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HomeMy WebLinkAbout25470 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO RUHMINt - LhCI'RILAL I PERMITNO. APPLICATION/PERMIT PLUMING-MECHANICAL e� C q'�O BUILDING DIVISION BUILDING PRojBC'1'U ICSTIFICA'1'ION I 2 5 4 BUILDING ADDRESS. ��fWs/ SG/r A Jl✓l1IkG'/ I/Nd(M/�Z 5/7h�-�2'w T y{9� d/✓,t/ h//��- j/` 9 7�Z�O SANITARY NO APPLICA p[ONN SUBBM UTAL D ATE /02-59 A Al YYOCO/ MUT# LOTS 9-2&Ays OWNERS NAM76,iii CIOR'SNAMF .ICN SIC CONTROL El LIC NOSCi ENGINEER � i / 7 �C GI'1hAJ2_,,K Z;AaMAIrk �SPHO4NN6➢/t e a/yo/S!Q/{ I BUILDINGPERMITINFO� Y. ELECTRIC FEE I R_ LI)q F PI.UAtd M[CN PERMIT ISSUANCE LICBNSEDCONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL ❑aZ Ihereby affrmthat l am licensed underprovmons off after9(commenting wnh LOB DLSCRIPI'ION 1t100 Semmn70X)bfD......a 3 of the Bosoms,and Professions Cale,and my license is in PANELS FFy�LL❑ full force end crf •i ` • `�{J a0zW Iillfin arraal e�/Y1y- //-}1as, 477,24 l UPTOBOAMPS Ix ,?u Glen �LLConvacl�e--M/~CG �O`r" 201-]his)AMPS I __- 0 *I. ARhall be LTS DECLARATION Q.FT.FLOG S/SQ�1' -�0 IunJenumd my plans shall be usedaspubliorecond, OVER IBf10AMP5 ^) 3w- F4FJ (SIGNS ELECTRICAL f.. �� ,,.41 LmemeJ Prvfessinnul I ^ �yWI OWNER-BUILDER DF.CLARAI'ION Is`,�,SPECIAL CIRCUIT/MISC. r� �/1 Lx�(5t I hereby affirm that I am exempt from the Committers I.mene,Law for the 51 01 mjotting Iemon.(Section 70315JEnmeasand Probe as.nns Coda Any city or county I TEMP.METER OR POLE.INST. LL O¢ which requires a perms to construct,almr,u.,no ,demolah,er repmr nay Structum M_ a� m in nsuanee.ahnrc them Leant for such no fle aSigned Statement I POWER DEVICES (J� CC prom yore, pp permit top, 0K 0m hemmer sod pmvction7 )of Lisburn the Comrecmrs License Law(Chapter ax�oLL 9(commencing with Section 7(100)n(Dmsion3nf the Husinesn and Professions Cale) ` SWIh1MING POOL ELECTRIC _ VALUATIO1N enpr m nnhal he is exempt lhercfrom and the basis for ibe alleged exempooa AnyvmI Sony rot' I / / 1 F­- Section 7 031.5 by any applicant for a permit subjects the applicant a nv0 pcnalt of OUTLETS -SWITCHES-II%TURKS— L Y a nut more than five hundred dnlldm(85(10). II NEW RESIDENTIAL ELECTR —SQ.I'f ❑do wrk,andthempcny.ommyempendeeswitheredfrsale(sole 0O .Bsinen, f� I1 STORIES TYPECONS'fRUC'I'ION y3— will Pr thewod,and the Tod ontrsnor,License sal apply 1. a owner I f !_ II ss /� �T © n ■ and Pndessiore Coda The Contmmnd License Iqw Jnes nut apply If en owner of (III \fl N progeny whobuilds erimpmves thereon,and whodceswchwor' 'nowelforthmugh his I OCC.GROUP. 1 R nwnenipinyees,provWallMn such impmvementsurenot imm�dedurof @mod lnr Ali lf, L / GROUP, I A p howevewtheave the on en of,oeatiesat he did noneyem improve of Y _ p`✓1 holder will have the harden of proving that he JW not hold onmpmve far purpose of V' sE) IQTY.I PLUMBING PERMIT I FEE I TAY 4 WDD ZON. ❑ I,cw•rnaoDt(See ny,1.Business it licensed Contractors V/11C construct the protect(Su.total Business and Professions orempr ve Contractor's _ _ is loo apply with acotinen nywhoseddsonmt to thereon,and PERMIT ISSUANCE ehocontrams forsuclt projects with unmtnutor(a)I¢enacd pursuant the Contractors ALTER RAIN&VENT- LicenxLaw D WA'1I!R(RA) ' PIiB SUMMARY ❑ I nut exempt tinier Sec B&P C for this reason RACK FLOW PROTECT DEVICE. I SANITANI' nUfl IDE FEES N Owner ^^te RFf-EIPrk WORKMAN COMPENSATION DECLARATION (GRAINS-PLOOR,ROOF,ARFA,COND _ - SCIIOOL'PAX YN eA ads,Compensmmalnsuranceortacenifiedcopythereof(Secu3g110.Le C.jwt r�11IXTURES-PER TRAP 1 � (PARK I'EE YFCE11=red N coca 1l employee's under W,perms ' RPOEp'rM GAS-PA S\'STEM-1 INC.40UTLETS �"a Pnhcyp - �� - BUILDING DIVISION FEES Compco'..P GAS-IAA.SYSTEM-OVER4I RA) PLANCHIiCK FEE ❑ Cerofied copy is hereby furnished s rCcrofird copy is fled with the city inspection division. GREASESNDUSTRI.WASTE INTERCEPTOR GRADING PER / CERTIFICATE OP EXEMPTION FROM WORKERS' GREASE TRAP (SOILS ME COMPENSATION INSURANCE (Otis section need not Ise completed lithe pemm is frronehundreddollers BHXBI (SEWER-SANITARY-STORM Ep.200PT I (ENERGY FEE. SCI —• or less) Immfy thmin the peHormancenf the worA for whmhthrspernn isissued,(shell Il WATER HEATER WIVEM'/F.LEC9R not employ any person in any manner so as to become subject to the Workers' 9 AID Compensation Lawsof CaLfomta Dar WATER SYS'I'EMA BEATING Ddte Itaciptk zZ Applican- O NO'nCETOAPPLICAM' ILSftermakmg this Cemficate of Exemption,you should ) NEWRESIDIiNTIALPI.MU SO,Fr. TOTAL: rA become subject o the Workres Compensation provisions ofthe Leber Code.you must lorm,ah comply with,oell provisions or fineperma bull be deemed blinked. (BUILDING FEE C�•1 `�O aQ CONSTRUCTION LENDING AGENCY _ SHISMIC PEE I hereby afford the ImM is a construction lending agency l'or @e performance n' (. r v U the aorkfor which this permit is issued(See.3097.Civ.C.) PL. IIs�� iiLECI'Ric FEE Leader's Nab— PLUMBING FEE -- O U L.end,n,Add,- (QTY. MECHANICAL PERMIT I FEE I �O .cndy That have read this upplicniion and roam that the aMwe mformntmn is MECHANICAL PEE r� 4 omen.lagrm tocn,and with enmity and cepresentatiesofthd stmt lewsrelaong to I f 1'GRh11'I'ISSUANCIi f-' building constructor,and hereby euthorim representatives of thisnrylo enmr upomhe if-14 CONSTRUCf1ONTAX L) Z above-mentioned property for inspection purposes ALIEft OR ADD TO MUCH (We)agree o,save,indemnify and keep harmless the City of C.pemno against - ImFilmes,luJgm i,costa unJ expenses whmhi y]W� ainst said City 1AIR HANDLING UNIT ITO I0,010 CFMI the granting of this P< ASR HANDLING UNIT(OVER 10,000 CFM) Sign/6re of ApplcanUCunOanm / Date I C EXHAUST HOOD(W/DUC ) +� PAID I IAZARDOUS MATERIALS DISCLOSURE I BEAT UNIT(I'O IW,q>n R'IVI Dale Receipt N/1 as def Will the cppfic by the Cupr:rtnouMuncipal Coda Chapter 9.12 end the Heal end Safety HEATING UNIT(OVER IIq,OW BTU) Tgj'A1I,p'1M,material Code,Section 25532(a17, I�yEN RATION FAN(SINGLE RESIDI q ❑Yes ❑No BOILER-COMP 13HP OR I W,(M10 BTU) I ISSUANCE DATE Will lhcapphcamor future hmlJmgoecupunmstogutpmentmdueors whmh,an LL//�� L/ harerduus Su complainants m defined by the Bay Area Air Quality Management NOBLER-COMP(OVER 100,000 BTU) I I- T tilcrt 1919 C/' ❑Y<s 0 N NEW RESIDENTIAL MIiCH SQ.FT. /s Q9 I have read the hazmdon,mmeriuls regmblments under Chapter 6.95 of the 93 California Health&Safety Code,Sections 25505,25533 Said 25534. 1 undemm�d that Ur•CIy/orU dihe bmldmg Jws not currently haveumnanl,Ihann,my rcsponsibiLly mnnufy the I I I I Occupancy of the regmreinems whch must be con pnono issuance of a Cenifcem ur Owner or amhonred agent Date h[o�,:jr— (ISSUED RY: �s-/s� ✓I orrict