The URL can be used to link to this page

27162 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OPCUPERTINO BUILDING-E RIUAL PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL n n BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION L G BUILDING ADDRESS: P SANITARY NO, 7�LICATION SUBMITTAL DATE OW :R N PHONE? CONTRACTOR'S NAME: LOT LIC O: - G4 355_ CZ70 N/C CONTROLIf ARCHIT'ECT/F.NGINEER: 1`-! LIC NO: IO ADDRESS: ❑ CONTACCT,�: /�,�,yp�p PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO tf_r— J-6B-Q'j� PERMIT ISSUANCE BLDG E LUM MF.0 LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL Plihi DESCRUMDN mz I hereby afOnathm l am licensed underpnscimcwChaprer9(commenting with al Sttdlor e add t PANELS of Division S of the easiness and Professions Cede,and my license is in C full force and effect UP T0200 AMPS Cy License Close Lle.# y6y Date Contractor 201-IMDAMPS z Orir� ARCHITF.CT'SDECLARATION OVER IBM AMPS SQ.FL FLOOR AREA $/SQ.FT. O z-❑ I understand my plans shall be used as public records. ¢'y�y�� License)Professional SIGNS ELECTRICAL LCA OWNER-BUILDERmDECLAAATION paraw SPECIAL CIRCUIT/MISC. O �� d F 1 a,aw affirm that 1 am exempt from the Contractor's License Law for the folicawhich anameon.(Scnion 7031.5,Businessand Professions Code:w npny so,woounty TEMP.METEROR POLE(NST. W Oco; which inquires n permit to construct,allen,Edit improve,demolish,or repair any smaaare Y0 thathor ois licensed parson to the the prvisiosoaut fcarsuch the Coperniuo License file La statement POWER DEVICES Z p thin m is licensed pursuant m the)of Division of the Commcar's License Law(Chapter 9(commencing with Section 7000)of Division3 of the Business and Professions Code) SWIMMING POOL ELECTRIC /� VAL��Uff1ATION �lyx Wim unbar he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES- L L� L••�•J 4 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of FIXTURES _` not more than five hundred dollars($500). C Po' ❑ 1.asowneroftheproperty,ormyemployeeswithwagesastheirsoleccompensatiNEW RPSIDENTIAL ELECTR Son. Q'FT. STORIES TYPF.CONSTRUCTION y will do the work,and the structure isnot intended moffered forsale(See.]044,Business and Professions Code:The Contractor's License Law does not apply to an owner of propertywhobuildsnrimpmvesthereon,and whmdoeasuch work himselfmthmughhls DEC.GROUP RBS.UNITS ownemployees,provided that suchlmprovementsam not intendedoroffered forsale.If, however,the buildingor improvement is sold within one year of completion,the owner- T builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ Las ownerofthepropeny,amexclusively contracting with licensed convectors to QTY. PLUMBING PERMIT FEE FLOOD ZONE APN consumer the project(Sec.7044,Business and Professions Code:)The Contractor's License Law does not apply to an owner ofpmpeny who builds or improves thereon,and PERMIT ISSUANCE who contracts forsuch projects with accoun (s)licensed pursuatto the Contmtmrs License Law. ALTER-DRAIN&V[3NT-WATER(EA) PB85UMMARY ❑ I am exempt under Sec. ,B&P C for this reason BACK ROW PROTECT.DEVICE T IDE FEES SANITARY Y N Owner Date RECEIPT N DRAINS-FLOOR,ROOF,AREA,COND. WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN ❑ IbereM1y affirm thud haves certificate ofcansem to self-insure,...certificate of RECEIPT# FIXTURES-PER TRAP Workers Compensation Insurance or acenieed copy thereof(Sec.3800,Lab C.)which PARK FEE Y if N covers all employee's under this permit GAS-EA.SYSTEM-1 INC.4 OUTLETS Policy# BUIL 1 I ON FEES Company GAS-EA.SYSTEM-OVER 4 HbO PLANCIECK FEF ❑ Cenifird copy is hereby mounted. ❑ CeniRed copy is fled with the city inspection division GREASFBNDUSTRL WASTE INTERCEPTOR GRADING r CERTIFICATE OF EXEMPTION MOM WORKERS' GREASE TRAP SOILS FE �� COMPENSATION INSURANCE (This section need not be completed irthe permit is forons hundred dollars(SIM) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE unless.) Icenifythm in the perfonmanceofthe weak for which this permit is issued,l shall WATER If EATER WNENT/ELECTR not employ any person in any m as m become subject to the Workers' PAID Q 7-. CCrormeeationlawsof Califomin. Date so_ WATER SYSTEM/IREATING Dam Recti NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: zi become subject to the Workers Compensation provisions of the Labor Code,you must �i forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEEF,L �# Q7-. CONSTRUCTION LENDING AGENCY SEISMIC FEE 1 hereby affirm thin there is a cons[mction lending ngrncy far the performance of U O the work for which this permit is issued(Sec 309],Civ.C) TOTAL: ELECTRIC ME II. (r Lenders Name PLUMBING FEE P lamedes Address QTY. MECHANICAL PERMIT FEE U 1 certify that 1 have read this application and state that the above information is O >" W correct.(agree to comply with all city and county ordinances and stem laws relining to PERMIT ISSUANCE MECHANICAL FEE F" � buildingemarruction,and hereby authorize representatives ofthis city mender upon the U 7 above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX .^. (We)agree to save,indemnify and keep harmless the City of Cupertino against lithIIe�jvdgmenra s,costs and expenses which may in any way same againexaid City AIR HANDLING UNIT(TO 10,010 CFM) in coce of threnting of this permit. ' I9 AIR HANDLING UNIT(OVER 10,04M Credit Signamreof Appllc m/Comact Date EXHAUST FOOD(W/DUCT) PAID HAZARDOUS# ERIALS DISCLOSURE HEATING UNIT TO 100,000 BTU) Date Receipt# Will the applicant(it future building occupant store or handle hazardous material HEATING UNIT(OVER IOO,WO PTU) TO as defined by the Cupenimo Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(e)] 11 Yes ❑No VENTILATION PAN(SINGLE REBID) V BOILER-COMP(RHP OR 100,000 BTU) ISSUANCE DATE Wusair coma owmaxure debkifined by the Area rnt ualitic Managemench t P p B D • hazardous air conmminanu as define)by the Bay Area Air Quality Managemem BOILER-COME(OVER 100,000 BTU) I'V District? ❑Yes ❑No NEW RESIDENTIAL MECH. SQ,FT. IJII[�A(I] 24 q 1 have read the hazardous materials requirements under Chapter 6.95 of the 1995 California Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that !x" if the hui lding does not currently have a toward,that it is my responsibility to notify the V Uj- LUr occupant or the requirements which must la,met prior to issuance of a Ceniticate of Occupancy. Owner m authorized agent Date TOTAL: ISSUED BY: �- OFFICE APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OPCUPERTINO BUILDING-E RIUAL PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL n n BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION L G BUILDING ADDRESS: P SANITARY NO, 7�LICATION SUBMITTAL DATE OW :R N PHONE? CONTRACTOR'S NAME: LOT LIC O: - G4 355_ CZ70 N/C CONTROLIf ARCHIT'ECT/F.NGINEER: 1`-! LIC NO: IO ADDRESS: ❑ CONTACCT,�: /�,�,yp�p PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO tf_r— J-6B-Q'j� PERMIT ISSUANCE BLDG E LUM MF.0 LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL Plihi DESCRUMDN mz I hereby afOnathm l am licensed underpnscimcwChaprer9(commenting with al Sttdlor e add t PANELS of Division S of the easiness and Professions Cede,and my license is in C full force and effect UP T0200 AMPS Cy License Close Lle.# y6y Date Contractor 201-IMDAMPS z Orir� ARCHITF.CT'SDECLARATION OVER IBM AMPS SQ.FL FLOOR AREA $/SQ.FT. O z-❑ I understand my plans shall be used as public records. ¢'y�y�� License)Professional SIGNS ELECTRICAL LCA OWNER-BUILDERmDECLAAATION paraw SPECIAL CIRCUIT/MISC. O �� d F 1 a,aw affirm that 1 am exempt from the Contractor's License Law for the folicawhich anameon.(Scnion 7031.5,Businessand Professions Code:w npny so,woounty TEMP.METEROR POLE(NST. W Oco; which inquires n permit to construct,allen,Edit improve,demolish,or repair any smaaare Y0 thathor ois licensed parson to the the prvisiosoaut fcarsuch the Coperniuo License file La statement POWER DEVICES Z p thin m is licensed pursuant m the)of Division of the Commcar's License Law(Chapter 9(commencing with Section 7000)of Division3 of the Business and Professions Code) SWIMMING POOL ELECTRIC /� VAL��Uff1ATION �lyx Wim unbar he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES- L L� L••�•J 4 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of FIXTURES _` not more than five hundred dollars($500). C Po' ❑ 1.asowneroftheproperty,ormyemployeeswithwagesastheirsoleccompensatiNEW RPSIDENTIAL ELECTR Son. Q'FT. STORIES TYPF.CONSTRUCTION y will do the work,and the structure isnot intended moffered forsale(See.]044,Business and Professions Code:The Contractor's License Law does not apply to an owner of propertywhobuildsnrimpmvesthereon,and whmdoeasuch work himselfmthmughhls DEC.GROUP RBS.UNITS ownemployees,provided that suchlmprovementsam not intendedoroffered forsale.If, however,the buildingor improvement is sold within one year of completion,the owner- T builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ Las ownerofthepropeny,amexclusively contracting with licensed convectors to QTY. PLUMBING PERMIT FEE FLOOD ZONE APN consumer the project(Sec.7044,Business and Professions Code:)The Contractor's License Law does not apply to an owner ofpmpeny who builds or improves thereon,and PERMIT ISSUANCE who contracts forsuch projects with accoun (s)licensed pursuatto the Contmtmrs License Law. ALTER-DRAIN&V[3NT-WATER(EA) PB85UMMARY ❑ I am exempt under Sec. ,B&P C for this reason BACK ROW PROTECT.DEVICE T IDE FEES SANITARY Y N Owner Date RECEIPT N DRAINS-FLOOR,ROOF,AREA,COND. WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN ❑ IbereM1y affirm thud haves certificate ofcansem to self-insure,...certificate of RECEIPT# FIXTURES-PER TRAP Workers Compensation Insurance or acenieed copy thereof(Sec.3800,Lab C.)which PARK FEE Y if N covers all employee's under this permit GAS-EA.SYSTEM-1 INC.4 OUTLETS Policy# BUIL 1 I ON FEES Company GAS-EA.SYSTEM-OVER 4 HbO PLANCIECK FEF ❑ Cenifird copy is hereby mounted. ❑ CeniRed copy is fled with the city inspection division GREASFBNDUSTRL WASTE INTERCEPTOR GRADING r CERTIFICATE OF EXEMPTION MOM WORKERS' GREASE TRAP SOILS FE �� COMPENSATION INSURANCE (This section need not be completed irthe permit is forons hundred dollars(SIM) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE unless.) Icenifythm in the perfonmanceofthe weak for which this permit is issued,l shall WATER If EATER WNENT/ELECTR not employ any person in any m as m become subject to the Workers' PAID Q 7-. CCrormeeationlawsof Califomin. Date so_ WATER SYSTEM/IREATING Dam Recti NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: zi become subject to the Workers Compensation provisions of the Labor Code,you must �i forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEEF,L �# Q7-. CONSTRUCTION LENDING AGENCY SEISMIC FEE 1 hereby affirm thin there is a cons[mction lending ngrncy far the performance of U O the work for which this permit is issued(Sec 309],Civ.C) TOTAL: ELECTRIC ME II. (r Lenders Name PLUMBING FEE P lamedes Address QTY. MECHANICAL PERMIT FEE U 1 certify that 1 have read this application and state that the above information is O >" W correct.(agree to comply with all city and county ordinances and stem laws relining to PERMIT ISSUANCE MECHANICAL FEE F" � buildingemarruction,and hereby authorize representatives ofthis city mender upon the U 7 above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX .^. (We)agree to save,indemnify and keep harmless the City of Cupertino against lithIIe�jvdgmenra s,costs and expenses which may in any way same againexaid City AIR HANDLING UNIT(TO 10,010 CFM) in coce of threnting of this permit. ' I9 AIR HANDLING UNIT(OVER 10,04M Credit Signamreof Appllc m/Comact Date EXHAUST FOOD(W/DUCT) PAID HAZARDOUS# ERIALS DISCLOSURE HEATING UNIT TO 100,000 BTU) Date Receipt# Will the applicant(it future building occupant store or handle hazardous material HEATING UNIT(OVER IOO,WO PTU) TO as defined by the Cupenimo Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(e)] 11 Yes ❑No VENTILATION PAN(SINGLE REBID) V BOILER-COMP(RHP OR 100,000 BTU) ISSUANCE DATE Wusair coma owmaxure debkifined by the Area rnt ualitic Managemench t P p B D • hazardous air conmminanu as define)by the Bay Area Air Quality Managemem BOILER-COME(OVER 100,000 BTU) I'V District? ❑Yes ❑No NEW RESIDENTIAL MECH. SQ,FT. IJII[�A(I] 24 q 1 have read the hazardous materials requirements under Chapter 6.95 of the 1995 California Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that !x" if the hui lding does not currently have a toward,that it is my responsibility to notify the V Uj- LUr occupant or the requirements which must la,met prior to issuance of a Ceniticate of Occupancy. Owner m authorized agent Date TOTAL: ISSUED BY: �- OFFICE