Loading...
20399;ANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY Building Project Identification ldd.: 7 2 w�� a_ PELWT NO. 2039 Name: ane: A AL UA CITY OF CUPERTINO-BUILDING DIVISION APPLICATION I PERMIT BUILDING-ELECTRICALPLUMBINC MECHAMCAL _ant>\ •.Na e>� �O� _ LIS,;Jy �.1 1.]/ 335 CATEGORY CONTROL N (Architect/Engineer. Lk. Nex QTY ELECI'RIGPERMIT `' FEE. - 'i- BUILDINC-PERMIT-INFO':. Addmsa: PERhtITISSUANCE I:D CONTRACTOR'S DECnsRATION firm that IhthSyWo7Dthatlam Bcm3oftheunder pray..dP.Chapterode,.. me API'LIANCESRE9DENTIAL ]OB DESCRIPTION lice ISection 7fXD)ot Divldm3ofthe8uslnessand Pro/nslanaCade,and my License Cla Llc.0 Ikeae bin full ( and dfect-=� PANELS Date Contractor 201T020AM AMPS Amshall eumnlaCLARATIO I understand my pts shall be used n puretic records. OVERIOOOAMPS SQ. Fr. FLOOR AREA S/SQ. FT. SIGNSELECTRICAL Licensed Professional ` So PECIALCRCUIT/MLSC V OWNER -BUILDER DECLARATION T hereby that aexempt frothe Contractors License Law for the affirmm m 11 i'7 G�LO awn TEAR METER OR POLE INST. following mason.(Section 7031S, Business and Pmfmwns Code: Anydty or muntywhich requbma permit tommtruct, alter, improvem , cieolbh,orrepalr any structure prior to Its Issuance, a bo requires the applicant forsuch permit to file a si ned statement that he is licensed pursuant to the provlslom of the POWER DEVICES SWIMMING POOL ELECTRIC _�rrss�� 0 OUTLETSSWITCHESFUCNRES I. Contractors License Law (Chapter 9 (mermencing with Section 7000) of Divi. sion 3 of the Business and ProfessionsCode) orthat he is exempt therehomand the dab for the alleged exemption. Any violation of Section 7a11S by any ape fora perml($SM. the appOcanttoadvil penalty of nor more than VALUATION �� G Q ve hundr C] 1, ownerll theproperly,or myemployeesinwithwagesn their sole OC]1, aro voce vshe pm NEW RESIDENTIAL ELEGTR SQX-T. STORIES TYPECONSTRUIMON s compensation, work andehes not Intended or offend for sale (Sec 7014, Buslnns and Pro(essba Code the Cantnctols Llceae Law Business and Code: The TOTAL does not apply to an owner of property who builds or improves thereon, and whoduessuchworkMmssBorthrough hlaownemployen, provided that such Improvement are not intended oroffered forsale. If, however, the building or OCC. GROUT' RES IRxTTS Improvement tsold within oneyearo(completiontheowner-bullderwlll have th,�urden of proving that he did =build or improve for purpoaeo(sale.). LJ L as owner of the property, am exclusively contracting with -1— contncton to construct the projectt(Sec- 7014, Bustin and Professions Code: -I—, ..... TY, :,�• ,PLUMBIN PER-+�-�FEE ], - FLOOD ZONE MN PERMIT ISSUANCE "l The Cantnctor's License Law does not apply to an owner of pmpe,v who1 builds or Improves thereon, and who mre ructa for such pVam jewith a ecesed pursuant to the Contractors License Law. I am exempt under Sec B is P C for this rtason JAT TER DRAIN' Vp-NT-WA _+�'FEE'SUMMARY--"+ BACK BAFLOW PROTECT. DEVICE DRAINS FLOOR ROOF, AREA, COND. SANITARY Y_ N_ RECOP T N Owner Date WORKMAN COMPENSATION DECLARATION I ❑I hereby affirm that I have a certificate of consent to self -insure, or a certificate o(Workpen'Compereadanlaurance osa ceKBied mpytherto((Sec. 3800, Lab CJ () Cis pp Collryp LJJII G ` Com FO(NRES PER .TRAP S�� < SCHOOL TAX Y_ N_ RECEIPT N GAS EA. SYSTEM.1 INC.4 OUTLETS PARK FEE Y N RECENTIf GAS EA. SYSTEM-OOVER BUILDING DIVISION FEES Cenlfied copybhereby fumished. CertNed copy b (fled with the city Iapettion dlvlalon. CREASEANDUSTRL WASTE INTERCEPTOR PLANCHECKFEE GREASE TRAP CERTIFICATE OF EXEMPTION FR OM WOR KERS' COMPENSATION INSURANCE Crhi.0 .. need nor becompleted lithe permit b(orooe hundred dollars PAID Date Reml LN �1Q} SEWER-SANITARY-SIl7RM EA 200FT WATER HEATER W/VENT/ELECTR ENERGYFEE Y N_ (5100arelo(the work farwhlch /his pert Is blued, I Mfyth t ylhat the performance, mi WATER SYSTEM/TREATING I shall not employ any person In any manner n as to become subject to the Worken'Compensation Laws of California. Date PAID Appitcant NOTICE TO APPLICANT: If, after making this Certificate of Faemptlon, you should become subject to the Workers' Compensation provisions of the Labor NEW RESIDENTIAL PLMB. SQFr. Date Remi t# TOTAL: BUILDING FEE aco Code, you must forthwith comply with such provisions ortht permit shall be deemed mvokrd. SEISMIC FEE CONSTRUCTION LENDING AGENCY Iherebyaffirm that then is. construction lending agency for the perform- anteoftheworkforwhichthbpeK tttoed(Ser-3097,Civ.C.I Lender: Name Lender's Add By that l have read this application and Kate that the above Information bcornct. I agnetocomplywlth all chyand muntyordmantes and Kate laws TOTAL: �"� ELECTRIC FEE aa� Ly PLUMBING FEE ©!'� ,. s. QTY.;";-. MECFIANICAC'PERMIT- MEC MECHANICAL FEE CCIc-n g4FEE:r. PERMIT ISSUANCE ' y,, FEESMEC PAID: relating to building cerotruction, and hereby authorize representatives ofthb city to enter upon the abmv rrgruioned property for Inspection purposes. (We) agree to save, Indemnify an d lamp harmless the City of Cu peftlno against liabilities, judgments, masand expen. which may In any wayacerue ALTER OR ADD TO MECH. Date Recei t# AIR HANDLING I1MT (f010,000 CFM) SUBTOTAL' against said City in consequence of the granting of this permit. AIR (-IANDUNGUNIT (OVER lo,000CFM) CONSTRUCTION TAX Signature of Applicant/Contractor Date EXHAUST HOOD(W/DUCD �LQ CONSTRUCITON TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfutue building occupant store or hand Is hazardous material as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the Health and Safety Cod a pion 25532(a)7 ❑ Yes No HEATING UNIT (TO 100,000 BTU) Date RCCCI t# HEATING UNIT (OVER 100,000 BTU) TOTAL: s VENTILATIONFAN(SINGLE REBID) ISSUANCE DATE Will thea applicant tine building ant use ui ment or devices pp g occu p q p which emit hagem r contaminants as defined! by the BayAmaAlr Management Quality Management ent D contamcontaminantswtt7 4 Y. �LNo BOILER -COMP (3IE' DR 100,000 BTU) BOILFR.COMP(OVIR 100,000 BTU) haves read the ma materia, nqulrement under Chapter 6.95 of Sectio x75505, 75533 and 75534. ] heC.I,n emlfarnb Heatth A Skiing due. mdenta that ](the Wilding not try have a tenant, that ltbmy respoaibi ty to notify the occupa tofth re uiremanswhich must be con Frio r to L% cee oof�a.aCertificate o cm Ff s 1 Lj,. . U I`?Fllnit NEW RESIDENTIAL MECH. SQ.FT T x / I5SUEDB . Owner or agent Date gent TOTAL L OFFICE COPY