Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
S 1907
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _- CITYOFCUPERTINO BUILDING-ELECTRICAL PE IT NO BUILDING DIVISION APPIACATION/PERMIT PLUMBING-AIECunNICAL J 19 0 7 BUILDING PR0i IDENTIFIG'ATION 7.ypN ITA BY NO. APPLICATION SUBMITTAL DATE IfU1LDINGADUR1iS©� 0 � � Y D 8 � N rbc a. 23 g $ OWNERS.* Y I'kroNC: CONTRACTOR'S NAME: LIC NO. NIC CONTROLp 'ARCH /ENG1N1zE LIC o: ADDRESS: ❑ Y, IVCTn G-),NwoW CONTACT: PHONE: `. r �f RN [I0 BUILDING PERM IT INFO 4 Y,Q /Iv / v '� _ ❑ Consulgint Flees Paidby Appliednl(Initial)I l BLDG EI.EC'I' L1JMB MECH � k L w � ❑ E�❑ ❑ LICENSED CONTRACT'OR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm date I am licensed ander Provisions of chapter v Rommcn@ng JOB DESCRIPTION QR•Z with Section 70X0(pefUivoioo3oflhe Bu.ines,mal Profession.Code,ead my liceme is RESIDENTIAL: in full force and vlTmt. PERMITI,SSUANCE W 35 ❑SFDWL ❑KITCH17N REMODEL �U'U Li'eme Clus, Liv.0 APPLIANCES-RESIDENTJAI. ❑AUDI TION ❑PLUMBING RIi.PIPE �zw Date Cantruumr GG ARCHITECTS DECLARATION ❑MUI:H ❑ .UNpl STRUM URAI. IIS ZOy? lundedmnd lay plena shall be usedmpublicrecmds PANELti MOD1171CAlION , OZ-� UP TO 2g)AMPS [3INTERIOR ❑CHIMNEYRITAIR F�FW Licensed Professional 201-IOCOAMPS IMPROVEMENT E]SWIMMING POOLS X�J OWNER-BUILDER DECLARATION Y w� I hereby ofirtOVER I(XXIAMI'S ❑BA'TH REMODEVRIiI'Allt ❑DEMDLITIGN In hat than tm exmnPt from the Contractor's I.iecmd Law for the W U followin Sartlan)031.5,Hit...leas and Profession.CoPln:An t t ❑OTHER °� g reason.(. Y city or cam,Y SIGNS I11.HC'I'RICAI. a7 3 w r~ wman Pavlwm.a perllat m aoanmaL tutee imparva,demobs,,Pyr repatr am.traelura _ prior t.,,aissurace,also requires the applicant lot such pennitm file v signed stmanent SPECIAL CRICUIT/MISC. oar � y that Once;lmemcd to...art to the proAkinnaorthe Convacmr's Limme I.aw(Chapter l nW 0 (commencing with Section]000)of Division3oftheBusinessandProfessionsGdc)nt TEMP.MIffIiRORPOLF.INST D I a c oG that he is exempt therefrom and the basis for the alleged exemption.Any vmonfnn of ❑NFW BLDG/ADDITION ❑DEMOLITION H Section 7031.5 by any applicant for a permit subjects the applicant an a civil Penalty of POWER DEVICES ❑T17NANT ❑FOOD SERVICE F it more than five hundred dollar.6500). �Q ❑I,as,-arr of the propcny,or my employees with wattles as Their sole comPenmtinn. SWIMMING 11001.ELECTRIC IMPROVEMENT will do the wad.,and the structure is Nin Imended or offered far sale(Sec.9044,Bmiad,, ❑OTI IER not Professinm Code:The Contrml a's Lleense Ww docs not apply to an owns of OUTI.F'I'S-SWITCHES-ENTRIES propcny who builds or improves th<rcnn,and who does such work himself or through his own employcex,provided that such improvements am not intended or offered fm NEW RESIDENTIAL ELECTR SQ FT. sale.If,however the building or improvement is sold within one year ofcompletion.the SQ.FT.FLUOR AREA SISQ.Fr. owner-builder will have the burden of proving that he did not build or inmpmve for pur- pose of sale). ❑1,as owner of the propeny,oat exclusively contracting with aerated contactors to OTAL: construct the pngect(Sec.9044.Rosins and Profession Cloth:)'[lie CnnlmeollI Ll- sense Law does adapply toanowner(it propeny who builds or improves thereon,and QTY. 'PLUMBING PER FEE' who contracts for such Imperial with a contractors)licensed pursuant In the Common s License Law. PERMIT ISSUANCE ❑ 1 am exempt under Sec. .11&P C for Nis revson ALTER-DRAIN&VENT-WATER(GA) VALUATION Owner Dine / WORKERS COMPENSATION DECLARA'T'ION BACK FLOW PROTECT DEVICE 1 1 hereby afitm under ponulty n1'perjury one of the following decla ation.v ❑ I have and will toomom a Cehificatc afConwm to self-inure or Worker's(Amper- DRAINS-FLOOR,ROOF,AREA.GOND. STORIES TYPE CONSTRUCfION stied as provided for by Section 3700 of the Labor Code,for the performance of ON work for which this permit is ism ed. FIXTURES-PER TRAP ❑ 1 haveend will maintain Workers Corapvmotion Insurance,as required by Section PfXl of Labor Code,far the perinmmnce ,fine work for which this pemnit is issued. GAS-EA.SYSTEM-I INC.4 OUT LETS DEC.GROUP AI'N My Workers Co atu matins Insunmce artier and Policy,number arc: Carrier: PolicyNo: GAS-EA.SYS'I int-OVER4(EA) Clili'fIi KATE OF F.%IiMI'1'ION FROM W ORKERS' COMPENSATION INSURANCE GREASUINDUSTRL WASTE IN'T'ERCEPTOR - BUILDING DIVISION FEES (this section nealnm McomplecA if the permit is 6nmc hundrcddullud 61!X11 GREASE TRAP of less) � PLANCII[CK RB Icenifyffin in the performance of the work for which this permit isissoed,l shall SEWER-SANITARY-S IURM EA.200 Fr. ot nemploy any penton in any maerso m nnIn became object at he Worked'Compete ENERGY FEE Zi salon Law,ofCalifornia.Dote y� WATER IIEAfL'R W/VENTll2LEC'I'R Q Applicant GRADING EEE F7 fn NOTICE TO APPLICAN'E It,aftermaking this Cenlficatvn1'l7aanptiom,you should WATER SYS TEM/IREX['INC ? become subject to the Workers Compcmation Pmvisinns of the Who Cadc,you must SOILS FEE forthwith romply with such provisions or this permit shall IN deemed revakN. WATER SERVICE pw A .�T. z CONSTRUCTION is ac ONLENDINGAGENCY NEW RESIDENTIAL PLAIB. SQ.14. PAID I hereby whiaffirm tam Here isacanstee.30 len ding agency for the Performance of Dae Rmeiptp W Ihcwurk art which this permit is lvweA)Sec.3119),Co.C.) � U Lender's Nunre 'f0'rAL:U Lender's Address IOTA ' W 1 sonify that I have read this application and..ate Nat the above information is BUILDING PEE UFy correct.l agree menmply withaH city and county crdloaoces and state laws relating it, QTY MECHANICAL PERMIT FEE Z building mnmm�ion,and hereby amhorim mpreseradmes ofthis citym enteruponthe '1 lI IC FEE above-mentioned philosophy for inspection pug . !s s( U1 (We).gree to me,indemnify and keep harmlessthe Citi,al'Cupertino almost PERMIT ISSIJANCF. 11 E1,1eC1 RIC FEE Q liabilities,judgmunw.eastsand expenses which may in any way acerae against said City ALTER()[I ADO TO MECH. an Pmeyuenof Ih ca a grinning of ens This pa NhUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' AIR HANDLING UNIT(TO I0,d(ECFM) SOURCE REGULATIONS. JUEC1.6,NICAL ME AIR HANDLING UNIT(OVER 10,000 CFM) CONST UCfIONT X Signature ofApdwerVCmdrot Date EXHAUST'HOOD(W/DUCD HOUS1 MI'rIGAT10N P'li HAZARDOUS MATERIALS DISCLOSURE Will Oo upplicmmer future bu'ddia,00,apam smrcor handle haeardous material HEATING UNIT(TO 100.000 11111) as Jellied by the Cultivation Municipal Code,Chapter 9.12,and the I Ieahh and Sal eiy Cale,Section 2553200^ HEATING UNIT(OVER 100.1X1)BTU) ❑Yes ❑ No PAID VENTILATION PAN(SINGLE R[Slip Date iptM Will the applicant ar future building cecupant use de uipmenn or devices which BOILER-COMP(3HP OR 1011.000 13TU1 emit hazardous air contaminants as defined by the Bay Area Air Quality ManagementTOTAL: District? E]Ym 0 N BOILER-COME(OVER 100,000 IITU) I have Iwd the hazardous materials requirements under Chapter 6.95 of me Cull- AIR CONDITION I?R —9 m m ce ISSUANCE DATE fomin ftealth&Safety Cade.Sections 255115,25513 and 25534.1 undcruand tam if the NEW RISIDENTIAL MECH. SQ.FT. r-k rj building does ncurrently have a tenant.that it is my responsibilitynotify the cupant l of the regWmment.s which must One met prior u,issuance Oda Cmificam of Occupancy. Uwncr,le zan...sed agent Date TOTAL: ISSUED BY: OFFICE