIALuvws . l.rrrwt. ; CLINT I1ACfOR'S N li: 1.1 945 yGA �iaa, - ): ADDRESS: . ❑STRUCTURAL ❑. Consultant Fees Paid by Applicant (Initial) N QTY. ELECTRIC PERMIT Liter 9 (commencing ' ❑ BATH RhMO/DFhJR/B�P�A,I,It de, anJ my cc tsc iq L1 OTHER L I'l RMH ISSUANCE IaLf.�}lGrv� APPLIANCES - RESIDENTIAL PANELS UI' TO 20) AMPS OWNER - BUILDER DECLARATION' I hereby affirm that I are excng+t from the Convalaor'x License Low ran the following reason. (Section 7031.5, nosiness and Professions Code: Any city.r county which requires a permit to construct, alley, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuanuo the provisions of me Contractors License Law (Chapter 9 (commencing with Section ]000) of Division of she East new end Professions Code) in that he is exempt merefom and the basis I.r the alleged esmr,tinra Any violation of Section 90316 by any applicant for it pennil subjeels tam applicant to a civil penalty of not mom than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees wtm wages as their sole compensation, will do the work, and the structure is net intended or offered forsole (Sec. 70414, Business and Professions Code: The Contractors License tow does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements ate not intended or offered for sale. If. however, Ilse ho tiding or i allato men, is sold as iakin one year of completion, the owner - builder, will hove the burden oI proving that he did stn hu ild or imprrne fin Pur- Prior ofsale^). ❑ 1, as r of the prapsmy. am exclusively contmning with licensed transitions m cmrs construct the Project (Sec. TWy Business and Professions Code:) TTe Contrrme, Li- u Law does not apply to an owner of property who builds or improves thereon, and who contract far such projects will) a contracons) licensed pursuant to the Contractor's License Law. . ❑ I am eantnptunder Sec. ,Ii &PC }or lhisralem Owner Dam ' WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury aneof the following declarations: ❑ I have and will maintain a Certificate of Consent to selfdnsare for Worker's Compen- eatl e. ar prnvidM for by Section 37110 of the Labor Code, for the performance of the all for which Ibis permit is issued. 11 have and will maintain Workers Compensation Insurance as required by Section W of she Labor Code, for the performance of me work for which this permit is issued. IT his seaien need net be contorted i fill pennil is fin- line hundred not has f$1of or less.) - 1 certify than in the nabsuarma. of the work far which,his permit is issued, I shall rs m not employ any peon in any manner as to favors, subject m me Worker' Cnmpen- O,Z smio. Ldwsof California. Date 7 Applicant NOTICE TO APPLICANT: If. after making this Cenificam of Exemption, you should (~ became suhjaO to the Worker's Compensation provisions tit the Labor Code, you mail W forthwith manply with SUCK provisions or,hisp,air shall hederned revoked. 0 U 0 CONSTRUCTION LENDING AGENCY 1 hereby affirm thin (hem is s construction d (See lending agency for the Performance of � � � the work for which this permit is issued (Sec. l(19], Civ. C.) U Lender's Name fenders Address as I unify (hut I Tree read do. nppliculin i and sore Iho she above itfornmlion is V] correct. 1 agree Ili comply with all city and county collimators and &late laws ratming ni QTY V building construction, and hereby vulb Us, representmivcs of mis chytn enter urym me anew- mentnoned Pmpeny for inspection pm s as. y(We) agree m save, indemnify and keep hmmlcns the City of Capital. against liabilities, judgments, costs and expenses which may in any way name against said City in consequence of the granting of this permit. - APPLICANT UNDERSTANDS AND L MPLY WITH ALL NON - POINT, ' SOU CG RGGU IONS. ' SC Sign reef Applican-dConvcti n HAZAR SMATERIALSn store OSUR Will the applicant urfmure ipalCooccupantstemor handle hazardous material m to, S,, by the Cupertino A1unIelryLl Gdc, Chapter & 12, Imdl the Health are Safety Cade, Elves 25572(a)p ,i]Yes C] No . 'Will the applicant or future building occupant use equipment or devices which mil hazardous air accountants as defined by the Bay Area Air Quality Management District? ❑Yee _7 No I rate end (he ImamA e, arroadahrectmements under Chapter fi 95 of the Call- foraiiii Health & Safety Code Sections 25505 8533 and 25534 1 understood that if the handling d I currently h arrant. mat it is my maDarasibility to notify the occupant of the regmrements which mml be mar prior to issuance ofa Ccnaficare of Qc psmal,. OVER 1000AMPS _ SIGNS ELECTRICAL . SPECIAL CIRCUIT/MISC. TEMP. METER OR POLE INST. I POWER DEVICES, 41 SWIMMING POOL ELECTRIC OUTLETS —SWITCHES — FIXTURES NEW RESIDENTIAL. EI.ECTR SQ Fr. TOTAL: PLUMBING PERMIT' ALTER— DRAIN & VENT — WATER (EA) HACK FLOW PROTECT. DEVICE DRAINS — FLOOR, ROOF, AREA, COND, PINT OBIS - PERIRAI' GAS — EA. SYSTEM -1 INC. 4 OUTLETS GAS — EA. SYSTEM OVER 4 (EA) GREASMNDUSTRL WASTE INTERCEPTOR GREASE [RAP SEWER— SANITARY —STORM F.A. 200 Er. WATER HEATER W /VENT/ELECTR WATER SYSTENUTREANNG WATER SERVICE NEW RESIDENTIAL PLMB. SQ.-FT. It MECHANICAL PERMIT PERMIT ISSUANCE ALTER OR ADD TO MECH. AIR HANDLING UNIT (1'010,00TCFM) AIR HANDLING UNIT (OVER town CPM) EXHAUST HOOD (W/DUCf) HEATING UNIT (10 100,000 BTU) IIRAfINGUNIT(OVER 1(X),O(X)BTU) VENTILATION FAN (SINGLE RESIDE BOILER —COMP IJHP OR 1(1(1,000 BTU) BOILER —COMP (OVER 100,(X10 BTU), AIR CONDITIONER I NEW RISIDENf1AL MECH. SQ, OFFICE SAND'AI ' N/C El BLDG FEE BUILDING PERMIT INFO RESIDENTIALuvws . l.rrrwt. ; 0 SFDWL ❑ KITCHEN RI ?MODEL ❑ADDITION El PLUMBING RE -PIPF. El MULTI-UNIT ❑STRUCTURAL MODIFICATION ❑ INTERIOR ❑ CHIMNEY REPAIR .IMPROVEMENT ' ❑ BATH RhMO/DFhJR/B�P�A,I,It DEMOLITION L1 OTHER El NEW BLDG /ADDITION El DEMOLITION []TENANT El FOOD SERVICB IMPROVEMENT DOTTER SQ. Pr. FLOOR AREA PA FEE NOV1219 Vpp44,U,AT'ION Vi y` tAlI) lYU STORIES TYPE C( OCG GROUP- t BUILDING DIVISION FE[S ' PLANCHECKTEE., ENERGY FEE GRADING PER SOILS FEE . PHE PAID Date Receipt g TOTAL: BUILDING Fill' SEISMIC PER ELECTRIC FE l PLUMBING EEG CONSTRUCTION TAX HOUSING MTTEAO1 IN ME PAID Uum ReceiptN S/SQ.IT.