Loading...
99090159• a y w^ U_O OU V UZ a APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO xuamuc-eLEc'ra1cAl, reR IT BUILDING DIVISION APPLICATIONIPERMIT PLUMBING -MECHANICAL BUILDING PROJECT IDFNTIFICAT10N - BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE 2,S) FP OX :S NAMF,: PfION:: 1 CONTRACTOR'S NAME.: 2 LIC NQ P /3 NIC ❑ CONTROLp ARCHITECHENGIN R: LIC NO: ADDRESS: as Z CONTACT: PHONE: BUILDING PERMIT INFO SS ❑ GOnSWldnl Fm Paid by Applicant (Initial) BLDG ELECT PLUM[{ ECH El 1:1�M❑ L ENSE CONTRACTOR'S DfiCLARATION 1 hereby affirm Na 1 am licensed under provisions of Chapter 9 (commencing Q'ry ELECTRIC PERMIT FEE JOB DESCRIPTION I'F.RMIT ISSUANCE whh Sc,tiun9a10)of Dlvlsinn3oflhu Buslnmsuod Profession,G ,nndmyiiieen is lm full force andoff-. Ewnsc Cluxx_ ? Lre.M RESIDENTIAL: ❑SFDWL 0 KI' 1'CHEN REMODEL ❑ADDITION ❑PLUMBING REPIPE MODIFICATION ❑STRUCTURAL MODIFICATION APPLIANCES-NESIUEN9'IAI. Date _ Commnor ARCHITECT'SDECI, ANTION Iunderxtanl myplam,luoll bemedasp Iicrecus PANELS UPTO266AMPS 0INTERIOR OCHIMNEY REPAIR IMPROVEMENT 0SWIMMING POOLS Licensed Pmfe,innal 201-1000AMPS DWNEN-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Cammemrx License Law far the following reason (Section ]0315, Brearesx and Professions Code: Any city or county pxATI{REMODEIIREPAIk ❑DEMOLITION ❑OTHER OVER IW6AMI's SIGNS ELEC'PRICAL which requires a permit In construct, alter, improve. demolish, or repair any stmeture SPECIAL CIRCUIT/MISC. prime to its issuance, also requires We applicant for such potion, to File a signed as¢mem that he is license) pu mortlo the pno,kme--the Cnn,mcmr's License law(Cbapmr 9 'I EMP METER OR POLE I NST. COMMERCIAL' (commencing with Section 7000) of Division 3 of the Business and Processions Calc) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 0 NEW BLDG/ADDITION 0 DEMOLITION Section ?031.5 by any applicant for o permit subjects the applicant to a civil penalty of POWER DEVICES ❑TENANT 0FOOD SERVICE not more min Eve hundred dollors W(W). 0[.as ownerofthc proiwrt, army employees with wagesa their sole compntstame. will do the work, and the Slmchmc is riot intended oroBend for sale (Sec ]614, Business IMPROVEMENT ❑OTHER SWIMMING POOLELECRIG OUTLETS -SW ITCHES-FIX'I'URIi. and Professions Cede: The Contractor's License Law dors not apply m at, owner of NEW RESIDIiNTIA1 ELECTR SQ 1-. property who builds or improves thereon, and who does xii work himself or through his ow. cratdoyeas.parochial th I such ininowcoment, are ma intended or uttered for -le, III i building... p c ld th' n y f completion the owner -builder isll have the burden f forcing that he did not Wild or improvefor pur- F -c of ".1c.). 0 1 f thep perryexclusivelycontracting with licensed contractors to �SQ.IT. FLOOR ARBA.- -•- r ^ I � •• LSQ. FT. 1 1n T AL: construct the prejut(Sce 4(44 Business and Profes Code) The Commcors U. c se Law does not apply to an owner of property who builds orimprovnthcaon,and who contractsfor such pn'jeets with a contmemr(s) licensed purmarn to the Convenor's (�.� CCfI 2'1 1999 ( JLr j QTY. PLUMBING PERMIT FEE PERMIT ISSUANCE19 License law. ❑ I am csempt under Sec. . B & P C fur this reason 1� ALI'P.R-DRAIN&VENT-WATER EA)nV Owner Date VALUATION { o t WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT. DEVICE J ' Iherchyaflirm mnderpenol,ynfperjury eneot the Grllowingdeclarations: I M1twe and will mainmin aCeniGcae of Con<em molt -insure fm Workers Compen- sation, a pmWdhi for by Section 3]00 ol'the LaMn Coale, Int the performnncc of ,bc DRAINS-MOOR,ROOPAREA,COND. STORIES TYPECONS'1'RUCTION work lint which this pemnil is issued. FIXTURES - PER TRAP 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 3VIXlofthe Labor Code, for the performance riche work for whkhthispermitisissued My Workers Compensation Insurance carrier and Policy number see: Croner: Policy No.: GAS - EA. SYSTEM- I INC. 4 OUTLETS OCG GROUP Z4APY7� I ' GAS - EA. SYSTEM -OVER 4 HIM GREASMNDUSTRL WASTE INTERCEPTOR CH RTIFICATE OP EXEMPTION FROM WORKERS' COMPENSATION INSURANCE y BUILDING DIVISION FEES Into orimmnced mol Memuldecd if,he permit is fninschminreddollarc 14100) or Icss.) GREASE TRAP PLANCHECK FE -E SEWER -SANITARY -STORM EA. 200 FP. ENERGY FEE I certifytha in,he performunceofthe workrovehich this permit is issued. Lshall no, rind, any per enym mer seas ur beatmre subject the Workers Compen- an WATER HEAI'RE WNENTIELECI'R GRADING FEF: sation Laws of California. Doc Afeldwoot NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should beronre xuhjca ur the Worker's Conrpensaunn pruvi.tioto, n(,hu Labor Code, you must WATER SYSTEM TREATINC, SOILS FEE WATER SERVICE forthwith comply with such prm'isions or this permit that W deemed coveted. CONSTRUCTION LENDING AGENCY Iherebyulfien ohmmcre is aurnxwetion lcnd,a, agency forme pcdonnonee of PAID t Dore Reeelpt a I f.. L f-_ NEW RESIDENIAL PLMB. SQ. FT. '. TOTAL: ,he work for which ,his permit is issued (Sec. 3097. Co. C.) Lender's Name TOTAL: Lender's Address k. BUILgING F6HL f Z Ie. JQ 1 cattily that 1 have read his application and nate that the above informu,ion is , tical.) agree err comply with all city and county ordinances and slate laws relaingm building construction. and hereby aumorire representatives mf this city to enter upon the QTY. MECHANICAL PERMIT FEE- " SEISMIC FEE PERMIT ISSUANCEELECTRIC FEE _ above-mentioned property for inspection purlmses. emnity and keep the City of Cupertmo against (We) agree m save, indharmless PLUMBING FEE Iiubillde" adgmcnrs, costs and ripensexwhichm anywm,ocOuc against said City a. asequence of the griming his p mi,. ALTERORADDTOMECH, AIR HANDLING UNIT(TO IO,00( CFM) MECHANICAL FEE APPIICA ' UNDEMTAN AN WILI. IMPLY WITH ALI, NON -POINT sou .EI-GULATIO'S. AIR HANDLING UNIT (OVER I0,060 CFM) CONSTRGCTIO'TAX res gt antro of Applicao/Contractor Dante EXHAUST HOLD(W/DUC) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100.600 BN) Will meapplicum or cusum b ddingoccupnnutnre or boodle bnenrdeu.arnmenal as defined by the Cupc lino Municipal Code. Chapter 9.12, and the Health cad Safety Calc, Sermon 25532(o! HEATING UNIT (OVER 100,000 BTU) O Yes ON. Will thea Bean, or future Wilding t use equipment or devices which PP dby the Arco i, hurardous sir cuntuminonre us ddincd by Om Boy alma Air Quality Management VEiNILATION HAS ISINGLE RESIDE PAID Dote Receip T BOILER- COMP(3HP OR 100.00) BTU) BOILER -COMP (OVER Ialig0 BTU) nict, 0vc' 0No AIR CONDITIONER I have real the hamrdous ma tats requi moons mock halccr 6.95ot the Cnli- Firmin HealthOwe"ate" Coda Sectio 255115, 533 unJ 25 . 1 understand that if me ISSUANCE DATE aaj NEW RESIDENTIAL MECII SQ. FT. building IcutrenllY eat an,.,Lai airy rcxpu ility to nutily the mcupant/ y�/) n the nwhit cox, ",etre s uCenifieaeof Occripase, ISSUED BY: TOTAL ser or umMJ agent Dam OFFICE