Loading...
S 1911 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELFICI'RICAL PESIT N(1. BUILDING DIVISION APPLICATIONFPERMIT PLUMBING-MECHANICAL. BUILDINGADDRESS SJ 1911 BUILDING PROJECT IDENTIFICATION A SANITARY NO. APPLICATION SUBMITTAL.DAT[ C-1 u z7 0v HONE: © NIC CONTROLp C /N CON'1'eACIOR'S NA 1I E: (� �� ryC— ARCHITECT/IiNGINIiIiR: LIC NO: .. ,A(! („�J 1CCj ❑ CO PACT: PHONE: BUILDING PF IT INFO f5 q F1 D v C'C ❑ CORSU .On Fees Paid by Applicant(Initial) BLDG ELECT 4PLUMB MECII LICENSED CONTRACTOR:1 DI!CLARATION ❑ ❑ ❑ 1 hcmny mTon that I am Iicenssd under pmvisiore of Chapter 9(a:mmemdng QTY ELECTRIC PERMIT FEE hoc with Section]Iexpofuivi.inn3onhe Businosomd l4afe's'ne Codetad my license is JOB DESCRIPTION is full firwc and.ffcEl. PERMIT ISSUANCE RESIDENTIAL: d�F aUU License Class Lica 0SFDWL O KITCHEN REMODEL sna g HZW Dara Comancon APPLIANCLS-RESIDENTIAL ❑ADDITION OPLUAIRING REPIPF 1.7ti ARCHITECTS shallbease DECLARA'DON PANELS DMULT[-UNIT []STRUCTURAL OZ 4 Z undcntnnd my phumv shall he usN as public recnnla MODIFICATION UP-Z"ANIPS ❑INTERIOR OC YREPAIR F F_W haamseJ 1'mlesstonal IMPROVEMENT Z,�j OWNER-BUILDER DECLARATION 2(II-I WBAMPS IMMINC POOLS y 0.0.'0 u]a I herchy affirm Ihot I um excntpl from the Commclors Liccuse Law fm the OVER EXHIAMPS D BATH REMODHIAI PAIR 0 DEMOLITI(� x 3 0.F Hollowing reason.(Section 7031.5,Business and Iho1'c"mr,Cole:Any city or county i F'LL LLO to which"Force n'—if m co nstma,-her,improve,demolish,or repair any"mature SIGNS ELECTRICAL. El OTHER �D ' prior to itsan reslaino thicIapplicantfor such Plant to file a signedstatement SILCIAI.CIRCUIT/M 15C. Nn 1 :d l I I p p on, in,C I el n's I c l (Chapter rJ tal00 (cam enc g thS f,]001)) fD :ron3 fll B : ssu dP f..' ns Cala)or FLMP.METER OR POLE(NST. COMMERCIAL: 6 4 n C that he n exempt Wercfmenand Ne hnsis for the alleged exemption.Any violation of 0. Sceioo]031.5 by any applicant fora o F'm thea I penalty of POWER DIiVICES ONEW'RLDG/ADDITION ❑DEMOLITION .-y pecten sn Ic s pp icanusacivll OTENANT its y not mom than five ep,,,ddol lx my employees 1:1 Tom SERVICP. �a D 6o The work,he prapeny,or my employees wish wagewwhcieude compensation, SWIMMING POOL ELECTRIC IMPROVEMENT will do the work,and lM1e sm-"am is not intended ornRered for ale(Sm.7074.Business ❑OTHER L3 m and 1'mfessions Cale:The Commocuu:x License Law does not apply to an owner of OUTLETS-SWITCHES_FIXTURES popery who holds or improves flemon,and who dace such work himwellit through his own cmploycev,puwided that such Improvenmmts ore oat Im.aded.r offered Sar NEW RESIDIiN'GAL HLEC.'R SQ F1'. sale.If,however.the building orimpmverenl is sold within ane year efcompletion,the SQ.PC FLOOR AREA VS .FF. owner-builder will navethe burden of proving that he did not build or improve for pur- PAI Q Lose of ale.,, f A B D ev I,as owner of We See,T urn sinew,i add Poalmedag with Ikea'Camromors i- Tarn L. comtmct We pmjcd(Sec.]oa4,Business and Pvdes'iuns code:)ITe Contocmr's Li- censeLaw d:rsnot apply Inanowner ofproltenywho builds orimproveelhereon,and QTY PLUMBING PERMIT FEE 'JUL 24 gHga who contracts fartech projects with a Termin res)licensed pursuant tothe Commatur's License Law. (]lam exempt under Sec- .I1&P C far Nls eawn PERMIT ISSUANCE G�TY OF Oat ALTEk-DRAIN&V1iNT-WAI'F.RIEA VALUAI'10 ORKHR:SCOMI'loNSATIOND, ARAI'H RACE FLOW PROTEC'II DEVICE 1 herchy affirm under penalty of pe jury one of Ne following declamations: ❑ I have and will maintain a CliifcataofConscnun self-insua far Worker's Compen- DRAINS-FLUOR,ROOF,AREA,COND. 'anon,as pmvided for by Section 37011 of the Labor Core,for the performance of the STORIES TYPE CONSTRUCTION work for which this penal is ismee. FIXTURES-PER TRAP ❑ 1 have and will maimain Worker's CanINT,,on In.wranee,us require)by SeRion 3700 date WbsrCore,far the pe,fomance of the work for which this ps,npa is issued. GAS-EA.SYSTEM-I INC.4 OUTI.EI'S MY Wnr y�} I umnce canner and l'nlle� OCC.GROUP APN Carrico nj " � _Policy Nn.. GAS-EA.SYSTEM-OVER4(EA) CIiRI'IFICAFEOFF.XEMPTIONPROM WORKERS' pQ COMPENSATION INSURANCE GRCASHIINDUSTRL WASTE IN FURCEPTOR BAI' - or less) This mainnm b .need e complied if the Permit is forone hundred dollars(S IIID/ GHEASF. BUILDING DIVISION FEES ' - - — Ieonilylhatintha lwrfarmana:al the work far which this I is issued lsholl PLANCHECK FEE not.nmlo an the SHWER-SANITARY-STORM EA.210 F-E P Y Y person in any manner so as m henune wbjm to the Worker.:Compen- ENERGY ITE O z 'mita ant .(California.Doc WATER HEATER WNENF/ELECTR 7 Applicata GRADING 17EE G Sit)'! ss TO subject 1.he MI':IL after nuking This Ccrtilicum of E abs,, o dyou should WATT7R SYSTEMiTRW ING a ? brash s compythe Workers Cnmpenation provisions of fhe Inbar Gale,you must SOILS FEE 6nhwith comply with wen Provisions or this permit shall be deemed revoked. W0. Q W'KHiR SERVICE 5z CONSTRUCE ION LENDING AGENCY NEW RESIDINTIAL PLMB. S II PARD I nerah Ifirn that there is a xonNtuction lendin Q Utile Recelptp U O the work for which Nis peorrit is issued(Sec.309],Civ.Cjemyfor the lxrlistmance.I Vtondo's Name W Le Ive.v TOTAL:Address T(YIAL: pv 1 cer-by that 1 have read'his application and state that file above limitations,is I1111LDINC PEE C1zGe) comet.l agree m comply wird all city and county ordinances and some laws relatingm QTY. MECHANICAL PERMIT bolding construction,and hereby authorize representatives of this city 10 enter neon the FEE SEISMIC LLE a�ove-mentioned progeny for iaspeclion pmpoms. (W.)agme ,,a,.,mdamity sad keep hannlocs No Cit fCu nlnsnainst PERMIT ISSUANCE Iiabi limies.judgments,costs and expenses which may an y d CLIiCTR1C PF,F. yin any acrneagainu said City ALTER OR ADD TO MECH. in rnnsequence of the gmming of this permit. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WI-I'If ALI.NON-POINT ae UNI'T('I 010jait)CPM)SOI111CBRfI r N' MHCIIANICAI.FEH UNIT(OVER InfH0 CEM( CONSFRUCALFflON LAX Signaem of nFlors,UContm.tor 'a (W/DUCKGAZ.AIsDOUS MAI HRIALS DISCLOSURE HOUSING MITIGAI'It IN FEE Will the rgsplicam orfuture building mccupantumcm,handle hazadous matcnal GOD 110.000 BTU)as&fired bymhc Cuperdmo Municipal CNe,Chapter 9.12,end the Health and Safety Cal.,Section 25532(x)? J (OVER 100.000 H1111 D Yew /No VENTILA'T'ION FAN(SINGLE RESID) PAID ;. Will Ne applicant ter inwre building occupant use equipmetn or devices which Dae Receipt 0 emiohuzuNousuirconaminunos defined by the Bay Area Air Quality Management BOILER-COME OR Im,000 BTU) Diene" /�5 'TOTAL: ❑Yes v", BOILER-COMP(OVER 100.000BFU) I have read the himarl materials mquiremcnts under Chapter 695 of the Cali- AIR CONDITIONER fornia Himillh&Safety Cal,.Serfionv 255115,25533 and 25514,I under, Wal if rbc ISSUANCE DATE M1uilJing does not currently havcaanant.that it is my responsihilitymnmiTy thmxcupant NIiW RESIDIiNI'IAL MIiCII. SQ.IrI'. art tswnicn rule n I.issuitlKeo Cmmcaleor icy. i 7 ownermxanmamee agemt � ♦ Dae neral.: ISSUED BY: OFFICE