The URL can be used to link to this page

04100036 (4)oz �t CITY OF CUPERTINO "' ( ��Q-. BUILDING DIVISION PE � �+7" ,M g'NN.31 WELKIN INTERNATIONAL IND IZMITND04100036 BUILDING ADDRESS: OWNER'S NAME: PERMIT ISSUE DATE E: SANITARY OL NO. ARCHREC IENOINEER: BUILDING PERMITINP BLDOO BLECI' PLO O LICENSED CONTRACTORS DECLARATION Job Description I bemby aRrm that 1 w B¢ved under Provisions Of ChaN m 9 (exmmswins _ - with 7 )OfDPoisien3ofWBusi fesuorucode. aM mylmmueis in rml�rera arta 1Q Licence s La.1 REMODEL --MS.. ]BATH/WINDOW REPLACEMENT/ noneC Con ARCHITECTS DEC ATIU I understand my plans shall be used as per Ie commit Licensed Professional OWNER -BUILDER DECLARATION I hemlry a riim that I em exempt (mm W COnuaclurs License Law for de . following mason. (Section 70315. Budd eta and Pmfessiow Code: My city Or county Which mquirw • Permit In conmrwl, Aller. Wpm,, damnliah, or repair uY almCmm nnn s License Chopler9 " W is Oansed peraram th ftprviciebns Nt the Ccanus<loritSoV Sq. Ft. Floor Area Valuation (emnmencing wide Section 7000) of Div oft of the Busiwas and Professions Code) an that W b exempt dondroa and the bass IOf doe &listed eaempuom MY vieluloes Or 3 ZRNRd"crO 0 Occupancy Type Semon 7031.5 by arty applicant for a permit subjects the Applicant to a rni Kathy Of rlrp mom deer five hundred d011us ($500k ❑ 1, u owner of the prepany, army employcu with wages u Ilmbsole compensation. uired Inspections - q P will do die wOlkand the snmumbnotinm&duoffemdfOlule(SeC. 70M,BwinasRe Law thea Appy a an owner Of and Pro(wthow code: The Conclac, uarlse a = w pmpeny who builds or imprams dvumn. and who deses s Soh work himself or through his plan,mployees. provided thuswh Imponwarma am outisanded woBered forum IL howeswr, the Wilding or improvement is Sold within ow You of=mpicdm the Owner- Wilder will Mae the admen or proving that W did wt Mid Or improve (os Purpose Of sale.). ❑ I. u owner oj y couumting wide:)awed uaosess .. countesses. ct Seen Boniness Aad oo Coubamars centrum dee proem o B a who Wihdoce,lds nd ds nor awe [ave dna vel Apply je an owner of mappens who Wilda w improves Wmon.Ond, apply in property who contracts fosswh prmKca with a eonpanos(q Iiconwd punwm the W Cenroetars I am exempt under Sec. . B k P C for this moon 0 1 sure exempt OwnerDataWORKER'S COMPENSATION DECLARATION 1 hereby alum under penally of perjury one of the following declandons: ban and will maintain a Certificate OfCce,ext m self -insure for Workers Compen. u"Oh. u provided fur by =cm 3700 of the Libor Code, fos thus Perfomuco of dos Souk for which thus pemit is isswd. ❑ I bane and will maintain Workers Compensation taproom. u required by Section 371 of d, IAEar, Code. (m the pedmnnssa of the work for which this permit is bound My Workers Compen en Irs. artier and I' number am: -t 7 G / d rear. k D Policy . C TIFlCATE OF EXEMPT30N FR WORKERS' COMPENSATION INSURANCE (This section wed not W completed if tad Parretti, forms, hundred dollars (S11) or ICSL) 1 ceNfy dust in the per(om=m of ths work for which this permit is iuued. I shall out employ any penin in any manner so u to become ubjwl In the Worb=' CentPensadm Laws of Csllfmmis. Dam Applicant NOTICE TO TO APPLICANT: If, afar making this CendOate Of Ea,mptios, you should ' become subject in the Workers Compensation provisions of the "Wr Code. You most forthwith amply with swh provisimu or this permit "I W deemed revoked. 1 CONSTRUCTION LENDING AGENCY _ 1 hembyarfnm deer them Is a convection lending jency for the Performance of ' dee work for which this pemil Is issued (Sm. 3097, Civ. C.) Lender: Nares Under, Add= 1 1 comfy that I Moe read We application and sass than the AW W hdounadce Is ' ecrrea I apse a comply with all city sad =Only on inkrms ad sass Iowa rtl.dAt a building cenpucdom=d hemby=thonm mprt Mliva Of this City to man upon the for inspection abom-mendmed property puryoaa sad hcop bamass the City of Cupertino said City j (We) agree m uw, indemnifyexpenses liabilities, l.ts.costs=dapenswwhieh may lnuy wrysmwagdnsno ArCrty in emagwwa Of the granting of this pumil. 1 APPyPLIC ND�AND WILL COMPLY WITH ALL NON -POINT LA Issued by: Date GUONS SRC�� 9!�/ 6 Re -roofs Type of Roof te gneare ofA plie=HAZARDOUS MATERIALS DISCLOSURE "'Ate Will the applicant Or imus Wilding Omuputsam or handle haurd=a material as de0ned by the, Cupenim Municipal Code, Chapter 9.11, and the Hmldp and Safety Code, ec 25531(.)7 (gNe All roofs shall be inspected prior to any roofing material being installed. to If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant n¢ equipment Or ucvices which` t h.sIum us air eonamiaunts as th,Owd by the Bey Ams Air Quality Management all new materials for inspection. smm7 ,/ ❑Yee ®Nu 1 have mW the haurduusmaterlals requirements underChapmrb.95Of th, Califor. tib Ha]"SefctyC.M,ScN.25505,25533=d M534.lundcnand Netiflhc building drew Out cumnlly he. a n4 that it Is my responsibility n nodl'y da Oceuput of On myuirt nuwhich mwl met nosusmcofaCepdfiaamfOccup say. Signature of Applicant Date All roof coverings to be Class "B" or better Own err O thus d ag tit It,ste CUPEkTINO a 1,� *CITY OF CUPERTIN* PERMIT APPLICATION FORM IAPN # Fee Description o L7 Date: 1 Building Addres : MECHANICAL ailingddress (if different from building address): AS-0� Owner's Name: y� G`v MECHANICAL Phone #: Contractor: Ctv Xl � i MECHANICAL BBOILER3 License #: g�2 6Z�J Contact:i t�`i x�C r� Phone: #a€ —338 Fax: �9B- 733-0989 Cupertino Business License#: Building Permit Info: Bld ❑ El ❑ BBOILER5 Plumbd' Mec Job Description: Residential p.g.Q, w i ( tem W.v,( �7,�,� ,p 'case Qr.Y `0 v Co ercial Sq.Ft. Floor Area: Ind/Off/Comm/Quasi BUILDING $/Sq.Ft.: Cost of Project: BUILDING Occupancy Group: BUILDING Type of Construction: Constax — Resi/Mobile BUILDING Please check this box ► ect is a second -story addition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ BELEC1001 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to, 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu: MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXB Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL LV BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 2733(- 1of3 2_9(r/y r6c' CUPEI,TINO *CITY OF CUPERTINO* PERMIT APPLICATION FORM Quandty Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCONMffi New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING / BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apoaratus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 OITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING. BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL 6A V MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING - • 3 of 3