Loading...
23680APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification Building Address: C;215-V9,C(% PERMITNO. /� /"g /"a /"� 0 G 3 �h18 sere. oftone: r,L CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDINGELECTRICAL PLUMBINGMECHANICAL A A A Co act r'eNa Licc..�No: '—+ `.ems 7/ � CATEGORY CONTROL # ArcMtect/ gineer. Lk. No: QTY ELECTRICPERMrr FEE BUILDING PERMIT INFO Address: PERMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby i -.with Seetion force andeffeon3o(the Buslnevand ProfeaslonsCode,and my oction7")ofamlken3ofthcunder provisions dPmfmionsr c,andm license bins form and APPLIANCESRFSTDEMIAL JOB DESCRIPfiON / PANELS License Class LION .# Date Contractor 701-1000AMP5 ARCHITECTS DECLARATION I understand my plamshall be used as pubecrecords. OVER 1000 AMPS SQ. FT. FLOOR AREA $/SQ. FT. SIGNS ELECTRIC SPECIALCIICI71 TEAtp,METEi(OR LE Licensed Prefesskal OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. 7031.5, Business and Professions Code: Any city or county which requires a permit toronstruct, alter, improve, derrollsh,or repair anystmumptlortoite ante,alsomqubestheapplinniforsuchperMtm file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Cha pter9(commencing with Section 7000) of Divi- skm3ofthe Busi-esaand Professions Code)orthatheL cwmptthemfmmand the basis for the alleged exemption. Any violation of Section 70715 by any fora permit subjectathe applicant to a civil penalty of not more than five 1, as owner nerofthedollars pr. ❑Lasownerof theproperty,orhe employees nwithwage as their sole POWER DEVICES DAT VALUATION SWI.Th9NC POOL ELECTRIC OUTLETS -SWITCHES -FIXTURES NEW RESIDENTIAL ELECTR SQ.ET. SI'ORIFS TYPE CONSTRUCTION tion, will do the and theamcture not intended or offered for role sale(Sec. Business.work (Sc. Profession Code: The an h License Law ppy to owner of or improves apply loan owner ofp pertyrough who does who does intelf or his owne. nemorimpmovidedthRand at such whodoemortsa OCC.GROUP Rf ,TS net dedorwgh If,hoes,providedhe ilding or improvem ent iarenotintended earo co for sale. If, however, iklerwdl have improverrcnth-Id within oneycaro(complaioMthe owner-builderwlll have TOTAL: tl eypurdao of proving that he did not bund or improve for purpose of sok.). Ll L as owner of the property, am exclusively contracting with licensedPERMIT contraciore to construct the project (Sec. 7044, Business ami Professions Code: QTY. PLUMBING PERMIT FEE ISSUANCEA� V ri p(gO z NE AAPNr The Con ohm's License law does not apply to an owner of property who builds or improves thereon, and who contracts for such p(ojects with a ,5tp.aorta) licensed pursuant to the Contractor's License Law. LJ I am exempt under Sec. B k P C for this reason ALTER -DRAIN & VFM-WATER (FA) BACK FLOW PROTECT. DEVICE FEE SUMMARY OUTSIDE FEES DRAINS A, COND. FLOOR, ROOF, ARE �.�S PER TRAP SANITARY Y N RECEIPT N Owner Date IIaaAA WORKMAN COMPENSATION DECLARATION 11 hereby affirm that 1 have a mrtl0cate of consent to self -insure, ora m iirole of Workers ComperwHonlnsurance oramrti(kd ropythemof (Sec. SCIBOOL TAX Y N_ RECEIPT' N GAS EA. SYSTEM -1 INC.t OITILETS PARK FEE Y_ N RECEI'r N 3800. Lab 1'ollmy p_`y_,z GAS EA. SYSTEM -OVER 4 (EA) Co�Cul Q, GGL BUILDING DIVISION FEES Certmed copy is here miffied. Certified copy is filed with the city inspection division. 'C GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE GRFASE7RAP CERTIFICATE OF EXEMPTION MOM WORKERS' COMPENSATION INSURANCE (TMs section need na be complded if ted permit h for one hundred dollar (5100)oify that I llnot that ti the Nor n in an (heworkmanner so as to b corn emnlHa iso ed,the I shall not employ any person f any manner ro az to become subject to the Workers' Compensation lawn of California. Date Applicant - NOTICE ca APPLICANT: If,a after making this ationlpro is Exempt a Lyou n s or this p of the Labor should become subject to the Workers' such provisions Code, you mus: forthwith comply with such provisions or this permit shall be Marcos revoked. PAID Date Remi t# SEWER -SANITARY -STORM EA "FT WATER HEATER W/VEE`/ELECTR s(� ENERGYPEE Y N — PAID Date RC i t# WATER SYSTEM/TREATING NEW RESIDENTIAL PLMB. SQFr. TOTAL: BUILDING "E TOTAL: CONSTRUCTION LENDING AGE'VCY I hercbyaffirmthat there hamestruction kndi-gagency, forthe perform. arm of the work for which this permit b issued (Ser. 3097, Civ. Q SEISMIC FEE ELECTRIC PEE Lender'. Name Lsndcr'a Address I certilythatl have mad this applicationand Gate that theabove information QTY. MECHANICAL PERMIT FEE PLUMBING FEE MECHANICAL FEE bmrmct. I agreete, comply with all city and county-rdinarms and state laws relating to building construction, and hereby author ice representatives of this PERMIT ISSUANCE city to enter upon the abovcme-Boned property for inspection purposes. (We) agree to save indemnify an d keep harmless the City of Cupertino against liabillties,judgments, costsand expenses which may in anywayacaue permit.10,000 against said City in --sequence of the granting of this peat. ALTERORADDTOMECH. AIR HANDLING UNIT (TO CFM) Date ReCei t# P SUBTOTAL' AIR HANDLING UNIT (OVER I Q000 CEM) CONSTRUCTION TAX Signature of Applicant/Contractor Date EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100,000 BTU) Will the applicant or future building occupant store or ha nd le hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12 and the HealthandSafety CQde ion 75537(a)7 ❑ Yea �K I No Date RCCCI t# - HEATING UNIT (OVER 100,000 BTU) TOTAL: VENTILATION PAN (SINGLE RE9D) ISSUANCE DATE P A' Will the applicant ELairc rebuilding occupant by theequipmentArea devices which emithazardouaalrcontaMwnbas defined by the Bay Area Air Quality Maagcmron Dlstrla7 Y:a No BOILER-COMP(3FiP00, OR 1000 BTU) 9hadrequirements mode, h5533 BOILEILCOME (OVER 100,000 BTL) salthe aChapte46.95-( et Se ons 25505, the Gliandt Health k Safety Code, Sections have Land, that It understandthat notifyithe the. does not e currentlyhavewhichL that It bay responsibility to notify the ocmpant of the requirernents which at be met JUN 18 1992 NEW RESIDENTIAL MECH. SQ.FT. ior(o lssuanmofa Ce neat o(Ocmpancy. UII1 V�(f vUl CfiI IIVIi nem or out oriud agent Datelip ISSUED BY:a TOTAL: OFFICE COPY