The URL can be used to link to this page

31295 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO I BUILDING.ELECTRICAL PERMIT NO. 31295 w w BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 11 •CJ UJJ 1V� BUILDING PROJECT IDENTIFICATION - BUILDING ADDRESS: y1 �, a , q,5d �� SANITARY NO. APP/LICA1[ON SUBMITTAL DATE LI OWNER'S NAME: 6 /O( PHONE: - JCONTRACTOR'S NAME: l/ LIC NO: �' V t.<LE' o qd NIU CONTROL# ARCHITECTIENGINEER: . po,_ LIC NO: ADDRESS: 4% t/ •f,t I' ❑ CONTACT: -,VfYP QS-j BUILDING PERMIT INFO "Y*aD fENSED Iy. �, 91'xy ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECW_ " PV/ Saw I�r 1:1 El ❑. LICCONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE 1 hereby affirm that 1 em licensed under pm,isi.as of Chaptem Cooper,9(enmenciag JOB DESCRIPTION �0ZO with Section 7001 Division 3 fine Buxlnessaad Professions Coal my license is PERMIT ISSUANCE. ^ RFCIDFNTIAIa in full farce and elle ZUV License Class 4' alae -- ❑STOWL ❑KITCHEN REMODEL rFWM Dam�ContracmrAPPLIANCES-RESIDENTIAL []ADDITION - ❑PLUMBING RE-PIPE F, ARCHITECTS DECLARATION 7 rn ❑MULTI-UNIT ❑STRUCTURAL y O n 7j ' I understand my plans shall be used as PANELS public records pMODIFICATION IOZ-- UPT0200AMPS ❑ yrr.INTERIOR HIMNEY REPAIR : Licensed Professional ' U OWNER-BUILDER DECLARATION 201-1000AMPS IMPROVEMENT 1 hereby off nn that 1 am exempt from the Contractor's License Law for the OVER 1(100 AMPS ❑BATH REMODELrIREPAIR ❑DEMOLIT ON ipy,O W U following reason,(Section 7031.5,Business and Professions Code:Any city or countyBIONS ELECTRICAL ❑OTHER Tie I•* • C -I\-tiM ala 4 y which requires a permit to conswn,alter,improve,demolish,or repair any suucture L.eO e I O M ' �� priermits issuance,also requires the applicant for such pmmitut file a signed statement SPECIALCIRCUIT)MI . t V an Nat he is licensed pursuant to the provisions ofthe Contractor's License Law(Chume,9 COom £ (commencing rib Section 7000)of Division 3 ofare Business and Professions Code)or TEMP.METER.ORXLE INST. COMMERCIAL: F y o TZ that he is exempt therefrom and the basis for the alleged exemption.Any violation of re El NEW BLDG/ADDTf70N ❑DEMOLITION ZZ ySection 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEV E$ El TENANT ❑FOODSERVICE or mothan rise hundred dollars(8500} � QO ❑1,os owner of the property,or my emploees with woes as their sole cum IMPROVEMENT y g peneation, SWIM# GPOOLE IC a o will do the work,and the structure is not intended or offend for sale(See7044,Business ❑OTHER 0.W m and Professions Code:The Contractor's License Law dues not apply men owner of OU ETS-SWITCH - T ES - property who builds or improves thereon,and who does such work himself or through his own employees,Irovidul that such improvements are nut intended or offered for W RESIDENTIAL LECTR S aide.If,however,the building or improvement is sold within one yemof completion,the SQ.PfpI OQR IRF6 S/SQ.IT.. caner-builder will have the burden of proving that he did not build or improve for put- /�4 6I pose of sale J. . ❑1,as owner or the propeny,am exclusively continuing with licensed contractors to TOTAL: f eamstmm the project(Sx.7044,Business and Professions Coda)... Commctor's Li- OCT A �['(1� sense Lew does not apply m an owner of propenreCy who builds or improves thereon,and QTY. PLUMBING PER FEE 4 RE who contracts for such projects with a contractor(s)licensed pursuant to the Contractors �x License Law. - a PERMIT ISSUANCE CNY VI- VUI'CHIINU E] m 1 eexempt under Sec, ,B&Is C for this mason ALTER-DRAIN&VENT-WATER BA) Owner Dote VALUATION ' WORKER'S COMPENSATION DECLARATION ffirm BACK FLOW PROTECT.DEVICE. �,J I hereby aunder penalty of perjury one of the following declarations: 'Z Ihave end will maintain eCenificate of Consent mself-insure Tor Worker's Couipem DRAINS-FLOOR,ROOF,AREA,COND. since,as provided for by Section 3700 of the Labor Code,for the pco mmance of the STORIES TYPE CONSTRUCTION work for which This permit is issued FIXTURES-PERTRAP ®I have and will maintain Worker's Compensation Insurance,as required by Section 3700 mdue Labor Code,Trade,permoreace of the work for which this permit is issued. GAS-EA.'SYSTEM-I INC,40UTLETS OCC GROUP, DPN. My Work 's Compensation Insurance canner and Policyn er e: Camier. p�tn,_F�aL" rll � Policy No.: GAS-EA.SYSTEM-OVHR4(HA7 - CERTIFIC COMPENSATION WORKERS'�YJ, I/I IpY GREASIVINDUSTRL WASTE IN CEPTOR COMPENSATION INSURANCE 1 BUILDING DIVISION FERS (This section need not bewmpleted lfthepermlt is for mnehundred dollars($100) -GREASE TRAP or less.) x PLANCHECK PEE Loy any that in the any manner of the work for which this the Workis ers Crutch- SEWER-SANITARY STORM EA.200 FT. not employ any person in any manner so as m became subject m the Workers'Compen- ENERGY HE Z smioa Laws of California.Date O Applicant WATER HEAT NENT/ELECTR _ GRADING FEE ti NOTICE TO APPLICANT.If,after making this Cenifcate of Exemption,you shomld WATER 5 TEMaREATING F become subject m the Worker's Compensation provisions of the Labor Cade,you must - SOILS FEE � forthwith comply with such provisions or this permit shall be deemed revoked. WqT SHRVICE f Q 7. CONSTRUCTION LENDING AGENCY W RESIDENTIAL PLMB, SQ.FT. PAID L)0 Thereby affirm mm there isaconsuuminn lending agency fonhe performance of Dam R elpt# the work for which this permit Is issued(Seo.301 Civ.C) , OLender's Name _ TOTAL: {UTJ Lender's Address TOTAL: y 1 certify that 1 have read this application and state that the above information is BUILDING FEE In correct.l agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE U sZr building construction,end harebyauthorize representatives of this city 10 enter upon the SEISMIC FEE elwve-mentioned property for inspection purposes; PERMIT ISSUANCE(We)agree m save,indemnify and keep harmless the City of Catarina against ELECTRIC FEE liamlities,judgments,costs and expenses which may in any way accme against said City AUTERORADDTOMECH. in consequence of the granting of this permit. PLUMBING FE 'APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT PIR HANDLING UNIT(TO 10.tXp CFM) SOURCE REGULATIONS. - MECHANICA FEE AIR HANDLING UNIT(OVER 10,000 M) CONSTRUCT NTAX Sigeamreof Appli,masCornractin Date EXHAUST HOOD MIDUCT) HOUSING MI IGATION FEE" HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100, TU) as defned by the Cimarron Municipal Code,Chapter 9.12,and the Health and Safety Code,Scone.25532oul HEATING UNIT(OV 1W,II00 BTU) ❑Yes No �v VENTILATION N(SINGLE RESID) PAID P _ - Date eipt# Will the it contaminants or future building by the nt useDay A ea Air Quality or lity Managemces ent nt BOILER- MP QHP OR 100,0(10 BTU) it hazuNous air conmminams as defined by the Bay Area Air Quality Management ' gmt4 BOIL COMP(OVBR IgLtX10 BTU) .r TOTAh: ❑Yes ON. I have re ad the hazardous materials halmoments under Chapter 6.95 of the Cali- A CONDITIONER- ISSUANCE DATE Tornio Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the OiSEW RESIDENTIAL MECH. SQ.ET. building does not currently have a tcnanh that it is my responsibility to notify the occupant of The meat me which must m t prior m issuance of a Cenifcateof Occupancy. - Owner or authorize agent - Date TOTAL ISSUED BY: OFFICE APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO I BUILDING.ELECTRICAL PERMIT NO. 31295 w w BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 11 •CJ UJJ 1V� BUILDING PROJECT IDENTIFICATION - BUILDING ADDRESS: y1 �, a , q,5d �� SANITARY NO. APP/LICA1[ON SUBMITTAL DATE LI OWNER'S NAME: 6 /O( PHONE: - JCONTRACTOR'S NAME: l/ LIC NO: �' V t.<LE' o qd NIU CONTROL# ARCHITECTIENGINEER: . po,_ LIC NO: ADDRESS: 4% t/ •f,t I' ❑ CONTACT: -,VfYP QS-j BUILDING PERMIT INFO "Y*aD fENSED Iy. �, 91'xy ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECW_ " PV/ Saw I�r 1:1 El ❑. LICCONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE 1 hereby affirm that 1 em licensed under pm,isi.as of Chaptem Cooper,9(enmenciag JOB DESCRIPTION �0ZO with Section 7001 Division 3 fine Buxlnessaad Professions Coal my license is PERMIT ISSUANCE. ^ RFCIDFNTIAIa in full farce and elle ZUV License Class 4' alae -- ❑STOWL ❑KITCHEN REMODEL rFWM Dam�ContracmrAPPLIANCES-RESIDENTIAL []ADDITION - ❑PLUMBING RE-PIPE F, ARCHITECTS DECLARATION 7 rn ❑MULTI-UNIT ❑STRUCTURAL y O n 7j ' I understand my plans shall be used as PANELS public records pMODIFICATION IOZ-- UPT0200AMPS ❑ yrr.INTERIOR HIMNEY REPAIR : Licensed Professional ' U OWNER-BUILDER DECLARATION 201-1000AMPS IMPROVEMENT 1 hereby off nn that 1 am exempt from the Contractor's License Law for the OVER 1(100 AMPS ❑BATH REMODELrIREPAIR ❑DEMOLIT ON ipy,O W U following reason,(Section 7031.5,Business and Professions Code:Any city or countyBIONS ELECTRICAL ❑OTHER Tie I•* • C -I\-tiM ala 4 y which requires a permit to conswn,alter,improve,demolish,or repair any suucture L.eO e I O M ' �� priermits issuance,also requires the applicant for such pmmitut file a signed statement SPECIALCIRCUIT)MI . t V an Nat he is licensed pursuant to the provisions ofthe Contractor's License Law(Chume,9 COom £ (commencing rib Section 7000)of Division 3 ofare Business and Professions Code)or TEMP.METER.ORXLE INST. COMMERCIAL: F y o TZ that he is exempt therefrom and the basis for the alleged exemption.Any violation of re El NEW BLDG/ADDTf70N ❑DEMOLITION ZZ ySection 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEV E$ El TENANT ❑FOODSERVICE or mothan rise hundred dollars(8500} � QO ❑1,os owner of the property,or my emploees with woes as their sole cum IMPROVEMENT y g peneation, SWIM# GPOOLE IC a o will do the work,and the structure is not intended or offend for sale(See7044,Business ❑OTHER 0.W m and Professions Code:The Contractor's License Law dues not apply men owner of OU ETS-SWITCH - T ES - property who builds or improves thereon,and who does such work himself or through his own employees,Irovidul that such improvements are nut intended or offered for W RESIDENTIAL LECTR S aide.If,however,the building or improvement is sold within one yemof completion,the SQ.PfpI OQR IRF6 S/SQ.IT.. caner-builder will have the burden of proving that he did not build or improve for put- /�4 6I pose of sale J. . ❑1,as owner or the propeny,am exclusively continuing with licensed contractors to TOTAL: f eamstmm the project(Sx.7044,Business and Professions Coda)... Commctor's Li- OCT A �['(1� sense Lew does not apply m an owner of propenreCy who builds or improves thereon,and QTY. PLUMBING PER FEE 4 RE who contracts for such projects with a contractor(s)licensed pursuant to the Contractors �x License Law. - a PERMIT ISSUANCE CNY VI- VUI'CHIINU E] m 1 eexempt under Sec, ,B&Is C for this mason ALTER-DRAIN&VENT-WATER BA) Owner Dote VALUATION ' WORKER'S COMPENSATION DECLARATION ffirm BACK FLOW PROTECT.DEVICE. �,J I hereby aunder penalty of perjury one of the following declarations: 'Z Ihave end will maintain eCenificate of Consent mself-insure Tor Worker's Couipem DRAINS-FLOOR,ROOF,AREA,COND. since,as provided for by Section 3700 of the Labor Code,for the pco mmance of the STORIES TYPE CONSTRUCTION work for which This permit is issued FIXTURES-PERTRAP ®I have and will maintain Worker's Compensation Insurance,as required by Section 3700 mdue Labor Code,Trade,permoreace of the work for which this permit is issued. GAS-EA.'SYSTEM-I INC,40UTLETS OCC GROUP, DPN. My Work 's Compensation Insurance canner and Policyn er e: Camier. p�tn,_F�aL" rll � Policy No.: GAS-EA.SYSTEM-OVHR4(HA7 - CERTIFIC COMPENSATION WORKERS'�YJ, I/I IpY GREASIVINDUSTRL WASTE IN CEPTOR COMPENSATION INSURANCE 1 BUILDING DIVISION FERS (This section need not bewmpleted lfthepermlt is for mnehundred dollars($100) -GREASE TRAP or less.) x PLANCHECK PEE Loy any that in the any manner of the work for which this the Workis ers Crutch- SEWER-SANITARY STORM EA.200 FT. not employ any person in any manner so as m became subject m the Workers'Compen- ENERGY HE Z smioa Laws of California.Date O Applicant WATER HEAT NENT/ELECTR _ GRADING FEE ti NOTICE TO APPLICANT.If,after making this Cenifcate of Exemption,you shomld WATER 5 TEMaREATING F become subject m the Worker's Compensation provisions of the Labor Cade,you must - SOILS FEE � forthwith comply with such provisions or this permit shall be deemed revoked. WqT SHRVICE f Q 7. CONSTRUCTION LENDING AGENCY W RESIDENTIAL PLMB, SQ.FT. PAID L)0 Thereby affirm mm there isaconsuuminn lending agency fonhe performance of Dam R elpt# the work for which this permit Is issued(Seo.301 Civ.C) , OLender's Name _ TOTAL: {UTJ Lender's Address TOTAL: y 1 certify that 1 have read this application and state that the above information is BUILDING FEE In correct.l agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE U sZr building construction,end harebyauthorize representatives of this city 10 enter upon the SEISMIC FEE elwve-mentioned property for inspection purposes; PERMIT ISSUANCE(We)agree m save,indemnify and keep harmless the City of Catarina against ELECTRIC FEE liamlities,judgments,costs and expenses which may in any way accme against said City AUTERORADDTOMECH. in consequence of the granting of this permit. PLUMBING FE 'APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT PIR HANDLING UNIT(TO 10.tXp CFM) SOURCE REGULATIONS. - MECHANICA FEE AIR HANDLING UNIT(OVER 10,000 M) CONSTRUCT NTAX Sigeamreof Appli,masCornractin Date EXHAUST HOOD MIDUCT) HOUSING MI IGATION FEE" HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100, TU) as defned by the Cimarron Municipal Code,Chapter 9.12,and the Health and Safety Code,Scone.25532oul HEATING UNIT(OV 1W,II00 BTU) ❑Yes No �v VENTILATION N(SINGLE RESID) PAID P _ - Date eipt# Will the it contaminants or future building by the nt useDay A ea Air Quality or lity Managemces ent nt BOILER- MP QHP OR 100,0(10 BTU) it hazuNous air conmminams as defined by the Bay Area Air Quality Management ' gmt4 BOIL COMP(OVBR IgLtX10 BTU) .r TOTAh: ❑Yes ON. I have re ad the hazardous materials halmoments under Chapter 6.95 of the Cali- A CONDITIONER- ISSUANCE DATE Tornio Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the OiSEW RESIDENTIAL MECH. SQ.ET. building does not currently have a tcnanh that it is my responsibility to notify the occupant of The meat me which must m t prior m issuance of a Cenifcateof Occupancy. - Owner or authorize agent - Date TOTAL ISSUED BY: OFFICE