Loading...
23013 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Address: "Z Z 3 013 - 0563 G, reams: one: - a� V 6C CITY OF CUPERTINO-BUILDING DIVISION. _ A C.nkractrukhl.ev,: Lie.No: APPLICATION I PERMIT BUILDINGELECTRICAL PLUMBINC-MECHANICAL. CATEGORY CONTR A Itect/Engineer. Lie.Nr: q'j^t •ELECTRIGPERM FEE , BUILDING PERMIT INFO Address: PERNIITISSUANCE — LICENSED CONTRACTOR'S DECLARATION I hereby affirenthat lam licensed under provisions of Chapter9(commene- APPLIANCESRESID L o L7s- Ingwith5eRlon7000).!Diviion3oftheBusinssandProfessio .Cde,and JOB DESCRIPTION ielslR ' LicenseCass nLi.# b13Z Uj `i ja� _Contractor Q ARCHITECT'S DE LARATIONAMI s 41 Il'y �qqp±± O I understand my plans aha]beused u public records. OV 1000 AMPS SQ.FF.FLOOR AREA $/SQ.FT. HE �j Licensed Profeskmal GNSELECTRICA Gfn 6 O OWNER-BUILDER DECLARATION SPEOLILCIRC TSC .F I hereby affirm that am exempt fromthe Contractors License Law for the F & following reason.(Section 7031.5,Business and Professions Code:Any city or TEMP..M OR POLE INST. l` county which requires a permit to construct,alter,improve,demolish,or repair file prlorte its issuance,aborequiresthe applimntforsuch permitto Vfile a signed statement that he is licensed pursuant to the provisions of the DEVICES 3 ec WIMMIG POOTRI Contractor'.License Law(Chapter 9(commencing with Section 7000)of Dm- SNL ELECC si.n3.fth.B.9I e...dProfessioru Cade)orthath.i....ptthercf..and VALUATION O the basis for the alleged exemption. Any violation of Section 7031.5 by any , applicant for a permit subjects the applicant to a civil penalty of not room than OUTLE'ISSWITCt{ESFIXTURES �O 0OQ«.d(J five hundred dollars($510), 0 I,as owner of property, NEW RESIDENTIAL ELECTR SQ.FT. SID TYPE CONSTRUCTION p p rty,or my employees with wages as their sole 7a compensation,will do the work and the structure b not intended or offered for q sale(Sec.7044,Business and Professions Cade:The Contractors License Law 2 does not apply to an owner of property who builds or improves therm,and OCC.GROUP RES.UIVTI'S whodoes.uchworkhlmaelf orthrough hlsownemployms,provided thatsuch improvements are not Intended oroffered forsals.If,however the Wilding or TOi - Improvement b sold within oneyearofcomplellon,the owner-bullderwlli have tgLlIurden of proving that he did not build or improve for purpose of sale.). QTY; " ' ; P[:I;IMBING PERMIT Y FEE'' FLOOD ZONE APN u L as owner of the property,am exclusively contracting with licensed PFltMIT ISSUANCE r contractors to construct the project(Sec.7074,Business and Profession Code: - The Contactors License Law does nae apply to an owner of property who ' j builds or improves thereon,and who contracts for such ptojecb with a ALTER-DRAIN&VENT-WA cgB(pctorW licensed pursuant to the Contractors License Law. OF SUMMARY LJ I am exempt under Sec. B&P C for this reason BACK FLOW PRO'('FGT.DEVICE LES Owner Date DRAINS FLOOR ROOF,A SANITARY Y N N WRECEIPT COMPENSATION DECLARATION FD(TURE4 PER TRAP SCHOOLTAX Y N ❑i hereby affirm that I have a certificate of a ccAlft to opy there. ora RECEIPT N ceriflLab ofWorkeri Compenattonlnurana ora certi(icd copy thereof(Sec. GAS EA.SYSTEM-1 INCAOUTLETS Policy # C. PARK FEE RECEIPT p Policy M 1 gS-�'3 -R 1 �6/i GAS EA.SYSTEM-OVER d(EA) Com anv BUILDING DIVISION FF.GS Certified mpy is herebyth the ted. F%!1/fp GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFGE edified copy b(fled with the city Inpec[lon division. �Q7 CERTIFICATE OF EKEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE (t'hlisectonneed not becompleted ifthepermlt hforomhundred dollars SEWER-SANITARY-STORM EA.7001117. Date emi t# ($100)or less.) Icertifylhae In the performance o(thework forwhich thio permit la blued, WATER HEATER W/VENT/ELECTR E FEE- Y_ N_ I shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING Workers'Compensation Laws of California.Date - PAID O Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. ecel t# Z O NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Hsh.ld become subject to the Wm1ora Compenattm provision of the Labor -FAL: OI Cmde,you=at forthwith cornplywlth such provisions orthb permitshall be BUILDING 'E W > deemed revoked. , CONSTRUCTION LENDING AGENCY SEISMIC FEE' a I hereby affirm that there is a roostruction lending agency forthe perform ELECTRIC FEE Z ance ofthe work forwhich this permit is Issued&c.3097,Civ.C.) TOTAL: V O Lender's Nam PLUMBING FEE LL I- Lender'.Address QTY. ''. MECHANICAL'PERMIT "i' FEE,' MECHANICAL FE OW Imrtifythatl havereadthisappliatim.nd statethetheabovelnformation a bcornect.I agree to complywith all cltyand county ordinances and state laws PERMITtSSUANCE FEES PAID:` } W relating to building mnatruction,and hereby authorize representatives oflhis F Z city to enter upon the above-mentioned property for Inspection purposes. ALTER OR ADD TO MFCH. Date lies] [# — (We)agree to save,indemnify an d keep harmless the City of Cupertino P against liabilities,judgments,mks and expenses which may In anywayaccem AIR HANDLING UNIT(TO 10,000 CFM) SU OTAL: againstsaid Clty kmrce ofthe sorting of this permit. ( J o ^/S�� AIR HANDLING t)Mi'roVER].,alio CFM) 'CONSTRUCTIONT X Signature of Applirant/Contactor Dale IXFIAUS'F HOOD(W/DUCT) CONSTRUCTION XPAID: 'HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) material as defined by the Cupertino Municipal Cade,Chapter 9.1$and the Date R ei Fkalth and Safety Code Section 25537(a)7 HEATING UNIT(OVER 100,000 BTU) T T ❑Yea No Will the applicantorfuture building occupant as equipment or devices VENTILATION FAN(SINGLE RESID) ISSUA&(-'1:, T,R which emlt hazardous air contaminants as defined by the Bay Area Air, �'M 87 allty Management District? BOILER-COMP QHP OR 100,000 BTU) u�u Yes No FEB _4• 1 IhYe read the hazagoN No. requlrcments underChapfer 6.95 of BOILER-COMP(OVFR 100,000 BTU) ']A(�2 the California Health&Safety Code,Section 25505,25533 and 75534.] 1a7�7 understand that if the building does not currently have a tenant,that it is my NEWRESIDENTIALMECH. SQ.FT `x�qy L _ .responsibility to notify the occupant of the requirements which mu at be met V 117 VFCUPt:mIIjVU prior to issuance of a Certifleste of Omrpa nry. Owner or authorized agent Date ISSUED BY: TOTAL: OFFICE COPY