Loading...
24250 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Praia n Identification � � PIIawTN Budding Add o(Z� WWI k 4 2 5 0 nap ame:� one: /lT_ CITY OF CUPERT[N6BUILDING DIVISION q,'2—^ I�N c tranar. me: LicLic.Na APPLICATION /PERMIT `r C� A itect/En nee BUILDING-ELECTRICALPLUMBING-MECHANICAL CATEGORY C Icy 81 .No: CJ QTYELECTRIC PERM I-P E BUILDING PERMIT INFO y Address:t J3 3 QXanw.. t $ PERhIITiSSUANCE e� E:1LICENSED CON ACTOR'S DECLARATION I hereby affirm that l am licensed under provLtlons of Chapter 9(commene- APPLIANCF&RESIDENTIAL IrJOB DESCRIPTION ingwith Sedion 7IX10)of Dlvlsion3ofthe Businemand PmfesslonsCode,and my �S license hile fullforce and effect PANELS `T�1 License Clam LI<.0 i Date Contractor AL ARCHITECPS DECLARATION 1 q�v re0 7 I understand my plane shall be used as public records. ER 1 AMPS SQ.FT.FLOOR AREA $/SQ.FT. fn d U Licensed Professional GNSELEC C 2 a,s �< OWNER-BUILDEReDECLARATION SPECIAL Ihereby afflrmtexempefmm the Caner TION lren.Iaw(or the VVVV11 Qp following reason.(Section 7011.5,Business and Professions Code:Any city or OZt' which requires. mittoromwd,aller,im cove,demoltsh,orre 1 TEMP.M OR POLE INST. EI'= aunty quresapr p par anystrumlrc prior to its tutuance,also requirestheapplicanl for such permit to POWERDCES a U file a signed restaurant that he Is Banned pursuant to the provtsima of the 3�� Contndor's Licemelaw(Chapter9(commencing with Section 7000)a(Divi- SWIMMIN POOLELECIRIC O sion3ef the Basins.and Profe.bns Code)arthat he6e.m there(mmandVALUATION G 6 5 the busts for the alleged exemption. Any violation of Section 7031.5 by any UTLETSSWITCHESFlJ(NRFS {5 applicant for a permit subjects the applicant to a civil penalty of not more than �- c, five hundred dollars($500). NEW RESIDENTIAL ELECTR ❑ SQ.FT. STORIES 7Y1'E CONSTRIX;I'ION 1,as owner of the property,or my employees with wages as their sole compen.tion'21 do the work and the structure 6not Intended or offered for psale(Sec 7014,Business and Pmfa.Wm Code:The Contrad.e.License Law S$ docs not apply to an owner of property who Wilds or improve thereon,and OCC.GROUP RFS.UNITS does such work himself or through his own employees,provided that such improvements arc not Intended oroffered for sale.K however,thebuilding er improvement issold within one year ofcomplethu,the owner-Wilderwlll have tir*rdenofpmaingthat hedidnat ildorimpmve(mpurpaaeofua .). Ory. PLUMBING PERMIT FEE FLOOD ZONE AIN LJ L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to construct the project(Sec.7014,Business and Professions Code: The Contractor's Limn.Lw does not apply to im at of property who ALTER-DRAIN k VENT-WATER(EA) Wilds or improves thereon, and who contracts for such projects with a FEE SUMMARY ,,99tt_Iador(s)Ilce . nd pursuant lothe Contractor'sLicense Law. BAC](FLAW PROTECT.DEVICE LJ I am exempt under Sec B k P C for this rea.n OUTSIDE FEES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N . Owner Date - RECEIPT WORKMAN COMPENSATION DECLARATION SGi00L TAX Y_ N_ ❑I hereby affirm that I have a certificate of con.m to self-Insure,or RF.C©PI'N cenlI tate of Workers'Comperuatlonlrmuranm ceacenified copy thereof(Sec. G 1 PARK FEE Y N 3800,lab CB — Poliry p RECEIPT N Com any - G - 4 BUILDING DIVISION FEES cc copy It hereby furnished. GREAIDESTRL I PLANCHECK FEE ❑CenlOed ropy 6 filed with the city W pectlon division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE7RAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM E.A.HIOFL Date Recei t# (Thissectlon need net becompleted Rthe permit Etfor ora hundred dollars ($]W)or lcu) WATERS TER W/VENT/ELECTR ENERCYFEE Y_ N_ I unify that In the performance of the work for which this permit is lamed, 1 shall not employ any person In any manner is,as to become subject to the WATER SYSTEM/TREATING Workeri Compensation Iowa of California. Date PAID OZ Applicant NEW RESIDENTIAL['LMB. SQ.FT. Date Recel t# Z O NOTICE TO APPLICANT.If,after raking this Certificate of Exemption,you HN should bnomesubject to the Workers'Compensation provlsiom ofthe Labor TOTAL: CC 7 Code,you most forthwith comply with such provesiomor this permit shall be BUILDING �e deemed revoked. W — CONSTRUCTION LENDING newer SEISMIC FEE 40a e (hereby afirun that there is a construction lending agency for the perform- TOTAL: ELECTRICFEE M Z ance of the work for which this permit It tsaedeSe 3097,Civ.C.) V O Leader'.Name PLUMBING FEE _ IL — Lender's Address QTY.I MECHANICAL PERMIT FEE MECHANICAL FEE OW Imnlfythatlhavemadthieapplkatlonandoatethattheaboveinformatlon IL Incorrect.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID: >. relating to building comtmctloq and herebyauthorlu representatives ofthes (_ 2 city to enter upon the above-mentiomd property for Inspection purposes. TER OR ADD TD MECIL I �' JBi4QaSomt0aava,lndrnudfya it keep harmless the City of Cupertino Date WjI t# V *S.g.wfl?AppUcam/CMFcf.r judgmenb . dexpenseswhlchmay anywayaccrue AIR HANDLING UNIT(TO 10,000 GEM) SU IC Inconseque o the granting of this pe it CONSTRUCTION TAX o / AIRHANDUNGUNIT(OVERIO,(U0CFM)Data EYEIAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID' HAZARDOUS MATERIALS DISCLOSURE _ t Will the applicant or future building occupantstore or handle ha,cardous HEATING UNIT(TO 100,000 BTU) Date Regie material as defined by the Cupertino Municipal Code,Chapter 9.12,and the I IMth and Safety Cede Section 255324)? HEATING UNIT(OVER 100,000 BTU) ❑Yes r]No Will the applicant orfutum building occupant use equipment or devices VENTILATION FAN(SINGLE RF_SID) ISSUANCE DATE which emit harardous air contaminants as defined by the Bay Area At, Quality Ma usgement Dist rid? BOILER-COMP OHP OR left"RED) 4Yea ❑No P A I Y bavcrcadthebazardousnuterialsrequirements under Chapter 6.95of BOILER-COMP(OVI]it00,000BTU) {-4 the California Health k Safety Code,Sedlom 25505,25533 and 255M. 1 understand that if the building does not currently have a tenant,that It is my NEVIRESIDENTIALMECH. SQ.FT OCT 1 Ilia responsibility to nosily the occupant of the requirements which must be mart prior to L.uanm of a Certificate of Occupancy. GIT"e; Owner or aulhorbod agent Data ISSUED BY. O OFFICE COPY