Loading...
24121 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project ldemlflcali. PERMIT NO Building AddreQY r 241 21 G am 15 o P' e_-rr rA s 2'-92!51 CITY OF CUPERTINO-BUILDING DIVISION contra or'.N.me: LIc,1: APPLICATION /PERMIT -�� �Erl S IV ('V �pL(0491 BITILDINGELECTRICALPLIIMBINGMECHANICAL CATEGORY CONTROL# act/Englneen Lic.N. �7 QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Addreas: 3�(� 1 woo r PERMITISSUANCE LU LICENSED CONTRACTOR'S DECLARATION E Lp I hercbyaffiren that l am Licensed under provisions of Chapter 9(commene APPLIANCES-RESIDENTIAL JOB DESCRIPTION ingwith Section 7000)of Dlvidan3ofthe BusirmanandProfessionscods,and my license Is in full force and effect n _,J�a PANELS License Class LICK ItAoKsfl f - ,#�^Pa • '/• DateContnctor UP TO 200 ANU'S ARCHITECPS DECLARATION 201-IOW AMPS Q O I understand my plane shall be used as public records. OVER IOW AMPS ^ SQ.FT.FLOOR ARA f/SQ.FT. IN E Licensed Pm(easianal SIGNS ELECTRICAL 11 I L S E D OWNER-BUILDER DECLARATION 6 ,�\ f—• p1 fn]a SPECIAL CIRCUIT/M15C 1 IC�� �••s� g t"G3 I herebya(Ormthatlam exempt/mm the Contraa[ore Lirenx Law(or the qq (ollowingreason.deas.n7mIS,Bu.muotand,ftnp.n.Code:Anycityor ',,,✓ n countywhie rcqulresaperMIS,m 1irmse ralPbnprove, Code: h,y city r TESIRMFI'ERORPOLEINST. `a X77a anyathmbem prior to its lsseance,91.0 requlreathe applicant for such permit to POWER D�� DATE 106 U file a algned statement that he b licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 70ns 00)of Dial- SWIMMING POOL ELECTRIC �' VALUATION s,307 Mon 3 ofthe Business and PrefeasloCade)orthet he b exempt therefrom and �'•33 the basis for the alleged exemption. Any violation of Section 7MI.5 by any « applIcamfor.permit subjects the a pplleant too civil pens try of not more than OUTLETSSWITCHES-FIXTURES Ove Fj1,as rcwnerof the 00. NEW RESIDENTIAL ELECTR_SQ.FT. STORIES TYPE CONSTRUCTION �n ❑Las owner of the property,or my employers with wage a thele cola compensation,will O dothe workand the s dure Intended oroffered for sole(Sec. y C Business and Professions Code:Thehe Contractors License law n $ donet apply to an owner of property who build.or imprwn thereon,and OCC.GROUP RES.UNITS who does such work Mmaelf Intendedorwgh his own e.If,ho eprovidedthat such ilding or improvementsare no ithinone earofcd(orsale.ILh ner-g deer illh ve TOTAL: Improvement baoW wlthinoneyearo(complNlorytheowner-buliderwlllhave tittIserden of proving that he did not build or improve for purpose ofsale.). QTy. PLUMBING PERMIT FEE FLOOD ZONE APN 11 L as owner of the property,am exclusively mntraning with licensed contnciors to construct the project(Sm 70K Business and Professions Code: PERMIT ISSUANCE �r _ The Contractor's License law does not apply to an owner of property who ALTER &VENT WATER[FA) 1 1 y bullds or Impmvn thereon,and who contracts far such projecs - -twith a FEE SUMMARY e �actor(O Ilanmd pursuant to the Contractor's Lt...I.. BACK FLOW PROT[CT.DEVICE LJ I am exempt under Sec B&P C for this reason DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_ Owner Date RECEE'T N WORKMAN COMPENSATION DECLARATION FI%1.URE5 PER.IRAis �r SCHOOLTAX Y_ N I hereby affirm that I have a certificate of consent to self-buss,,ora RECEIPT N rertifrrste of Worker'Compereadon lnsunnnora ramified ropy therco (Sec. CAS EA. INC.60UTLE15 PAIU 3800,1.6 Cd C FEE Y N Policy p GAS G.SYSTEM-0VER 6(FA) RECEIPT N Com any BUILDING DI VI SION FE ISS MCehifiedmpylafilM thtl dd. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE MCedified copy la filed with the cityIns)>ectlon division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA XpFrl. Date Rec i t# Uhis lesson need rad be completed If the permit V(ore hund oored dollars ($1 W)orless) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N Icertlfy that in the perfarmenreafthe work(arwMcA this permit le lased, I-ball not employ any person In any manner eo as to become subject to the WATER SYSTEM/TREATING Workeri Compensation laws of Olifornla. Date PAID. 0 Z Applicant NEW RESIDENTIAL PLMB. SQFT. Date Remi t# Z O NOTICETO APPLICANT.X.fier making this Certificate of Exemption,you Hshould Femme subject to the Workers'Compensat ion provisions of the Labor TOTAL: M > Code,You=at forthwith comply with such provisions or this permit shall be BUILDING FEE W _ deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE d IhenbyafRr Chat there U a construction lending agency for the perform- 7 Z ance oflheworkfarwhichELECTRIC FEE lhis permit is Issued(See.3097,CIv.C.) ELECTRIC FEE V O Lander'.Name I LL Lando.Address QTY. MECHANICAL PERMIT PGE MECHANICAL FEE OW Iredify thatl have readthb appllratlonand state thattheabove Information CL 1s carrctt.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID: >. W relating to building construction,and hereby authorlu representatives ofthis H Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. — (We)agree to cava Indemnify an of keep harBdess the City of Cupertino Date Receipt# against liabilities,judgments,coatsand expenses which may In anywayacems AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: against said Cijty In mmryuenn of1he gra rating cf this permit. 2�_ ,(� 7 AIR HANDLING UNIT(OVER IO,ODO CFM) CONSTRUCTION TAX Signature-AAppBcant/Contraacct`orTTatta EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MA IALSDISCLOSURE Will the applies at or future building occupant store or hand le hanNous HEATING UNIT(TO 100,ODO BM Date RCmi I# material as defined by the Cupertino Mu nicipal Code,Chapter 9.12 and the Healthand Safety Cade Sectur,25532(4)1 HEATING UNIT(OVER 100,000 BTU) TOT r Yenr]No Will the a ppllcant or furors building occupant uu equi pemat or device VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which chat havrdous air contaminants as defined by the Bay Area Air 0..Ioy Marugement Dotm,t? BOMFR-OMP(3HP OR 100,000 BTU) Yea No OW have read the haza ..materials requlrcments under Chapter 6.95 of BOILER-COMP(Ova too"BTU) the California Health&Safety Code,Sections 75505,75533 and 25536.I V" understand that tithebuildingthe occupant of t e rrcuivenoat.ntly have Lenarwhich thatb mans my NEW RESIDENTIAL MECIi. SQ.FT responsibility c of a notify occupant of iherequiremenb which must be reset q prior to Issuance ola Ccrtifirele of Ocsvpanry. t Owner orauthomard agent Date ISSUED BY: 1rs �T YP TOTAL: — OFFICE COPY