Loading...
22926 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY s;ildin Project Identification PERMIT NO. Building Add� W G7 . 22926 ne A A sere sV�J� a CITY OF CUPERTINOLBUILDINC DIVISION / coma o ,nonce: L IJA IL APPLICATION /PERMIT L C/ BUILDINGELECTWCALML BING-MF FT t,7CAL CA�RY CONTROL# Architect/Engineer. Lie.No: - QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addrcm PFRht1T ISSUANCE f.Yl ❑ ❑ ❑ LICENSEE CONTRACTOR'S DECLARATION I�f I herebyaon7000)that I Divisised on ofthe erpessand sofChapter 9 frajmaC2de'.(oneemenc. my API'LIANCESRF.STDEN7IAL JOB DLSCKB"DON 11...I.I. a deffeon3 olthc Buelvasand Profe ane e,and my license is in fu and effect. _ O PANELS 1 V-\y`�[Q"1/!f` �h Llmnu�C��IQj Lie. # l Date far*YI�Cantraam S/ iOj AL so ID B ARCHITECFSDECLARATI 201-IOW A.MIsS M 0 7 I undentand my plan shag W ua d as public records OVER IWO AMPS SQ.FT.FLOOR AREA $/SQ.FT. 0 Licensed Professional SIGNS ELECTRICAL _MTAL E D IN G 6 w OWNER-BUILDER DECLARATION res R Fn SPECIALCIRCUIT/MISC t., 7 1 hereby af0rm'hat I am exempt from the Cont radar's Limnse Lew(or the Z$� p following reason.(Scetion 70115,Business and Professions Code:Any dy or countywhichrequirenaperndtWmmtmMWter,improve,demolbh,orrepalr 7EMP.ME1'ERORI'OLE INSI'. few reJ any stmcture primto its issuance,aborequirestheappllvnt fmsuch permit to POWER DEVICES DATE W6�i1 file a signed statement that he is licensed pursuant to the provision of the Contractors Licene Law 9(commencin with Section 7000)of Divi- VALUATION 6 Ater gw SWIMMING POOL ELECTRIC F,V1 sion3ofthe Bus mand ProfessionCWe)orthathebeumpttherefmmand L 6 5 the bash for the alleged exemption. Any violation of Section MIS by any OUiLETSSWITCHES IX17URES Ay SQ U a applicant fora permit subjecta the applicant to a civil penalty of not mare than live hundred delta.(5500). NEW RESIDENTIAL ELECIR /G F-1 1,as owner of the property,or my employees with wages as their sole SQ.FL STORIES TYPE CONSTRUC PION compensation will dothe,work,and thestruclure b not Intended or offered for 5 0 ask(Sec 7044,Bwiness and Professions Code:The Contractors Lt..Law F{$g does not apply to an owner of property who Wilds or improves thereon,and OCC.GROUP RES,UNITS "www who does such work himselforthr0ugh his own employees,provided that such Improvements arc not intended oroffered forvle.If,however,lhebuliding or TOTAL: Mproverren'b sold withi...ora..f ecmpldio0.the owner-builderwill have thc9mrden of proving that he did not build or improve for purpose of axle.). QTY. PLUMBING PERMIT FEE Lj I,as owner of the property,am exclusively contracting with licensed FLOOD ZONE APN contractors to construct the project(Sec.7044,Business and Professions Code: PERMIT ISSUANCE The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VEM-WATER(EA) Wild,or Improves thereon, and who contracts for such ptojeces with a egn1(actor(s)licensed pursuant to Me Contractor's License Law. BACK FLOWPROTECT.DEVICE FEE SUMMARY L j 1 am exempt under Sec B k P C for this maven ex DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y N_ ' Owner ECL RECERT N WORKMAN COMPENSATION DECLARATION FDnURpS PER TRAP SCHOOLTAX Y_ N ❑I hereby affirm that I have a l certificate of comm to opytnsure,ora RECE'C# certl,lab ofWorkers'Compevatlonlvurancemacedlfled ropy'hereof(Sec. GAS.EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N 3800 Tab CJ RECEE'T 4 Polley p GAS EA.SYSTEM-0VER d(FA) Com y BUILDING DIVISION FEES C ❑ed copy b hereby 'shed. GREASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE edified ropy b tiled with the city W pection dlvlrlon. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCESEWER-SANITARY-SCORN Esu.?OOF I'. Date Recei lq CfMssedion need nat M completed It the permit b tarov hundred dollars ($100)arless.) WATER HEATER W/VENT/F7.ECTR ENERGY FEE Y_ N_ I mrtify that in the performance of the work forwhich this permit b issued, I,hall not employ any person In say manner m as to become subject to theWATER SYSTEM/TREATING Workers Compensation Taw,of Cal fomb.Date PAID 0 Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Remi t# Z O NOTICE TO APPLICANT;If,after ranking this Certificate,of Exemption,you should became subject to the Work 'CompensaHon prevfsho s of the Labor TOTAL: CC en mu N Code,you st forthwith comply with suchprovbv loorthispermitshallbe BUILDING FEE 2x00 dd voked. W ' mmereCONSTRUCTION LENDING AGENCY SEISMIC FEE a Ihereby affirm that there bamnstructlon lending agency for the perform TOTAL: ELECTRIC FEE D Z ance.flhewmkforwhich this permit b Issued(Sec.W97,Civ.C.) PLUMBING FEE C) 0 lenders Name F Lender'sAddress QTY. MECHANICAL PERMIT FEE OW Icertllythatl havercaathbapplicationani astetheuheabovat.1mmztIDn MECHANICAL FEE 1 Is cmmd.Iagree'.comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID: >. relating to building construction,and hereby authorize repm tathesofthb F N city wenterupon'he abovnmendavd property for lvpectlon purposes. ALTER ORADDTO MECH. _ Z Date Receipt# (We)agmc to save,Indemnify and kFetters Ic%ma in any Cupertino AIRHANDLINGUNTT(TO10,000CFM) U gsimtlbbi0uea, dg nn, owaand exp nses wM<h may In anywaya see SUBTOTAL: against as CBI lest segueegrami .(this permit. . /o si AIR HANDLING UNIT(OVER IO,000CFM) CONSTRUCTION TAX Signature of App nt/Contractor Date EXHAUST HOOD(W/DUCCI) CONSTRUCTION TAX PAID: HATAR DOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date ReceI tis material as defined by the Cupertino Municipal Code,Chapter 9.12,and the I lealth and Safety Code r.-Section 25532007 HEATING UNIT(OVER 100,000 BTU) TOTAL: Q Fj Ye, II No Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air ' Quality Management District? BOILER-COMP©ER'DRIW,OW RTU) PAID Ys MN. haveread the hazardms materialsrequiremenbunderChapter6.95 of BOILER-COMP(OVER 100,000BTU) the California Health h Safety Code,Sections 25505,75533 and 25534.1 OCT 31 1981 understand that if the building does nolcurrenlly hrveatreany lhatit fancy NEW RESIDENTIAL MECH. SQ.FT. responsibility to notify the occupant of the requirement,which must be reset prior to issuance of a Certificate of Occupancy. CITY OF r CUPEHIINU Owner or authorlud agent Dale ISSUED BY_�, TOTAL: OFFICE COPY