Loading...
23803 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ,Building Project Identification PERMIT NO. Building Address: 2380 CITY OF CUPERTINO-BUILDING IVIS] N rJ �'j`on�_ /'��a - nne: APPLICATION.,/ P MI �&I� / er BUILDING-ELECTRICALPLUM NGM AL CATEGORY CO OIC Arthitect/Fsgineer. 0 D QTY ELECTRIC NR T FEE BUILDING PERMIT INFO Address: PERM[TISSUAN � LICENSED COensed under DECLARATION _ T hereby affirm that lam Rcenxd under provisions of Gapter9(commmc ENTAL i OB DFSC Ingwlthsection7000)of DlWsion3oftheBusinessand ProfesslonaCode,and ' Ilrenx Is In fullfo a and effect C \. 4, Limn - LICN J Date Contractor . ARCHITECPS DE I_Q \ 20. AMPS 2 I understand my plays shag be used as pubbc records ER 1000 AMPS ".FL R AREA $/Sg. U.. BOO C Ft,luJ t, Llcenxd Professional - SIGNS EL TRI met, h G�-Z�r� OWNER-BUILDER DECLARATION SP IAL IR /MISC L, Ta I hereby afRrmthst l am exempt(romthe Contractor's License Law for the 9•. following reason.(Section 70315,Business and Profemlons Code:Any city or M IR OR POL SI. p� county which requires apermit oconstruct,alteglmprove,demolish,orrepair 11 a any atrudurepdur ertlshat heeg aLmrequ purtuart to the forauchpermit a D��g 01e a signed gatement that he V licensed pursuant to the proWsiom o! the Contractor's License (ChapterLaw 9(commencln with Section 7000)of Divl" 3�'•1nRw SWIMMING LELECTRIC VALUATION4'f: O sion3 of the Buslnessand Profemlom orthat f exempt therefrom and P.S the iasis for the alleged exemption. Any violation of Section 7 15 by any OUTL SWIICIIESHXTIJRFS 2, 2� applicant for a permit subjects the applicant to a civil penaltyof net marc than a OII R five hundred doarsll (S50m. SQ Fr. S NS'IT CTION ❑I,as owner of the property,or my employees with wages as their sole 7NE RESIDENTIAL ELECTR 2¢ compensation,will do the work and the structure Is not intended or offered for O sa1e(Sec.7044,Business and Professioro Code:The Contracto/s Llceme Law i 3 Q does not apply to an owner of property who Wilds or improves thereon,and OUI S who does such work himselforthrough his own employees,provided that such improvements are not intended oroffered forsale.If,however,thebulldingor heprovereentissold within oneyearofcomplMbn,theowner.bu derwlll have lht*rden of proving that he did net Wild or improve for purpose ofsakJ. QTY. PLUMBING PERMITFE TONE APN LJ 4 as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to construct the project(Sec.7044,Business and Professlom Code: The Contractors License Lew does net apply to an owner of property who builds or Improves thereon, and who contracts fee such puojeas with a ALTER-DRAIN&VENT-WATER(EA) Ctadorts)urensed pursuant to the Contractor'.urenx caw. FEE SUMMARY Ll I am exempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE DRMNSFLOOR ROOF,AREA,COND. SANITARY Y_ N_ Owner Date RECEII'TN WOR WAN COMPENSATION DECLARATION 5p{OOL TAX Y_ N_ ❑I hereby affirm that I have a rertiBa to of consent to self-Insure,or RECEIPT N rertlfieste of Workeri Compereation Imearance ora certifext copythereof(See. GAS FA.sYSI'FM"1 INCA OUTLETS PARK FEE Y N 3800,Lab C.) Policy N RECEPI N Co any GAS EA.SYSTEM"OVER 4IRA) BUI LUINC DI VI SION PE ES ffMtRedpy cois hereby furnished. - CREASE/INDUSRL WASTE INTERCEPTOR PLANCHECI ❑Certified copy b filed with the city Inspection division. q CERTIFlGTE OF UEMITION FROM WORKERS' GREASETRAP PA _ COMPENSATION INSURANCE SEWER SANITARY-STORM EA 200FI a e Recti TA (Thin section need not W completed lithe permit b for one hundred dollars ($10()orlese.) WATER HFATFAW/VENT/ELECTR ENEMY FEE Y_ I certlfythat In the perforrranm of thework forwhlch this permit is lswed, I shall not employ any person in any manner w asme b'd to the WATIRSYSIFM/TREATING - Workers'Com atlon La 1GR(ornla.D PAID OZ AppOont 5 NEWRESIDENDALPLMB. SQFT. Date Remi t# Z O N'OTICETO APPLICANT:If,after making thisCertificate of Ex piton, u should become subject to the Workers'Compensation provisions fthe r TOTAL: W Code,you=at forthwith comply with such provisions or this permit shall bea. lL BUILDING ITE J deemed revoked. CONShat TRUCTION LENDING AGENCY,_ SEISMIC FEE 4 Il Z Thereby orkf rwhicere lsacomt 6Issued dingCSec. 097,0 for the perforrry - TOTAL: ELECTRIC FEE \ 7 Z anceof the work(orwhich Wb permit VLaved(sec.3097,CIv.CJ O O 'Lender's Name - PLUMBING PEE IL F LendcreAddress QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW I certlfythat l haveread this application and gaethatthe above information �/ FEES PAID: CL isommct]agree to comply with all city and county ordinances and gate laws PERMIT ISSUANCE relating to building construction,and hereby autharkee representatives of this I- N city to enter upon the above-mentioned property for Wpection purposes. ' ALTERORADDTOMECH. Z Me)agree to save,indemnify an d tree armthe e City of Cupertino - Date Reecipt# V' against liabilities,judgments,cog ex n whlchmay in any ay caue AIR HANDLING UNIT(rO 10,10 CFM) SUBTOTAL: agalminud Ity In on of nt' of thle pemnIt.� - S AIRHANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX sign ppRE D e EXHAUST}IOOD(W/DUCT) CONSTRUCTION TAX PAID: mMATERIALS DISCLOSURE WIIltheap,B n re ,,,rrrrrr building occupant store or handle hazardous ){EATING UNIT(TO 1ng(00 BTU) Date ROCeI t _+y mlalthaas Safety by the Cupertino Municipal Code,Chapter9.12,and the 55 Piralth and Safety Code Section 25532(a)7 FIFATINC UNIT(OVER 100,000 BTU) TOT\ . ❑Yes . No .Will thaappliant or fuwmbulldingaecvpantuxequipr ntordevices VENTILATION FAN(SINGLE RFSID) �IS�UANGG DATE which emit hazardous air cortaminams as defined by the Bay Area Air Quality Management District? BOILER-COMP OIE'OR 100,M BTU) [Rave I—INo AUG (�p�Q have rcadtheh. ousmoteCa6requimm nbunder Chapter6.95o(. BOILER-COMP(OVER 100,0000N) 5 1D.7L. the Califomlx Health&Safety Code,Sections 25505,75533 and 25534.1 understand that if the bu llding does not ev meetly have a tenant,that it ix my NEW RESIDENTIAL MSCI 1. SQ.1T '/s responsibility to notify the occupant of the requirements which must be ort My Ur �NUrrnIIIT prior to Issuance of a Certificate of occupancy. .-I\L, Owner or authorised agent • Date - ISSUEDBY: �/6 OFFICE COPY