Loading...
23752 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Addms: to?,-n- f7 P�I� CF3� V7E1 ► 23J f 52 wners ams: 4J7 { CITY OF CUPERTINO-BUILDI G I I ��y� cont . a Lk.No: APPLIC TI P R IT `1 Architect Engineer: Q Lk.No: BUfLDINGELEC MECHANICAL CATEGORY CO � Q E E FC PERMIT FEE BUILDING PERMIT INFO Add—AQ. &C / I ANCEo Ill I� Ib( LICENSED CONTRACTOR'S DECLAWATION L� (� I hereby afflrrnthat l am licensed under provisions of Chapter9(commen ANCESRESIDE TOB DEKIIJITION Ingwith Se on7000)of Division3ofthe Buslneuand PmfeWona Code,and my li¢nae le In full fo and affM. 4FRW Llmnze m ��LieNwjVLid.r_ECTS C TIO OpI understand my piers,shall be usedvpublle records aSQ. .FLOOR AREA $/SQ.FT. Fi Licensed Pmfessimal SI ELECTRICAL << OWNER-BUILDER DECLARATION 1 herebyafBrm that Iam exempt fromthe Cons' adore License law for the SPECIALCRtCU[T/MLSC pfollowing....(Section 7031.5,Business and Pre=ions Code:Any city or TEMP Fq countywhlchrequlmaper tommh d,alter,impmve,dem it h,orrepalr any awcturetatement has he tier rryWrosuant t the rovi, penNtto PDWER DEVI J 1 Rk a signed statement that he t Bernard pursuant to the proWlons of the + Oeci- Communes LicenseLaw(Chapter 9(mmmenctgwith Section,7000)ofDivi, 1.�0"J elon3o(the Buateseantl Pro(esslonsCode)orthat hetsxemptthemfromand ,SWIMMING C VALUAl]ON cnzb Q.•�77 the Weis for the alleged exemption. Any violation of Section 7031.5 by anyq uE.s Tc ^ �{L Applicant fora permit subjects the applicant to a civil penalty ofnot more than a� `s five hundred dollars($5001. NEW RESIQENTIAL ELECTR SQFF. STORIES 'IYPECOINSTRIICTTON �n ❑L as owner of the property,or my employees with wages as their sole < compensation,wBldothe w¢k and thestadure t net intended or offeredfor O sa1e(5ec.7061,Buslnessand Pmfenlow Code:The Contradoe.License law does not apply to an owner of property who builds or Improves thereon,and EE OCC.GROUP RES.UNITS who does such work himself or his own employees,provided that such Improvement are not Intended oroffered forsde.If,hmvever,thebulldingor Improvement tsold within oneyearof completion,the owner-bu1W erwill have 1hgJlurdea of proving that he did not build or improve for purpose ofule.). QTV PLUMBING PERMIT FEE FLOODZONE APN L�L as owner of the property,am exclusively contracting with II¢nsed contractors to construct the project(Sce.7064,Business and Pmf.hmECode: PERMIT ISSUANCE The Contractor'.Lisa Law does not apply to anowner et propertywho ALTER-DRAIN A VENT-WATER G bulWs or Improves thereon,and who contada for such p(ojeda with a FEE SUMMARY c9II[r+d ¢ or(a)Bneed pursuant to the Contractor's License Law. BACK FLOW I'I60'1'FCT.DEVICE LJ I am exempt under Sec B h P C for this reawn • DRAINS-FLOOR ROOF,AREA,GOND. SANITARY Y N Owner Data RECER'rN WORKMAN COMPENSATION DECLARATIONJVTURFS'PER TRAP SCIiOOL TA% Y N Q[hereby affirm that I have•¢rti0¢te of consent to sellsu -Inre,¢a R10EIT`r N moo,Late C.) S SF ate of Workers C.mpensationiruunna¢a¢rtifled copythereo((Bec. GAEA.SYFM-1 LICA OUTLETS PARK FEE Y N RECE policy N GAS EA.SYSFPM-OVER 6(EA) DING DI N Com any BUILDING DIVISION FEES efflMConifled copy t hereby furnished. city GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECKFEE �Ccrtl(led copy t toed with the city inspection division. CERTIFICATE OF O(EMPFION FROM WORKERS' CREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.2DoF7. Dale Recei (rhlsseciion need not be completed B the pemNt t forom hundred dollars (.9100)orlees) WATER HEATER W/VENT/E.FCTR ENERGY FEE Y_ � , I¢rtifythattlhep r nm ha�v¢ orwMch this percnit[steed, I shall not employ a y r amt. 'd to the WATER SYSTEM/TREATING Workers!Comperes a. Re PAID ZZ Applicant NEW RESIDENTIAL PLMB. SQ.Ff. Date Recei tic O NOTICETO LICANT:ILefler makln ht Certificate of Exemption,you f" should become subject to the Workers Compensation provisions ofthe Labor TOTAL: N Cade,y.0 mu at forthwith comply witheuch provtl.ns.rtht permitahallbe B 1 1 W > d¢med revoked. d C CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby afRrmthot then t a cors,tmction landingagency,for the perform ELECTRIC FEE D Z ance of the workforwhkh this permit t issued(Sec.3097,Civ.C.) 02 lanier'.Name PLUMBING FEE LL h Lender's Address QTY. MECHANICAL PERMIT FEE �0 MECHANICAL FEE O W I¢dlfythat l have readthtapplicationand statethattheaboveleformation IL is l agree to comply with all city and countyordtancesand=is laws PERMIT ISSUANCE � FEES PAID: } relating to building construction,and hereby authorbe repreeentatives of this FIC f. 03 city to enter upon the abovo-mentbmd property for inspection purposes. ALTER OR ADDTO MECH. Date Recei IN Z (We)agree to uve,1 fy a p harmless th 1 Cv Exmin. V agalutltbNtiea,)udg t pe h ya AIR HANDLING UNIT(TO I0,00)CFM) SUBTOTAL: against said City In e f 1 t AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX Siguture Applicant/Contractor Data ]1AU57 HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future bu0ding p..t store or handle hazardou. HEATING UNIT(M I00,0I0 BTU) Date Recei tic material as de0ned by the Cupertino Municipal Code,Chapter 9.1$and the I and Safety Cade Section 25532(a)7 HEATING UNIT(OVER 100,000 BTT) TO ❑Yrs No Wlli the applicant or future building Part use equipment or devices VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE which emit hazard...air cents minuets as defined by the Bay Area Air p 11 Qua lity Ma agement District? BOILER-COMP©1-n,'OR 100,000 BTU) A E Ye. ❑No (\ have read A d the basad us materials requlmments under Chapter G95 of ER IL -COMP 100,000 BTU) -��� �O "the Ill=Health SafetyCode,Sections 25505,25533 and 75536.I understand that lithe building doesnut currently have a tenant,that it t my NEWRESIDENTIALMECH. SQYr. neponaibBlty to notify the occepant of the requirements which resat be and prior to Issuance of a Cxmficate of Orco pa icy. 611 ser QVrwk Owner or authorized agent Data ISSMDBY:�h OFFICE COPY