Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
04010117
CITY OF CUPERTINO - »d°��!•g.g*aa;=♦�� %�?(`•�>��3�" I�i�'+>^ �3 -�e�'' BUILDING DIVISION - PT✓RMIT CCONlRACTl/A4INFO44MATION _ A BUILDINGADDRESS: PERMIT NO 04010117 SA.NTAal A.RA. Air OWNER'SNAME: PERMITISSUEDATE ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH (� 0 �Op LICENSED CONTRACTOR'S DECLARATION' Job Description 1 Manby,affirm Net I am Ifwved under pmvisions of Chapter 9(commencing p �� with Scction]IXp)af Dividon Sof NaTyainessmd Professions Code,and my liccnu is in tall fort— B¢ ,_� Lla.0 apo RUN GAS LINE FROM METER TO COTTAGE j$Z Lie Cl Gaa'azmr �INALED ^^q ARCHRECI-g D ATION U 1 understand my plana shall W used public rtcnNa ;;� LwanxsdPmfeminnal FEB 1 0 2004 3 OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Comractors Licenu Law for the following reason.(Section 703 1.5,Business and Professions Code:Any city or county $ which requires a permit to construct,alter,improve,demolish,or repair any structure _iy prior to its issuanre.elsu requites the applicant for such permiuo filcasigncJ sutemcnt fpree thelheislicensed puuuanttothe provislonsnfNeCmetracmriLicensclLaw(Chap¢r9 Sq. Ft. Floor Area BU"Ra ton yh$ (commencing with Section?")of Division 3 of lW Business and Professions Cask)or Nat he is exempt therefrom and dm basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of er Occupancy Type not more than five hundred dollars(s500). 3 21*_N2bSATb. O O p y yp ❑1.as owner of the Property,m my empleyeu with wages u Heir sole eompewtlon, will do the work.and Ne structure is not intended oroaemd for sale(Sec.7044,Business end Professions Code:The Contractees License Lew does not apply to an owner of _ Required Inspections property who builds or improves thereon,and who does such work himself or trough his own employees,provided Oat impmwmenu arc not Intended oroRered forage.If, however,the building or improvement is sold within ane year of completion,the owner. builder will have the burden of proving thin he did nal Wild or improv far purpose of sale.). ❑1,v owner of the property,am esluainly contracting with licensed contractors to conswer dm project(Sec.70",Business and Professions Code:)The Connector's Li. cove Law does not apply to as owns of property who Wilds or improve timrton,ted, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. - ❑lamexemptunderSee ,BkPC for this moon 0 v wner Date _ WORKER'S COMPENSATION DECLARATION 1 hereby M.under family of perjury one of the following declarations: I have and will maintain a Certificate of Covent toulf-insum for Workers Comport- $Alien,u provided for by Section 37M of the Labor Code,for the Amformauc of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance.ex required by Section 3?00 of Ne Lobar Cade.for the performance of the work for which this permit is issued. My Workers Compensation Ivumnme artier and Policy umber a-rt(7: No.: 7k3 fCFM Dl D COMPENSATION INSURANCE (LTtssection need not W completed if the permil is rormtehundred dollars($ip)) or Mas.) I cenify that in the performance of the work(or which this Permit is issued.I shell not employ any person in any manner An u to become subject to the Workers'Comlacron lon Laws of California,Data Applicant t NOTICE TO APPLICANT:If,after making this Comficste of Exemption,you shnulil became suhjeet to the Worker's Compensation provisions of the labor Code,you mug .JO forthwith comply with such provisions or this Permit hall be deemed mvokcd. 'Z'-" CONSTRUCTION LENDING AGENCY 4 F Ihereh affirm that there i$a contraction leading a enc for Ya g g Y'n Performance of .. dv > the.,it for which this permit I$issued(Ser.309?,Civ.C.) W Q Lender,Name ;0 z Lender,Address V Q 1 cenify thg 1 have read this application and aura Net Rte above infmmnian is ty ^. amounts.I ree m to comply with all city and county onl nmucc3 and sum laws relating C) rV^ building construction,and hereby Authorize reprtsemuives of this city to enter upon me �0.Wi aWvcmemianedpmparty ire inspection which ms (•+ (We)agree to save,indemnify and keep harmless the City of Cupertino against V5 inconsequuce,ofue costs and expenses which may in any way eccvc against mid Ci ty U Z A cPLICANTc UNDERSTANDS of this Permit. APPLICANT UNDERSTANpS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURCE RE IONS. Re-roofs mute AppheanUCo auto' Dam HAZARDOUS MATERIALS DISCLOSUR Type of Roof Will be applicant or future building occupant store or handle hazardous material as dented by the Cupertino Municipal Code,Chapter 9.13,end be Health and Safely Cade.Section 255324)? All roofs shall be inspected prior to any roofing material being installed.❑Yea (21N. Will the applicant or future building Occupant me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hazardnusai r contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. term? p ❑Yes fgNu I have mad the hamadous mauriais m4uimmenB under Chapter 6.95 of the Cali for. Iia HcAllh&Safety Coda Sectors 25505.25533 and 25534.1 undcmaod that lithe Wilding Jou not currently have a tenant that it u my responsihility to notify IM mcupanl of the mquimmen 'ch muss et prior to issuance of a ccopficam of Occupancy. Signature of Applicant Date tam 0 amhan'rnJ All roof coverings to be Class "B" or better " a em Dem g CITY OF CUPERTINO o 4010V CITY of PERMIT APPLICATION FORM CUPERTINO ma P APN# 7 J Date: Building Addr ss: Owner's e: Phone#: Contractor: License #: 4/51o,�a/ � 6 3©0 Contac • Cupertino Business License#: Div ilding Pe it Info: Bld Elect ❑ Plumb Mech ❑ Jo e 'ption: ential IN A))v o mercial ❑ Sq.Ft. Floor Area: /Sq.Ft.: Cost of Project: / Occupancy Group IV i Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER] Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. HousingMit. Fee BUILDING _# -2 3o - I of J--) CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM -QuantityFee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTMIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 SRICITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group1 BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL . BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance . MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUU DING BMISCELL Building Mise Fees BUILDING • 3 of 3