Loading...
24684 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PF.RMITNO. a�a ^ A S8 APPLICATION/PERMIT PLUMBING-MECHANICAL L �6J BUILDING DIVISION BUILDING PROJECT 11)ENI'IF'ICATION BUILDING ADDRESS: / // ��J^ SANITARY NO, APPLICATION SUBMITTAL DATE C/��© 6V /-c/ UNpr# LOT# OW RS NAME: PHONE: CO ACfOR'S NAME: LIC NO: NIC t q yJL \RCHI GINEER: LIC NO: ADORFS� r � S 5 CONTACT /PHONE: d4-1ELECTRIC PERM T FEE BUILDING PERMIT INFO BLDG ELECT PLUMB PERMITISSUANCF. El 11 LICENSED CONTRACTOR'S DECLARATION APPLDINCES- ESI AL JOB DESCRIPTION py.Z Ihembyaffimtthatlem licensed underprovisiansofChepter9(mmmencingwith til-,p full ion]IKKforce dofecivision3of Ne Business and Professions Code,and my license is in ANC S K U❑ LicaricClaw affect. TO MPS 6zzly Lianm Class Lic.# F 6 L Date Contractor -1 AMPS y ZD�Z ARCIIITECTS DECLARATION V O - 1000 AMPS gQ.FI'.FLOOR AREA .FT. OZ-0 I understand my plans shall heretical is public records. �,'y SIGNS ELECfITICA Licensed Professional �yd' OWNER-BUILDER DECLARATION SPECIAL CIRCUIT C. 445yF I hereby affirm that 1 nm exempt from the Contractor's License Law for the Is13¢y following reason.(Section 7031.5,Business and Professions Code:Any city or county THMP.METER OR f'D,E I SfS Oy which requires a permit w mawmact,alter,improve,demolish,or repair any morture periortuiu issuance,idsore,dres Neapplimal foarall,rmit wfileesignedstetemrnt POWER DEVICES ap that he islirmsed pursuanno the provisions or the Contractor's License Law(Chapter LW 9(commencin with Section 7000 f Division 3 or the Business end Professiom Code SWIMMING PO ELECTRIC xo� (commencing )u ) L E D �A� ION W e^y Sermonat 7031.5 by ayapplicannd tfrra banIsmisforbjeasegedexemant to civil My of OUTLETS- CHES-FIXTURBS ^ F.zz4a notSecmn]th n v vnydreddamrs($50nruuubjena the applicannoacivil penalty of FO of mom then five hundred dollars($500). .y _ en❑ ofrawrk.afthe propcny,ormyemployeslorafwegcsasale(m. 0o ,Resadon, NEW RESIDENTIAL ELECTS _SQ. \) Tp ICSi -1 TYPE CONSTRUCTION y3°-° will dathewmk.vnde:The eremoniimendWm awdu, .,apply 1.anower,of - J ,,ad Prafusiom Coe:The Convncmr's License Law dam not apply to w owner of //Sl= properly whobuildvorimpmvca Nercon,and whntlmesucM1 work himaelfonhmugh his DATE RES.UNITS ten employxs,prov ided that such improvemen H tart not i mended or offered for sola.If, however,the buildingorimpmvement is sold with noue yeurofcompletiondhe owner- builderwillhuvetheburdenof in that he did not build or improve for f proving p purpnseo sale.). [II,asownerofthepmKny.amexclusivelyconuactingwiNticenacdconwctorsw QTY. PLUMBING PERMIT FEE FLOOD ZONE APN construct the Project(See.7144,Business and Profusions Cade:)The Contractor's PERMIT ISSUANCE License Law does not apply tom volumufpropeny who builds orimpowcs,thereon,and Locate Law.fmsuch projatswithmcommcmn(r)IicensW pursuantwthe Contnecmr'e ALTER-DRAIN&VENT-WATER(EfO FEESUMMARY I.icenaclaw. ❑ I um exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE OU I SIDE FEES SANITARY Y—N — Owner Data DRAINS-FLOOR,ROOF,AREA.GOND. RECEIPT# WORKMAN COMPENSATION DECLARATION SCHOsi Y N ❑ I hereby affirm that l have a ceni0cam ofcommat to aeli-insum,or a ceni0cate of RECEIPTN FIXTURFS-PER TRAP Wmkeri Compensation mide,uhis psmtacenifiedcopy thereof(Sce.Jg00,IsbCJ which PARK PCE RE "# N coven all employee's under this permit. GAS-EA.SY57EM-I INC.4 OUTLETS Policy p BUILDING DI SION FF&S Company GAS-FA.SYSTEM-OVER 4(G) PLANCHECK FEE ❑ Candied copy is hereby famished. ` ❑ Certified copy is Cled with the city inspection division. GRRASEANDUSTRL WASTE INTERCEPTOR GRADINGFEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE COMPENSATION INSURANCE aw l'Ihie section need notocomplaeA ifthe permit ie faronehundreddnllam SI00) SEWER-SANITARY-STORM EA.20017. ENERGY FEF. or less) I cent'any Numn inf any..of,so eek for whichthispenmito issued, kms' WATER NEATER W/VENT/ELECIR not employ any person to any manner so av w become subject to the Workers' PAID z Compensation laws of Celifomie. Data WATER SYSTEM(fRPATING m Receipt# NOTICE . 0 w NOTICE TO APPLICACandidateafter making this Candidate of Exemption,you should NEW RESIDENTIAL PLMB. SQ FT. TOTAL: F-� V) become subject to the Workers Compensation provisions or the Luber Code,you must I� > forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE W r-. z CONSTRUCTION LENDING AGENCY SEISMIC FEE 1 hereby affirm that permit is i conswa.3 lending agency for the performance of U O Ihework for which this permit is issued(Sec.J09],Civ.CJ TOTAL: ELECTRIC FEE Lenders Name Lender's Address QTY. MECHANICAL PERMIT FI?P. PLUMBING FEG U 1 canify that I have reed this application and state that the move information is MECHANICAL correct.l agree to comply with ill city and county ordinances and state laws relating to PERMIT ISSUANCE I,, boldingeonstmction,and hereby authorize representatives ofthis city toemeruponthe CONSTRUCTION AX U z move-mentioned property for inspection purposes. ALTER OR ADD TO MECIL (We)agree w save,indemnify and keep harmless the City of Capitation against liabilities,judgments,costs and cxpen. s which may in any weymmoso,ainsuaid City AIR HANDLING UNIT(TO 10.000 CFM) n myuence of the gmmmg fill perm p w AIR HANDLING ON]T(OVER IO.Ol10 CFM) ' Signature of Applicent/Contrscmr Date FAHAUST HOOD(W/DUC) PAID HAZARDOUS MATERIALS DISCLOSURE. HEATING UNIT(TO 100.000 BTU) Data Receipt# Willtheapplicant or future building recupzot state or handle hazardous mmadal HEATING UNIT(OVER 100,000 BTU) T A as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Section 25312(a)? ❑Yes 11 No VENTILATION FAN(SINGLE,RESID) ISSUANCE TE Will theapplicanmrfmurebuildingoccupantuueyuipmemordeviceswhichemit BOILER-COMP(311P OR 100,0010 BTU) ' hatuadms sir contaminants as defined by the Bay Ates Air Quality Managanent BOILER-COMP(OVER 100,00)BTU) District? �k ' ❑Yea ❑No NCW RESIDENTIAL MECH. SQ.FT. 1 have read the hazardous materials requirements under Chapter 6.95 of the i $ 1*3 California Health&Safety Code,Sections 25505,25533 and 25534. I undersmnd that if the building does not currently have a terent,that it is my responsibility to notify the A `a k�) occupent of the requirements which..at be at prior w issuance of.of a Certificate of O 1.\II. Occupancy. "if ( Own<r or auNoriud agem Date T ISSUED BY OFFICE