Loading...
20444 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BuildingProject Identification PERMIT NO. Bjl�i xxPi4M .o .1-wue 20444 wners me: 257. hone: p W� K906((� -� E tZ( Zd 0 CITY OF CUPERTINO-BUILDING DIVISION Co^ntr�ad�ols Name: l. . I - Lic.N. APPLICATION I PERMIT S�2a r..+� �hdt 12-INO Vie"II BUILDING-ELECTRICAL PLUMBING- CATEGORY CONTROL Architect/Englecer. Ge No: MECFIAMCAL +a♦/,, h QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address, / / , PERMITISSUANCE El ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby effirmthat lam lkmsed underprovlmone olChapter9(mmmmc APPLIANCESFESIDENIAL JOB DESCRIPTION ingwith Se ion7000)ofDlvislon3oflhe Buslmuand ProfeasioraCode,and my Ike..is In full farce and cited. PANELS f9�� � Gam( LlcenseClass LILY G` 1I Date Contractor ARCHITECT'S DECLARATION 201-IODOAMIS 0Wl understand my plans shall be used as public records. OVERIOOOAMPS SQ.FT.FLOOR AREA $/SQ.FT. O U�j Lksmed Professional SIGNSELECTRICAL 6Ff'go OWNER-BUILDER DECLARATION grECIAL CIItCNT/MISC 2 s,Tidy I herebyaffirm that am exempt(romthe Contractor's License Law for the o ❑ following reason.eiactlan 70315,B ala..rdl Professions Code:Any city or CZI"� contywhich requires.peitmmt t. rud,allertraprove,denolbh,orrepair TQAP.M urmETQ(ORPOLEINST. anystructure pal its lssuance,ab,acquires theapplicant forsuch permitto file a signed statement that he is Ilmneed pursuant to the Provisions of the POWER DEVICES Ou, Contraciole License Law(Chapter 9(mmmencleg with Section 7000)of Divi- t F,�OS SWIMMING POOL ELECTRIC RIC on3o(the Buslnessand ProfessionaCode)orthat hebeaempttherefromand VALUAn]1Q 6 the WIC,for the alleged exemption. Any violation of SMion 70315 by any fJ OO OUTLETSFSES SWI7CHF7%TUR , 'q applicantfora permlbubjeMtheapplicanl has civil pensllyofnat morethan .+'� Sw�l Ove undrecidollarseiM. NEW RESIDENTIAL ELECTR_SQ, v S177W[S TYPE CONSIRI1Cf10N ..�r �I,as owner of the property,or my employees with wages as their sole t mmpc..allon,wllldothe work d0themacture bnotinmaded or offered far y; '3 s �\ Cl sale(Sec.7094,Business and Professions Code:The Contractor's License law does not apply tom owner of property who Wilds or Improves thereon,and \ OCC.CROUP RES.UNITS whodoessuchworkhimselforlhr ghhlsownempleyees,pmvldedthatwch Improvements are net Intended orofkred forsale.If,however,thebullding or 1'` 'ZTOTAL: s f Improvement heold withlnomyearofcompldlogtheowaer-bu0derw1)1 have t an of proving that he did net build or Improve for purpose of sale.). QTY. PLUMBING PERIIVIIT FEE: FLOOD 7DNE APN as owner o!the property,am exclusively mnlracting with licensed PFR MIT ISSUANCE :" atractam to construct the project(Sec.AA4,Business a ad Professions Cade: a d Caatndor's License law don not apply to m owner of property who ALTER-DRAIN&VFNf-WATER(EA) �T Wilds or Improvescontracts thereon, and who contrafor such p(ojects with a .1 rgR�actor(s)licensed pursuant tothe Comradah License Law. - FEE SUMMARY LJ I am exempt under Sec. B&P C far this maven BACK FLOW PRO'T'ECT.DEVICE OUTSIDE FEES Owner DRAINS Ff-OOR'ROOF,AREA,'COND. SANITARY Y N j Date _ a RECEPTY WORKMAN COMPENSATION DECLARATION FIXTIJRFS PER TRAP SCHOOL TAX Y N ❑I herchy affirm that I have a cert10rn of consent to spytheum,ora SECI=Y cert)0rateofWorkers'CompemabonlNunna oracertified copythereof(Sec. GAS RA. IINC40 SES 3800,Lab CJ Si m- PARK FFR Y_ N Policy Y RECGAS EA.SYSTEM-OVER 4(FA) DING DI x Cam any BUILDING DIVISION FEES CertlRed copy 1.herebyfurnished.thehM. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCI-IECKFEE Certified copy b(fled with the city inspection division. CERTIFICATE.OF I](L'MP"ION FROM WORKERS' GREASE TRAP PAID COMPENSATION SEWER.SAINITARY-STORM EA 2DOT Date Recel t# (Thissedlon need rat et be W completed tithe pertNt b!Drone hundred dollar ($100)orfeuJ WATER HEATER W/VENC/EI.ECTR ENERGYFEE Y N Ill net thinemploy o the performance ny m work for which ca penult is booed, I.hall n' employ any Peron in any manner at n to become subjM to the WATER SYSTEM/TREATING Workcr%Compenutbn Gwe o(Gllfornla.Date PAID O Z Applicant NEW RESIDENTIAL PCMB. SQ.FL Date Race] tic Z O NOTICE TO APPLICANT:If,after naking this Certificate of Exemption,you should bemme subject to the Workers'Comperum ion pmvWaa of the Labor TOTAL: N Code,you moat forthwith comply wlthauch pmvblmu orthb permit&hall be > deemed revoked. BUILDING W C CONSTRUCTION LENDING AGENCY SEISMIC FEE 1 a Ihercby afOrmthat them b a construction leading agency for the perform ELECTRIC FEE Z arm ofthe work which this permit is Issued(See,3097,Civ.Q TOTAL: 00 Iendee.Name PLUMBING FEE U. F Lander'.Adderae QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Icertifythat l have readthis applkstionam matethat theabove Information 1 Is correct.I dgme to comply with all city aM county ordinances and mate laws PERMIT ISSUANCE FEES PAID: >. W relating to building mnstacdon,.nd herebyauthortm representatives ofthb F Z city to enter upon the above-mentinnd property for inspection purposes. ALTER OR ADD TO MECH. — (We)agree to save,Indemnify cur d keep harmless the City of Cu pert Ino Date Receipt# agauxtlIs ties,wdg nus,nems and noes wh le],nuy lnmywayoccme AIR I IANDLINC UNIT(TO 10,000 CFM) SUBTOTAL: ag net e 1 City In e ce o nting of t Permit. s _z1 AIRHANDUNG UNIT(OVER 10,000CF11) CONSTRUCTION TAX g reof Applicant/ irractor Date EKHAUSTHOOD(W/DUC'p CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will theapplicant orfuture building occupant more orhandle hannlous HEATING UNIT(TO 100,000 BTU) j)a _ _ Recei t# material as defined by the Cupertino Municipal Code,Chapter 9.17,and the Tkabh and Safety Coda Section 25532(a)1 HEATING UNIT(OVER 100,000 BTU) ""� TOTAL: _1 Na 1 the appllmni ts, Wrebulldingo pantueeequipmentardevlceslces VENIIATION FAN(SINGLE RESID) I IH�- O JSSYA IW DATE which emit hamrdous air contaminants as defired by the Bay Area Air civ .lily Management Dlstrld7 BOILER-COMP UHPOR 100,0N BTU) Yes No - - havenadtheh. o mmerlalsrequ1mmenhunderChapter6.95of BORER-COMP(OVER 100,000 BTU) gib-1 PAJ Gunerino the California Health&Safety Code,Sections 25505,25533 and 25534. I understand that if the building does not currently have a tenant,that it b my NEW RESIDENTIAL MECH. SQ.FT. responsibility to notify the occupant of the ratio Lmrrenls which most be met prior to Issuance of a Certificateof Ocnrpamy. Owner or authorised agent - Date �"�"0...1`(Ja1xSLi TOTAL: ISSUED BY: OFFICE COPY