Loading...
29761 APPUCANTTO FILL IN INFORMATION WITHIN RED LINES•USE SALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. ^ ^ .a BUILDING DIVISION APPLICATION/PERNHT PLUMBING-MECHANICAL '2 UJ 1/ l6J BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: I eI-saL-s SANITARY NO. APPLICATION SUBMITTAL DATE OwHER'S NAME: PHONE: CO OR"NAME: LIC NO: 1/ 7 N/C COMI'ROLp �qRC!ITECT/IiNGINFaiR: .�C "L NO. ADDRE S© JUL, ElT J `Vtis � 4 V e CONTACT. 1k',,44S PHONE:p Q BU ILDINC PERMIT INFO ^'I Mr y pa —;139 ❑ Consultant F¢Cs Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH (E0� n rd X ❑ ❑ ❑ LICENSED C(oATRACIUR'S DECLARATION 11S TY. - EL177CTRIC PERMIT FEE I hereby alarm thou,I oin licensed under provisions of Crooner 9 moaimeSaiir, JOB DESCRIPTION "Z th Section 9IXg7of❑ivision3of Ne Business anJ Profusions Cdule,antl mylimnm is RESIDENTIAL: W00 wo PERMIT ISSUANCE mfoilforvarindeffec ❑SFDWL ❑KITCI TEN REMODEL. .F�UU License Clan. Lic.k - APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPC N Q 4 Date Commcmr � [-.0y> ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL ZO p 5 C 1 understand my plans shall be used us public records " MODIFICATION . 6PT020i)AMPS ❑INTERIOR CHIMNEY REPAIR P41- Licenced Professional 2111-IWIIAMPS IMPROVEMENT OWNER-BUILDER DECLARATION OVER II0x1AM1'S ❑BATH REMODEfJREPAIR ❑DEMOLITION C 1 hereby affirm that 1 ant exempt mom she Courant License Law for the LL0yu followingEl OTHER V- O _E a IAD bit Z mason.(Section 9o365,Business and vin,oloannifi Code:Any can or county SIGNS EhliCf ICA I rGRZC� ' N--r loilil LL which requires n permit m canstrud.alter,improve,demolish,or repair any cwewre or, prior m its issuance,also requires the applicant for such pcmd,to file a signed statement SPECIALCIR T/fi5 . 011 >, that he i,licensed punned m the TO.. innsofthe Contmnors License Law(Chapter9 , 00 (commencingSec,ion91NX1 of Diviainn 3 or the Business and PrOrmsci...Code)or '1'9MP.MHTER OLH REST. fOMMF_RCIAL• 6 e y that he is esemm therefrom and the basis for the alleged exemption.Any violation of - ❑NEW BLDG/ADDITION ❑DEMOLITION Y• Section Ill 15 by any applicant for a permit suhiccsa the applicant m.civil penalty of EAKER DBVICES ^m - El TENANT ❑FOOD SERVICE not more than live hundred dollars 05001. F >' IMPROVEMENT CEI 1,as owner of rbc progeny,or my employees with wages astheir aide compensation, SWIMMING POOL ELECTRIC and dmhework,and On.Cod isnot intended O1.0.do for sola(Sec.Ary,Business ❑OTHER L and Professions Calor improves eves th ram License law docs not ripply s if owner Of OUTLETS—SWITCHES—FIXTURES .. property who builds or tided that t such and who does such work deed or or through his own employees,provided that such improvements thin not yearofi or olYercd for NEW RESIDP.NTIAI.CLIiLTR SQ FI'. wool,howevcnthe vethnburdenmvemmnt is sold didironeildoriprovetforar, SQ.FT.FLOOR AREA fISQ.Fr. wnerbuilder will have the burden of proving that he did not build or improve for pur- posenfsale.). ❑ 1,as om wner nr the mismy.aexclusively contracting with licensed cantaacium To TOTAL: rorswet the project(Sec.9(Hy.Business and Pmfactors Ccde:)'Um Commence,Li- cerise Law does not apply to an owner of property Who had his or I upornes fiction,road QTY, PLUMBING PERMIT FEE who contracts for such protests with a contractor(s)licensed pursuant to the Contmetor's License law. PERMIT ISSUANCE: ' ❑In a exempt raider Sec ,B&P C for this memo' Owner - Data ALTER—DRAIN&VENT—WATER(PAT ,rt, VALUATION WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT,DEVICI? I hereby wi inn under penAry of perjury rine of the following declamW"tiame lJ I have and will maintain a Cenificatc of Consent to miNnstre for Worker's Compton- DRAINS—PLOOR ROOK AVEA,COND. STORIES TYPE CONS'1'1U1C1'ION ondon,ac To..idad fur by Section 3900 or the tabor Code.for the ands m ado a of the work fur which skis pemril is;Luded. FIXTURES—PER TRA I ❑1 have and will maintain Workers COmpemilinn Insurance,as required by Sestion 39010 or the labor Cale,rot the part'ommnce of the work for which this pump is issued. GAS—EA.SYSTOPII . U'r1.9T5 OCC GROUP APN My Workers t .tiedI urence synch and Policy num'ei ry,Il�� ,� Cold �..'n./ Policy No.: CC4 GAS—EA. STG1-DVI. J(EA) CER IPICAT: FEXEMPTION FROM WORKERS' COMPENSATION INSURANCEGREIASEANDUSTRL WASTE INTERCEPTOR This section need not he completed!iflhe pumit is for onehandroddollaro SIIO0) BUILDING DIVISION FEES Or less.) GREASE'IItAP PLANCHECK FEE I mrtifyrhm in the perfacrommoof,he..it for which this permit is issued,I shall SEWER—SANITARY—STORM EA.2(01 FT. nut employ any Person in arlymannce spas to became subject to rbe Wmkerc,'Comlxn- - ENERGY FEE C Z emiOn laws Of Calif omih.Date WATER HEATER WNENT/EL[CT ' 12 Applicant R GRADING FEE 4 NOTICE TO APPLICANT.If,nfit,making This Ccdificate of Exemption,you shoo Ed WAFER SYST61OKEATING a'7bome subject m The Worker's Compstwor n provisnsioof the Later Cade,you must SOILS PER W ;.0 ecforthwith comply with such provisions or this Exmot shall he deemed revoked WATER SERVICE Uz - CONSTRUCTIONLENDINGAGBNCY NEW RESIDENTIAL PLMB.- SQ.FL - PAID U QIheiehy affirm rhauhemem isisaconstruction lending agency for the perrntmanu of Data Receip,M the work for which Ihis Nrand is issued(Sea 3099,Civ.C.) T C U Lender's Name �U Lenders Address TOTAL: TOTAL: 7• I codify that I have read this application unit state that the tMwe;animation is - BUILDING PGE Vet) correct.l agree to comply with all city and county ordinances and state laws telating to QTY MECIIANICAL PERMIT FEE U Z building construction.and Thereby ammorize notphascritatives of this city to enter upon the SEISMIC FEE ' above-mentioned property for inspection purposes. PERMIT ISSUANCE ' (We)-.,.to is,indemnify and keep numbers the City or Cupedino against - ELECI Bid FEE liabilities,judgireirs,costs and expenses which may in anyway marmagainns said City ALTER OR ADDTOMECH. - - consequencein of The granting.1 this permit, PLIJMBINO FEE, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO TOA"CFM) M I NI SOURCE REGULATIONS. AIH HANDLING UNI (O F.R te CFP) CONSTRIICTIONTAX Signamrc of Applicam/Commcmr Data EXHAUST IOOD(W C) nTi: 1 HOI151NG MITIGATION FER HAZARDOUS MATERIALS DISCLOSURE Will the npplicam or fumrc building oecupnm start or hanJle harurdouxan ial It E. Tlbo UUIT CFO! I,IX BTU) as defired by the Cupenino Municipal Code.Chapter 9.12,and The Health nntl Safety Cada Section 25532(a)9 HEATING UNIT(OVER 100.0010 BTU) [I yes tIN,, VENTILATION PAN(SINGLE RES I D) PAID Dam ItcceiptN Wxi the orphaned communications m future building Occupant tae nlui it u or devices which BOILER—COMP(3IPOR IOO,01M1 BTU) emit M1a eNouc air contaminants m defncd ay the Bay Area Air Quality Managemom• TOTAL:.District? - ❑Yes BOILER—COMP(OVER IW-0110 IT FU) - �Nu � ' I have read the hoznNous mmeriaL,requimnrams under Chapter 6.95 Of the Culi- AIRCONDITIONER ,I SSUANCE DATE fomia Health&Safety Cade,Sections 25505,25533 and 25530.1 understand that if the- NEW RESIOI:NTIAL MECH. SQ.Ff. building doe nor currently have a would That it is my responsibility m notify the occupant ofthc rem,.motion;: c. mus,hcmet pimm'eswaiceaf u Cenifipno Owner or amhorired m Ume TOTAL: ISSUED BY: - OFFICE