Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
23771
:APPLI!;ANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification 7 PERMIT NO. Building Address: / ©G y I 23771 ! OZ r �"�Y �.J.JLJ n rs vrc: one: v A A e '13bjjoj6G CITY OF CUPERTINO-BUIL DIVISION Courador's Name: Lie.No: APPLICATIO ERMIT Amhliect en BUILDING-ELCCTRI A ING-MEC ICAL CATEGORY C Lk.No: QTY ELE TRI PERMIT FEE BUILDING PERMIT INFO Addmse I'FRF4T[ Ah Wm that ED CONTRACTOR'S DECLARATION Ihereby ectionemlhatl amlicensedoftheerpossand sof Chapter adoes9dc,and c- APPEAN .SIDENTAL JOB DFSCRB'fION ingwith Division ofthc Businessand ProfesaonCode,end my license Is in full(ism and died. License Clan Ic.9 Dale Contractor ARCHITECT'S DECLARATION 2 "00(i— MZ I understand my plans shW be used as public records. IPDWFRD SQ.FT.FLOOR AREA S/SQ.Fr Ij Licensed Professlorul C\LOWNBR-BUILDER DECLARATION `Iherebyafflrmthat lam exempt from the Contractor's Lirense Lwforthe I � O' eOca following masen.(Seat=7(0IS,Businea and Profession Code:Any city or "telR EINST. Fcountywhkhrcqulresa per wmmtmL, aAter,lmpmve,demoltah,orrepair lOQanystmdmprlortoitsbmance,at,sorNuimtheapplfmtforsuchper tto J- O K a U file a signed statement that he o licensed pursuant to the provision of the ) Ow Contractor's License Law(Chapter 9(mmmendng with Section 70()0)of Dlvi- SWIM14NG LELECTRIC 5 sion3ofthe Buslnevand ProfmlonsCode)orthat hebexempttherefc cd VALUATION f2vEi �"J the Faso for the alleged exemption. Any violation of Section 7(015 1 any �� ot morethan OITLTCHESFlXTUREs applicant fora Permit sub'kctatheaPPlicant to a civil penalty yof n ` D a QQ By,hundred owner of SQ.FT. STORIES TYPECONSTRUCTION NEW RESIDENTIAL ELECTR ❑e as owner ll the property,or he employers with wages r thele sok _ C7a compensation,Business and Kand desuoeiCde:TheCIntended actoe o License Law d s� 5 O sale(Sec. ppy to Businessand punpelon Code:TM Contractors Llmme law whododoes tapply loan owner ofporthrough who nemoyees,pooldedthatand OCC.GROUP RFS.UNITS E improv ss, tastework tInten Intended ownemploym,provldedihatsuch improv mems solei intendH oraofearnorsa n,the oweveq ilderwding orl have TO Improv menti roving thin°nsyearofcompleBon,rhe owner-bullderwill have n en orpro�mgthatbe did not Wildorbnpmveforpa rposeoraak.l. QTY. PLUMBING PERMIT FEE FLOOD ZONE APN L e owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE t nton on to rontroctthe project(Sec.70940uslnesa grid Profcalon Code: I Contncior's License law dnes n.apply to an owner of property who pLTIILDRA[NA VENTWATER(EA) builds or Improves thereon, and who contracts for such pt,ajeds with a aur(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY c d I am exempt under Sec. B k P C for this reason BACK FLOW PROTECT.DEVICE DRAINSFLOORROOF,ARFA,COND. SANRARY Y_ N_ Owner Date RECEIPTN WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP TOOL TAX Y_ N ❑[hereby affirm that 1 have a rertlRote of consent to self-Insure,ore RECIRPT N 3800t1IabC Worken'CompenaBonlnurance ore ceH(kd ropythereof(Bee. GAS EA.SYSTEM-1 INCd0`J'll s P FEE Y_ N_ RECEIPT'N C.ffCPolicy GAS -EA Rd(EA) BUILDING DIVISION FEES Cam any ! r v �CertiBed copy o hereby furnished. GREASE NDIISTRUINASTEI TO P NCI-IECK FEE 4 ❑Certified copy o filed with the city lnpedkn division. CERTIFICATE OF EXEMPTION FROM WORKERS GREASE - I Lf I PAID COMPENSATION INSURANCE SEWER-SANTT .XIOFT. Date RC CI #j (1'hlssection need nor be completed lithe permit o for oro hundred dollars (81 Bal ar levJ ENERGY FEE Y_ Immlythat In the performance of the work for which this permit is ismed, WATER TERW/VENT/ELECTR 1 shall not employ any person In any manner ro as to become subject to the WATER SYSTEM/TREATING Workers compensation Lew.of CalifornL..Date PAID O Z Applleant NEW RESIDTNIIAL PLMB. SQFT. Dots'. Recei t# Z U NOTICE TO APPLICANT:If,after making l his Certificate of Exemption,you HN should become,subject to the Worken'Compensation provolons of the Labor TOT CC Code,you most forthwith comply with such provisions ortho permit shalt be BUIL IN W ] deemed revoked•CONSiRUCT10N LENDING AGENCY S EISMIC CL C I herebyaffirm that there o a construction lending agency for the perform- TO D Z ante afthe workfor which this permit o Lawed(Sec.3097,Civ.C.) OLender's Name 8 ELL F Leminr.Addms. QTY. MECHANICAL PERMIT FEE E ICALI cerdythat l haveread this application and statethatthe above infomation iO W incorrect.I agree tocomply with all city and county ordimecot.nd state laws PERMITISSUANCE E ID:} a rcizlingt building conWdlon,and hereby authorve representatives of thisZty toepnbeabuve-ere Honed property for Inspection purposes. ALTER OR ADD tt)MECH. Da[c Remipt# (W ogee to.ave,Indemnly an d keep harMem the Clty o!Cupertino agoln llablurts.,7adgmenU,amtaandempenntwhichmayfnenywayaceue AIR HANDLING UNIT(TO 10,00 CFM) S BTOTAL: agal t said yinconsequenceof tbe g oftAIR HANDLING UNIT(OVER 10,000CFM) NSTRUCTION ASgna m.fApp rat/Contmckm' EXHAUSTHOOD(W/DICT) NSTRUC_:CION XPAID: HAZARDOUS MATERIALS DISCLOSURE Will the appBont or future building occupant store or handle haurdous HEATING UNIT(TO 100,000 BTU) Date R i t# material as defined by the Cupertino Municipal Cade,Chapter 9.17,and the Hnithand S.fety Code SeHon25532(a)7 HEATING UNIT(OVER 100,000 BTI) TO L: CC��I Yes No VENTILATION FAN(SINGLE RESIDE hick odt ha7anenior vwuarre nmeing acmpant usedby the Bay nt Area devices ISSUANCE TA E whicheManage ent air rIc17 mss defined by the gay Arca Au Quality Management D'uWNo BOILER-COMP DHI'GR1(IO,1XT)BTU) 4Yea C�Na U8,18199� havercadthe h r�iousmateriao"otormentsunderChapter6.95of BOILER-COMP(OVER IW,000 BTU) the Callfomk I lealth h Safety Code,Section 75505,25533 and 25539.I undmtand that if the building don not currently have a tenant,that it o my NEW RESIDENTIAL hfECli. SQFT car yUr Gpi I11VV responsibility to natty the occupant of the requirementsco which must be nt rial prior to Issuance of a Certificate of Occupancy. NN Owner or authorized agent Date ,roT �� ISSUEDBY:�E Ft OFFICE COPY