Loading...
S 1711 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PE lir NO. BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL 1711 BUILDING PROJECT IDENTIFICATION DING ADDRESS: SANI'T'ARY NO. APPLICATION SUBMITTAL DATE X0333 �. Wo(.F� D " •aft NE 'S HA 74M CONTRACfOk'S NAME: //(l LIC NO: A V NIC CON] //'R��ULN LIC NO ADiz q" ❑ ��J CONTACT: PH '' �,. BUILDING PERMIT INFO -M'paI 0 Lf <.74(16+ ❑ Consultant Fees Paid by Applicant(Initial) gLlyl ELECT PL. UNIII ECII LICENSED CONTRACTORSDECLARATION QTY ELECTRIC PERMIT FEE 4MT ��r�Y• TL'LR_ 1 hereby alarm mal 1 am licensed under previsions of chapter 9(commencingJOB DESCRIPTION WOO, with Section 70NBof Dlvision3of the Business it Professions Code.and my license is PERMIT ISSUANCE RESIDENTIAL: F Iy F in full tome and effect g 9 31 Z - ❑SFDWL ❑KITCHEN REMODEL ZUU Liccnse Class Contra AI'I'LIANCES-RESIDENTIAL. ❑AUDI UON ❑PLUMBING BE PIPE Nod Ualc ConVaflOr IV'L t� W\+- N, v, ARCHITECTS DECLARATION PANELS ❑MUL'I'LUNIT ❑STRUCI'URAI Or° , ZZ I undersmnd my plans shall be used as public record, MODIFICATION OZN,0 UI"T021NFAMPS [I INTERIOR [I CHIMNEY REPAIR P4 t: Licensed Pndesu...I 201-I"AMPS IMPROVEMENT 0SWIMMING POOLS G 0-) OWNER-BUILDER DECLARATION 6 I hereby affirm ma 1 an eaempt train the CnmracloA Liccnse Law for the OVER IgNInMPS [I BATH REMODEIBEPAIR DEMOLITION X6X0 c.U following reason.(Section 7031.5.limmusx and Pmfesions CNe:Any ciy or county SIGNS ELECTRICAL ❑OTHER W 3 U.hQ which requires a Permit to consuoa,alter,improve,Jemnlish,or repair any xtmemm FLLO-5 prior m its issuance.also requires the applicant for such permit to file a signed statement SPECIAL CIRCUIT 1 $ Ny•.l that he is liecnaMpureunm to the prvvivinnnof+he Canvucmr's Licenee Law(Chapter9 - fctr110 ommencing wilh$ection?(NN0 o1'Diviaiw3nf me Business anJl'rolw,innxCNe)nr 1'EMP.MES .'IFRORPOLEINCOMMERCIAL; a a e y ma he is exempt maefr m and the Wo,for the alleged cxemptinn.Any violation of ❑NEW BI.DG/ADDITION ❑DEMOLITION Mrn Section 70315 by any applicantfor ape+roil.wbjecu the applicant o a civil penalty.f POWER DRVI mZENANT ❑FOOD SERVICE t more than five hundred dollars(55110). H Z Y PN0VEMEN'1' =Q Las ow.endmepmpcny. remyempinyftaimmwages aslbei(See compensation, SWIMMING POOL ELECTRIC fFSo will do Professions aodme he Contractor's inrtnense Ea aadl does or apply an.Business OTHER ,Fe m and Pmfexsionx CNc:The Gm thereon Lica+m Imo docs nor apply to iowner u OUT LETS-SWITCHES-FIXTURES hpimperryis own who build,or improves thereon, pr who dues inch work himselfor through his oxo employees,provided mat such improvement,thin no,intended or nffemd for NEW RESFUFNTIAL CLECTk SQ PI'. sale.ILhowever 11 have the improvement is s,he noneycar, compintion.the S .F1(X)R AREhy,L LSQ.FT. mof.1der will have thin buNcn of proving the he JiJ not buil)or improve for'Ur— pars ofselc.). cons%s awn r of me property.,Envious, enntrnaing wise h The C n...cotn, to cone La the es not (Sec.o an waxiness and Pmfexsionx Code)The Contractors nd cctwc Law dads not apply to an owner ntp+ofnY who sebuilds ers inmI.thmCthereon,ar, QTy, PLUMBING PERMIT FEE, whowntme0 for such pmjecu with a conmacmgs)licensed pursuant to me Contracmr's License Eaw. PERMIT ISSUANCE 1 am exempt under Sec. ,B&P C for this reason Owner Dam AUTER-DRAIN&VENIF-WATER D?AJ LIl 'ION WORKER'S COMPENSATION DECLARATION BACK FI.OW PROrEC..DEVICE s * I hereby affirm under penalty of perjury one of the following declarations. r� I. �` ❑I have and will maintain a Certificate of Consent msch6mmre for Worker's Camper. DRAINS-II.00R,RODE AR1iA.CONU, N O STORIIIq TYI'Fi CONSTRUCTION cation,as practical for by Section 37M of the Isbor Cole,for the.-Romance of the work for which this fN uOul is issued. FIXTURES-PER TRAP O 1 have and will maintain Worker's Compe+xalion Inwmnce.to required by Section 3700.fthc later Curb.I.,me pert.+mance of the work tar which this .at is ixs.ed. GAS-EA.SYSTEhhI INC.AOUTLETS OCC.GROUP ANN My Worker's Compensain.Income,carrier and Policy number am: Cartier:�ICCy2 rte. Policy Na: C. Y GAS-EA.SYSTEM-OVERJ(EA) CERTIFICATE OF EXEMPTION('ROM W ORKINS' COMPENSATION INSURANCE GREASOINDUSTRI.WASTE IN'FERCkPPOR BUILD O TI'S issection need not be,completed!ifthe pm e +it is forone hundred dollars GREASETRAP ar IcsaO(ThPLANCHIiCK FEE Icenify that in the performanceof the work for which mix pennil is ixsucJ,lshall SEWER-SANITARY-STORM EA.2(q PT. not employ any peruse in any manner m as m become subject the Woken'Camper- 13NERGY FEE OZ satin.Laws of California.Dae WATER HEATER WNENTIELF.CTR GRADING FEE Z Applicant h NO ICE TO APPLICANT:IL alcor making mis Cenilicate of Iacmpdon,you.should WATER SYSTEMOREATING 3 pcnsa provisimem 5015 FEE fK ; fecomc sub'ect y the Workets Com tion f the later CNC,you met � Embwilh comply with such provisions onhis pemtit shallbedeemed revoked. WA'T'ER SIiHVICF. d [� = z CONSTRUCTION LENDING tionled AGENCY NEW RESIDENTIAL PLMB. SQ.Ff. PAID Receipt N V 0 I fair which Ink,mad i is a construction on lending agency forme performance of rework .which mix perms is issued(Sou.3097.Civ.CJ 0 U 'Lender's Name TOTAL: 0 V Lender's Address Iverify that I have mad this application and stain that the above information is BUIL 3�l F y career I race to comply."but city and county ordinances and.sum laws relating In QTY. MECHANICAL PERMIT FEE U Z building construction.and hereby aumorim aprescrativcs of this city m enter upon the SEISMIC above-mentioned property for inspection purposes PERMIT ISSUANCfiA (Win)agree to save,indemnify and keep harmless the City of Cupeni.o against f [LECTRI FEE Y Iiah dies,jud,amot,fosts and capcnses which may in any wayaccmeagain.asaid City AL's ER Olt ADD TO MECH. D PLUM GFEE y in consequence of the granting of this permit 7 O APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT DO 0.000 CFM) & SOI C'. ,ULA"PIONS. �u.gA�s' A PEE AIR HANDLING UNIT(OVER 10.000 CIM) CONS'IRUC ON'1'AX If 6:7 Signatum0 ppbcanUComrsctar 0< EXHAUST HOOD(W/DUCf) H G ION FEE HAYARDOUS MATERIALS DISCLOSURIi Will the applicant or future building occupant store or handle haeafdous material HEAT(NO UNIT(TO 100,000 BTU) as defined by the Cupertino Municipal CNe,Chapter 9.12,and the Health and Safety AjIIAID CNo.Section 25532(a)? HEATING UNIT(OVER 101000 BTU) —'Ycs NnVENTILATION FAN(SINGLE RGSIO) - WII the applicant or future building occupant use equipment or devices which Dec Rnci t I stmt Noon ua air contaminants as defined by the Buy Area Air Quality Management BOILER-COMP OHP OR 100.000 BTU) District?. BOILER-COMP(OVER I00.g1(l BTU) S El Ycs (-I No I have read 0+e htuarduoa materials quirements under Chapter 6.95 or the Cali- AIR CONDITIONER ISSUANCE DATF, fund.Health&Safety Cade.Section,T5505.25533 and 25534.1 i ndexluN that if tlie NEW RESIDENTIAL MECH. SQ.FE building caresser..ad,haver,tcnanr that it is my rtspNm,ibility reunify the.. at of the requirements which must he met prior m issuance or a Cenilicate of Occupancy '�'{I��ql ,�)/ Owneroraahemsed cm Uats AL' t ISSUED BY: Nom"•✓ � _- • '© OFFICE