Loading...
20839 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED L'INES'— USE BALL POINT PEN ONLY Building Protect Identification - PERMIT NO. Budding Address: - 20839, I98s LI rde ,6rcccF, I. ck n� wne s A rt I a're CITY OF CUPERTINO-BUILDING DIVISION 6iZ7cnY•a Na n.NAPPLICATION /PERMIT �' _ BULDING-ELECTRICAL-PLUMBING-MECHANICALCATEGORY CONTROL#616/C 1 v L Architect/Engineer. Lk.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: - PERMITISSUANCE -LICENSED CONTRACTOR'S DECLARATION YL Iherebyafflr that l am licensed under provisixesof Chapter9(mmmenc- APPLIANCES-RESIDENTIAL JOB DESC ON n Ing with Section 7000)of Division3 ofthe Business and Professions Code,and m licenselsinfullandeffxt PANQ S Llcen Class Lk.N 3 ie O O � Date�Contractor _ 417-c t ARCHITECTS 2014000 AMPS IL qczX Iuodmgand myplansshaBbeusedu public remMa. OVERIOOOAMPS SQ.FT.FLOOR AREA $/SQ.FT. °CC Licend Professional SIGNS ELFfTRICAL � �//( OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MLSC i t ip., p I herebyaffirmthat l am exempt from the Contractor's License Law for the - ZOora ZW following rem .(Section 70313,Business and Pro(esebna Cade:Any city or TEMP.METERORPOLEINST. W =ntywhichrequtmapermitwmmtmct,alter,Impmvema ,delleh,orrepalr q� .'ci anystmc mpriwtolts Wuame,alsorequireslheappBcantfwr chpermitto POWER DEVICES E5 file a signed statement that he is licensed pursuant to the provisions of the - G613 w Contractors License Law(Chapter 9(commencing with Section 7000)of Divi- VALUATION `N SWIMMING POOL ELECTRIC . f50S the basis for the ed Profemion. AnyCodsviolation hat f exempt therefrom and D © Q the baste far the alleged exemption. Any violation of Section 7031.5 by any OUTLETS—SWITCHES r D 0� applont fora pemNt aubfectstheepplkant toe dull penaltyo(natnnrethan five hundred dollars(5500). NEW RESIDENTIAL ELECTR E]1,as owner of the property,or my employees with wages as their sok �'hT' STO TYPE CONSTRUCTION compensation,will do the work,and the structure is not intended or offered for Osale(Sec.7044,Business and Profeslona Code:The Contractors License Law $ does not apply to an owner of property who builds or improve,thereon,and OCC.CROIII' RES.UNITS who doessuchworkNmeelforthrough hlsownemployees,providecithat such ^ improvements are not intended oroffered for sale.](however,the building or TOTAL: 4 ' Improvement UeoldwithinoneyearofcompletioMtheawner-buBderwill have the burden of proving that he did not Wild or Improve for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE - APN L1 L as owner of the pmperty,nm exclusively contracting with licensed pp 4,p ISSUANCE - contracto s to construct the project(Sec.7044,Business and Professions Code: ? The Contractor's License Law does not apply W an owner o(.propeky who ALTER DRAIN k VFM-WATER(EN BV Wild,or Improves thereon,and who contracts for each pVopcb with e - m,,Il1Bt((ador(s)licensed pursuant to the Contradorb License Law. FEE SUMMARY L_I I am exempt under Sec. B k P C'for this reason` BACKFLOW PROTECT.DEVICE OFETSIDEFEES DRAINS-FLOOR ROOF,AREA COND. a SANITARY Y N_ Owner - Date RECEIPT If WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N_ E31 hereby affbm that I have a certificate of consent to elf-Insure,or IV(NRES.PER TRAPCRECEIPT N adifimteof Worker%Comper tlonlruuranwwamdifiedropythemof(Sec. GAEA.SYBTEM-I INCA PARK Y N 38(10,Lab C0 S RECEIPT# Poliryk GAS F.A.SYSTEM-OVER4(EA) Comany ' BUILDING DIVISION FEES ❑pCactified copy is hereby famished. CREASE/INDUSIRI.WASTE INTERCEPTOR PLANCHECK FEE F-1 Certified mpy b filed with the city Inspection division. - CERTIFICATE OF EXEMPHON FROM WORKERS' GREASE TRAP PAID - COMPENSATION INSURANCE SEWER-SANITARY STORM EA 200FT Date Recel I# (This section need not be completed If the permit is for one hundred dollars ($100)mless.) WATER Ffl:A.I.FR W/VENT/Q.ECTA ENERGY FEE Y_ N_ ' I certify that in the performance of the work for which this permit la Issued, - I,hail not employ any person in any manner an as to become subject to the WATER SYSTEM/TREATINGTO Workers'Compensation Laws of Callfomla.Dale - PAID O Z Applicant NEW RESIDENTIALPLMB. SQFf. Date Recei t# Z O NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you P: ' should became subject to the Workers'Compenaation provisions of the Labor TOTAL: y Code,you must forthwith comply with such provisions or this permit shall be j deemed revohad. BUILDING FEE Z .cid W — CONSTRUCTION LENDING AGENCY SEISMIC FEE CL G [hereby affirmth tthem is a mnatrudlon lending agency for the pedomt - TOTAL: ELECTRIC FEE 45 D Z arm of the work for which this permit Is issued(Sec.3097,Civ.C.) U O Lmder',Name PLUMBING FEE L LL H Lemice.Addes. L QTY. MECHANICAL PERMIT FEE MECHANICAL FEE x� OW Icedifythatlhavereadthisapplirationandstatethattheabovelnformation f1 kmrrect.I agreeto comply with all cityand county ordinances and state laws PERMITISSUANCE r2- FEES PAID: } W relating to building romtrudion,and hereby authorise representatives ofthb /fr cit to entero the abovcmentloned a for inspection sea. ALTERORADDTOMECH. vJ ~ ? Y(We)agm t save,indemnify and keep harmless te City of Cupertino �' Date Receipt# V against h4ab ,judgments,mets ane expenses whit may In anywayamme AIR HANDLING UNIT CFO 10,000 CFM) SUBTOTAL' against nronegguenm Ke antingo th pertnit AIR HANDLING UNIT(OVER IO,000CFM) CONSTRUCTION TAX 0,70 fin pplicant/Co recto Date ' ExLiAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS ATERIAL DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) ' - Date Recel t# material as defined by the Cupertino MuNcipal Code,Chapter 9.12,and the HEATING UNIT 100,000 BTU) health and Safety Coddec Ion 25532(x)2 'TOTAL: Fssi, ❑Yee - 7]fu. VENTILATION FAN RESID Will theapplkant futurebuildingompant use equipment or devices ) .'ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air �Agggs , Quality Management rid BOILER-OOMP(3HP OR 100,000 OM ARID 4Yee o haPe read the bazar ous materials requirements under Chapter 6.95 of BOILER-OOMP(OVER 100,000 BTIN �, q 1890 the California H h& sty Cod,Sections 2SSa5,25533 and 25534:I undembrAth t he building doe,not mrrently have a tenant,that it b'my NEW RESIDENTIAL MECH. SQ.FT. 1� respossiblll oilfyt eoccupant of there entente which must be met as{ , prior to an o ificate o(Ompan /tq V4 Cupid's' neo uthmixed agent Date TOTAL: ISSUED BY' y`•)-^ �� OFFICE COPY