Loading...
26683 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO -G-ML CHANT A, PERM"'"°. 26683 APPLICATION/PERMIT 1'LUMBIRG-MECIIANICAI. BUILDING DIVISION BUILDING PROJECT ID4:NTIFICATIO\' BUILDIN�Gi//ADDRESS ,:,�(1 I' •/t (//1 SANITARY NO. APPLICATION SUBMITTAL DATE / ag+ ✓1 (v{/ I/ • UNITM LOT# OWNERSNAME: /J PI q CON R'SN E: LIC NO: _I/ NIC CUNUROL# RC1f11I:CT (NEER: LIC NO: ADDRESS: I ❑ 'ONTACI': PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO L w^'� L BLD ELECT PLU❑M9 MI❑CII Iq 1--eqPERMIT ISSUANCE LICENSEDCONTRACfOR'SDECLARATION APPLIANCES-RESIDENTIAL Ihereh affirm that l amliectsed under .>•/ JtO�BDESC ION p¢Z yet provisionsof Chapter9(commencingwilh syl(G� �f/+4.4r 4100 Section 70N00)o1 Division the Business and Profes t0s and my liameis in PANELS / FF 014.. full force and a tett. Ford n} 'r�J)y.a FZW Its Cfs Lic.# 14/ `� • UPT02WAMPSI /J�/� 1 h=y Date Contractor '{x�.ate 201-EXQ AMPS (/t ZONZ A CIIITECfS DECL T V OVER I"AMPS SQ.FT.FLOOR AREA g .r. O Z L O l senders rad my plans shall 4 used as public r L!=w SIGNS ELECTRICAL jLivensed Pod,,sionul d'dc'Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. XLou F I hereby artirn that I tun exempt from the Comuacter's License Law for the µl3 a m following reosom.(Section 7031.5,Business and Professions Coda Any city or county TEMP.METER OR PULE INST t ON; which requires a Permit to construct,arm,improve,demolish,or repair any structure F.WY$ prion.itsransom.also requires theapplicant forsuch permit to file a signed smtement POWER DEVICES W K a0O that he is licensed pursuant to the Provisions ofthe Contractor's License Law(Chapter aXo 9(commencing w lib Section 7000)of Division 3.],he Business and Professions Code) SWIMMING POOL ELEfRIC VALUATION yl_y or that he is exempt hctefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWIT FIXTURES �,>00 sJ' t Z> m Section]031.5 by any applicant for a permit subjects the applicant a civil Penalty of Exo not more than five hundred dollars(S5W). wt:,, ❑ Lasownerofthe proper NEW RESID LELECIR _SQ.FT. y,nrmyemployeeswith wages theinolecompensation, STOR7E.S TYPE CONSTRUCTION a3— will Bothe work,and the structure is not itnendedoroffened for sale(See.I0,4,Business / and Professions Costs:The Commcmrs License Law does not apply m an owner of popery who builds ser improves theom,and who does such work himself rer through his ownemployms,providMNatsuchimprovementsummtintendedaroffere f6r e.If, ..GROUP RES.UNI IS however,the buildingor improvement is sold within one yearo(completion,theowner- TOTAL: Q builder will have the burden of proving list he did not build or improve for purpose of U sale). ❑ I,samatirofthe property,amexclusively contracting with licensedconractorsto QTY' PLUMBING PERMIT FEE LOO ZONE "N O construct the project(Sec.70414,Business and Professions Cade:)The Contractor's License hawdcesnnt apply non nwncnal property whnbuilJsarimprovcsthereogand PERMIT ISSUANCE whoconmmts forsuch projects with aconameor(s)licensed pursuanuothe Contractor's Lice.Law. ALTER (EA)) PEE SUMMARY ❑ I am caemPt underSa. D&P C for this reason BACK FLOW PROTECT.DEVICG UTSIDI:PEES SANITARY Y N Owner Date RECEIPfp WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR.ROOF,AREA,GOND. SCHOOLTAX — YN ❑ Thereby affirm thetlhavu acenificmc of conxmto self-insure,oro cenific+re of l RECE_In Worken'Coan do Insurance fiedcopythemof(Sec.3SW,Lab C.)which FIXTURES-PERTRAP 11 RK I YN coversall cnupl c' d GAS-EA.SYSTEM-1 INC.40 LES V :. s>r �• RECEIPT Policyp _ nBUILDING DIVISION FIT ES Company GAS-EA.SYSTP,M-OVER 4 HT 1` 1 I^t), t Cl Certified copy i. reby misbul. L V L E K E ❑ Certified WRY is Bled w the city inspection division. GREASFJINDUSTRL WA TEI RCEPfOR / Ir,FIiE CERTIFICATE OF EXEMPTION PCOM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (This aceto hand not be tom ted ifthe permit is forone hundred dollars($100) SEWER-SANITARY- ORMEA2WFT. ENERGY FEF, leciifythatinthe Perf nn a (thew kfo vhichthispemi Isisim WATER HEATERW ENT/ELECTR not employ any person n y k SO become o t t O z Compensation Laws of 1' f�'e ate WATER SYSTE /TREATINGAppliPAID Coot/ rs Date Rcccipt# Z 0 NOTICETOAPPLICA Laftermaking r Ce sora of Eseat on,youshould NEW RESID AL PLMIL SQ,PC TOTAL: ^F fn becomesubjeciminc work sCompensalio o softhe Labor Coda,you must � ; forthwith comply with such provisions or this vit, Ilbedeemedrevoked. BUILDING FEE �w y Q CONSTRUCTION UEbIDING AGENCY SEISMIC FEE Z 1hcmbyaffirm quit them is construction lending agency for the performance of V O tboworkfor whidnM1is permit is issued(Sec.309C.)],Civ.CJ TOTAL: ELECTRIC FEE Isnders Name Q U Lenders Address QTY. MECHANICAL PERMIT FEF PLUMBING FEE I ani fy that 1 have read this application and state that the above mforamore is correct.l agree to comply with all city and county ordinances and state laws relating to MMECH—SQ. T ISSUANCE MECHANICAL FEE F-' � buildingcansweGon,and hereby+uthonse mprtsentativesofthis city menterupon the U 2 above-notak ed propmy for inspection purposes. ORADDTOMECH. CONSTRUCIIONTAX (We)ul ce to u.Indcmni and keep harmless the City of Ca y,no a ainst 41� ' mem,c sts ande eswhichmoyin anywayaccmee ainsts' Cby NDLING UNIT(TO 10.000 CFM) ofd min permitNDLING UNIT(OVER 10"CFM)pp ica VCbnva De ST HOOD(WJDUCf1 PAID IIA%AR I MA' IALS UISCLOSUBE NG UNIT IW,(N10 BTU) Dam me p# the applicant or future wilding occupant store or handle brardens material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety G UNIT IW,OW B ) T A Code.Section 25532(0)] El Yea 0N LATION FAN(SINGLE SID) -COMP(3HP OR ,000 RTU) ISSUANCE DATE Will theapPlican or future building occupant use equipmemordevices whichemith:vardous air conmmmams as defined by the Bay Arca Air Quality Management -COMP IOV IW.Oo0 BTU7 A District? ❑Yes ❑NoESIDENT 1.MECH, SQ.Ff. JI L991 have.cad the hazardous materials regalre 533 under Chapter erst of the {I1i7 1991 if the uil Ingdo& ortmCode,Sections25505,25533and25534.(understandNatCITYiftruebuildingdoesnotnients lyhaveamnatn,thatitismyssuanceoflt enotify theb (/(- (lut'tHUry xaupam of tlm rcyuimmcn¢which mus M1c mel Prior w issuance oft Certificate of Occupancy. Owns m authowed agent Date TOTAL: ISSUED BY: 0FFICE