Loading...
S 0309Tutu Pen I lues _ I lee PAI I PnIIJT PFN nNLY APFLRJAIYI IV ri"murrvmm�no�a. CITY OF CUPERTINO - BUILDING - ELECTRICAL. BUILDING DIVISION APPLICATIONIPERMIT PROG-MECHANICAL NC PB(1JEGT IDEN'1'IF'IL'ATION BUILDING PERMIT N(1. S 0309 BUILDING ADDRESS: ���{T YI✓✓ 221oG LINDA VIS i��—I CupeaTlNoy CA cjSDl� //1 63—sT SANITARY NO, DAf' APPLICATION SUDMITTAL f: OWNERS NAME: PRONG M oN S N6 Yl2ss s19s CONTRACTOR'S NAME: LIC NO' uM ELEC01000. 0?2,j8 N/C ❑ CONTROL N ARCHrtECT/ENGI EER: LIC NO: ADDRESS: 3yl`9 wAV0EWY ST PAW /kl.T4 CA I CONTACT: PHONE: �ER Q+A'w LJ/iNG S'67v3rI[p ❑Consultant Fees Paid by Applicant BUILDING PERMIT INFO BLDG El LU❑MB M�1 LICENSED CONTRACTORS DECLARATION/ 1 hereby affirm mat 1 am licensed under prnvisians ar Chapter 9 mnmmeneing with Section 7")of Division 3 of the Business and Professions Csili my license is in full bncc and effect Cbg 29� License Class r Lie.M Dice Cantm RCHITEC'S DECLARATION 1 understand my plans shall he used no public records QTY ELECTRIC PERMIT FEE JOB DESCRIPTION RFS ❑SFDWf. ❑KITCHEN REMODEL ❑ADDITION [I PLUMBING RE -PIPE ❑MULTI -UNIT []STRUCTURAL MODIFICATION C3 INTERIOR ❑CH[MNEY REPAIR IMPROVEMENT (]SWIMMINGPOOLS ❑BATH REMODEL/REPAIR 0DEMOLITION �. PERMIT ISSUANCE APPLIANCES—RESIDENTIAL - / PANELS rf Z UP TO 2W AMPS 2-v Licensed Professional OWNER -BUILDER DECLARATION 1 hereby offiem that 1 nm exempt from the Cuntmetor's License Low for the f fallowing reason. (Section 7031.!1. Business and Professions Cedm Any city or county 201-10MAMPS OVER IWd AMPS SIGNS ELECTRICAL Which requires. permit m cart wet, otter, improve, demolish, or repair any structure 3 Prions it, issuonee,ul.m requires the applicant for such Permit to file a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law (Chapter 9 (commencing with Section 7") of Division 3 of Base Business and professions CodOar that he is exempt therefrom and the basis for me alleged exemption. Any violation or Section 7031.5 by any applicant for a pennitsubject the applicant to a civil Penalty of 41 4V 1"414 CZ V CCIMMER , ❑ NEW BLDG/ADDITION ❑ DEMOLITION []TENANT ❑ FOOD SERVICE SPECIAL CIRCUIT/MISC.V TEMP. MFTER OR POLE INST. POWER DEVICES nut mom than live hundred dell ... ($5110), 01. as ownerofine propcny. or mycmployecswithwagcs ns their role compcnution. will do the work, and the structure o not Intended mothered forsule (Sec. 7044, Business 3 and Professions Code: The Comrecmrx License law does nm apply to an owner of IMPROVEMENT OTHER SWIMMING POOL ELECTRIC OUTLETS—SWITCHES—FIXTURES property who builds or improves thereon, and who doessuch work himself or through his awn employees. provided that such improvements are not intended or offered for sale. If, however. the building or improvement is sold within one year of completion, the wnerhuilder will have the Emden of proving that he did not build or improve for par - NEW RFSIDIiNT1AL GLECTR SQ FT. SQ. FI'. FLOOR AREA $)SQ. 17. Post oNd ). I, as owner of the property, um exclusively controlling with licensed contractors to conslmct the pmjmt (See. 7044, Business and Professions Coale:) The Contractors Li- cenist Law does not apply to an owner of property who huilJs or improves thcanal and QTY PLUMBING PERMIT FEE who contracts for such Projects with a contractors) licensed pursuant to the Contractors License Law. 1 am exempt under Sec. . B & P C far this reason PERMIT ISSUANCE ALTER - DRAIN & VENT- WATER (EA) VALUATION Dam Owner WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT. DEVICE ' 1 hereby allirm under Penalty of perjury one of the fullming declarations: I have and will maintains Certifeam cf Consent to sel6insma far WoAme, Camper- sation, as provided for by Section 3700 of the Labor Cade, Nor he purfonnonre of the work for which this Permit is issued. DRAINS— FLOOR. ROOF, AREA. COND. STORIES TYPE CONSTRUC'MON FIXTURES — PERT RAI' GAS— EA. SYSTE.M.I INC. 4 OUTLETS 1 have and will maintain Workers Compensation Insurance, as required by Section 37M cruise lanresde, for the performance of the work for which this Permit is issued. OCC GROUP ANN GAS EA SYSTEM OVER 4(EA) My Workers Comiensmion Insurance carrier and Policy number are: Comcc Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASMNDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES GREASETRAY PLANCHECK FEE Cnisactionneed niche completed ifthe permit is foronehundrniddlar.(SIM) or less.? I certify that in the perfumunce of the work far which this permit is issued. l shall not coupon, any from in any manner so as to become ltmjrc Io the WoUseri Co.,.- r sstiontawsof Culifomia. m / AppliesN�.� ✓ iNOTICE TO APPLICANT. If, after making this CeNficat Exemption, you should becomesubjectm the workers Comthis previsions the Leeds Cade, you must forthwith comply with such provisionsms or or this permit shall be deemed revoked SEWER—SANITARY— STORM EA. 2011 FT. ENERGY FEE WAT'ER HEATER W/VENT/ELECIR WA'I 17R SYSTENV TRCAT1NG WATER SERVICE GRADING PEE SOH -S FEE CONSTRUCT LENDING AGENCY T I hereby athrm that them isacnnstrunion lendingageney for the perfmmence of the work far which this permit is issued (Sec. 3097, Civ. CJ Lender's Name PAID NEW RESIDENTIAL PLMB. SQ. 19'. Uma ReceiptN TOTAL: UTOTAL Lender's Address is BUILDING PEE L 1 certify that I have read this application and stain that the anise infmmmlon n covet. l agree to comply with all city and county ordinances and state laws existing to building convection. and hereby amhodae mpresentaoses at this city to enter upon the QTY. MECHANICAL PERMIT FEE SEISMIC HE PERMIT ISSUANCE above-mentioned property for inspection purposes. (We) agree m ewe, indemnify and keep harmless the City of Capron- against Iiabilifiee.judgments, costs and expenses which may in any way eccne against said City IiLECIRIC IFS ALTER OR ADD TO MECH. PLUMBING FEE in coreallarea of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT AIR HANDLING ON I'r(TO 10," CFM) MECHANICAL PEE SOURCE REGULATIONS. AIR HANDLING UNIT (OVER ❑t,000 CPM) " CONS'1'RUCI'ION TAX Signmurcof APplional ntmctor Data EXHAUST HOOD OVIDUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant smrenr handle hexandommmerial as Jcfined by the Cupertino Municipal Code. Chapter 9.12, and the Hari wet Safety Ctdc, Section 25532(x)7 - HEATING UNIT (TO IW,000 BTU) HEATING UNIT (OVER 108.000 BN) VENTILATION PAN (SINGLE RISIU) ❑Yes ❑No PAID Date ReceiplM V 11 Bae applicant or future building occupant use equipment or JI locs which emit hamrdous air contaminants as defined by the Bay Area Air puality Mmagement BOIL ER—COMP (3HP OR IR MO BTU) TOTAL: BOILER -COMP (OVER 100.000 BTU) DistdctI El Yea ❑Nn require final llet me haaallous materials mento under Chapter 6.95 of the Cali- mm if the fornix Health gdoes& Safety Cole, Section 25505, 25533 and 35534.1 as army Wilding does cad curtendy have a tenant, mot it is my responsibility m notify the occupant .fine requirements which must Na met poor an issaanee M a Certificate of Decapanry. ISSUANCE DATE ^ ISSUED BY: l Q NEW RE5IDCNTIAI. MECH. SQ. FT. TOTAL: Owner or authorized agent Dam UFFIGt HyAN,vJsPaeT Yr.