Loading...
22193 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY Building Project IdentificationPERMITNO. Building Address: .. 22193 O\wners ameOO: one: YG.t.. f- C-4a, s k,11 CITY OF CUPERTINO-BUILDING DIVISION 7��e21Y Conte o'. Lk.No: APPLICATION / PERMIT J 7 © Name: N BUILDING-ELb TMCAI PLUMBING-MECHAMCAL CATEGORYCONTROL N An:hltect/Engineer. Lic.Na QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: PERMfTISSUANCE ❑ ❑ El LICENSED CONTRACTOR'S DECLARATION Iherebyaffrmthat l am licensed under provisions of Chapter 9(mmmmo APPLIANCFSRSADENTIAL fog DESC"'I N ingwlth Se i..7000).(DlNtl.n3ofthe Buslremand Profeulo..Cod,and OC/I/fara/"Ir license Is In full force and offset. PANELS License Clan Lk.N Date Commdor UP TO 2DOAMPS ARCHITECTS DECLARATION 201-IODD AMPS OVEO � SQ.FT.FLOOR AREA S/SQ.FT. p�p�uu reO I understand my plum shag be used as public records. FG� Licensed Professional SIGNSELECTRICAL OWNER-BUILDER DECLARATION SPOCULCR2CUIT/M15C Fo'v7I hereby affirm that[am exempt(.the Contractors License w for the 2 F following reason.(Section 70711.5,Business and Professions Code:Any cityor TEEM,METER OR POLE INST. countywhkhrequimsapermlttowmtmn,alter,knprov,dernikh,orrepalr an ystr mmpdortolbls ancealsorequlrmtheapp-ontfwmOper tto ROWER DEVICES r file a signed statement that M Is licensed pursuant to the provisions of the Orst� Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi. NC POOL ELECCEC F.30a sm.3ofthe Buneesand PmfesalonsCod-)orthat bels exempt therefeemand VALUATION •]] the W.I.sis for the alleged exemption. Any violation of Section 7831.5 by any .ION o XT.lntps' I u D�s (it/ < appu..t fora permrm it®bjects the applicant to a civil penalty of not oethen five hundred dollars(SM. NEVj4EMIDENTIAL RLECTRSQFf. ' $10R16S TYPE CONSTRUCTION 1,as owner of the property,or my employees with wages as their sole compensation,wW dothe work andthe structure isnot Intended or offered for Osale(See,70Sy Business and PMemions Code:The Contractor's License Law y �$ doss not apply to an owner of property who builds or improves thereon,and DATE OCC.GROUP RES,UNITS�w whodoneuchworkhimxlforthrwgh Maownemplayeea,pmvided thatvrch -nprovemenleare net intended or offered for sale.If,however,the building or - TOTAL: Improvement Is sold with)noneye.r.feempletion,the owna------- t"rifes -----t"rden of proving that he did not build or improve for purpose of sale.). QTy, PLUMBING PERMIT FEE FLOOD ZONE APN u L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractowet in rs to mtruthe project(Sec.70K Business and Professions Code: TM Contractor's License Law does not apply to an owner of property who W-ds or Improves thereon, and who contracts fee such ptiolects with a ALTS-DRAIN&VENT-WATER(EA, cq,,aBITactor(.)limned pursuant to the Contractor'sLicense Law. gpCK FLOW PROTECT.DEVICE FEE SUMMARY LJ 1 am exempt under Sec. H h P C for this reasonOUTSIDE FFTS DRAINS.FLOOR ROOF,AREA,CONED. SANITARY Y N • Owner Date RECEIPT N WORKMAN COMPENSATION DECLARATION FIXNRES PER TRAP SCHOOLTAX Y_ N_ ❑1 hereby affirm that I have.cerHnote of consent M sect-Insure,or. RECEIPT N cemlflmteof Work WCompewHonlm con ma"Mfkdmpythereof(Sec. GAS,gA gYbTEM1 INCAOUTLElS PARK FEE Y_ N- 3800,lab C.) RECEIPT N C. M CGAF.EA.SYSTEM-OVER a MA) BUILDING DIV]SION FEES Cam any ❑pCerlied copy I.hereby tumlMed. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑CcrtdWed copy is filed with the city inspection division.. CERTIFICATE OF EXEM Pf10N,FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 20017Date Rete) til IThlseenlon nerd net be completed H ted pemdt ls(scene hundred dollars 3100).eless.) WATER HEATERW/VENT/m F(•TR ENERGYFEE Y_ N— I rertifythat in the performance of the work forwhich this permit Is blued, I shall not employ any person in any manner so m to become subject to the WATER SYSTEM/TREATING PAID Workers'Compensation laws.(California.Date Z Applicant NEW RESIDENTIAL PCMB. SQFT. Date Remi tit Z NOTICETO APPLICANT-.If,after making this Cantfces of Exemption,you O should beemnesubjecttothe Wmixers'Compumhtlon provisiorm ofthe Labor. TOTAL: F fA Code,ymi mu at forthwith comply withsuch provlslormorthls permit shall be [j L > deemed revoked.CONSTRUCTION LENDING AGENCY SEISMIC FEE Il C Thereby affirm that there is a construction lending agency for the perf.rry - TOTAL: ELECTRIC FEE 7 Z anm097 ofthework forwhlch this permit is Issued 3 ,Civ.C.) PLUMBING FEE 02 Lender's Name LL ~ Lender.Addem. QTY. MECHANICAL PERMIT PEE MECHANICAL FEE OW IcenifythatllmvereadthsappbaHonand statethattheabovelnfommtun IL lscorrect.Iagrestocomplywilhall dtyand county.rdlnanamand state laws PERMIT ISSUANCE FEES PAID: W relatingtobulldingeonstruction,and herebyauth.rUls e representativesofth Z city toenterupon the abovcccomtined property for impectlon purposes. ALTERORADDTOMECH. DBI- Rotel IN (We)agree to save,Indemnify an d keep harmless the City el Cupertion V agaWtllabNtles,N ,rostsan pen hlch Puy Ina ccrue AIR HANDLING UNIT DO 10,000 CFM) SUBTOTAL: a vt sold Cl 1 con 11 eolaoft anung tMa permit AJR HANDtJNG UN17(OVER I0,0B0CFM) CONSTRUCTION TAX Isknate of Applies/Contractor Date DUST HOOD(W/DCCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE, Will the applicant orfuture building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei tIf nealthaas definedbythecdion mMunicipal Co d,Chaptcr9.I2,andthe Health and Safety Cade genion 75532(x)7 HEATING UNIT(OVER 100,000 BTN TOTAL: ❑Yea ON. Will theapplicant orfuturebuilding occupant useequlpemnt ordevices VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE which scut hazardous air contaminants as defined by the Bay Arca Air - Quality Management District? phiPOA 100,000 BTU '�Yrs [a No ,It•t/`_'t_IIIG7{ Mxrcadthe haadrdo ematedab requlremenb under Chapter 6.95 of gOR.ER-COMP 100,D00 BTU) the Califon la Ilealth k Safety Code,Sen loan 25505,2W3 and 25534.1 understand that if the building does not currently have a tenant,that It is my NEW RESIDENTIAL MEIN. SQFf MAY RA MQJ responsibility to notify the occupant of the requirements which=at be met y prior to Issuance of a CerHflate of O=pancy. fj1 Owner or authorsISSUED--agent Data TOTAL: BY V OFFICE COPY