Loading...
29788 ,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPWCATION/PERMIT PLUMBING-MECHANICAL. 29788 BUILDING PROBECI'HIM[FICA TION BUILDING )UNESS. SANITARYNO. - APPLICATIONSUBMI'ITALDAU S c - L�/D OWN13R'S NAME: PH NF.:1 CjWf TO R'S NAM/p' LIC O: I SO _a \�'� v 14O NIC CONTROL It CII - '1'IGNGINE[R: LIC NO:b DI255: r ❑ f 41401 CONTnC . HONE,: , - I BUILDING PERMIT INFO /� a ku 1 _ ❑ Consultant Fees Paid by Applicant(Initial) �YKL�Qy1G ELECT PLUMB MECH 19 rtl(, LICENSED CONTRA TOR. UECI. N31153 ATION I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing QTY. ELECTRIC PFRMIT FEF. p g JOB DESCRIPTION 1Q1a�a'Z in with Section 7000)of Division 3 of the Bmirr"mJPofessiens Calc,and mylicense is RESIDENTIAL: FOO full farce and -3� PERMIT ISSUANCE �[21 ❑SFDWL ❑KITCHEN REMODEL �U� License Class�_ L]o.0 �� �� APPLIANCES-RESIDENTIZ� Dam Commnor AL ❑ADDITION ❑PLUMBING RF.-PIPE <S ARC]II'1'ECPS DECLARATION MULTI-UNIT ❑STRUCTURAL. 'Z 0912 lundersmnd my plain shall be used as public recordsPANE S s MODIFICATION pZ 0 .. _ UP T02010AMP5- EJ INTERIOR El CHIMNEY REPAIR �•�[_ Lianscd Professional 201-1001AMPS IMPROVEMENT OWNER-BUILDER DE CLARATION OVER I(XIf1AMPS BATH REMODFUREP IR ❑DEMO TON I herby affirm that I inn exempt from the Cannacmr's License law for Ihe �q5 3 U following reason.(Section 7031.5,Business trod Professions Code:Any city s county SIGNS ELECTRICAI. OTH1f'R t++ O which requires a permit ne consuvm,alma improve,hpannish,or repair any ateme a S�4�Rs{ prior to its isnunnce,alnn mquimy the applicant for such permiuo Eleasigned statement SPECIAL CIRCUITIMI 1 11 ythin he is licensed pmsuonuo Itualocions of me Contractor's License Law(Chapter 9 SOC (commencing with Seninn 7000)ofDivisionlof the Business and Professions Cade)nr TEMP.METER OR ST. COMMERCIAL: 6 c c that he is exempt therefrom end the basis for the ullegeJ exemption.Any violation of [2NEW BLDG/ADDITION, El DEMOLITION 4• Section 7031.5 by any applicant fora permit,aneastheapplicannoa civil penaWER DlIVICESlly of POENANT ❑FOOD SERVICE rN not more Nan five hundred dollam H50B. NMPROVFMENT O ❑L,u.,nwnend me progeny.or my employees with wages us theirwle cnmocnsation, SWIMMING POOL I. CWR _ will do the work,andmr,muco ,Isnot amm dorofferel for isle(Sec.73,14,Business ❑OTHE 6 3 and Pronasions Cade:The Contracmrs License Law does not upply to un owner of OUTLETS-SWITCH FI URES property who builds or improves thereon,and who does such work himself or through his own emgloyces,provided shot such improvements mm nut imm�Jed or offered for NEW RESIDENTIAL FLECT SQ IT. sale.ithowever,the building orimpmvernem is vdJ within one yearof completion,the SQ. .MOOR AREA $/SQ.FT. owner-builder will have the burden m proving that he did not bull([or improve for our- pose of sale]. ❑has owner of the progeny,am exclusively enmmcning euro licensed compmors to T P construct the project(Sec 7044,Business and Professions CMa:)The Contractor's LI - nulawdoesnotapplytoanownerefpropeny who builds or improves thereon,and QTY. PLUMBING PERmTT FEE who combats forsuch projects with a contmctomn Iicemed pursuam Ionic Cmnmctors License Law. PERMIT ISSUANCE El Iamexetnpt under sec. ,B&P C for this reason Owner Data ALTER-DRAIN&VENT-WATER(EA) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW nip PROTECT.DEVICE �j,�-r ^ I hereby arunlerfpenahy of perjury one of the following declamtionr. —76 fto ❑I have and will maintain a CenificalrofConsem1.self insure for Workers Compete DRAINS-FLOOR,ROOF,AREA,COND. STORIES . TYPE CONSTRUCTION cation,as provided for by Section 3700 of the Linor Code,for me performance of the - work fnrwhich this fermitisissued. I FIXTURES-PER TRAP ❑I have and will maintain Wicker's Compensation Insurance,a required by Seetiun 3700 of Ne Labor Code,for the performance ofthe work for which this permit is issued. GAS-EA.SYSTEM.I INCA OUT LETS © OCC.GROUP APN My Worker's Compensation Insurance earner and Policy number are: - Carrier: Policy No.: GAS-EA.SYSTEMOVER 4(P-AI CERTIFICATE OF EXEMPTION PROM WORKERS' COMPENSATION INSURANCE GREASMNDUSTRI.WAST13 INTERCEPTOR (This sermonaced not be completed if the Input is for one hundred dollar,ISI W) IIUI D DIVISION FEES less) GREASETRAP. PLANCIIi?CK PE+ Iccnify thatimhe performance ofthe wod forwhith this gcnnitis ivmW,I stroll SEWER-SANITARY-S'PORM EA.200 FT. nmemployany.pcomminanynnu ersr cI uo the Woheri Com pen- ENERGY FE Oat- Z cation laws CM Rgy FIs � - 5 WATER HEATER W/VENT/F.LECTR GRADI E Z Applicant u lY AJ 3 y tr CA NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTGM/1'BEATING is a become subject to the Worker's Compemmim Provision of the Labor Coale,you must SOILS kTa fonhwiN compiY with such provisions nr this permit shall be deemed invoked. WATER SERVICE � Z CONST RUCTION LENDING AGENCY NEW RESIDENTIAL PL.MB. SQ.IT PAID U animation Nem iso combustion lending agency for the pedorman.nor Da Receiptp fL 2 1 hershy anik for which'his Permit is issued(Site.NAG,Civ.Cd Lender'.,Name TOTAL.: LyO {U tenders Address TO D"MIC Fr or I certify that I have read this application and state that the above information is DING FEE h c recLLagtxe nt cmnply with sell city unA county aminancas and amts laws reloting to QTY. MECHANICAL PERMIT U ,� building construction.and hereby aumorire representatives nfthis city toenter upon the SUIS 1>EE above mentioned progeny for inspection purposes. (We)name to save,indenmity and keep harmless the City of Cupertino against PERMIT ISSUANCE CfRIC Iiabilities,judgmems,costs and expenses which may in any way acme against said City pCpBR OR AOD TO MECH. PLUMBING in consequence of the l mining of this Permit. - APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UN I'1(TO 10.000 CPM) MECH L'EE SOURCE REGULATIONS, AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTIONTAX Signature ofA,daswlCommcIm Dam EXHAUSTHOOD(W/DUCTI HOUSING MITIGATION FEE MATERIALS DISCLOSURE Willme applicator or future building occupants, a or handle hazard ons m.o,did HEATING UNIT(TO 100,000 BTU) A O m defined by the Cupertino Municipal Code,Chapter 9.12,and the Healm and Safety Code,Section 25532m)? HEATING UNIT(OVER 100,000 BTU) - DYes ❑Nn VENTILATION FAN(SINGLB RESID) PAID ' Will the applicant future building occupant iwhichData Receipt p mit haaardmi,ar contaminant,as tle3neJ byhe Day A...Air Quality Management BOILER-COMP(TIPOR 00,000BTU) ,TOTAI District? ' ❑Yen C]No BOILER-COMP(OVER 100.000 BTU) I have read dm hazaNnus mereriaB mens under Cha tar 6.95 of me Celi- AIRCONDITIONER mluim p IS ANCU DATE frsmia Hcahh&Safety Code.Scniom 25505,25511 and 255]4.1 unokrnanJ that if the NEW RESIDENTIAL.MECH.reSQ.ET. .-./ building doe,not currently broca onz ,that it iatny resMutstbllity,,notify ho occupant ! 111 of me requirements which must be met prier to issuance of a Cenificate of Occupancy. , s Owner or authorized agent DataAL' b ISSUED BY: OFFICE