Loading...
20252 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bulldln Pm'ea Identification PERMITNO. Bulldln Addresa: 2 0 Z C 2 _ obi e J 11� 3h, �f rne. CITY OF CUPERTINCLDUILDING DIVISION APPLICATION / PERMIT a KJ BUILDINGQ.ECTRICALPLUMBINC-MFGHANICAL CATEGORY CONTROL M Architect/Engineer• Lie No: QTY ELECTRIC PERMIT FEE BUILDING PERMITINFO Add. PERAITISSUANCE thereby LICENSED IED CONTRACEO WS DECLARATION , 1:1 1:1 I am 1:1affirm that licensed under islonsafharn APPLIANCESRESIDEN7AL JOB DE '170N InfDivi.d3o(theBuM..andProfesaon$Codeandmy license is infall force and die . - PANELS c`hi`,`r\�� Date es ClaLie p Date Contractor UPT0200AM ' ARCHITECTS DECLARATION 201-1000 AMTS Oa 7 I understand my plan shat be used u public records. OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT. O Licensed Professional SIGNSE[.ECIRICAL Q OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC F. (hereby affirm that lamexempt fromthe Contractor's License Law for the ZOfollowing reason.(Section 7011.5,Business and Professions Code:Any city or Tp2yp METEROR('OLE(NST. P f' county which requires a permit to constrod,alter,Improve,demolish,or repair q� anyatra na.Prior to It.i auance,.hm requires the applicant for such permit to 6 file a signed statement that he is ficensed pursuant to the provisoes of the POWER DEVICES Contractors License Law(Chapter 9(commencing with Section 7000)of DWI. VALUATION SWIMMING(VOL ELECTRIC SOS eb basis for Any orthtl M1eisexempt therefrom and ©G, the basis for the alleged exemption. My violation of Section 70.1.5 by any OUTLETSSWITCHfSFIXTURFS L�1 /'� �� applmnt fora permiteubjectstheapplcant toe dull pevityanet mom than 1 coo $ five hundred dollars($S00). NEW RESIDENTIAL ELECTR ❑I,as owner of the property,or my employees with wages as their sole �SQTT' STORIES TYPE CONSTRUCTION X compensatlon,wOldo the work,and thestmdure is not Intended or offered for sale(Sec.7 ZwH.=...rd professions Code:The Contractors License Law ' 3$ does notapply loan ownerof property who builds orimproves thereon,and OCC.GROUP RES.UNITS who doessuch work himself or through his own employees,provided that such Improvements arc not Intended oroffered forsale.If,however,thebuilding or OT Improvement esold within omyearofcc mplMim,the owner-buaderwlll have - t en of proving that he did not build or improve for purpose of sale.). QTY. PLUMBINGPER NE EI,Mas owner of the property,am exclusively contra.....with 1—sedFLODD7DNE APN contnctore to mnswct the project(Sm 7065,Business and Professions,Cade: PERMITTm rANCE 1 The Contractors License Lew does not apply to an owner a property who boude or Improv.thereon,and who contracts for such ptojem with a ALTER-DRAIN k (EAI FEE SUMMARY cgBlp&or(.)licensed pursuant to the ContnMors License Law. BACK FLOW PROTEC CE1 A OUTSIDE FEES LII am exempt under See B k P C for this reason DRAINSFLOORROOF REA,CO SANITARY Y_ N_ Owner - Date RECEIPT# WORKMAN COMPENSATION DECLARATION .l.U�s PER TR SCHOOL TAX Y N ❑I hereby affirm that I have a mrtificate of consent to self-Insure,w s RECENT N mdtflmteofWorken'Compev Holy mnmoramAifh mpythenwft5et' GAS F.A. -1 INCA OUTLETS PARK FFR Y N 35W,lets C.)Policy# RECEIPT'# GGAS EA.SYSTEM-OVER 6(FA) � Com ray - BUILDING DIVISION FEES Go BUILDING GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑Certified copy Is filed:with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FI. DB1C Recei tk Q .. hlese .o.need rad be completed(the permit b ifor one hundred dollars (SIO(Borless.) WATER HEATER W/VEM/ELECTR ENERGY FEE Y_ N_ I mrtifythat ts the performance of thework forwNch this permit is issued, I shall not emp ray person..any.a.ner. pabis&to the WATER SYSITM/•IREA.DNG PAID Worker.Compe tion V Bforoia. Date V O Z Aipitmnt NEW RESIDENTIAL PLMB. SQFT. Date Revel HI Z p NOTICETD aP CA : at r king this Certificate of Exemption,you should become sobject to the a ri Compevat ion provisions of the Labor TOTAL: N Code,you most forthwith comply with such provisions or this permit shall be BU LU j decmed revoked. CONSTRUCTION LENDING AGENCY I SEISMIC PEE M I hereby afRrtntr w there isamnstmctususi(Sec. ,Civ.Q perform ELECTRIC FEE Q Z Lender the work for which this permit islswed(See.3097,CIv,CJ TOTAL: Q2 Lender's Name PLUMBING FEE lyh Ieeders Aaamsa QTY. MECHANICAL PERMIT FEE MECHANICALFEE O W Imrtl.I are hiveread mply is with aliotynand dcounte that the yordinances and 1 iscormct.lagrceto comply with allcttyand county ordinances and state laws I'FRMTf ISSUANCE FEES PAID: } N relating to building construction,and hereby authortae representatives of this H Z city to enter upon the above�merfcmed property for Inspection purposes. ALTFRORADDTOMECH. Date Recei til z (We)agree to save,indemnify an d keep harmless the City of Capers Ino against ltiolitlee,Judgment.,costeand expenses which may In any way accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: against said City in consequence of the granting of this permit. AIR HANDLING UNIT(OVER 10,000 CFM( CONSTRUCTION TAX Signature of Applicant/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the appllmrat or futum building oaupant store or hand le haaardous HEATING UNIT(T0100,000 BTU) - Date Revel tq material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Coder�Section 2SS32(a)7 HEATING UNIT(OVER 100,000 BTU( TOTAL: ❑Yes II No Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISWANGE DATE which emit haaardous air contaminants as defined by the Bay Area Air 4–tri1116a, Quality Management D.strict7 BOILER-COMP(311POR IOO,IXD BTU) Y. II��I No a have read the haaar•3eusmmertaisrequimm ntsunder Chapter6.95o( BOILER-COMP BTU) MAY U 3 1,,C:(,,J the Gliin eLlthk Safety Code,Sections 25505,25513 and 75530.] .ndenta t IT the NiEdingdo.na.or tlyhaveatenantthat itismy NEW RESIDENTIAL MECH. SQ.FT. r.povib ityto aifytheo toftherequirementswhichmostbemet City of CtL ifflIT o Prior an of.Certltic eo( panty. - S 5 U ,�,e�aaxF,� n or auth 'sad age ate ISSUED B TOTAL: OFFICE COPY