Loading...
19652 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,— USE BALL POINT PEN ONLY Building Pro'ect Identification . PERMIT NO. �BWId;Ag�AcIdreas: - " - . 19652 l.o' 7 7t-� , Ft 2z C: C Phone: wnerV. ,e - - e U -:CITY OF CUPERTINO-BUILDING DIVISION c6ndma Na - Lm.Nn • .APPLICATION'%PERMIT.— BUd fLUING- ECTRICALPLUTO MBING MHAMCAL CATEGORY CONTROL � . Arch et/En neer. LI$Na: tQTY t'c's( t t,ELEL'TRIC PEI{1411TIt i sl.. FEE' :'I t BUILDING:PERMIT(INFO a':' Address: _ PERMITISSUANCE - LICENSED CONTRACTOR'S DECLARATION �'• L1 ` Ihereby affirm that Lane licensed under provisions of Chapter 9(comment. APPUANCESRESIDENTIAL _ )OB DFSCRI'fION s ingwith SeRion7000)6f Division3ofthe BuslnessandProfessionsCode,and my - lianm Is In full force and effect. PANELS - r License Clam '^ Llc.# s �P Data Contractor ' UP IQ 200 AMPS ARCHITECTS DECLARATION 201-IMOAMPS fI 9Z I understand my plans shall be used as public records. OVERI00)AMP9 SQ.FT.IlAORAREA $/SQ,FT. µqqµ! CO E (� Lhanse,d Professional SIGNS ELECTRICAL - - 66 w 6 OWNER-BUILDER DECLARATION f I"n Fi3 SPECIAL CIItCUIT/MISC - 02 a owingrason.(hatlamexempt 31.5,Business he sad Professions Code: Law tort he - pp following reason.(Section 7eetto Business and Professions Code:demolish, d or O Z f.� y ty TEMP.METER ORPOLE INST. anystmcountyhkh mguirviartolts manceao muimsth.mprove, sucorrepair tto q .`ri- 3ny atmcture tatemelte that he is sins reed pursuant to the provisions rMt a POWER DEVICES. file a signed statement that he Is licensed pursuant to the provbiom of,the O u, Contractors License Law(Chapter 9(commencing with Section 7000)of Divi- " �0 shun 3ofthe Business and Professions Code)or that he Is exempttherefromand SWIMMING POOL ELECT VALUATION p, the basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSWITCHFSFI ES' Q applicant fora permit subjects the applicant to a civil penalty ofn.t more than `��5 Q five hundred dollars($500). ; 4 r`7ti+u• - ' W �n ❑I,as owner o(the property,or my employees with wages as their sole � NEW RESIDENTIAL ELECTR STORIES TYPE CONSTRUCTION i. compensation,willdothe work and thestructdre is not intended or offered for , g q ask(Sec.7044,Business and ProfessionsCode:The Contractor's License Law F,,�� $ does not apply to an owner of property who Wilds or Improves theme,and '�^ who does such work himself or through his own employees,provided that such OCC.GROUP RES.UNITS improvements soared intended orofferedforsals.If,however,thebulldingor u :.. TOTAL improvemntissoldwhhinoneyearofcompleton,theowner-bu0derwilI hav - te mien of proving that he did not build or improve for purpose ofsal.) 'Qq'Y,:1 •t ,PLUh'IBINC'PERMtTa+ ,:x,r ?`•FEE : •FLOOD ZONE APN j L as owner of the property,am exclusively contracting with....need PERMIT ISSUANCE - contractorstoconstructtheproject(Sec.7044,Business and Professions Code: L. .The Contractor'.Licenm Law does net apply to an owner of property who Wild. or Improve.thereon;and who contract. for such ptojets with a ALTER-DRAIN&VENT-WATER(EA) co,Lttct 9)licensed pursuant to the Contractor'.License Law. - 'OLt:4`k •'i`.'EEL .LII am exempt under Sec. B &P C for thta risen. BACK FLAW PROTECT.DEVICE Owner' .' • DRAINS FLOOR,ROOF,AREA,CONTI. SANITARY Y -' N - • Date ^ RECEIPT p WORKMAN COMPENSATION DECLARATION. - FIXTURES PER TRAP SCHOOLTAX Y N ❑I hereby affbm that I have o l rtum h of consenti d eel theure,or - RECEIPT a cemfiab o(Workers'Compensatlon lr,.urana ora artlfkd mpythereof(Sec. GAS EA.SYSTEM-I INCA PARK FEE Y ' N 3800,Lab C.) ' Policy q - RECEIPT#- Com an GAS EA.SYSTEM-OVER 4(EA) „ Y BUILDING DIVISION FEES Certified copy Is herebyth the city GREASE/INDUSMLWASTEINTFRCEPTOR PLANCHECK FEE, • ❑ Certified copy Is(lied with the city Wpection dlvlslon�� ,. + CERTIFICATE OF LXEMPFIONFROMWORKERS' GRE\SETRAP PAID '- COMPENSATION INSURANCE - (TMssetion need not becomplted lftheperret isforonehundred dollars SEWER-SANITARY-STORMEA.200F]'. ,. - Date RCCCI f# ($i W)or leas.)., •, WATER HEATER W/VENT/dFLTR ENERGYFEE Y� N I metifythat he the performance of thework forwhhch rile permit is Issued, I shall not employy any person in 4n manner eo an to become sub so to the _WATER SYSTEM/TRLATING �(� PAID Womk.rs'Corp�.AsLawe a( orris:DateZ'';LJ�_-!}� - . 0 Applicant_ 1(( //���f,' ,d/�7y NEW RESIDENTIAL PLMB. �j,.FI. Date Reuel t# Z p NOTICE•T' ' AM:If,a er rnad Is Certificate of Exemption,you . Fshouldberorie subject tothe Worker.Compe...tionprovl.lonsofthe L.b., TOTAL: . N Code,you mo at fe i1h comply with such provisions orlh5 perretahall be W > ,: deemke ed revod. - - BUILDI G FEE d. G CONSTRUCTION LENDING AGENCY: , rv SEISMIC FEE I herebyaffiren that theie Is a construction lending agency for th pert rm- Ly ELECTRIC FEE 'M Z cans of the work for which this permit is Issued(Sec 3097 Civ C) TOTAL _l 0 Mders Name . t PLUMBING FEE LL H• • Lenders Addreas - QTY _?;, MECI-(ANICAL"�LERIIIIT t"':''+t'.�FEE'�, MECHANICAL FEE ` O W Icertify that]have read thisapplicatienand statethattheabove information - a correct.I agree to comply with all ttyand county mclin.eresand gets law. PERMIT ISSUANCE,.' FEES FAID: - - N• relatingtobulidmg construction,and hereby authorae representativesofthb ' F-Z city to enter upon the above-mentioned property for lnspecdon purposes, ., ALTER OR ADD TO MECH. Dale' R2Ce1P[# — (We),agree m save,Imn ndeify an d,keep ham ess the Cltypf Cupertino - againstliabilities,judgments,mansard expenses which may In anyway.... AIR HANDLING UNIT(TO 10,000 CIM) SUBTOTAL: against i In romcq. the granting of this -,f AIR HANDLING UNIT(OVER 10,00)CFMi - CONSTRUCTION TAX r% roof Applicant/Contractor ,Date EXHAUSTHOOD(W/DUCT) - CONSTRUCTION TAX PAID: HAZARDOUS N fRIALSDISCLOSURi - Wfllthceppllcantorfutureb�li hng omrpantstore or handle hatrardous HEATING UMT(TO 1(A,000 BTU)• Date Recel1 t# materials.defined by the Cupertino Municipal Code,Chapter 9.1 2,and the . Health and Safety Cole Section 25532(a)7 - HGTING UNIT(OVER 100,00)BTI . , -+t e ❑Yes No . 1 + TOTAL: IS Will the.pplica.dor future Wilding occupant me.qulpmet Aebices VENfILATIONFAN(SINGLE RESID). ' .ISSUANCE DATE. which emit hazardous air contaminants as defined by the Bay Area Air i Quality Management District? +` BOILER-COMPOFII'OR100,0WRTU) - 4Yee. ❑No, have read the hazardous materials requlrementsunder Cha pter6.95otER-COMP(OVER 100,000 RTU) the Cali(ornla Health&Safety Code,Sections 25505,25533 and 2S5M.�I r-B understand that if the building does net currently have a tenant,that it le my NEW RESIDENTIAL MECH. SQ.FI'. rmponsibButyto notify the occupant ofthe requirementawhich must be met' " prior to issuance oft Certificate of Occupancy, Owner or authorised agent Date ISSUED BY: TOTAL: OFFICE COPY