Loading...
22268 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bulldin Pro'en Identification 7 PERMIT NO. Building Address: - 22268 nen me, ane: A a CITY OF CUPERTINO-BUILDING DIVISION _ p rat. rsN+me: Lk.No: APPLICATION I PERMIT L ' BNLDINGELECTRICA4I'LUMBINGMMHAMCAL CATEGORY CONTROL» Arrhltect/Enginesr. Lk No: QTY ELECTRICPERMIT FEE BUILDING PERMITINFO Address: PERMIT ISSUANCE 1:1 ❑ ❑ LICENSED CONTRACTOR'S DECLARATION thereby affirm that l am licensed under provisions of Chapter9(commrn APPLIANCESRESIDENTIAL JOB DESCRR'7TON Ingwith Section7000of Dlvblon3ofthe Buaine..and Pmfmion,Code,and my license I.In full force and effect. PANELS Data Class LIeM de `(' Date Cont.ctor ARCHITECTS DECLARATION 201-1000 AMPS q f/SQ.FT. q��uu rs0 O I understand my plans be used u public records. 1 ti�yyy Licensed Professional SIGNSELECTRICAL E R OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/M15C I hereby affirm that l am exempt from the Contractor'.License law for the qq following reason.(Section 71111 S,Business a nd Professions Code:An cityor C Kt'Iy ceuntywhich requires a permit tomruhuct,alter,improve,demolbh,orreair TFMI'.MEIFR OR POLE INS(. G `'0 7 -file palette,Its bauance,aW requleaslhe applicant for such pererdt to POWER DEVICES 1 5 file a signed statement that he b licensed pursuant to the provisions of the Ow1� Contractor'sLicense Law(Chapter 9(mmmentlngwlth Section 7000)of Divi- SWIMMING POOL ELECTRIC UA BOJ don3ofthe Busln....d Professi.vCode)orthathebeumpttherefromaVALTIqNo nd Sn....7777 the basis for the alleged exemption. Any violation of Section 70115 by any applicant fora permit subject the applicant to a civil penalty of not more than 01177-ETSSWITCHESFIXIT02FS 0 "2 '9 Q five hundred dollars($500).I+ NEW RESIDENTIAL ELECTR 7< �T,asowner t the property,or my employees or with wages r theirsole �7'T' 6 TYPE CONSTRUCTION compensation,44,Business ess and rk and the.0 de:e Is The Contractors intenor offercense L w or O sale(-m.P ly 9usbswandf property Code:Theimpov,the..e Law 3$ deer not apply torn owner of property who nempoyees,provided reoR and OCC GROUP RES.UNITS whodoementsa eartInte dedoroughndowne.If,hoes,providedthatsuch improvements am notintended earo(co for rale.ILh ser-buflderwilt have TOTAL: Improvement band wlthlnorlcycarofc-mpldloMtheowner-bu0derw111 have tilli proving that he did not build m ireprove for purpose efsale.). QTY. PLUMBING PERMIT FEE L as owner of the property,am exclusively contracting with limned FLOOD ZONE APN rontract-n in roreBuct the project(Sec.7041,Business and Professimu Code: PERMIT ISSUANCE The Conm tractor's License law does not apply to an owner of property who ALTERDRAIN&VEN7WATER(FA) Wilds or improvers thereon,and who contracts for such ptojed - - a with a FEE SUMMARY ccnador(s)Ilmosed pursuant to the Contractor'.License Law. BACK FLOW PROTECT.DEVICE Ll]aexempt under Sec. B k P C for this mean. DRAINS Fli ROOF,AREA,COND. SANITARY Y_ N_ Owner Date RECEIPT If WORKMAN COMPENSATION DECLARATION - pI hereby affirm that I have a certificate of cww.t to self-Insure,ora pp(NggS PER TRAP SC7100L TAX Y_ N_ RECFII » 3800,Lab Cd nifieste-(Work--'Comw . peilan lusunceora mnified copy thereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N Policy If — RECm'T N CAS FA.SYSTEM-OVER 4(EA) any BUILDING DIVISION FEES Certified copy is hereby te �Certilied copy b filed withh the city inspection dlvlelon. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECICFEE ty CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWERSANTTARYSTORM FA 200}l• Date Recei t# (fhb section need not be c-mpleted If the permit b forons hundred dollar P (Slro)er less.) WATER HEATER W/VEM/ELECTR ENERGY FEE Y N I cenifythat In the performance of the work forwhich thi.permit b issued, I shall not employ any person In any manner n as to become subject to the WATER SYSTEM/TREATING PAID Workers'C.Por..tion Law.of California.Date rP A scant Z O become NOTICE TO APPLICANT.If,after mating this CertBka/e o(Exemptbn,you NEW RESIDENTIAL PLMB. SQtL Date Recei t# Fshould bee subject to the Works.'Compensation provisions of the Labor TOTAL: r/1 Code,you must fon hwlth comply with such provisions or this permit shall be BUILDING U W > deemed revoked. f] CONSTRUCTION LENDING AGENCY SEISMIC FEE a I hereby affirm that there ba construction lending agency for the b Wperform TOTAL: ELECTRIC FEE 7 Z anca of the work for which this permit ued(See.3097,Civ,C.) V O Lender'sName PLUMBING FEE LL F Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W rma Irentfythatfhawmadlhbappliationand natethattheabovelnfotion 1 isroreed.I agreetocomplywithaildty.ed couniymelinancetand gate[am PERMUISSUANCE FEES PAID: } rela0ngtobulldingromtructlon,and herebyaWhedce repre.entativesoflhi. (— N city to enter upon the above-mentioned property for Inspection purposes. ALTER OR ADD TO MECH. ? (We)agree to save;Indemnify an d keep harmless the City of Cu peruse Date Receipt# V' against liabilities,judgments,costa and expenses which may In anyway amue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: 3' agalrs id City In consequence of 711n,of WapennlL ATR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX g®sure a( leant/ eN.ctMADate EXfiAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUSTERIAL ISCLOSURE Willthe plimntorfutureWildingottvptstoramhandiehavardous HEATINGUMT(TO100,000B7U) Date Recei t# materials fined by the Cupertino Munlcip Code,Chapter 9.12,and the - Hralthan fety Cod-Srcion25532(a)? HEATING UNIT(OVER 101,000 BTU) TOTAL: n❑Yes No 3��� Willthe applicant or Nre building occupant use equipment or devices VEN77LATION FAN(SINGLE RESID) 1$Sl7f1YN�&DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? BOILER-COMP PEE'OR 100,000 BTU) ��� Vas ❑No d u havereacithehazardaus material,requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BN) the California Health&Safety Code,Sections 25505,25533 and 25534. [b s ,s48{ understand that if the building doe,not eareently have a tenant,that It my NEW RESIDENTIAL MECH. gQE7 04f: ,CUQono responsibility to notify the occupant of the requirements which most be met prior to Issuance of a Certificate of Oceu pa ncy. t TOTAL: � Owner or auihodred agent Data IggOEp gy; V. I U OFFICE COPY