Loading...
23550 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Pro e"Identification PP MIT'NO. Budding Address: 2� 23550 ';&0Vnes arm: one: Ig e or w, Cuiainj CITY OF CUPERTINO-BUILDING DIVISION c' • Comtndora Name: Lica Non APPLICATION / PERMIT —\—Z—Asi B(ALDINGELECTRICALPLUMBING-MECH LAICAL CATEGORY CONTROL Y Aahlted/Engineer: Llc.No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Add.: P[RA9TISSUANGE LICENSED Osmod under n OR'Serpr DECLARATION O ivith Syafarmthatlamlkeneefthe B.provblonsatChitio.C(rommenc- APPLIANCESRESIDENfiAL J01190IISCRRrrio.. InenseIIn fon 7000)of Dloffect otthe BuslndeandPro(esslonsCode,andmy �_ (!I license Is In full fog and effect. PANELS Llcen Clam �D LIc.N 6CQ672 Date B: Contranor (yap UP 10 2DO AM25 ARCHITECT'S DECLARATION 2014000 AMT'S LM 1Q+�rel Q❑ I understand my plans shall be used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.IT. E O(/ Licensed Professional I SIGNS ELECTRICAL fn OWNER-BUILDER DECLARATION SPECIALCIRCUIT/M15C - t �' 1 ZH, IherebyafflrmthatI am exempt from the Contractor's License Law for the I V P4 ❑ following reanon.(Section7031S,Buslneeaand PmI.km.Code:Anydty or /-^1 i, /. _ !� county which rcquiresapermit tume tmct,alter,Improve,demolish,orapair TG5?.METRORroLEINSf. T (' g anyatructure pdortoln Wuance,a horequireatheappdcantforsuchpermitto TOWER DEVICES �� ` I I� PJ O F file a signed statement that he Is licensed pursuant to the provisions of the Qb y Contractor's License Law swMhuNcrootRLECRC AT SOS smn3os he Business and exemption. Any hion of exempt therefrom and _ 770N O p5 the basis for the alleged exemption. Any violation of Section 70115 ni any OUTLETS-SWITCHES-FIXTURES applicant fora.arms(subjede the applicant to a cavil penalty of nil more thin .ACL` Ove I,aso owner ofthepr. NEW RESIDENTIAL ELECIR cope asowner l theproperty,ormy employees inwithended as offered sole _Si STORIES TYPE CONSIRIICTTON sole(Sc.70K dess ando the Prrl,andmes Code:Th Coot ntractortended or License Law O ask(Sc.7654.to a now owner f property Code: Contractors License law 5� whoddoes oessucht.pply toanownerofproughhis o nem oreproovideves thereon,and OCC.GROUP RES UNITS whodoeseuch workhimself a throughhisownemployees,providedthatsuch Improverrcntaarenot Intendedorof(eco !oleate,If,h ner-g deer ilingve TOTAL; 'unprovemant'swill withinoneycarolcompldlogtheowner-bullderwlllhave (t(9jurden of proving that he dm not build or improve for purpose ofwle.). QTY. PLUMBING PERMIT FEE p DZONE ApN LI L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE ce.micti n to.antruct the project(Sec.7044,Business and Professions Code: The Contme or's License Law does not apply to an owner of property who ALTER-DRAIN AVENT-WATER(PA) Wilds or Improves thereon, and who contracts for such paokM with a cop[(actor(a)licensed pursuant to the ContracmYs License Law. BACK FLOW PROTECT.DEVICEFEE SUMMARY I am exempt under See, B A P C for this reason OUTS 1 UP F Denner Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N RECEIPT p WORK MAN COMP ENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y_ N_ ❑1 hereby affirm that I have o certificate of convent to opy thereof or RECEIPT Y certificate of Worken'Comperuatlonlmurana ora certl(ed ropy themof(Sec. GAS EA.SYSTEM-1 INC.4 OUTLETS Poli lab C.) t PARK FEE Y N_ Policy Y RECLB'T N Com an CAS EA.SYSTEM.OVRR 4(EA) �..e Y BUILDING DI VISION FEES Certified copy ifiled with the city inspection division. Is hercbytum Certified copy la CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑ ty CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANffARY-STORM EA 200F1' Date RCCCI t# (Thlsse"ion need not becompleted ifthe ps it forone hundred dollen (SI00)ortess') WATER HEATERW/VENT/ELECTR ENERGY FEE Y N_ I certtiythat in the mance fthework rwhlch this permit Is Issued, — I shad not employ at non 1 ny man r o d t ecome sy feet to the WATER SYSTEM/TREATING Workers'Coon o Laws Ca[if ate' 2- PAID OZ Applicant NEW RESIDENTTALPLMB. Q.T. Date Refef t# Z 0' NOTICE TOA? L .If,afternu Certificate of Exemption,you should be..au othe Works eneotlon provisions ofthe Labor TOTAL: N Code,you must forthwith comply wl suchprovbimu orthis permit shall be j deemed revoked. BUILDING FE W p CONSTRUCTION LENDING AGENCY SEISMIC FEE CL I hereby affirmthat thea 6 a corutmction lending agency for the perform- ELECTRIC FEE Z. an.of the work for which this permit Is Issued(Sec.3097,CIv.C.) T ate' C) Q la'dder's Name PLUMBING FEE _ LL I- Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Imrillythatl havereadthisappliohonan matethattheabovc lnliumenlon bcoract.l agrato comply with all dtyand county ordinanmandstatelaws t PERMIT ISSUANCE FEES PAID: } C relating to building comtructinn,and hereby authorize rcprcsentatives ofthb 1— N city to enter upon the abovnmenlloned property for lmpection purposes. ALTERORADDTOMECH. Z (We)agree to save,Indemnify an d keep h rmlcss the City of Cupertino Date Receipt# O agalretliabillliey}dements,mate and expene which maylnanywayaceme AIR HANDLING UNIT ITO 10,000CFM) SUBTOTAL: agairutsaldC y Ir wqu mofthe ant epfth permit. NR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTIONTAX 21 AZARDOUSM CONSTRUCTION TAX PAID: Bigwtu t/Contractor Date EXHAUST HOOD IW/DUCT) SDISCLOSURE _ Will the applicant or future ruin occipantste, hapten le hazardous FSFATTNC UMT(TO 100,000811]) material as dented by the Cupertino Municipal Code Chapter 9.12,and the -- Date RCCCI f# Health and Safety Code Section 25532(a)? HEATING UNIT(OVER 100,00 BTU) TOTAL: �e ❑Yd N No Will the applicant or future building occupant useequipment ordevices VENTILATION FAN(SINCLE RESID) ISSUANCE DATE which emit haeurdous air contaminants as cleaned by the Bay Arca Air Quality Management District? BOILER-COMP OHP OR 100,000 BTU) 4Yue havercadthe h.2uNsomalerlalsreerylrcmentsunder Cha pier 6.95of BOILER-COMP(OVER 100,000 BTU) pp the California Health k Safety Code,Sections 25505,25533 and 25534. I P 1' Gt understand that if the building doll not currently have a tenant,that it is my NEW RESIDEf-MAL MECH. SQFTT. V rnpornhility to nolify the oavpart of the requirements which must be and prforto( uanceofa CertiticateofOmpancy. 1' qpR 19 Owner or authorized agent Data L, TOT ssuEDe OFFICE COPY