Loading...
20563 ArrLIUAN I TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Protect Identification PER.MITNO. Building Address: 20563 Ib3� �Ita3 Cre�e� P l_ .p I� one: Totm(me. fi Ike cJ�U 98 110b CITY OF CUPERTINO-BUILDING DIVISION Conatsra_etersName, ueNn: APPLICATION 1 PERMIT ,R'N�� �" N O BULDINGELECTRICALPLUMBINGMECHAMCAL CATS O CONTROL p Architet/Englneee Lie No: L QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: M _ w)&+iijGTr ERMTISSUANCli ❑ ❑ ® ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions of Chapter 9(comment, APPLIANCES-RESIDENITAL JOB DESCRIPTION Ing Moth Setion7000)Of DiAsion3ofthe BuenenandPmfessfon'Code,and my license is In(u nd effect PANELS W� Date Cls®V46-Llc N r ,,,,i paC� Date. 14�C HI ECTSraC-1'ctLARAA`-"Ca_ItJ_1`v�P . ARCHITEeuSD DECLARATION OVER0O AMPS ODDAM q OVER]000 AMPS f/SQ.TT. q��vv ot0 Z [underetand my phm ehaB be used n public remrda ' - SQ,IT.FLOOR AREA k d� Licensed Professional SIGNS ELECTRICAL 6OWNER-BUILDER DECLARATION 9'ECIALCBtCUT/MISC Z. 4 Ihercbyafflmn that l am exemptfrom the Contractor's License Law for the ppppp fallowing reason.(Setion 7031.5,Business and Professions Code:Any city or 0 i'iy county which requires a permit to cetutrut,alter,improve,demolish,or repair TEMP.METER OR POLE INST. 5 33 anya suture tate e t W t he is lice re d pursuant to the provisions of t e POWER DEVICES O O. Ole a`Igoe. kens statement that he V licensed punuant to the pro 7000) of the Contractor.ofthe Hughes Lw rodeaser9(comme thmheding hSetW therefof Divi- SWLMAINC]VIOL ELECTRIC tgenbasis for the aIle a dProtmlon. Any violation bSodion herefromany - VALUATION ' the I for the alleged exemption. Any violation o!Section 703 L5 by any 6X ape hundred delta.tsubjetlstheappBcant loo civil pesuityofnt nnret)an OVILETSSWIICIiESflXTURES five I,as o ner of the property, ro NEW RESIDENTIAL ELECTR FT. MI,as will oche w0etty,arhe employees isswllhended r offered for ES TYPE CONSTRICTION' E mmpematlon,willdothsworkandthesCde:Ths ContendesLimfere.(or Y O sale(Bet. ppy Business and f property Code:The or imptars Llmem hw �$ doneassucytoanowner ofprough whonerniarimprovnted thatand OCCGROUP RES.UNITS who don eats amrkhlmse intended hlsownemp,howeprovidedth mash improvementsarenet Intended earodoo forsak.IL howeveq thebulldingve TOTAL Improvement issold within omyearo(compinion,the owner-bullderwlll have tfte,,hurden of proving that he did not build or improve for purpose of sale.). QTY, PLUMBING PERMIT E FLOOD TONE APN Lj L as owner of the property,am exclusively contracting with licensed pFltMIi ISSUANCE contractors toconstruct the project(Sm 7044,Business and Profession Code: The Contractor's License Law does oat apply to an owner of property who ALTER DRAW A VENT WATER(EA) Wilds or Improves thereon,and who contracts for such ptojecha with a ry0tr-tlar(s)lforsed punuant to the Contractor.License Law. FEE SUMMARY BACK FLOW PROTECT.DEVICE U I am exempt under Sec. 0 k P C for this reason OUTSI UP FEES Owner - DRAINS FLOOR ROOF,AREA,CONI. SANITARY Y N Date RECEIPT N WORKMAN COMPENSATION DECLARATION TEXTURES-PER.TRAP OOL TAX Y N ❑I hereby a((Irm that 1 have a cedifiate of consent to self-Inwre,ora RECEIIPT M cenl(late ofWorkeri CQomperieatuiggqqn 1ir,s nceara cetl(hd copythereo((Sec. GAS,EA.SYSTEM-1 INCAOUILE15 FARRIER Y N 3800,lab CJ11� 1� I 1 7 'RIiCEI'1'p Co Y s T GAS EA.SYSTEM-OVER 4(EA) m {'n -Nle' BUILDING DIVISION FEES Mcetmea ropy k nk tlfl cop V l byd witht� sheer.he styIrupetmn aim.Ion. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE t CERTIHCATEOFENEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE (TMsaectlon neednut be tompinM lithe permit is for un e reldroddollars SEWERSANITARY-S[ORM EA.3001'7. Date Recei t# (f1I ordifess.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N Illcuy that Nthe performance Any the mwok forwmcbeco become esubjec koros — 1 Whale not employ any perws In any manner w n m become subject to the WATER SYSTEM/TREATING , 0 Q worker:CompenaBon laws of Call(ornk. Date PAID — z Z Applicant Z O NOTICETO MPLICAtothe after omper dim,pro ar Esemptmn,you NEW RESIDENTIAL PLMB. SQFT. Date Rece1 t# should eyon,oma aubjAct rthwit ou Worksss'Comp roviskma.rtispervisions it s Lobar TOTAL: _N Casae. at forthwith comply with such provision orthb permit shall be IL IN � > deemed revoked. G FEE LU G CONSTRUCTION LENDING AGENCY SEISMIC FEE Ihembyaffirm that there laa comtsunion lending agency for the perform TOTAL: p ELECTRIC FEE :3Z ance ofthe workfor which this permit kdsund(Sec.3097,C1v.C.) .(� Tqlar 02 Lender;Nam PLUMBING FEE IL 1— Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Iceditythatlhave read lhkappllationand aatethat(heabova lnformatloe 1 is correct.l agree to comply with all city and county ordinances and stale laws PERMIT ISSUANCE FEES PAID: } W. relating to building corutructIon,and herebyauthorixempresenlativnofthis F Z city to enter upon the above-mentioned property for Inspection purposes. ALTER OR ADDTO MECH. Date RCCe1Pt# V (We)agree to save,Indemnify an d keep harmless the City of Cu pet Ino - agalnstBabllities,judgments,ones and expenses which may In any way Acwe AIR HA NOLING UNIT(To 10,ODO CFM) SUBTOTAL: agairut uld Cetyl con enceo he antln Ihls permit. AIR HANDLING UMT(OVER I O,WO CTM) CONSTRUCTION TAX S re. App s mono Data EXHAUST HOOD(W/DICT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIA S ISCLOSURE Til cappliant or future building oau score orbandleh.rdous HEATING UNIT(TO I00,000 BTU mate a as defined by the but Municipal Code,Chapter 9.17,and the _ Date Reaei t# _ Hnithand Safety Cade Sectlon75532(x)7 HEATING UNIT(OVER 100,006 BTU TOTAL, �- 0 YnM NO Wllltheappiicant orfuturebulldhRoccupantuseequlpment ordevices VENTILATION FAN(SINCLE RESID) ANCE DATE which emit harardeus air contamiwnta as defined by the Bay Area Air ®! Quality Management D❑lsWt7 BOILER-COMP OHP OR 100,000 BTU) P4 Yes m. N No j h nla ealth a o�mode,b tions 2mennundeAnd 25534. 1 of BOILER-COMP(OVOt 100,000 BTU) -VI 2 19904 - the Glflornla Hcalih&Sa! Code,Sections 75505,ZS533 and 15534. 1 ( L/ understand that if the building don not wrrcntly have a tenant,that It is my NEW RESIDENTIAL MECH. SQFr. responsibility to notify the occupant of the requirements which must be met 014 prior to Lssuanm of a Certificate of0aupancy. Owner or authorised agent Date ISSUED BY:�1'i''�VJ s*--NtW�+CI 70TAL: lu OFFICE COPY