Loading...
B 0110 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITYOFCUPERTINO BUILDING-KLBCTRICALPERMIT NO. SI 1O BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. SOOO11 I `8 O13. BUILDING PR0JEC'9'LDEN'1'IFICA'TI0N BUILDING ADDR�:�� ' 1 SANITARY NO. APPLICATION SUBMITTAL DATE OWNER'S NAME:Fen US6� 1'IIONIi: CONT^CfOR'S NAM N/C L'ON'I NtJ.p s RCHI ILL /ENGI ER: LIC NO: AMISS: ( �� r ❑ CONTACT: ��P5 1`1101,11: p' [/CCJI! BUILDING PERMIT INFO �� �pJ` -�3 L p— ❑ Consultant Fees Paid by Applicant(initial) nOc ELECT PLUMB MUCH LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE y 1 hereby affirm that I an.Bce ted under,atwor ns of chapter 9(commencing _ JOB DESCRII PION CZ with Saadon]O01 Division 3ofthe lmomesvend Pmfessina,Coda and my l kens,is RESIDENTIAL: PERMIT ISSUANCE W 1in full4lrcc and eBccs`` � ❑SEB3WL ❑KITCHEN REMODEL aU License loss' Lic.N APPLIANCES-RESIDENTIAL. El ADDITION ❑PLUMBING RIfPIPE rF� Dwe�-/ Cootmetor ARCHITECTS DF.CIARATLON ❑MULTI-UNIT Cl STRUCTURAL ~hZ l undersand my plans shall beuud as puhire Home, PANELS MODIFICATION / UPTO200AMPS 7i© ❑INTERIOR ❑CHIMNEY REPAIR oz-Q r4.E'.W Licensed P..fessionul 201-1000AMPS IMPROVF.MHNf SWIMMING POOLS Y S J OWNERBUILDERDECLARATION OVER IIMXIAMPg ❑BATH REMOUEURIiPAIR DEMOLITION C C 4 I hereby aff it that I am exempt train the Contractor's License Law for the Sd d U following lesson.(Section 911.31.5,Business and Profossions Code:Any oily nr county SIGNS ELECTRICAL. ❑OTHER J-u LB a LL E' which requires a permit to construct,altea improve,demolish,or repair any structure V AQ r 1",1�0 Prior to it,issuance,ulso rcquime Ne.ppbcant forsuch permit to file.signedstmemrnn SPECIAL CIRCUIT/MISC. W;!(y that he le licensedpurxuanl to the provisions of the Contractor's License Law(Chapter 9 -00 h'ommemcing with Section 7000)of Division Sof the Business and P..Ex.imx Gde)mr 'TEMP.METLER UH POLE INS'I'. COMMERCIAL: 0,6 p C Lha he is exempt therefrom and the basis far the alleged exemption.Any violation of ElNEW BLDGIADDI'fEON ❑DEMOLITION SSdd r- Section 903 L5 by any applicant for a permit suhicell the applicant to a civil Penally of POWER DEVICES W� not mom than Bvc bundle dollars lS500), ❑'TI?NANT FOOD SIiRVICI? IMPROVEMENT =6 L ses owner of the proppe erty.or my employees with wages as their sole comnsation, SWIMMING FOOL ELECTRIC [D kc Owill Jo the work,and the stmemrc is not endednrnffemed far to(Sol 704E,Business ❑OTHER tai] m Emand Professions Cade:The Contractor's License Law Jxs not apply to an owner ofOU'I'LETS ;-SWITCIIIIS-PI%'I'URI?S C property who land:L or improves Iherenn,and who does such work himself or through his own employees,provided that such imprmontents arc not intended or offered for NIEW RIESIDENTIAL ELECTR n Its, Sl)n.. sale.If,hawever.1,c huildingor improvement is sold withinone ycarefcnmptefon,the SQ.FI'.FLOOR AREA S/SQ,FT owner-huilder will have Ne burden at proving that he did not build or improve torpor- ,so 0 1 o s Cosi. JUN [� 1.as owner of the properly,nm exclusively enamctlng with licensed cmmtmsrors i- OT �l nnstmat thees not (See.t)an wnerof andry whobnsds or i TheContthereon,Li- - waseLowdoesnstcpplynsan ithatafpropeny whobuilds or improves thereon,and QTY. PLUMBILN�'iIPE so, FEE ho contents for such pmjeets winhacommmnr(sl licensed pursoom to the Centimeters l� License Luw. PERMIT ISSUANCE I am exempt under Sec. ,B&P C fonhlsreason ALTER-DRAIN&VENT-W'A'TER IEA) VALUATION Owner Uate WORnderPCaltyof NSATION DECLARATION following HACK FLOW PR(TI'EC'1'.DEVICE I hereby affirm under Penalty of perjury one of Ne fallowing dedaet's Co, Ihave Pan,williialtia byinee om3i700 of CnnmmloCodefar for WorkersCompen- DHAINS-Po.00R.ROOF,AREA,COND' SE( TYPG CONS3'RUCfION neaten,vs provided fpr by Senior 3]00 of the hnlaa Gdc,far perfnrance of the work for which this permit is issued. PLX'1'UR11S-PER TRAP I hawof and will ash,fon Workers Compensation Insurance-h Ink Permit by Section 3700 of the Labor Gda(mr the performance of the work ha which this permit is issued. GAS-EA,SYSTEM-1 INC.40l1TLETs OCC GROUP APN My Worker's Compensutian Insurance earner and Policy number arc: Comer. Policy No.: GAS-EA.SYSTEM OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' GRIEASFIINDUSTRI.WASTf:INTERCIEPBOR COMPENSN'ION INSURANCE BUILDING DIVISION FEES _ ('Reis section need not hecompleted ifthe permit is formal hundred dollars 0Ran GREASETRAP or lcvc.l PLANCIfECK 1§:13 I cerlfymat in the perPommnceo(the workfir-whichthis permit is issued,lshall SEWER-SANITARY-STORM BA.200 LIE. not employ any pernan m' mon fir: m mSS�L i to the Workers'Compen- ENERGY FEE o Z '.tion L.ws of Cal' to r "�U WATER HEATER WNENT/ELECIR Z 0 Applicant �crs rs GRADING IEE i..t rNi NOTICE'10 APPLICANT.If,afOlmaking I is Ceniticate of Exemption,you should WATER SYS'I'EMO It EATING become subject n)the Workers Compensation previsions of the Labor Code,you must SOILS FEE UJ WATER comply with such provisions or this peril shall be deemed revoked. WATER SERVICE UZ CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL 1'LMB. SQ.Il'. PAID Dor leen t p LlQ kferebyaffrthin there Esand(Sm.i30 lending agency for the perfurunce of p w !-t theworkNance ch this peril is issued(Sea J099,Cis.C.) •F`--�t Lender's Nance 101'AL: IULJ Lenders Address TOTAL: 1 certify that 1 have must this application and state that Ne atone information is BUILDING FEE h correct.[same Ile vamply with all city tern county omninances and team Lrws rcl:ting NI In QTY. MECHANICAL PERMIT PEE )Z buildingeonsruetlon,andhemhyauthmrixe representatives oflhis city inciter upon the SEISMIC FEE above-mentioned property for inspection purposes. PERMIT ISSUANCE (1 (We)agree es suvq indemnify and keep hatlessthe City of Caperiraagainst 9LECIRIC FEE t v liahilities,judgmenw,msts and expenmhwhich may in any wayaccom.gansteaid City ALTER OR ADDTO MECH. - in asequence gm of the ntingaf this Fermi. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,001 CFM) SOURCE REGULAIONS. MECHANICAL Igili T AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX S,mitarremfApplicurn/Commanor - Data FEXIIAUS'I'HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will lheapplicam ter fmurctuaddingmcrp:tmstore mhanJlchazmdmonumnal HEATING UNIT ITO 100.000 IT LEE as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safcty Cade,Section 25532(.)1 I[EATING UNIT(OVER 100,0k)BTU) ❑Yes ENm VENTILATION FAN SINGLE RLSID) PAID Will the applicant or frame building.urpam use equipment or devices which Dam Receipt If emit hamrdoms air concomitant,as defined by the Bay Amu Air Quality Management BOILER-COMP(3HP OR 100.000 BTII) TOfAL. District' BOILER-COMP(OVER 100,(X10 BTU) El yes []No AIR CONDI'['IONF.R mad W ' Ih.ve the hazous material,requirtmenn unJer Chalner695 mf the Cali- - ISSUANCE ATFn Tunis Health&Safety Code,Salinas 255(15.25533 and 25534.1 understand that if the NEW RESID ENTIAL MECH. SQ.FI'. el I _q 'I hnilding Aoca nmI aarcntly htrvc u leant.Nvt it is my respoasihllity m notify the nreuPam UJ( of rhe requirements which must he met pdnr m isxuance of a Cenificam of Occup:rnry. Ownerormahorival agent Dan TOTAL ISSUEDBY: OFFICE