19950 APPLICANT TO FILL IN INFORMATION WITHIN REDLINES — USE BALL POINT PEN ONLY
Building project Identification - PERMITNO.
Building Address:
19950
Regnart-, RI wnera ante. Phone:
APPLICA UONSUBMII IAL DATE
Wolis 253-7772 CITY OF CUPERTINO4BUILDING DIVISION CTO
Contractors Name: - o: APPLICATION /PERMIT L C
A.A.A. Furnace C O .. O S O J1 .N 36 BUTLDINGELFC IRICA4PLUMBINGMECHANTCAL CATEGORY CONTROL 0
�. Architect/Engineer..: Lic.N. _
FEE, "BUILDINGTERMITINFO,',;:-- ',
`Q rY' ' ',"fiLECTRiG'PERMIT, • ,. . �='
Address
IBRM1775SUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION '
]hereby offirm that l am licensed under provisions of Chdpter9(rommenc- MPLIANCPSRESIDEMTAL ]OB DFSCRITTON
Inense 1 Season incensed
effeon3 olthc Buslnemand ProfeaaloneCode,and my 4
license Is In full force and Mfect. PANELS
anrecl _ cry{y�y 346361
nate-8-3-0–�A"�i;''S & VAp—Furnaee Till-100onMI S.
I tuty . OVER 1000 AMPS s/SQ.Fr.
SCOC Iundentand my plaweMlM used upublic rcrords � � - SQ.FT.FLOOR AREA
oU' Licensed ProfessionalSIGN5 ELECTRICAL 0
6 OWNER-BNLDER DECLARATION SPEC
IALCB2CUIT/MISC
0. A
r-- y IFereby afOrmthat lam exemptfromthe Contractors License law for the 1,-�• R
following reason, 700]5; �
Business and Professions Code:Any city or P.MET OR POLE INST. IC.�
FE� countywhlchmqulresaperMttocowtmdaltegimpmve,den lBh,ormpair B
Onu anystraciam prior to its lasuance,ebo regWrealFe eppBcant(or such perMtto POW DEVICES O
4 Ole a signed statement that he Is licensed pursuant to the provisions of the
3"G Contractor's License Use(Chzpter9(rommnndngwith Section 7000)of East SW'P4MING POOL ELECTRIC
sion3mfthe thednessand Professions CedOmthat he lsexempt therefromand - ALUAUON
G the basis for the alleged exemption. Any violation of Section 7031.5 by any
1�G5 a'
applicant fare permit subjects the applicant to a civil penalty of oat mom than OUTLEISSWITCHFSIIXTURES
E flue hundred dollars(x.00). NEW RESIDENTIAL ELECTR �,Ff.
�n I,as owner of the ro STORIES M'ECONSTRUCTION
p pelta,or my employees with wages r thele dole
Q compensation,Busdotsework,andthen ode:Th natintended ldcarsedfor
❑ sale($ec.7044 Business and Professions Code:The Cantranore License Taw
� $ don not apply to an owner of property who builds or improvm thereon,and OCC.GROl1I' RESUNTTS
who donsuchwork himself orlhmugh hlsownemployeee,provided that such
improvements are not intended oroffered formic.If,however,the building or TOTAL: '
Improvement iaseld within oneyearofcamplettoq theowner-bullderwill have
t rdea of proving that he did net build or Improve for purpose ofsale.). QTY, ;.,;?'t, 'PtiLID4BING PERMIT " ':'.FEE ', plOpppp],}p ppN
u L as owner of the property,am exclusively contracting with licensed PERMRISSUANCE
contractors to construct the project(See 7014,Business and Professions Cade:
The ContnRoes License Law does nat apply to an owner of property who ALTER-DRAIN kVENT-WATER(EA)
builds or Improves thereon, and who contracts for such p(ajects with a
cactor(s)licensed pursuant to the Contractor's License Law,
7nta . 'FEE SUMMARY
RYI am exempt under Sec B k P C for this reason BACK FLOW PROTECT.DEVICE
Owner Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
WORKMAN COMPENSATION DECLARATION RECEIPT N
❑I hereby affirm that I have a rertIDote of concent to self-Insure,or a" FIXTURES'PER TRAP SCIIOOL TAX Y N
mni0ate of Workers Compewtion Imumnmara mnified ropy themof(Sec. RECEIPT N
3800,Lab C.) GAS EA.SYSTEM-t INCA OUTLETS PARK FEE Y' N
I'allry
any p_ IC—' -7..&_1-O 2-3 GAS FA.SYSTEM-OVER 4(PA) RECEIPT p
Com U- -A— BUILDING DIVISION FEES
Certified ropy is herebydWith the
ed.city GREASE/INDUSTRL WASTE INTERCEPTOR PLANC14ECK FEE
C�I cenmea ropy Id mea..am me eery inspection airramn.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRM PAID
COMPENSATION INSURANCE SEWER SAFIRARY
(TFlssetlion need not becomplelea ifthe permit Leforone hundreddollars 'SRM EA.200Fr. Date Recei tilt
(510I orrilythat in the proformentrue ofthe work for which this permit is Issued 0)mless.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y N
I shall not employ any person in any manner m w to become subject to the . WATER SYSTEM/TREATING
Workers'Compensation laws of C.I forma.Data PAI p
Z Z Applicant
Z O NOTICE TO APPLICANT;If,after making this CcnifEate of Exemption,you NEVRESIDENnALPLMB. SQ.FE Date RCOCI Iq
Fshould become subject to the Workers'Compewat ion provisions of the Labor TOTAL:
W0 Code,you must fort hwith comply with such provisions or this permit shallM
> deemed revoked. 3 DINEl
4. p consrrtumoN LENDING AGENCY SEISMIC FEE
I hembyaf0rmthat there isacowtructlon lenaingagency forthe perform- TOTAL: ELECTRIC FEE
O ante of the work for which this permit et Issued(See.3097,Civ.C.) "
V rander'e Mame PF - .. PLUMBING PEE
Iy — aero nddreaa QTY. MECHANICAL PERMIT', ' FEE. : MECHANICAL PEE
O W Icenlf thstl Mvere.dthlsa Ilatlonand statetMtthadarecinformation
IL is cormci.lagree to comply with all dtyand county ordlnanres and state laws 1 ' PERMIT ISSUANCE 1Z .00 FEES FAIR:
relating to bet iding rowtrudan,and hereby authorize reprexntatives of this -
I'- Z city to enter u Pon the above-mentioned property for Inspect ion purposes. ALTER OR ADD TO MICH.
— 1. (W a re to save,indemnify an d keep harmless the City of Cu Fenian Date _ _ Receipth
retha iticajodginmrts,rost ndexpenenwhichmayinanywaysecme AIR HANDLING UNIT 10,000CFM) - SUBTOTAL•
agaiwtal Chyle segue the granting of this permit.
_ AIR HANDLING UNIT(OVER 10,000Cr•'M) CONSTRUCTION TAX
piss /Con 9-0- IXI-IAOS'f FI00D MIDUCT) CONSTRUCTION TAX PAID:
HAZARDO MATERIALS DISCLOSURE
W111 the applicant o rebuilding occupant store or handlehazardous HEATING UNIT(TO 100,000 BTU) YOIl Date CCI IN
material as droned by the Cupertino Munidpal Code,Chapter 9.IZ and the
Flealthand.'WetyCadae�.S�ection2553T(a)?- HEATING UNIT(OVER 100,000 BTU) TOTAL:
Yr. - Ili No •
Will the applicant ortown,building'occupant use equipment or devices' VENTILATION PAN(SINGLE RFMD) S�R$$u N TE
Which emit haardous air contaminants as defined by the Bay Area Air
. Quality Management District? BOILER-COMP pFIF DR 100,0(q BT LE
4 Yea C No
have read the M1azar srwtedab requirements under Chapter 6.95 of BOILFIbCOMP(OVER 100,000 BTU) `
the California I lealth k Safety Code,Sealow 25505,25533 and 75534.1 I
understand that lfthe building does not currently have.tenant,that It E my NEW RESIDENTIAL MECH. SQ.FT. v
rnpowibi' if yt antof ulmmentsw hmust be met ,
prior ssuanceo C Ificate of anry. fn1�
Owner or rind agent- `9at ISSUED BY:�— / �
. TOTAL: 3.0_.40. ll
OFFICE COPY