Loading...
20033 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY - Building Project ldcntlflcatlun - PERMIT NO. Building Add mss: Z/7Zal I!?&.&IV o-kr (:,VWArr- 20033 ' - ere time: one:' �fJjer C% STOKES 2ti$=9'(69• CITY OF CUPERTINO-BUILDING DIVISION' Contractors Nacre: Lac.Na APPLICATION / PERMIT -jeS�L F BUILDINGELECTRICALPLUMBING- CA3LGORV CONTROL M�n ArRM/Engineer. LIc.No: _ 4 MECFIANICAL `a ( �i (j• G TO L3S j g ,t ' ,BUILDING PERMIT INFO , p •QTY (t - ,.ELECTRIC PERMIT, ;a'-FEE' • - ndareaa:Z/724 IIectmer_iT G'�I°• ,. PERhunsgUANCE, • �v.1 1I��rS I t.u0 [� W V� ❑ LICENSED CONTRACTOR'S DGCLA RATION I hereby affirm that lam licensed under provisions o(Chapter9(rommono- MPLIANCFSRF.SIDEMTALn[��O�' Ing ith5etion7000)of Divnsim3ofthe Businessand PmfemlonsCode,andmy r ;�� (cense is In fail farm and offect. PANELS —`7 License Clam Llc.p ,r 4,0— / Dale• Contractor " rU •Q l ARCHITECTS DECLARATION - 701-1000 AMPS 2 I understand my plans shall be used as publicrecords. OVER100EAMPS SQ.FT.FLOOR AREA f/ .FT. CO' (� Licensed Professional - SIGNSELECTRICAL 6, OWNER-BUILDER DECLARATION ',=SPEUIT/MISC I„< Iherebyaffirm that l am exempt fromthe Contractor's License Uwfmthe po following reason.(Section 7031.5,Business and Professions Code:Any city or O Z t. OR POLE INST. 'F� cwntywMch riortossissuantocorotmuirestheaprove,demsuch,ormpair mittoanystmture paler tentshathas ,aW requlrestheappllant for such perMtto CESfileasigned statement that M tv Ilceneed pursuant to the provisions of theContracor'sLicense Law(Chapter9(rommencing with Section 7000)ofDivi- sion3oft heBuslnemandPmfemlomCode)orthathelnexemplthemfromand OOL ELECTIIIC the basis for the alleged exemption. Any violation of Section 7031.5 by any pZ DDO applicant for a permit subjects the applicant to a civil penalty of not morethzn - / ITCHESSHKTURES - S`p dflvrM doliers($500). TIAL ELEC3R SQ.FI', STORIES TYPE CONSTRUCTION Z�n I,as owner of the property,or my employees with wages as theirsole compensation,wflldo Me work,andthe structure Isnot Intended or offered for M ole(Scc.7644,Buslnmsand Professions Code:The Contrator.Llcerue Law - ��� does not apply to an owner of property who builds or improves thereon,and OCC.GROUP RFS.UNITS whodote such work himself or through Ms own employees,provided that such M Improvements are not Intended oroffered fmsale.If,hownvepthe building or TOTAL: _7y Improvement Fssold withlnonsyearofcomplellon,the owner-bullderwill have , ihe�urden of proving that he did not build orlmprove for purpose ofsale.). QTY, 'PLUMBING PERMIT TFEE pfgpp7pNrR APN u L as owner of the property,am exclusively mntracfing with licensed pp yy ISSUANCE contractors to com of the project(Sec,7094,Business and Protesslom Code: 1 The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENT (EA) Wilds or Improve therm and who contracts for such pto)ecta with a Z. VQ c,,LLLLt{{actor(s)II secig "A.the Contractors Limnse Law. FEE SUMMARY ` LJ I am ex uncia ec B&P C for fhb reaeoR BACK FLOW PROTECT.DEVICE OUTSIDE 1:1"S Owner Dace DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y N OR OMPLNSATION DECLARATION RFL©PI'N ❑I hereby affirm that I have s re tiHate of consent to self.insure,or a 3 rXrURHS PER TRAP J .,10 SCHOOL FAX Y N certiBate of Workeri CompevaHon Iruurance or a mrtifledcopy thereof f&e - q 'q RECEIPT X moc,Lab C.) / GAS EA.SYSTEM-1 INCA OUTLETS a�v� PARK FEF. Y_ N— polipq p - RECEIPT N Cam any GAS EA.9YSTEM-OVER4(EA) BUILDING DIVISION FEES MCerlmea copy iii herebyfurnished.the city GREASE/IND L A rI FF I ANCI-IECK FEE ey9 ' ❑Certlfed copy b flied with the city Impaction division' [.J CERTIFICATE OFPXEMPTION FROM WORKERS' GREASE •. ��' _ '❑ ID COMPENSATION INSURANCE SEWER SANITA YSTO Date Recei t# (I'hlsso slon need norbe completed If the permit b for one hundred dollars - ($100)orlemJ - WATER HEATER(Ml�/ELECTR NERGY FEE 'Y N fomuce Inemlythat In the pernof the work forwhnch this permit is issued, I — 1 shall not employ any person In any manner so as to become obis t to the WATER SY51FM/TIiG771M1G Worken'Compensationlawsaf California. Date PAID - z Z Applicant _Z O NOTICETOMPLICANT:If,after makinglhns Certlfialee(Exemplion'you NEW RESIDENTIAL PIMB._SQ.FT. Date Iiecel t# should become sub)eet to the Workers'Comperoation provisions of the Labor TOTAL: N Code,you most forthwith comply with such provisloa orthis permit shall be BUILDING FEE D7'f10 - W 9 deemed revoked. - a p. CONSTRUCTION LENDING AGENCY SEISMIC PEE IBerebyafNmlhattherebacoeswtion lending for perform TOTA _vD ELECTRIC FEE 0 anceoftheworkforw is fhb per_M�issued(Sec.30W,Civ.C.) (,) 0 Lcode,'.N.me___* IY -I PLUMBING FEE U U 1= Lenaer.Aaarem QTY, _MECHAN16AL PERMIT"' MECHANICAL FEE O W Iartlfythatl havereaatheiappllatam.nd sooth.itheabovelnformation S bcomet.I agreetocomply with all cntyand county ordinances and state laws PERMIT ISSUANCE FEES PAID: } N relating tobullding censtructnon,and herebyauthorize representatives of this - F Z cityt ;)rteru ntheabove- RtlonecipropertyformspMionpurposes. A ORADDTO (We)a e to ave,ins (y an d keep harMem the Clty of Cupertino Date ReCCIPt# V" against 11 it 1 pdgme a and x enms which may In any wayaccme AIR NDLINC T 10,000 SUBTOTAL: against In con a of nun o(thle permit AIR FLAN HC UNIT(OVER to, FhD CONSTRUCTIONTAX Z Signore of Ap nt/Comr� Da�7.P FmLsusTII (w/DUCn CONSTRUCTION TAX PAID: AZARDOUS MATERIALS DISCLOSURE Will the applica nt or future building occupant store or handle hazardous HEATING UNIT 0E, OTU) Date Recei t# material as defined by the Cupertino Municipal Code,Chapter 9.17,and the Healthand Safety Codze��f n25532(a)7 HEATING UNIT(OV 0,000 BTU) TOTAL: r_1 Yea TJ No Will the applicant or room building occupant use equipment or devices VENTILATION N(BING RESID) ISO' DATE which emit hazardous air ro Hants..deflnedby,the Bay Area Nr Quality Management Dl - 7 BOILER- Tin rr Yes No - MAY U1 I�UJ have read the hau our materials requirements under Chapter 6.95 of. BOB, .COMP(OVIT100,000B the Califerrh Flealth&Safety Code,Sections 25505,75533 and 25534.1 undersian at tithe I ag doesnot currently have a tenant that it b my RCSIDFNIIAL MECH. .FT .respond i tontify o an fth requirements which must be met Qbj O`Cwlgrfinco prior to a of a C airy. _� _jD � � kV Owner or out agent � - D.te .. ISSUED BY: 7-F'V� TOTAL: ��/�����' OFFICE COPY -