Loading...
S 2756 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECT RICAL PERMIT NO. BUILDING DIVISION APPLICATION/PF,RMIT PLUMBING-MECHANICAL S 2756 BUILDING PROJECT'IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI'TT'AL DATE OWNER'S NAME. PHONE: CON'1'RACIOk'S NAME: LIC NO: PER LW'4 LIC NO: `ADDRESSf SIC � 2 2 CONTROI # CHIT'`T/ENGINIibk: . e 2.1'Z ZY CON'IACIQ,{PHHO�NNE:, BUILDING PERMIT INFO H i Ka �0-`1 \TI VJ E—] Consultant Fees Paid by Applicant(Initial) B 2-4149 LDG i ELECT PLUMB MECH LICENSED CONTRAC'TOR'S DECLARATION QTY. ELECTRIC PERMIT FEE 1 M1emby.fosse that Into licensed name,pro,inons of(cipm,9 commencing JOB DESCRIPTION FOOC'L wnh Sec6on9W0)ofDiviaion3anhc eusinas sera rmfesiions Code.ander license is RP.SIDENTIAL = in full force and duct. y PERMIT ISSUANCE nnaa <-U License Class Lt..# ysFDWL ❑KITCHEN REMODEL NZW Date, Complain, APPLIANCES-RESIDENTIAL. ❑ADD]'T']ON El PLUMBING RR-PIPE WW ARCHITECT'S DECLARAI'[ON ❑MULTI-UNI'P C1 STRUCTURAL z0°pz I and emland mblirmemod, Vuyplmassholl be used as PANELS MODIFICATION Oz4Q UP TO 200 AMPS El INTERIOR L1 CHIMNEY REPAIR Q,�2f Licensed Professional 201-10x10AMPS IMPROVEMENT E]SWIMMING POOLS s�S OWNER-BUILDER DECLARATION a C a Q I hereby affirm that 1 am exempt from the Cotumu..r's License Law for the OVER 1003 AMPS 0 HATH REMODEIlRI?PAIR El DEMOLD'ION 'jX O y U following rens....(Section 9031,5,Business and Frotcsvuns Code:Any city or coumy SIGNS ELECT RICAL ❑OTHER W a c y wM1icM1 requires u permit e,uemwd,aper,improve Jcnudisb.nr reparz any sWmurc ^,�7 w0w prior o its issuance,also requires the applicant for such permit i..file a signed statement SPECIAL CIRCDIT/M ISE. y�yy� that he is licensed pursuant to the provisions of the Commetors License Law(Chapter 9 00 (wmmencing with Section 9001)of Division 3 of the Business and Professions Code)or 'TEMP.METER OR POLE INST. COMMERCIAL d rye o a that he is exempt therefore and mo oasis for me alleged exempdnn.Any viomdon..f 0 NEW BLDG/ADDITION ❑DEMOLITION ��m Section 70315 by any applicant fora permit subjects the applicant to v civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE ^O rotor p than live hundred dolls¢(3500). IMPROVEMENT Ol,m.wner oFlhc properly,or my cnepl.yeas witM1 wages as their sole mmpencmion. SWIMMING POOL ELECT RIC F. will dothe work,vadthe some. reisn.t intended moBered forsale(Sce.9044,business did THBR W 3 m and professions Code:The Contractors License Law dews not apply to an owner of OUTLETS-SWITCHES-FIXTURES properly who builds or improves thcmom and who dors such work hinesdl or through his own cmployccs,provided that...M1 improvements arc urn Intended lir of for NEW RESIDENTIAL ELECTR SQ h-1: 911 sale If,however,the building.1lmpmvearnt is sold within no ye.,ore... Linn,the �9 ^� SQ.W.FLOOR AREA $/SQ.ET r-builder will have the burden of proving that he did not hulldor improve far Aur- 3Q L Q 2 {ase or sale). Q�p E] 1,as owner of the property,am excludvely contracting with licensed contractors to � ( '`Z s'L, 33 ? 7 consumer me project(Sec.7044,Rosiness and Profession,Co.,.,The_ wo,rs Li- .,c Law does not apply to air owner of property who builds or narcoses thereon,and QTY PLUMBING PERMIT FEE who contracts for such projects with a contmetor(s)licensed pursuant to the Contmamr's `17 License Law. PERMIT ISSUANCE 5 0 lamexroammdef Sen. ,B&PCfa dr,m.,v. Ownar ALTER-DRAIN&VENT-WATER(' VALUATION lite WORnder nal P Sp NDEC], fsinng declarations:I ION HACK FLOW PROTECT.UE �Qr"�` © ^O Ihercby officer anderpeCOMPip a lv O l have,and will maintains Certificate.(Consent tosdf-insure ha Worker',Common- DRAINS-FLOOR,ROOF.AREA,CON STORIES 'I'YPI?CONSTRUCTION rection,ac provided to,by Section 37M.f the Lab...Calc,to,the perfommacc of the work for which his permit is mated. FIXTURES-PER'MAY Ns 0 1 have and will maintain Workers Compensation Insurance,as required by Section 39W of the Labor Code,fanhe performance of the work for which this perm..isemed GAS-F.A.SYSTEM-I INC.4 OUTLETS ACC GROUP APN MysC.mpensntion lnsumncecarrieraad Policy number lire: Carrier: Policy No.: GAS-BA.SYS9P,M-OVlik 4(EA) CERI IIyCATE OF EXEMPTION FROM W ORKERS' COMPENSATION INSURANCE GR17ASOINDUSTRL WASTE INTERCEPTOR (Thisecett.a need not he mmpletiodde t is foroae hundred dollars G 100) I3U1 DING DIVISION FEES )coni GREASHTRAP I or leas) PLANE KkE I eenllythntimhepnnaneeofinew..rk forwhich lhispermiu,issucl,lshull SEWER-SANITARY-STORMEA.20UFI'. not employ any person in any manner ren as to become subject w the Wnrmae'C..mpen- 13NL'R Y P O Oz curve Laws of Celibarm.Data WATER BEAT ER WNESIVELECTR z Applicant ORAL HIIC -E h NOTICE 10 APPLICANT:if,after making this CerliOcalc of Exemption,you sbnulJ WATER SYSTF.MaREA'I'ING a becou me timeco he Workers Compenro shien pvisions of tire ro e Fact Code,yu most SOILS Forthwith comply with such provisions or this pectin shall be decried revoked. WATER SERVICE. d A UO CONSTRUC iso IIPON LENDING AGENCY NEW RESIDENTIAL PUSH. SQ.1"1', PA11 I borwhich re.that there issued(Suctior lending agn,cy for pednrmance of Dom Receipt# the work for which this permit is issued(Sec 3099,Civ.C.) QLender's Name T AL Z O WLender's Address y 1 ecrlify that 1 have read this application and shoe flee.the above in[ormmion i, BUILDING FEE Z) mrrcet.1 agree to comply with all any cad county ordinances and state laws relating m QTY. MECHANICAL PERMTP FEE O'Z building constmction,and hereby authorize representatives ofthis city to enter upon the SEISMI' PERMIT ISSUANCE-m above uuimmal phTe ry for incpeaion parpeecs -J (We)ag,ee,,1111,ladnnrify and keep harndcs the Ciey of Cuperdn.against HLP FEE G.� m conics,rydnor'he'came ex'his prnnit. may in eny way asses vgaiaa sail City phl'Ek OR ADD TO MECH. in c 'itonstruction ce UNDERSTANDS tbisD WILL PL G I'EG APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Alk HANDLING UNIT(TO 10,000 CFM) SOURCE REGULATIONS. MEC ANICAL PL'G ' s-q AIR HANDLING UNIT(OVER 10,001 CPM) CO SIRUCTION TAX 7 Z Si ter IApplican ommemr Ilam/ EXHAUST HOOD(W/DUCT) HOU. NG MITIGATION FL'E HAMMOU dAl'ERIALS CLOSURE. Wi 11 the split icmnt or future ^^^",- tu.re...handle mounds.,material HEATING UNIT(10100,10X)BTU) as definM by the Cupenin.Municipal Code,Chapter 9TI2.mail the Houlth and Safety Code,Sec6en 25532(10". HEATING UNIT(OVER 100.000 BTU) ❑Yes E]No PAID VENTILATION FAN(SINGLE RL'SID) Date Receipt# of Will the im,,o applicant or fume.building occupant HE A equipment or devices which mit hazardous air enmuvinants us Jefmul by the Bny Aran Air Quality Management WILGR-COME(3HP OR IgkUa1139'UJ Distnm? [:J Yes ON. BOILER-COMP(OVER 100.000 BTU) I have mud the hazmdons materialsL under Chapter 6.95 of the Cali- AIR CONDITIONER reyairemen p �IS5UAN 6 DATE�� li,miu Hamm&Safety Cale,Sections 255!15.25533 and 25534.1 understand mat if the NEW RESIDENTIAL MECH. SQ.PT. building does not currenly boss..levan,,that It is my resp.ncibility to notify the xcvpnm .RM1creyuiremennwhich"amb ,dpdnrm,'mirmeofacenifwteof Ocu ane y. Owner o an o zed.. Date T A ISSUI3U HY: OFFICE