Loading...
23924 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY Bulldin Proed ldceliflratlon PERMIT NO. BWldkg Addreva: _ - - 23924- IODAM wners ossa: one: $PLr?_ CITY OF CUPERTINO-BUILDIIaG D ISIPN ontractar's Name: sea.No APPLICATION I IT 90 e.1 jos BUILDINGALICTRICA FGIiAMCAL CA RY Architect/Engineer. Lie.N. ` 11 CPBRMIT E M1�BUILDING PERMIT.INFO ' Address: 555 LOQ+ 11 \4a4�. P ANCE LICENSED CONTRACTOR'S DECLARATION I hereby affirm that(am scared under provisions of Chapler9(cormnme ANCESRESIDE L jub DESCRB'1 ION Ingwith Sedian7000)m Divbdon3 afthe Buslnessand ProfesslonsCode,and my Ie in ppNF25 1�x Ilrense cors and affect. 163" f License-lass Licp �T 1 Date Contnct cue ARCHITECTS DECLARATION 201.1 AICA re0 Z I understand my plain shall be used as public records ' OVER �• ��Rh—T S/� Po! O SI FCTRI .rr Ilial Ely�j Licensed Professional Z OWNER-BUILDER DECLARATION SPECUL CULT/MLSC l hereby affirmthal l am exempt from the Contractors Llrense haw for the ORO F's lolkwing reason.(Section 7031.5,Business and Profeulons Cade:Any dty or CCER OR POLE INST. H countywhich moues a permit to mretrua,alter,improve,derrollah,ormpair g anystruchme priorto its Issuance,also mWirna lheappEnt forsuch permit to POWER DEVICES t5 flle a signed statement that he Is licensed pursuant to the provisions of th Owl Contractor's Llcerse Law(Chapter 9(commencing with Section 7000)of DlSVV24WNG IDOL ELECTRIC VALUe\glyf 30 yon3ofthe Business and Professlona Code)orthat heb exempt therefromand �6SaCr k5 Sn the basis for the alleged exemption. Any violation of Section 70315 by any OUTLETSSWITCHESE)RURES applicant for a permit suble is the applicant to a civil penalty of not more than ' five hundred dotka($SM. NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPE CONSTRUCTION owner of the property,or my employees with wages as their sok wmpensal{on,wWdothework,andtheatru mL,notintendedoroffe-dfor ' p sok(Sec.704y,,,.,and Profeselons Code:The Contractors License Law $ does not apply to an ownerof property who builds orlmprovesthereon,and OCC.GROUP RFS.UNITS whodomsuchworkhlrr self orthrough Msown employees,provided that such Improvenot ow ments are nontended oroffemd forsale.If,however,thebuilding or T Improvement b sold wlthln oneyearofcomplelbn,tM owner-builderwlll have ' tfLrrrden of proving that he did not bund or Improve for purpose of sale.). QTY. PLUMBING PERMIT ' FEE pI56D7ONF APN LJ L as owner of the property,am exclusively..trading with licensed PERMIT ISSUANCE contradon to construct the project(Sec.RM4,Buskess and Professions Code: I'm Contndor's License Law does not apply to an owner of property who ALTER-DRAIN k VENT-WATER(EM Wilds or improves thereon, and who contracts for such plojeds with a " •FEE'SUMMARY cgagador(s)licensed pursuant to the Contractor's License Law. TA RRU .Dr2c�— —OUTSIDE FEES LJ I am exempt under Ser, B k P C for this reason , bar. Data D S FIAOA ROOF,ARBA,CON SANITARY RECEIPT M WORKMANCOMPENSATIONDECLARATION Spgg Tp:;-;, - _ �', SCHOOL TAX .Y_ N_ pl hereby M.tN t I have a redificate of consent to self-insure,ora — _- . �+ / y RECE rr R cenlfiate ofWorken'Compensation lmunnce ora cenifled copy themsf(Sec. GAS EA.SYSTEM., V��tf �,., • �). d PARK FFE V N 3801,L6 ©LY1Os ' GAS EA.SYSF7OVER - RECEIPT- P.Ik DING DIVISION FEES Com any �'na-, edified copy b fhereby iled the cid. - GREASE/LNDUSTRL WASTE INTERCEPTOR ' ANCIIECK CedRied copy is(fled with the city WpMion division. I CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCESEWER-SANITARY-STORM EA.ZOOW. Date Receiptil (Ihbsedion need nal beemapleted lithe permit Isforone hundred dollars (SIM)or lased WATERHEATER W/VENT/E.ECTR ENERGY FEE Y_ N— I certify that in the performance of the work for which this permit is blued, I ehalf not employ any person In any manner so as to become subject 10 the WATER SYSTEM/TREATING pAID Workera Compensatk,-Uwxof Califomk. Date OZ Applicant NEW RESIDENTIAL PLMB. SObT. Date Recei til Z NOTICETO APPLICANT[Leger makingthb CertRlate of Exemption,you should become subject la the Workers'Compemation provivlona ofthe Labor - TOTAL: D Code,you=at forthwith comply with such provisions orthb permit shall be B D G �~ deemed revoked. NSTRUCTION LENDING AGENCY SEISMIC FEE W CO - — CL I hereby affirm that there is a construction lending agency for the perform, TOTAL: ELECTRIC FEE = Zarm.fthcwork((o��which this permit is Issued(Sec.3097,Civ.C.) PLUMBING FEE V O 1ceder'e Name_J 3r_ FEE MECHANICAL PERMIT LL 1- Lasser.AaareQ aa TM• MECHANICAL PEE O W I certlfythatl have madthbapplicPERMIT ISSUANCE atlonand statethatthe above information FEES PAID: bconed.I agreetocomplywnh andtyand countyordmanaeand state laws �. arelatingtobuilding construction,and hereby authorize representatives ofthb F" 2 citytoenterupon theaboss- .tioudp.pertyforirepndionpuose rpa. IR TOR ADD TO MECH. �+ Date Receipt# (We)agree to save,Indemnify an of keep harmless the City of Cu pertlrw AIR HANDLING UNIT(TO V against Whittles,judgments,costs and expenses which may In any wayaccme SUBTOTAL: agalrst Id City nc s seen-1of the granting of this permit AIR HANDWNGUCONSTRUCTION TAX 7 UNIT 10,000CFM7 Signature o(Appllcant/ tractor Ala EKHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZA US MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,0DO BTU) Date - Recei tM notarial as defined by the Cupertino Municipal Code Chapter 9.12;and the - Health and Safety CczeSSection 255324)7 HEATING UMT(OVER 1fq,OW BTU) TOT Yee LJ No Willtheappllant oruture building occupant use equipment or devices VENTILATION PAN(SINGLE IiFSID) ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? BOILER-COMP OH?OR 100,000 B17n P A I D Yea I❑No Ihave read the hazardousmaterials requirements underChapler6.95of BOILER-COMP(OVER 100,DODBN) theCall if fthebSafety Coda Sections25505,25533have a teen,that JUL 2 1992 the Callandthal alh building don Se ans25yhave33and 25534 itbmy NEW RESIDENTIAL MEiCH. SQ.FT resposulbllity to notify the occupant of the requirements which most be met - priorto seance fa rt ateof Occupancy. CITY OF CUrtn 1 uvv Owner or authorized age I)afe TO ISSUED OFFICE COPY