Loading...
22631 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL P N ONLY BuildingMI Project Identification PERT NO. BuOding Addre 22631 ne e: APPLICA CITY OF CUPERTINO-BUILDING DIVISION 2 Conraacrs Name: . Lie.Na: APPLICATION I PERMIT G BU[LDING-ELECTRICAL-PLUMBINC-MECHAMCAL CATEGORY CONTROL A tea/Engineer. Llc.No: QTY ELECTRIC_ PERMIT FEE BUILDING PERMIT INFO Address LICENSED CONTRACTOR'S DECLARATION PERNUTISSUANCE ❑ ❑ ❑ I hereby affirm that l am licensed under previalons of CTapter9(mmmenc- APPLIANCE3RESIDENTiAL t JOSDESCRE'IION ingwlth Seaion7000)of DiviWon3ofthe BusinessadPmfesslonsCode,andmy Iinnu let n fullf and effet 1 PANELS Lire. Chea Lie.M Ay 2 Date Contraacr/22!!M['es.�` �RCHITECI'S DECLARATION AI-1(00AMPS ^9O Iur.04md nyyl'uuslInuzsed as public records. OVERIODOAMPS SQ.Fr.FLOOR AREA $/SQ.Fr. 2SIlir p" i gal i SIGNS ELECTRICAL Lim rof lit 1 tC� OWNER-BUILDER DECLARATION SPECIALCIACNT/M1SC ' 7E+ Iherebyaffirmthatlam exempt from the Contractor's License Law for the oo Q following reason.(Settlor,70315,Business and Professions Code:Any city or FZ^� eountywhieh requires a pernitbmsutrua,alter,impmve,dennlish,orrepair P'MEfFR ORIOLE INST. S� a nystruthre EmartaW Wuame,aWrequiesthe applicamfw such penNtto 0 s ES file a igned statement that he is licensed pursuant to to the provblom of the POWER DEVICES O60µ Contractors License Law(Chapter 9(commencing with Section 700)of DIA- 30 slon3ofthe Bud mmdProfessbaCede)orthatheieemmptthem[mmand SWIMMING POOL ELECTRIC VALUATION < the beta for the alleged exemption. Any violation of Section 70315 by any OUTLETS-SWITCHESFIXTURES epph..t fora permit subjects the applicant to a civil penalty of not mon than 2 (�© five hundred dollars OW. NEW RESIDEI-MAL ELECTR SQFr. 5MR[ TYPE CONSTRICTION v �n ❑I,as net of thhee property,or my employees with wages u their sale compemaHm,will dothe work and ion,Co Code:The Intended oroffendfor Me dale(Sec.70µto.oBusiness and f property Code:The Cordractore License law $ don not apply tom owner of property who bunds to improves thereon,and OCC.GROUP RFS.UNITS whodoe=15arorkhlmxBort or offered hoar ae.If,ho ea,providhowever, the d thatbuilding gor improvemenlsarenmIntended eyearQerempldto theh evebuUder ilI have TOTAL; 'Improvementbwld withinoneyeam(compialoRlheowner-bullderwlll have tEis.pardenof proving that he did mtbuildorimpromfwpurposeofsale.). QTY. PLUMBING PERMIT FEE LJ L as owner of the property,am exclusively contracting with licensed FLOOD ZONE APN nt PERMIT ISSUANCE mntr- don to mntrud the project(Sec.70µBusiness and Professloce Code: the Contradors License Law dm net apply to a owner of property who ALTER-DRAIN&VFM-WATER(FA) builds or Impmvn thereon, and who contncta fee such pr,,e.with aFEE SUMMARY aor(s)incanted pursuant to the Contractors Llttme Law. BAC[C FLOW PROTECT.DEVICE LJ I am exempt under Sec. B Ar P C for this reasonOUTSIDE FEES Owner - Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N— , . RECEBR N WORKMAN COMPENSATION DECLARATION FIXTURES.PER TRAP SCHOOL TAX Y N [-]I hereby afflnn that I have a ttrtllicate of consent to self-insure,ora EEC®rT N certificate of Worker,'Compenatlonlmuranmwa certified topyth..f(Sec. GAS F.A.SYS'TFNI.I INC.40UTLETS PARK FEE Y_ N 3800,lab C.) J (`, — ccllgY ky ,_ .__/ 115 GAS.FA.SYSTEM-OVER 4 MA) BUILDNGRECGDDIVISION FF.ES Co env �f//e 7 6 Certl Mcopy5h mby fumlahed.� CREASE/[NDUS7RL WASTE INTERCEPTOR PLANCHECK FEE Certified copy ki filed with the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Date Recei til (ThisunionneednnbecompldedBMnepetbfroomhundreddollan B)wle (51Dss.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y N performance camlythat In the perfounce of the week forwhlch this penult h hued, _ I shall not employ any person In any manner an,as,to become subject to the WATER SYSTEM/TREATING Wwkers'Comperttlon lawsof Callfomh.Date PAID O Z Applicant NEW RESIDENTIAL PLMB. SQFT. Date Recei tN Z O NOTICE TO APPLICANT:$after making this Certificate of Exemption,you should became subject to the Workers'Compeaation provisions of the Labor TOTAL: V) Code,ymrnestforthwithmmplywlthsuchprovi morthiaper tehallbe BUILDING C '0 LU > deemed revoked. ' CL c CONSTRUCTION LENDING AGENCY SEISMIC FEE 1 I hereby affirm that mere is a mmtrualon leMingagency for the perfarmry ELECTRIC FEE 7 O anceofthe work fmvvhlch this permit hu lsed(Sce.3D97,Civ.Q TOTAL Lender's Name PLUMBING FEE LL F Lenders Address - CITY. MECHANICAL PERMIT FEE MECHANICAL FEE OW InreitythatlluvereadthisappBationandrtatethdiheabovelnformatlm (i banned.l agree to comply with all cityand muntyordlnanommilatatelaws PERMITISSUANCE FEES PAID: �. reI.tingtobuildl.gw"tmdion,andhereby.uthodu.p..tativn.fthIs N F U) city to enter upon the above,mentioned property for inspection purposes. ALTERORADDIOMECH. Date Recei tN (We)agree to rave,indemnify and keep harmless the City of Cupertim - 4g.m.tIj0IfiIrs,y0Smmts,cxxAamd experts which craylnaywayaceue AIR HANDLING UNIT QO I0,000 CFM) SUBTOTAL: agaW/ CI mequerux of the grant Ing of this permit. 6 AAIR HANDLING UNIT(OVER 1000 CFM) CONSTRUCTION TAX Sig ure of Applicant/Contractee Date ! EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will theappfiant orfuture building occupant store or handle harardcus HEATING UNIT(TO 100,000 BTU) Date Recei til material as defined by the Cupertim Municipal Code,Chapter 933 and the Health and Safety Code Ion 25537(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: iS ❑Y. No Will the applicant or tun building ocrupmt.m equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which ernt hxard...air cottamormla rte de0md by the Bay Area Air Quality Management District? BOILER-COMP DIE'OR 100,000 BTU) PUD 4Yes o /ASR havereadtheI. wamaterialsrequirementsunderChapter6.95of BOILER-COMP(OVER 100,000 BTU) Q 99 the California Health�f&y Code,Sedlom 25505,25533 and 25534.1 understand that lithe building does not currently have.motor,that it is my NEW RESIDENTIAL MECH. SQFT resporsib' torami the occupant of the requirements which most be m Frio n ntt� et a ritifiateofOccupi.q. /� G'' _ 2Z �-/ �f`r•—lam'— lea . "P7S A o aulhoriud agent Date - ISSIIHD BY: (JI,ryY/wAs'^� TOTAL: OFFICE COPY