Loading...
HomeMy WebLinkAbout19705 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BuildleR Pmiect Idemlllcation .. PERNg NO. : 19705 Phone: - APPLICA'DON SUBMI 17AL DATE CITY OF CUPERTINO-BUILDING DIVISION " ++ II G Contretmr'a Name: LIc.No: APPLICATION / PERMIT � 2— `� `/ — C 'r— BUILDING-ELECTRICALPLUMBING-MECI IAMCAL CAT=RY CONTROL N ' Architm/Engineer. Z) 7b S7 Lit,No: J 1 ./♦.! - Qiti � ' .ELECTRIC PERMIT'1, •'1;' FEE,, tr 'BUILpINGPERMIT INFO +I Address: Siv© .$ �lA{_/)•�` PERMITISSUANCE y .J' arty UM3 LICENSED CONTRACTOR'S DECLARA Oil N 1K K �• _ I hereby affirm that l am licensed under provisions cf Chapter9(mmmcnc-I APPLTANCESRF.SIDEM'IAL `,-/{/p/`/D�FIS/Y/�/`l�t/•B_/7/'/D/ON�DiD / ingwith Section force and effect PANELS Buelnessand ProtesslonsCode,antl my d W�q y full oforoeandvisio PANFIS License Class Llep Date r'ontrsctor' / - ITT01yo Amps /oZr 1 e� ARCHITECTS DECLARATION - I 201-1000AMP5 I CZ I understand my plamahall be weed as public remMw OVERI000AMPS SQ.Fr.FL RAREA $/SQ.FT. Licensed Professional SIGNSELECflHCAL ' I G� FLX' OWNER-BUILDER DECLARATION SPECIAL CIItCU1T/M15C 17v�O t., Ibseebyaffirenthatlamexempt fmmthe Contractor.Llumse]aw forth- 7.O.. following reason.(Section 7031.5,Business and Professions Code;An tl or ' OZ y ry TEMP.METER OR POLE INS). �� county which rcqulresapermitto mruWct,alteglmprove,demollsh,arrcpal• I q11 anystmetureprior to its issuance,also onto the applicant for such permit to POWER DEVICES [5 y (Ile a algae,statement that he b licensed pursuant to the peavisiom of th' Ow Contractors License Law(Chapter9(mmmencingwlth Section 7000)of Divi- SOS SWIMMING POOL ELECTRIC s1on3ofthe BuW..dProfessioru Code)arthat he6eu m mptthercfroand \. II VALUATION the bzant for the alleged exemption. Any t violation civi of Section 701.5 by any - --l.,�ETSSSWITCHCSf7XTURFS (' five hundred a permit subje tsthe appllcan'loativll pemlty dna morethan nom^ III""" five 1,as dollars t(SSW). NEWREMDEJITALELECTR FT.I STORIES TYPE CONSTRUCTION ❑I,ac owner of the property,or my employees with wages as their cols compensation,wllldothe work and'heatrucWrela not intended or offered foul / / -/-/-_ t a�'Q ssle(Bee.7014,BuainevandI'mfoutoru Code:The Contractors Limnae lase V "1ri l V $� who, lapplylorkhw rorth=gy s builds empl yi ,p eidecit atwel i � I_ OCC.GROUP RES.UNITS EEE whodoementsa not owns.If,ho a however,theedthatwd ll` '\\v ��. D Improvements arc not intended oraf(ercd for sale.It,hmveveg thebuilding or TOTAL: Q Improvement issoldwithinoneyearo fco mplmlon,thcowner-bullderwlllhav_ t119,p1rgiFn of proving that he did not build or 4nprove(w purpoecofuIs." IQTY. ,i�l �'')DING PE''}��{sss`N'.(d'T'T , - t' I,l'`FEE ' � FLOOD ZONE APN Llj'I,ae owner of the property,am exclusively contra with Ilmosed P IT U NCH contracture to mratruct the pmject(Sec.7044,Business and Professions Code: a Q The Contractor's License law does not apply to as owner of property who D k ,�(EN r- Wllds or improves thereon,and who contracts for such pwiret.with a "' { ' FEE SUMMARY,. ofnatme(s)Ilcespursuant to the Contractors Lters.Law. AEIC eu/w T TD CE I - LJ I am exempt under See. B k P`C for thin�regasaon __JD gn'rV DE Frrs i Owner _�-_ �,d-_/ - /,(_e. Date ?-[-��7!/ / RAINS ROO AREACOND. - I '1 D ISAMTARY RECENT I. ' Eby&fil aK that I have a ocruft., of DECLARATION stet to ��v c�1 TRAP IOC SCI IDOL TAX Y N l ❑I hereby affirm that I have o Insurate of convent to copy the. or a PTt RFLflPf N 3800,Lab C.WOrkeri Compematlan lraurance ors certified copythereof(Sec. / GAS F.A.SYSTEM-1 INCAOUTLETS P.11,lab Cd E �• OD PARK FEE Y N Policy X RECEIPT N Coss any GAS EA.SYSTEM-OVER 4(EA) I I BUILDING DIVISION FEES I E3Cattlnad copy is hereby furnished. the city GREASE/INDUSTRL WASTE INTERCEPTOR I PLANCHECK FEE Certified ropy R flied with the city inspection division. .CERTIFICATE OF EXEMPTION FROM WORKERS' l GREASE TRAP I PAID COMPENSATION INSURANCE l (SEWER-SANITARY-STORM EA.200Fr. , Date RCeel (Thiseess) need not becompleted tithe permit V(Drone hundred dollars pt# (g1I0)orless) WATERI IPATEt W/VENT/ELECTR Q /� �ENERGYFEE Y N Ill not thatln the par(ornunce of the work forwhkhthls penult is Issued _ 3ftJq D — I hall not employ any person in any manner so as to become subject to the / l WATER SYSTEM/TREATING .Worken'Compensatlon Lawe of CallfarNa.Date 2.0 PAID O Z Appliard ZQ NOTICE TO APPLICANT.Xafter coking this Certificate of Exemp ion,yowl NEWRESIDENTIALPLMB. QFf. Date Receipt# should become subject to the Workers Compensation provistwoomphe Labor TOTAL: CC N Code,you must forthwith comply with such peovWors orthls pemmit shallbe _ BUILDING ITR CC > deemed revoked. W CONSTRUCTION LENDING AGENCY I SEISMIC FEE ll I hereby affirm that there R a memtmdion lending agency for the perform- M Z arcs of the work(or which this permit is Issued(Sec.3097,CIv.C.) TOTAL:p ELECTRIC FEE O 0 . Lander',Nz,w i.- PLUMBING FEE 20-DD IL Lenders Addes. IQ'TY.� MECHANICAL PERMIT.11 "'FEE I MECHANICAL FEE U Inertifythat l have readthisappheattonand tlatethat the above information O W ie correct.I.S.tocomplywithaBdtyandcountyordinancesand state laws! PERMIT ISSUANCE I IT'EES PtII } N relating to building mmtmction,and hereby authodae representatives ofthb I Ii Zz�� S r� Z city to enter upon the above-mentioned propertytoriespectlon purposes, ALTER OR ADD MECH. _ (We)ages to save,Indemnify an d keep harmless the City of Cupertino Date ReCeip[# agairetha Jlitin,pdgmeys, oete and expenses which may It, wayacauel AIR HANDLING UNIT 8010,000 CFM) I I SUBTOTAL: C'�-lY agalns iry In m u ace of t sting of this permit. AIR HANDLING UNIT(OVER I0,0D)CFM) I I CONSTRUCTION TAX ` Signature of Applicant/Contractor Date EXHAUST HOOD(W/DUCT) I CONSTRUCTION TAX PAID: HA7ARDOUS MATERUe /ISCL65URE Will the applicant orfumm building occupant store or handle hazzrdoue HEATING UNIT(TO 100,000 BTU) I Date matenalas defined by the Cupertino Municipal Code,Chapter 9,12,and the RCCCiDt# (IPxlth and Safety Cede Senion2S532(.)? I rIGTINGUMT(OVFR 100,000RHj) I I TOTAL: µ )DD ❑Yea M No Will lheappliwnt orf utumbuilding occupant use equipment or devices VENTILATION FAN(SINGLE RISID) l ISSUANCE DATE which emit harardous atr mniamle.ets as defined by the Bay Area Air PAM Qu lity Management District? (BOILER-COMP(3?Es OR 100,0()BTU) l (�rWWIl1l Yea No !1® M ' IkW havamad Health a �uty C.da brequiremen,sunder Chapter 6.95 of I BOILER-COMP(OVER 100,000 BTU) �• QQ((�� the Celifodth.tifthbildin Code, .t.i s.tlyh,25533andt,th.t I I r as responsibility that lfthfy the ingdont of the requirhavea tenant,that il4my NEW RESIDENTIAL MECH. SQ Ff.I ropossib0ltYm ndity the occupant of the raquirerrenb which must be coed ' pour suanceofa9h Lcate f cmpanry. I MY Of Cum!rti"O Owner urawtluu agent Date is OFFICE TOTAL: OFFICE COPY e. /