Loading...
S 2340 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CI TY OF CII PERTINO BUILDING-ELECTRICAL PERMIT NO. Ty OF VISION APPLICATIONMERMIT PINGPOJECTLUMBING-MECHANICAL Q 3 BUILDING PROJECT IDENTIFICATION J BUILDING ADDRESS: SANITARY NO. APPLICATION SIB{MIITAL UAI'E X03`-10 cf5 PRASs DR , OWNERS NAME. PHONE: CONTRACTOR'S NAME U .0NO: . t7/T,6^/0 p/ R R /S N/c COST kol.a 4RCIIIT EIUUENG1NIillk; LIC NO: ADDRESS: ❑ CONTACT: PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm that I am licensed under previsions of Chapter 9(commencing JOB DESCRIPTION µµ110Z with Section 7")of Di vision 3 of the Business and Prnfessines Code,and my license is RESIDENTIAL: F�� In force and etton.n PERMIT ISSUANCE T D W F �O 6.7 4c 6 g ❑SFDWI. ❑PLUM ITN REMODEL E �UV Dole- ass Lick APPLIANCES-kP_SIDIiNT1AL ❑ADDITION PLUMBING RE-PIPE FZIzI Date Comments ViQti ARCHITECTSO - ❑MULTI-UNIT ❑STRUCTURAL F y . _4 1 understand my plans shall be used ass public ATION B �' PANELS blic recordsMODIFICATION OZ-F,•-� UP TO 200 AMPS ❑IN9'EkIOR [I CHIMNEY REPAIR Fa4 W Licensed Poncssinn.l 201-1000AMPS ,,��,IMPROVEMENT E]SWIMMING POOLS C OWNER-BUILDER DECLARA3'ION OVER 1100AMPS g 1eH REMODEUREPAIR (]DEMOLITION 6 I hereby affirm and I am exempt from the Cnrmicums License Law for the �4x(p6V following oners.(section 7031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER W C y which requires a permit to construct,alter,improve,demolish,or repair any structure prier,,its issuance.also requires the applicant for such permit m lite a signed stammenl SPECIAL CIRCUIT/MISC. V, ts o y that he is licensed pursuant m the now Sion of theCoomi'tor'a License Law(Cannot,9 RI�GC (commencing with Section 7")of Division J of the Business and Professions Code)or THSAR MILLER OR POLE INST. COMMERCIAL' iEP�(.c C that he is exempt therefrom and the basis for the site option.Any vinlminn of [I NEW BLDG/ADDITION ❑DEMOLITION W=m Section 7031.5 by any applicant for a pero mit sit .Ih a nn o civil Penalty of POWER DEVICES IZ>r ma I'm than five hundred dollars($A nn [I TENANT T (]FOOD SERVICE ^ZD iL Lasowma.f the IF pmy,s Ployce�0,ith wag . adecnntpensatnn, SWIMMING POOLEI.I:C'I'RIC p. willdothework,and lh uf��(,�tu�timm.de offered r t(Se=.7B14,Bmaness ❑OTHER W and Profession c:The C License Law dt uc n ply to an owner of OUTLETS-SWIT CLIPS-FIXTURCS D pmpmy who i r imp. thereon,and wh himself or though his own timid. wided that such'nproa, ..na m ed or offered for NEW RESIDENTIAL HLECTR SQ FT. sale Ll however, b ding ory�M{'vein Essodwithinom ear ompletlon.mr, FLOORAR E/SQ.Fp. owner-huilder wit he hQNknt#'proving that be did not build or upmve for put- �� / [s 1,a,wester of th operty.am ev,haively comment coed connectors to AL' 6/� p/ construct the project 7(M,L Business and Pro ode:)The Contractors Li UY na law does note man nw.crof 0 maker improves themon,and QTY. PLUMBING PERMIT' FEE snout basin, 'I it hdemnd r's licensed pursuant to the Contracto License I.aw. v .- ❑1 am exempt under Sec. ,B&1'C for this recon PERMIT ISSUANCE L ALTER-DRAIN&VENT-WATER(ITA) R VALUATION .9v Oner Date 3 a WORKERS COMPENSATION DECLARATION BACK FLOW Pk[YI'ECI'.DEVICE V 1 hereby uffmn under Penalty ofperjury one of the following de=Imvtim, ❑ I have and will mairimmuCenlficateofComenttosoll'-insere for Worker's Compcn- DRAINS-FLOOR,BOOP.AREA,GOND. STOLES TY PH CONSTRUCTION sm.n,as Provided for by Section 3700 of the Labor Code,for the performance of the Vhor which Nis permit is issued. FIX9'IfRES-PER TRAP h,fave and will maintain Worker's Compensation Insurance,as required by Section 370ot the Labor Cale,bathe Perfooumce ofthe work lin which(hisPermit is issued. GAS-ITA.SYSTEM-I INC.4 DUE IAITS DEC.GROUP APN MY WorAcrgCnnynnsutlun Insurance�N.yricrand y No.:smashf,�yfe�"� Q p GAS- My W s (Con is O Policy Na: Cl 6 C ITA.SYSTEM OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS GREASILINDUSTRL WASTE INTERCEPTOR COMPENSN'ION INSURANCE BUILDING DIVISION FEES (This section oral not heeamplead Edminmtit is forme hundrtddollars($100) GREASGTRAP or less.) PLANCI II?CK FEE Ioenifythmin the performmee of the work for which this Permit is issued,I shall SEWER-SANITARY-STORM EA.210FT. nm employ any Arson in any manner so as m become,object to the Wormri Cminsm. ENERGY FEE OZ side.Laws 4Ca1ifania.Date WATER HEATER WNENT/ELECT GRADING IEEE 0 Applicant N NOTICE TO APPLICAN'E If,after making this Cenifume of Exemption,you should WATI!R SYSTEMnBEATING SOLLS FEE a ; he...ire object the Wmkads Compensudon pm ki,Is of he Lahnr Cndc,you..rest _ {tl fnnhwith comply with such pmvisimm nr this pennil shall be deemed revoked. WATER SERVICE. 7 z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ.1O: PAID I herebyfarm that there is a construction lending forte rfonommend Da Receipt is rs gasmer rk L)� ore work lar which this permit is issued l See.3097,Civ.CJ OLender's Name TOTAL-' 0 U Lender's Address U& X Q. I certify that 1 have read this application and state that Ne above information is BUILDING S X (A anreat.I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE O U7. buildbegconamlinn,and hereby amhmio mpresemmivmnftbis city incinerates,the SEISMI 'T:E above-nmmionul prmITny fm inspcenn 111c, (We)agree to save,indemnify and keep harmless the City of Cupenico against Q PERMIT ISSUANCE Ii1.F.CTRIC :G Q Iianildics.judgmems.costs and expenses which may in any way norms,against said City J ACI IN OR AUDIT)MECIL © PLUMPING FL' e) z- in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT('1010.000CFM) "IONS. MECHANICAL IEE O SOURC17REGUL AIR I IANDLING UNIT(OVER I0d XX)CFM) CONS'IRUCTION TAX Signature of App roicintmcmr G Date EXHAUST GOOD(W/DUCry HOUSING MITIGATION ME HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hvardous material HEATING UNIT(TO I0L000 BTI) as defined by the Cupertino Municipal Code,Chapter 9.12,and the I le:dlh and Snfety Cale,Saban 25532(.)'1 HIiXI ING UNIT(OVER 110,00 RTU) C)Yet No VENTILATION FAN(SINGLE RESIDE PAID Date Receipt If tAft Will the aPplic.at or future building occupant use equipment or devices which Al BOILER-COME'pill'OR Igi,aXl li'1'U) emit hneardous air cumumimmtx as defined by the Bay Ana Air Quality Management DlsaieP BOILER-COMP(OVER Hinjan11 BEIG) ❑Yes ❑No I have rtad the hazardous material,rtgamentnts under Chapter figs of the Cali- AIR CONDITIONER ISSUANCE DATE fomia Health&Safety Cade,Sections 255D5,25533 and 25SLI 1 understand that if the NEW RESIDENTIAL.MECH. SQ.FF / �Q buildingdtros not currently hssesont m,that itonyotponsibility,,ramify the ece.Fina f 1 D a^ g T urthereq Veil which must oro isoancc ofa Cenifieat.of fkcupancy. �Q� T Owner. onzN agent Dam AL: ISSUED By: OFFICE