Loading...
24180 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Protect Identification Ph1(hEPNQ, 4180 6ullding Address: r CAS 9&V=:I, Wne(s stile. one. ITAL DA tii CITY OF CUPERTINO-BUILDING DIVISI - ContraRor'aName: Llc.No APPLICATION / PER BUILDING ELECTRICAL PLUMBING CAL CATEGORY C Qpr Arc Item/Engineer' Lk.N v SZ G— C• BUILDING.PERMIT,INFO :ELSG`fRIC• R .--.:'FEE Address: �/ S f/f es PERMITISSUANCE 1��..1I ❑ ❑ LICENSED CONTR CTOR'S INVELARATION yJ . Ihereby affirm that l am licensed under provisions of Chapter 9(commem, AP ANCW DENTIA OB DFSCRE'TTON. ingwlth Section7000)ot Divbian3ofthe BumneseandPro(esslonsCbde,and my license is In full fyy Band effect P LlrenseClass 17 LIc.M 437 Date q-yf�Contraathr /�f , ARCHITECTS DECLARATION 1-1000 S �O I understand my plans shall be used as public records. OVER DAMPS ,t, i� SQ. } R RFA J INJ $/SQ.FF. Licensed Professional NS ELECTRICAL r7 R 6 OWNER-BNLDER DECLARATION o IherebyafRrtntOW ass exemptfromthe Contraror's Llan.Lawforthe 51'ECIAL CIl2CUIT/MISC Li' y� I, �y ZOZ'a following reason.(Section 7¢113,Business and Professions Code:Any city or, TEMP.METER OR POLE INST. �4 countywhichrequlresapermittocomtmdaitegimpmve,demolbh,orrepalr g anystrucumo prlorto Its Issuance,alsorequirmthe applirantfor such permitto POWER DEVICES k5 file a signed statement that he Is licensed pursuant to the provisions of the Qb3p,N Contractor's License Law(Chapter 9(mmmencing with Section 7000)of Dtvl- SWIMMING POOL ELECTRIC SOS sionil ofthe Business and Profmalors Code)orthat he is exemptlherefromand VALUATION ?- O the basis for the alleged exemption. Any violation of Rection 7031.5 by any b OUTLETSSWITCHESFIXIURES C D�� t applicant for a permit subjectsthe applicant to a civil penalty of not more than u, m five hundred dollars($500. L as ownerofthe property, NEW RESIDENTIAL ELECTR SQSr. STORIES 711'E CONSTRUCTION e hp rty,or my employees with wages as thele sale compensation,B.shimwilldo he work andthe structure,Code:Th Contractoror or icatue d for Law O sale(Sec.7W4,to an owner f property Code:The or improves License Law whoa not apply to an owner d property who nbuilds or Improves thereon,and who doessuch whrk Mrtsel(rnthrough hisownemplayees,provided thatsuch OCC.GROUP RFS.UNITS Improvements are not Intended oroffered for sale.If,however,the building or T WV Improvement is sold within one yearofcomplellon,the owner-bullderwlli have . , tryQ_L,rNen of proving that he did act build or improve fee purpose of sale.). QT^[; PLUMBING PERMIT'• ".FEE ` FLOOD ZONE APN "L as owner of the property,am exclusively contracting with licensed Y pFRMIT ISSUANCE contractors to construct the project(Sec.7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN k VENT-WATER(EA) builds or improves thereon,and who contracts for such'p(ojety with a ��tt($actor(s)licensed pumuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE "FEE SUMMARY c(51 am exempt under Sec, B k P C for this reason Owner Date DRAINS.FLOOR ROOF,AREA,COND. SANITARY Y N re RECEIPT N WORKMAN COMPENSATION DECLARATION FD(TURES PER TRAP SCHOOLTAX Y N ❑1 hereby affirm that I have o certificate of convent to self-iher or RECEIPT M 3800,Uteo(Workers'Compersatlon lrsuranreora certified copythereof(Sec. GAS EA SYSTEM-1 INCA OUTLETS � PARK FEE Y N 380Q Lab C. 7 Collry M 9 �a3 7� / ( RECEE'C N CAS EA.SYSTEM-OVER 4(EA) Cwifi_ cop '1 - _ BUILDING DI VISI NFBES �(ified copy is heed with the GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑CertUied ropyb(iled with the city impaction division. C CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID 4OJ COMPENSATION INSURANCE SEWEILSANTTARYSTORM EA 200Ff Date a [# Ohlssection need not he completed if the permit la on thre huntlred dollam ($1I artifess) WATER HEATER W/VENT/ELECTR ENERGY FEE Ylet:eiptlf N Icertl(ythat In the performance of the wrnkfor which this permit is belied, — I shall not employ any person In any manner so as t ^ro cur jg-R to the WAIPR SYBTEM/TREATING Workers'CompenssL�tion laws of Calif o la.Date l.. PAID . OZ Applicant G+S CWA-1,Sam Z O NOnCE TO APPL NT:If,after making this Certificate of Exemption,you NEW RESIDENTIAL FLAIR. SQ%. should become subject to the Workers'Compensation provisions of the LaborOTAL: U9 Code,you must forthwith comply with such provisions or this permit shall be BU FEE W j deemed revoked. d c CONSTRUCTION LENDING AGENCY - S I FEE !hereby affirnthat there is a construction lending agency for the perform ELEC RIC FEE Z arse piths work whkhthb rmmyY biassed(Bac.3097,Civ.C.) TOTAL (� O Lenders Name n�a/A - - PLUMBING FEE LL t— wonders Address QTY: '°MECHANICAL PERMIT cr:FEE'.;' MECHANICAL FEE OW Icertitythatl have read this application and s[atethattheaboveinformatlon IL Is correct l agreeto complywlth all cityand county ordinances and mate Is" PFRMTTISSUANCR FEES PAID: } relating tobullding construction,and hereby authorize representatives ofthb F Z city to enter upon the above-mentioned property for lospeaton purposes. ALTER ORADDTO MECH. — (We)agree to save,Indemnify an d keep harmless the City of Cupertino Date Rece t# against liabilities,judgments,comaand expenses which may In anywayamme AIR HANDLING UNIT OO 10,000 CFM) $UBTOT again�st sad�//J ity M conseu the granting of this permit. ' >94d," ,v�fi/ O� �,_,�` AIR HANDLING UNIT'(OVER 10,000 CFM) CONSTRUCTION TAX Slgnaminne oofff Applicant/Contractor Date EXHAUSTHOOD(W/DUCT, CONSTRUCTION TAX PAI HAZARDOUS MATERIALS DISCLOSURE - Willtheapplicantorfuture building occupant store or handle hazanicas HEATING UNIT(TO 100,000 BTU) Date Reeef I# material as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the I9calth and Safety Code Se 25532(a)2 HEATING UNIT(OVER 100,000 BTL) TOTAL' ❑Yes b chef' Will the applicant or future building occupant useequipment or devices VENTILATION PAN(SINGLE RESID) ISSUANCE DATE which emit hazardhus air contaminants as defined by the Bay Area Air p ' Quality Management Distrl BOMEROOMP OHP OR 100,000 BTU) K 4 Ye. haveread the has pus materials requirements2553aChapter.1 of BOILER-CAMP(OVQt 100,000 BTU) theersiandta Health bSafety Code, of currently have a Land,that 1 SEP 23 1992 understand that n notify the occupant of t emqulyments which that it met NEW RESIDEN77AL MECH. SQ.I•T s.'�yL responsibility to notify the occupant piths rcquircments which must be met priortoles ceof Certific of Occupancy. IIVV 1l/�riin/XP.� 7-9Z \�\C]ITYVQr' �r Owner or.authorived agent Date TOTAL: ISSUED BY: OFFICE COPY