Loading...
21813 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification - PERMITNO. 810200drcImperial Ave, Cupertino ' 21813 Owner.Name: one: - A Measurex Corp., 255-1500 CITY OP CUPERTINO-BUILDINGDIVISION7� Contractor's Name: Lie.No: APPLICATION / PERMIT ,Applied P rotection Inc. 458200 BUILDING-ELECTRICAUPLUMBINGMECHAMCAL CATEGORY CONTROL Architect/Engineer. - Lk.No: - None - - BUILDING PERMIT INFO QrY ELECTRICPERMIT FEE • Address: Bi EJL�l PLUMB M�h PERMTISSUANCE ❑ ❑ ® ❑ LICENSED CONTRACTOR'S DECLARATION _ T hereby a!llrm tMtlam lkensaduMerprovWonnof Chapter9(mmmmc APPIIANCFS.RFSIDENUL JOB DESCRIPTION Ingwith Section70001of Dlvislon3ofthe Businessand ProfesslonsCods,and my ♦ - limnaei9lnlutlrgc�andeffec,. 45 20 PANELS Ly`NF LDI¢nsa•cl�ll-. yu Con�rtnr �-ed-P tectio i LM IQ 2M AM�S L- `l�ARCHITECI'S DECLARATION 201-IODDAMPS �qu Q CQC l understand myRA-shallbe used aspublle records. OVER IOOD AMPSSQ.FT.FLOOR AREA .$/SQ.FT. Licensed Professional ' . SIGNSELECTRICAL �<6 OWNER-BUILDER DECLARATION SpEC1ALCR2CUIT/MISC. - 7p, Iherebyafflrenthe l am exempt fromlhe Contractor's License Law for the (o0owing reams.(SMfon 70175,Business and Professions Code:Any city or O -� TEMP.MITER OR POLE INS17. - rr mantywhlchrcquimapermBtometmct,alterlmprove,de=tl h,ormpair anystructure prforto Its lsmance,also requireelheappliant forsuch permit to O POWER DEVICES file a signed statement that he is licensed pursuant to the provblons of the Contractor.License Law(Chapter 9(commencing with Seatfmn 7000)of Dlvl- 30C' knoll of the Business and ProfemionsCode)orthat hely exempatherelromand SWIMMING POOL ELECTRIC VALUATION the bash for the alleged exemption, Any violation of Section 70315 by any - 0 applicant for.permllaubjeaes theapplicant to a civil penalty of net more than I OUTLEISSWITCHESSFIXTURE5 iQ five.hundmeldollen($500), 01,as owner of the property,or my employee with wages as their sole NEW RESIDENTIAL ELECTR—SQFr. STORIES -TYPEOON9TRUC'I'I01, compensation,wllldothe work andtheatructure is not intended or offered for , Osale(See70KBusiockand Profeslom Code:The Contractors License Law �,I$$ does not apply to an owner of property who builds or Improves thereon,and 0.0. who deassuch work himself orthrough his own employees,provided that such ,OCG GROUP RES.UNITS Improvement arenot Intended aro((ercd formic.ll,however,thebullding or TOTAL; Impmce ntissoldwithinoneyearofcomple]oNtheowner,-builderwlllhave - 1t�urdenofproving that hedid nor bu0dorImprove for purpose of sale.). QTY PLUMBING PERMIT FEE FLOOD ZONE APN 11 L as owner of the property,am exclusively matracting with licensed PERMI7ISSUANCE contractors to construct the project(Sec.7014,Business and Professions Code: t'LC� The Contractor's License Law does mat apply to an owner of property who ALTER-DRAIN k VENT-WATER(EA) Wild,or improves thereon, and who contra for such pSo*u with a 15yactor(s)licensed pursuant to the Contmens'.Llcenm Law. FEE SUMMARY ,!B2ff1 am exempt under See. B k'P C for this rescan BACK FLOW PROTECT.DEVICE DRAINS FLUOR SANITARY Y N Owner - Date $R(TDF,AREA,ODPID. RECEIPT p g] WORKMAN COMPENSATION DECLARATION 1 �I hereby efflrtn that 1 have a mrtl0nte of concent to serf-Inwre,ora FTX7VRFS PER TRAP SCHOOL TN( R��Np mrti(Inte o(Wdrke�s'Compensatlonlnsunnre ora artl(Ind ropythereo(6ec. 1 GAS.EA.SYSTEM-11NC.4ODILEI'S 1 PARKFFR Y N 3800,Lab` FF–WP80435494 - RECEIPT« Policy Y—FTPeIBa.Tf-S-Fuad GAS.EA.SYSTFM.OVER 4(EA) Com any BUILDING DIVISION FEES [Certified copy 1.heed with the cit. GREASE/INDU5IRL WASTE INTERCEPTOR PLANCHECK FEE ' ed �CertlOed copy tilled with the city Inspection divlslan. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200717. " Date RC I t# (fNesenlan need not M completed If the pemNt V forone hundred dollars (f1 m"ify,ss.) WATER HEATER W/VENT./ILECIR ENERGYFEE Y N Icoout that emIn ploy an person In an thework.as to became the — I shall out employ any pears In any manner at m to become mbkct to the WATER SYSTEM/TREAT NC Workers'Compensation Laws of Califomt.Date � _ PAID Cf Z Applicant Date Recei 1# Z O NOTICE TO APPLICAM:It,after making thin Certificate of Exemption,you NEW RESIDEPIIAL PLM B.. SQjT. Fshould become subject to the WmIcen'Compareat ion prostate.of the Labor TOTAL: L Code,you=at forthwith comply with such provisions or th is permit shall be W > deemed revoked CON SELL UCTION LENDING AGENCY SEISMIC FEE 1 G Ihereby affirm that there t a construction lending agency for the perform ELECTRIC FEE Z ante of the work for which this permit t LmuM(Sm.3097,C1v.C.) .TOTAL: (�L L) O Landers Name ' PLUMBING FEE LL I— Lender's Address - QTY. MECHANICAU PERMIT. FEE MECHANICAL FEE OW Icertilythatl have read this application and ettnthatthc above ln(ormallon d is correct.I agreeto comply with all city and county ordinances and pate laws PERMITISSUANCE FEES PAID: } N relating to building construction,and hereby authorize representative.of this f- city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. Z Z (We)agree to save,Indemnify an d keep harndess the City of Cu Portion Date Reeof p[# against liabilities,Judgments,mats and expenses which may in any way accme AIR HANDLING UNIT(T010,000 CFM) SUBTOTAL: age GYrt said City In mneeq,erm.fthe ntingofthlspertnit �, ' AIR HANDLING UNIT(OVER 10,000CF•M). CONSTRUCTION TAX S1 jfure of Appunnt/ ontracur ya Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: - HAZARDOUS ATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT CIO 100,000 BTU) Date RCCDi t# materislaa defined by the Cupertino Municipal Code,Chapter 9.12,and the ' Health and Safety,Code Section 25532(a)? HEATING UNIT(OVER 100,000 BTU), TOTAL: ( LTV F-1 Ye o Will the applicant or r turn building occupant use equipment or device VENTILATION FAN(SINGLE RESID) ISSUANCE• p which emit hanrdous air contaminants as defined by the Bay Area Air Quality Management D Ldd? BOILBR-COMP OIB'OR 100,0(10 BTU) FEB 'r{� T Yet ous N have read ualtftaraommode,Sections 25505,2553 and 25534.1 of BOILER-C'OMP(OVI72100,000BTU) _ the erstandt Health k Safety Code,Sections25505,ve a tenant, �! understand to Rtifythe the ing occupoes note currentlyhavetenant,that it mot NEW RESIDENTIALh1ECli. 'Q.FI' mor to asuamnotifytheic teof of the requirements which must be rant ,of prior to Issuance ole Certlfl©te of Occupancy. - eOLps�ps�{`!R'O` Owner or authorized agent Data ISSUED BY: C\j�/�•2/V'�'^`'^�Y��R TOTAL: OFFICE COPY