Loading...
26628 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-El: RICAL PERMIT NO. BUILDING DIVISION APPLICATIONIPERMIT, PLUMBING C'l IDENTICAL 26628 IIUIhI;ING P120J6(YI'IDENTIFICATION BUILDING ADDRGSS: - -, 1 . ' SANI'T'ARY NO. APPLICATIONSUBMI//TTyyAI,DAIS �J V\ � W UNIT# LOT# �_2'y�►� OWNERS NAME: PHONE: CON'IRACI'OR'SNA LIC NO: —` l� NIC CONTROL •ARC]II'I'ECI'/BNGINEI312: LIC NO: ADDRESS: ❑ �g / CONTACT: PHONE: BUILDING PERMIT INFO ZQl'Y, ELECTRIC PERMIT FEC Lp IlQ EI ' P M UMECII PI?RMD'ISSUANCE LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL IOIi DISCRIPfION ptyZ I hcrehyaffirm Nal l um licensed under pmvisiomofL apmr9(cotmnencingwith IY00 fullSection rceand)nf Division3 of the Business and Professions Code,and my license is in ppNE1S FyZW fullforceClad effect, UP I'0201)AMPS << t� License Claus Corm ROD IOD. Date Commcmr 201-I"AMT'S a Z ONZ ARCHITECTS DECLARATION SQ.FE FLOG AREA sfSQ.FT. OVER 1000 AMPS OZ O 1 undersmnd my plans shall b,used as public records. 1 F� W� SIGNS ELECTRICAL Licenxnl Prnlessionel - a/1--111+1' a OWNER-exempt ?R n the CoATION gPEG1AI.CIRCUIT/MISC. iCO0F I hereby affirm that 1 urn exempt from the Qssions ra License Ism for the :yl which following rtaua.ermit to construct, Business and Professions or repAnyair city or county POWER ETER ORVICES M]LF.INST. #�Q j=�yM poor to Is tisane.alsomconstheapmr,imfrsuchcmanifttmrepeig enYsmctum f Y� pdurto stn issuance.also requires the applicant for such pclmiuo fileasigrrW statement POWER DEVICES µ�j p Thal he is licensed pursuant to the provisions of the Contractor's License Law(Chapter d m cmmencin th Suet on 4000 f Division 3 of the Businevsand Profeeslam Code) SWIMMING POOL ELECTRIC 9(u - Wou, bwl )o VAI.UATION� yYjtim Seor ction hciaexempt any applicant f the bmiefomhetsflicalleged exemption.Any violation of UTLES.SWITCHES-FIXTURES �ZY Se home.h. iv eanaeddrmlfmapermit subjects the applicennoecivil penalty of not more than five hundred Anlims(f3110B. K y3,2 w ❑ 1,a;owneroDhepmpeny,ormyemploycawithwegesustheirsolecompmuation, NEW RESIDENTIAL ELECIR _SQ.FT. STORIP TYPE CONSTRUCTION will doahework,and Nis e structure notI codedornffereAfur eale(Sec.RHq Bminem uod Profesaium CMe:'I'he Cown.Ur'e License Lav,does not apply m an owner of property whobtildsorimprovcsthereon,and whodoessuch work himselforncrtmgh his OCC.GROUP RFS.UNITS wnemployees,provided that such Improvementsaremot intendedoroffcredforsate.If, however,the building of improvement is said within one year ofcompletioo,the owner- T builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I,as owner ofthe pro)mny,am exclusively contracting with licensed contractors to QTY' PLUMBING PERMIT FEE ITOOD ZONE APN constrict the project(Sec.7044,Business and Profession;Cale:)The Contractor a PERMIT ISSUANCE License Lewdoesnut upply m on ownerof property who buildsmimpmvcsthercon,.d who contracts forsuch projabwith v contractors)licensed punn uano the Commences ALTER HEA)Liatru Luw. ( FEE SUMMARY ❑ In exempt under Sec. ,B&P C for thin moron BACK FLOW PROTECT.DEVICE. OUTSIDE '' SANITARY Y N Owner Dare DRAINS-FLOOR,ROOF.AREA,COND. RECEIPT#- WORKMANCOMPENSATIONDECLARATION SCHOOLTA% Y N ❑' Ihemhy nffinn thntlhnveacenificme nfconunt tv self-insure,Ura cenificete of RECEIPT Workers'Compereation Insurance or acertified copy themof(Sec.3800,Lab C.)which Fl%TUkFS-PER TRAP I � PARK FEE Y N coversall employee's mndenhispermil. GAS-EA.gYS'IEM-IJNC,4OUTI.IRS Policy# UILDI G ISION FEES CompanyCe" GAS-EA.SYSI'EM-OVER al IRA) PLANCHF �y ❑ GertlfiM copy is hereby famished. ❑ Certified copy is filed with the city inspection division. GREASEANDUSTRL WASE INTERCEPTOR GRADI CF.RTIPI A'I'I?Olt CXEMfTtBiFROM'WO KE7R� GREASE TRAP S i COMPENSATION IN -FRANCI? ('ITisaectiouneMrnl be completed if the permit is fornne hunSEWER-SANITARY-STORM EA.200FT. ENERGY FEEorles.)I ceno'ythorn th perfomamceofthe work for which this perWATER HEATER W/VFNT/ELECI'R .at employ any per, in any manner a ax.to become subject to the Worke PAID 7-. Comprnsmion Ltwso Culifnmia. Data WATER SYSTEMITREATING Date cccipl Applicant Z 0 NOTICH1OAPPLI NT:1 after hs c of Exemption.you should NEWRESIDENTIALPLMR, SQ.Ff. OTAL: F V2 becomes m the o o - a he Lobar Code.You mist a 7 forthwith comply wit s or this permit shallMdeemed revoked. BUILDING FF. — VL11 (� CONS R CTION LENDING AGENCY All, SEISMIC Z Iht forvi is Oa he eco dttRd Vr)ey rjle#erfonnun of 1' L O the.,,,it Name ch rmi Is issu e[!'�U9 1 J Lenders Name D Q U t<nd Address 'v QTY. MECHANICAL PERMIT FEC PL IN I EEE• I certify that have read This application ly state rhat the obo-e� r1^ W correct.lurecm m l Ih ail cit Jwwm nNinancm and etble roma rclatio to PIiRMTTISSUANCE �. MECHANICAL y n pyhe yon Y 8 'U Z Tiff buildingcanetred n, ill for im nthorizpmjp eourives of this city upon the CONSTRUCTI TAX L) z abov Wimioned pony forinxp41»putlmua. ALTER OR ADD TOMEC#. (We)agree w comfy and keep hmmleu N<City of Cupertino agaimt Fabilities.judgmence,cost,and flxpen hich yinany weyoceme agninsuviJ City AIR ItANDLING UNIT(TO 10,0Ltl CTM) rnming of 's panto wg AIR HANULINGUNIT(OVER 10,UWCFM) IQ ✓2 Sig ammo(AP1Ji—bConl nor Da EXHAUST HOOD OVIDUCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,0(10 BTU) Dm t _� Receipt# Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(OVER 100,000 p'fU) ride- d by the Cupertino Municipal Cale,Chapter9.12.and the Health and Safety Code,Section 23332(e)? 11 Ycs ❑Na VENTILATION PAN(SINGLE RESID) Will the uconta manus its defined by me tuy Area Air Quality Management BOILER-COMP(3HP OR I00,f#10 BTU). 11 'HANCE ATE huzardnu.v air contaminants its defined by the Bey Area Air Quality Management Dlsttlfl4 10 BOILER-COMP(OVER 1000BTU) ❑Yes ❑No NEW RESIDENTIAL MECII. SQ.IT. A B I have rend the hicoSafety Coe motion,reyuirtments under Chapter1 vas 6.93 of the �'9 California Ileahh&Safetyently 25505,25533 it sand,lumai 1undersand That (f�; q ifthe huilof the snotwrtemlhich mushave a t be nice ois to issuance Cedrto ionthe /y /M� Occupant of the reymirements which muss he ren prior m ixsuunce of a Cenificme of Occupancy, n..,. Owner m mithonzM agent Date TOT ISSUED BY: C _ OFFICE