Loading...
22463 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LIN EST'�— USE BALL POINT PEN ONLY . Bulldin Naiad identification IAV l M� PERMITNO.' Building Address: 22463 _ 10 700 ►J � 106Aer1.� QWfl � sNFI_,_ nes one: 'Rep �lr*M%3 PPI�i9Q 5 CITYOF CUPERTINO-BUILDING DIVISION • Contra Name: Ue.N. APPLICATION / PERMIT BUILDING-ELECTRICAUPLUMBING-MECHAMCAL CATEGORY CONTR011tf SYC Architect/Engineer: Llc No: l0I / QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addreac PTRMITISSUANCE �� LICENSED CONTRACTOR'S DECLARATION Ihereby ectloarmthat am licensed h"O. 3ofthederpressand sof Cs5ioms9de,and c APPL[ANCESRESIDEN77AL ]OB DESCRIPTION It..I isful7000)ofdeffecn3oflheBupnemandPro(caponsCode,andmy PANELS license la In full force and died. / LicenseChu Date Contort ncior ARCHITECPS DECLARATION - 2014000"PS q�q�ua Ore OC I understand my Ohm aMI be used u I"''public records. OVER 1000 AMSQ FT MOOR AREA to (a Licensed Professional SIGNS ELECTRICfia- C 7 ei GGGG"a�Ltll OWNER-BUILDER DECLARATION �7 1 J z�o, I hereby affirmlhat l amexempt from the Contractoes License Law forthe - O Z following naso..(Section 70115,B.Mrmx and Prof®ions Code:Any cityor s L C� countywhlch requirma permit to construct,alter,improve,demoWh,orrepair arystmcham peiorto lb Wuance,aborequiresthe applicant forsuch permit to ppyyER DEVICES Iy ilk a signed statement that he h ilcenaed pursuant to the provisions of the Cont.d.e.License Law(Chapter 9(mmmentlng with Section 7000)of Disk1QTY. VALUATION sion3oflheBupnemwdProfemWmCade)orthathehemmptthemfmmand the basis for the staged exemplion.'Any violation of Section 70115 by any ,appllantforapermilsubjectstheapplicanttoacivilpenaltyofnetmorethanTSSWTTCHESFIXTURESL..y-�five hundred dollars(5500). SQ SIDRIFS CONSTRUCTION ESIDENI7AL ELECTR Ff.I,as owner of IM properly,or my employees with wage ea their outscompensation,wlldo the work andthe structure b not intended or offered fornrete6ce.78♦4,BYaiM9aa.dPmf.m .COde:TheCOnldoe.Li.R lw does not apply to an owner of property who Wilde or improves thereon,andOCC.GROUP RFB.I/NrTS who doessuch work himself orthrough hie own employee,provided that suchImprovements are net Intended or offered for axle.][however,the building or TOTImprovement hwldwithinomyearofcomplaton,theowner-builderwill have en of provingthat he did nmWild orlmprove for purposeafsaleJ. PLUMBING PERMIT FEE' FLOOD ZONE APN owner of the property,am exclusively contracting with licensed PERMITISSUANCE �s ntncion to construct IM project(Sec.7044,Business and Professions Code: The Contnctoes License Law don not apply to an owner of property who Wilds or Int rove thereon,and who contracts for such ALTER-DRAIN&VENT-WATER IEA) FEE SUMMARY on 5actor(-)licensed pursuant to the Contra toes License Law,%�with a LI I am exempt under See. B &P C for this Mason BACK FLOW PROTECT.DEVICE OUTSIDEFEES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N . Owner Dae RECEIPT p WORK MAN COMPENSATION DECLARATION �.�S PER TRAP SCI{OOLTAX Y N Ell hereby affirm that I have a certifiu[e of consent to self-Insure,a a RECEIPT 0 certificateofWorkers'Comperoatlonlmurance or a certified copy lhemoft5ec. GAS EA,SYSTEM-1 INCAOUTLETS PARK FEE Y N 3800,Lab C.) RECEIPT N PWIry tl CO any GAS.EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES 9" rttil Certified copy b herebyturnlahed. GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECI&e{ss'Z�� Ceed mpyhfiled with the city Inspection division. �} CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP - PAID^-a- r '�TDt COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.700FT. Date Rcce!i t# (This section need not be completed tithe permit is fee one hundred dollar (5100)mlem) WATER HEATER W/VENT/EL(CTR ENERGY FEE Y N Icertlfythat In the performance oflhework forwhich this permit is Weed, //�� I shall not ekemploy any Person In any manner w asto become subject to the 'i qp (pOOa Workers'Compensation laws of California Date WATER SYSTEM/TREATING PAID? OZ Applicant - NEW RFSTDENTIAL PLMB. SQFT. Date RCceI t# Z O NOTICE TO APPLICANT-.If,after making this Certificate of Exemption,you should become subjed to the Workers'Compemal ion provisions of the Labor - TOTAL: a. N mo CC Code,you at forthwith comply with such prosialom or this permit shall be L G FEE W , reI dssed revoked. /9�,a�—.y CONSTRUCTION LENDING AGENCY SEISMIC FEE f_arYti� 1 CL F3 Ihembyaffirm that there b a construction lending agency for the perform TO ^e ELECTRIC FEE Z Lenderlhe work(or which this permit is Issued(Sec.3097,Civ,C.) V O IciWer'e Nanta PLUMBING FEE LL F Landers Add mm QTY. MECHANICAL PERMIT FEE O W Imrtlfythatlhavereadthsapphatbnand statethattheabovelnforrmlion MECHANICAL FEE (1, iscomect.l agree to compiywith all cityand countyordlnances and elate lawn PERMIT ISSUANCE S— FEES PAID: N relating to building comWciion,and hereby authorize representative.(this F Z cityloenterupon the above�rmstioned property for Inspection purposes. ALTER OR ADD TO MECH. Date Receipt# Me)agree to save,Indemnify an d keep harmless the City of Cu perlkw V against liabNties,judgments,cups and expenses which may In any way accrue AIR HANDLING UNIT(TO 10,OW CFM) SUBTOTAL: ags 1 CI Inst f anting fthl permit / +A✓D� _ AIR HANDLING UNIT(OVER 10'"CFM) CONSTRUCTION TAX Qa Signature. pp"cant/ ontracior Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HA2ARDOUSMA ERIA RE Wllltheapperant car future bulldl pant re rhandlehavrdous HEATING UNIT(TO 1(0,000 BTU) Date Recd tit material as defined bytM Cupertino u cip'IC haptcr9.lZaodthe Health and Safety Code Section 75537(a)7 HEATING UNIT(OVER 100,000 BTU) TO ❑Ye No Wllllhe applicant or lure building occupant use equipment or devkm VENTILATION FAN(SINGLE RI3ID) .ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Arca Air . Quality Management District? BOILER-COMP(3HP OR 100,000 BTU) - I—I YesI— No pp ave read the hazy oue materialsmaterialsrequiremnnb under Chepter 6.95 of BOILER-COMP(OVER 100,000 ITV) B'pp�N K ' the Califmh Health&Safety Code,Sections 75505,75533 and 75534. I understand that if the building does not corrcntly have a tenant,that it is my NEW RESIDENTIAL MECH. SQFr ���� reapmruibl lty to notify the occupant of the requirements which=at be met OCT 2 nee cy. .eros oath sized agent Date - 4 ISSUEDV OF CUPEHTINU 0T OFFICE COPY