The URL can be used to link to this page

28997APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CITY OF CUPERTINO - BUILDING -ELECTRICAL BUILDING DIVISION APPLICATION/PERMIT _ PLUMBING -MECHANICAL. 62e32- EsigT67-S ❑ Consultant Fees Paid by Applicant (Initial) ��Z �w . QUU R - Ymm1 Ico, 7 y2 Z O taitq OZ-� 1It W peX C Q 30.0 a y on' y1r�,"yJi •.l I thereby affirm the, 1 nm licensed under pm visions of Chapter 9 (commencing with Satian ]000)��``f Uiv'sio ofthe Busincxsv Pmfc"um,C e��yyyd my license is in full force and6re4. l/ Ucen 1 l:// Ick / Date Conwm ARCI{LILLY'S U[ 1 I underound my plane ,hull be.,cd ns public m,.ad, / /-x" �,,(�QQJ% QTY. ELECTRIC PERMIT PERMIT ISSUANCE APPLIANCES - RESIDENTIAL RANM S UI'T02W AMPS Licensed professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason.(Section ]031.5, Business and Professions Code. Any city or county which requires a permit to concoct, alter, improve, demolish, or repair any our ure pdorm ns isaance, also teyuires the applicant for such pelmitmfile aligned swmmem that he is licensed pursuant to the provisions of the Curnavior's License Law(Chapter 9 201-1000AMPS OVER 1(X10 AMPS SIGNS ELECTRICAL SPHC1ALCIRCULOMISC. TEM P. METER OR POLE INST. GOO d {y o K iYfl Cy (commencingwith Section](NN))of Divivion3ol'tb.1{usinexs and Profesninns Code) or thin he is exempt mammon and the basis for the alleged exemption. Any sustain. of Section 7031.5 by any applicant for a Penna %objects the applicant to a civil penalty of POWER DEVICES f=CI, d•F W d 3 - not more than five hundred dollars ($500). ' as owner of the pmpcny, or my employees with wages as their sole cnmpcnsatioh. will do the work. and the structure is not intended or offered forsale(Sec.](H4. Business and Professions Calc: The Conuamors License Law does not apply to an owner of property who builds or improve, tderem, and who does such work himself or through SWIMMING POOL ELECTRIC " _ OUTLETS- SWITCHES -FIXTURES; BLDG his own employees provided that such improvenrtns aro a., intended or offered far NEW RESIDENTIAL ELECTR SQ LT. sale If, howevca the building or improvcmcnt iv told within onn year ul'cotepletimi the owner -builder will have the burden of proving that he did not build or improve for pur- pose of sale.). TOTAL ❑ I. as coner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. ]UpL, Business and Professions Cade:) The Contractors Li- QTy, PLUMBING PERMIT cense Use does not apply to m owner ofpri who builds or improves thereon. and who contracts for such pnsj"%%with a contractors) licensed pursuant to the Contmemrs - PERMIT ISSUANCE License Law. I ant exempt under tie.. ,B& P C lin thi,mason ALL ER - DRAIN & VENT- WATER ULO Owner Dam WORKER'S COMPENSATION DECLARATION ereby affirm under penalty of perjury one of the following declarations: BACK FLOW PROTECT. DEVICE DRAINS- FLOOR, ROOK AREA, COND. avemd will maintain a Certificate ofComenuoself-insure for Workers Compen- cation, as provided for by Section 37W of the Labor Code, for the perfommnce of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section FUTURES - PER TRAP 3700 of lh Labor Coda the Porro cofthe wink for which this permit i, ivvueol My W tier and Polir9�y'�r /are. / / J GAS -1A. SYSTEM-] INC. 4 OUTLETS GAS - EA. SYSTEM .OVER 4(EA) Cori Policy N.L CERTIPIC EXEMPTION PRAM WORKERS' COMPENSATIONecompaINSURANCE GRFASFJINDUSTRL WASTE INTERCEPTOR (This section need not becomplemd if Ne prnnit is (Drone hundred dollen (S10o) or lest) GREASE TRAP Qz z O .�.r > :D Q �Z Vr I certify that in the performance ofthc work for which this permit is issued,) shall not employ any person in any manner so as m bocome subject m the Workers' Compen- cation laws of California. Uate Applicant NOTICE TO APPLICANT: IL, after making this Certificate of Exemption, you should become subject to the Warker's Compensation provision% of the Ivbor Code. you must forthwith comply aithsuch provisions or this permit shall bo deemed revoked. CONSTRUCTION is a construction ON LENDING AGENCY Iher thithattherc itsd(Se]ending agency for performance of SEWER -SANITARY-STORM EA. 200 FT. WATER HEATER W/VF:N'1'NLBCfR' WApER SYSTEM?REATING WATER SERVICE NEW RESIDENTIALPLMB. SQ. FT. W F I hick the workfor which this pemrit in issued (Sec. 304]. Civ. C.) Landers Name Q U 04 F 0.t h V 2 Lender's Addrces 1 certify that 1 have real this application and state that the above information rs cores. l agree to comply with all city and county ordinances and state laws renting to building concoction. and hereby authorize representatives of Niscity loetnerupon the above-memioned property for inspection purposes. (We) agree to save, indemnify and hairless keep haless the City of Capmino against liabilities,judgments, costs and expene, which may in any way accrue against .said City in consequence of the granting of this permit. TOTAL QTY. MECHANICAL- PERMIT PERMIT ISSUANCE g1.TI3R OR ADD TO MECH, AIR HANDLING UNH (TO 10,000 CEM) AI' T UNDERSTANDS AND WILL COMPLY WITH AL1, NON -POINT S RCrto .�alJ 'IONS. .� �_ O AIH HANDLING UNIT (OVER IO.t%)0 CFM) fAppl' VC is Date ItAZA USMATERIALS DISCLOSURE EXHAUST HOOD(W/DUCD HEATING UNIT CSO 100.000BTU) HEAPING UNIT (OVEN 100,000 BTU) Willthe applicamm umL building receptor store orhandle f000mor,material as defined byline Cupetino Municipal Cr C. Chapter 9.12, and the Health and Safety Carlo , Seeman 25532(.)! E-1 Yes VEN'ILLATION PAN (SINGI.E RES ID) Will the applicant or future building occupant ux equipment or devices which emit bavardous air common... m definedby the Bay Arca Air Qmlity Management Dismay BOILER -COMP CUP OR K0,00a) BTU) BOILER - COMP (OVER I0LOW BTU) E] Yes AIR CONDITIONER I have read the haraimmo rwmnals requirements under Chapter 6,95 of the Cali- Sol H Safety Code. Sections 25505, 25533 anti 25534.1 understand that if the build' gdoex of eamontly have a tenant. that it is my resixinchility to notify the occupant nr mems nous et pdonal,wonaofa CFlyficye of �u� �/ I IM -M, i 1 y. NEW RESIDENTIAL MECH. SQ. IT. OFFICE JOB DESCRIPTION RESIDENTIAL: ._,..... .._ 28997 ❑SFDWL ❑ KITCHEN REMODEL SANITARY NO. APPLICATION SUBMITTAL DAL []STRUCTURAL VSQ. NIC ❑ INTERIOR CONTROI.# IMPROVEMENT 1ALA [IN 6 ❑ BATH REMODEUREPAIR ❑ DEMOLITION BUILDING PERMIT INFO BLDG LLCT PLUMB MECH ❑ ❑ ❑ FEE JOB DESCRIPTION RESIDENTIAL: ❑SFDWL ❑ KITCHEN REMODEL ❑ADDITION 11 PLUMBING RE -PIPE ❑MULTI -UNIT []STRUCTURAL VSQ. MODIFICATION ❑ INTERIOR >0 IMNEY REPAIR IMPROVEMENT 1ALA [IN 6 ❑ BATH REMODEUREPAIR ❑ DEMOLITION ❑ OTHER 'Si r- LaU. i11 BUILDING DIVISION FEES PLANCHECK FEE EN12RGY FEE GRADING FEE SOILS FEE PAID Dare Reecipt# TOTAL: BUILDING FEE FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL, FEE CONSTRUCTIONTAK HOUSING MITIGATION FEF. PAID Date Receipt# TOTAL: ISSUED BY: COMMERCIAL ❑ NEW BLDG/ADDITION ❑DEMOLITION ❑TENANT FOOD SERVICE IMPROVEMENT ❑ OTHER r SQ. FT. FLOOR AREA m v c' - VSQ. FEE 1/ 1ALA [IN 6 'Si r- LaU. i11 LTYPECONS'TRU BUILDING DIVISION FEES PLANCHECK FEE EN12RGY FEE GRADING FEE SOILS FEE PAID Dare Reecipt# TOTAL: BUILDING FEE FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL, FEE CONSTRUCTIONTAK HOUSING MITIGATION FEF. PAID Date Receipt# TOTAL: ISSUED BY: