Loading...
21926 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bulklinx Project Identification PERh9TNO. Building Acidres.: 21926 SO-740 va-i� one: CITY OF CUPERTINO-BUILDING DIVISION on dors Name: Lk.No: APPLICATION / PERMITAMN l /'t H X99/63 BLnDLNGFLFICTRICALPLUMBINGMECHAMCAL CATEGORY CONTROL# / / Archltec/FsglnSer.(—uLk.Na �O 1 c+..� QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO AddreA /�r_ //� /'5 I�f/Gf� lj-r• PFRMITIS5UANCE IrVx�I LICENSED CONTRACTORS DECLARATION I hereby affirm the l en licensed under provisions of Chapter 9(commmene API'ILANCES-RESIDEMIAL JOB DESC N IngwithSMbn 70N)of DiVlsion3ofthe Buskussand PrufesdosCode,and my #cense b N tun f ra and erne. v A PANELS L� Lk.._3`19/G 3 Dace CoMnear < sou ',r ARCHITECT S DECLARATION 1-I000AMI'S IOWUP TO 200AMPS ZC fpol!�en��my play�`Il b#u{da WbBcremNa OVER 1WO Ah1PS SQ.Ff.FLOOR AREA S/�.FI. F Y U Licensed est IN •E�`f, 9GNSELEC7RICAL fn6� OWNER-BUILDER DECLARATION S'ECIALCIRCUIT/1419C 7 1hereby Minn that am exempt from the Cantractori Luxtue law fee the o following reason.(Section 70115,Business and Professions Code Any dry or 'F ty c tywhkhrequie aper ttommiuMalter,impmve,demolbh,ormpatr P'MEIFR ORPOLE INST. `'�[ 7 any a signeepAmtolt.rwaagalcursed umumt to he t faachpemete RD�� ps U file•signed statement that M b Ikeneed pursuant to the provIsbr of the O cx� Cmuraeoh License Law(Chapter 9(ou clog with Section 7000)of Divi- SWIMMING NOL ELECTRICSQ OS sion 3 of the Business and Prdmbv Code)or the he b exempt therefrom and VALUATION y.' the basis for the alleged exemption. Any violation of Section 70315 by any /1 D p� appUantforape subjeeatheappB ttoadvlpen ltydnot morethan - OUTLEIS.SWIFl TCHFS )(TURESTSANTTARY O (/ ^ f��onareddolbn.SOB,. rY I,u owner of the Property,or my employes wkh wage as their sole RFSIDQJiIAL ELF-RR ✓Q'ET' TYPE CONSTRUCTION penutlm,wlldo the work,and the structure bout#seeded or offend for O ale 6ec 70K Busimand PrdmbrCodeTheCntactors Um.Law don tout apply town owner d propertywho Wilda ortmprovn thumor,and P RES UNRS IShoweverthebuIldtngm TOTAL:bnprovemeebsddw boneyurofcomple Ntheawner-W11derw shave QTY, PLUMBING PERMIT U 4 as owner of the property,am exclusively contracting with R¢nsed E APN contractors to construct the projM(Sec 7014,Btaknm and Prdmlons Cade, PERMR LSSTIANCE The Contractor's License law don not apply to an owner of property who Wilda or Improse theeort and win contract+ for such p(o)ets with a ALTER-DRAIN&VENT-WATER(EA) ryntrWorW licensed pursuant tow Convaeds License Law. FEE SUMMARY L�I e exempt under Sec B&P C for this rearm BACK FLOW PROTDCT.DEVICE OdfqI FIE FEES Owner Dee DRAINS.FLOOR ROOF,ARG,ODND. Y_ N_WORKMAN COMPENSATION DECLARATION RECET#hereby allrm that I have a certificate d consent to seNdw FD(NRES PEI[TRAP Y_ N_ REC artificer car Workers'Comperuatlm Insurance oraontlfled mpythereor CSec. EIPT# 3800.I,b CAS G.SYSII•M-1 WC40UU.EIS PARK FEE Y_ N_ 1'otkyY `32459 RFLFII'1'# CAS.G.SYSTEM-OVER 4(EA) Co nv un BUI LDING DIVISION FEES I I Certified copy b hereby fnmlannd. GRenCP/W'IXISTRL WASTE INTERCEPTOR PLANCHECK FEE 1R2g51`-eslfled copy b filed with the city Inspection division. L b CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID 1y C� 66C(.l COMPENSATION INSURANCESEIVFR gANITARY-STORM E.A.XI�'I. Date ReceI tM (Thin seNon need not be complded B the permit b forone hundred down f cswo)erless.) WATER 1-DATER w/vENT/©.rr.rR ENERGYFEE Y_ N_ I certify that In the pt,(...of w work for which this permit Is Issued, 131,41 not employ any person In any manner so as to become subject to Ihe WATER SYSIFM/TREATING Workers Compersadonlaws or California.Date PAI z Z Appllant NEWRESDENTIAL"ll. SQ Date RecCl til Z NC)nCETOAPPLTCANT:lf,afermakingthb Ce "ted Esemptton,you should bemrrc subject to the Workers'Compensexon provision o the Labor TOTAL N Code,you rase fort hwhh mmplywlth such provisions or this perch Nall be _ I NG FEE r IQ W > deemd revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE t d I hereby affirm that then Is a construction lending agency for the perform ELECTRIC FEE ZO eue of the work for which this permit is Issued pec.309'/, tv.CJ TOTAL,lenders Name PLUMBING FEE LLH Iender.Mdrm QTY. MECHANICAL PERMIT E MECHANICAL FEE O W 1certify that]have read thbappllatbW haabovelnforrrudio narte that the n 1 boned.]agreetocornplywhhalcl[yandcuunryerdlnanmandsiatelnevs PFRMRLSSUANCE FEES_ (�I � �D H relating tobuilding coru ing tsuct orise ion,and hereby authrepresenWtWn ofthIs Y4'�"�L FZ city to enter upon the abovcrmrtiomd property for WM pbn purposes. ALD TERORAD'IOMCfH. Date ReCrl ill (We)agree to save,bdemntfy an d keep harmless the City of Cupertino V sgaWt lhblBties,jadgmors,meas and expenses which may In anywayaccrue AIR IIANDUNG UNIT(DO 10,000 CFM) SUBTOTAL: ' against said City M consequence of the granting of this pend[. _ AIR HANDLING UNIT(OVER 10,f00 CFSO CONSTRUCTION TAX Slgoeun of Applicant/Contractor Date EXHAUST HOOD(W/D1KT CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant ornature Wilding occupant More or handk hUardoust HEATING UNIT(M 100,000 BTU) Date ReCel tN meerial as de0red by the Cupertino Municipal Cade,Chapter 9.1 7,and the 1 h and Safety Code Section 25537(a)7 HEATING UNIT(OVER 10,000 BTI) TOTAL: t Yn No Weltheappllantm tore Wlldbgocxupantuseequipmmwdevkn VENTILATION FAN(BWGIR RESU) I SC)/> -E DATE - which endt louardaus er contaminants as defined by the Bay Area Alr Quality Management DbtrM7 BOILER-COMP DHP OR IMOM BTU) 4YnNo havereadtheh—m rmaterial,requirements under Chapter 695of BOILER-COMP(OVER 100,00 BTU) ``t rR 1g`a1 the GTiv aHealth&Safety Code,Secttem 75505,25533 and 75531.1 1tea}{ undnearad wt it the WOding don not currently have a tenant,that It b my NEW RESIDENTIAL MECH. 9QFT. " respomWlllty to notify the pert d the requtremem,which roast W rM Ya .,Y{/��Y P issuance,d M uana Certificate orOccupxruy. M 1.4W. •" A411 -... ser or lhoriud agent Date TOTAL: ISSUED BY: OFFICE COPY