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HomeMy WebLinkAbout25587 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY PDILD;NG-F,CECfR CITY OF CUPESION PERMITNO. BUILDING DIVISION APPLICATION/PERMIT PI-IIMBINC-MECHANICAL 'BUILl11NG YROdECI'e1PM.N'fIFICA'I'ION j;. i - BUILDING ADDRESS. 25587 71ig-1:51I O' SANITARY NO. APPLICATION SUBMITTAL DAT'H UNIT LOT# �'•� OWNERSNAME. P10NIi: CONTRACTOR'S NAM13: LICNO: G z C5 4 NIC CONTROLp HCNITECI7ENGINEER: LIC NO: ADDRESS CONTACT: PHONE: aag11111 W: a::.s¢#a K�+''a: a yet z ;. "p 'B[71 bilsiG PERMIT INFO QTY. y ELCCITtIC .FPC t',. PERMIT ISSUANCEPLUMB LICENSED CONTRACTOR'S DECLRA ATION APPLIANCES-0.85IDENTIAL Myz I hereby offir WalI am licensed under provisions of Chapter 9(commencing with TOB DESCRIPTION JQ OO Section 7")of Division 3 of the Business unit Pmfessiona Code,add my license is in ppNpyg - ,Fj Lullnse ClndeffecL w .; ez License Class Cmun UP TO 2013 AMPS ',�1•(r" 1X' vs?y Dae Comncrm 201-IOW AMPS Fyz� ARCHITECTS DECLARATION SQ.FT.FLOOR ARLA b/SQ.fT, 20rnI s/GnJ ^ understand my plans shall be used as public recoOVER IOW AMPS 2z;:@ zrds. F@„I SIGNSPLCIRCUI N Laenud Pmressrmrel Rl s.IgL:`..+-'Ig'L Jog �owu OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/bRSC. ,I iqqi(SOaF I hereby offir that I ole exempt from the Conr<vne Laterite Luw Tor We su tQm following reason.(Section 7031.5,Business and Prolesdons CmJe:Anyeily or county TEMP.METER OR POLB INST. 1 j I 11rr j ��y; which requires a permit'oconsamct,alcor,improve,demolish,or lepav any hwdurc I� \//7 L'� �f prior to its issuance,also requires to applicant for such pemuuo IIlefts],rou,sudeader, POWER DEVICES SG p that he is licensed pursuantto the provisions of the Contractor's License Law(Chapter y� b' 9(Commencing with Sermon 7007 of Division 3 onhe Business and Professions Code) SWIMMING POOL ELECTRIC yo ,.,,n or Was he is exempt therefrom and the basis for the alleged exemption.Any violation,of, ON F-z� Section7031.5 by any epplicardfor.permit subjects the applic.tto.civil pe A,,of OUTLETS-SWITCHES-FIXTURE$ RE” t more than rive handled dollars($500). yNO ❑ 1,aeowncr.ftheproprty,ormyemployeeswithwagesastheirsolecompensedon, NEW RESIDENTIAL ELECITt _SQ.PT. STORIES 'T'YPECONSTRUCOON 3� will itod-limik,Cade; Ids, ommrcem icense -merit foreale(ply to owner of and Professions Code:The Contrecmr's ndwho Law does nm apply m an owner is properywhobuildsorimprovestereogandwnodnessuctende oroffifonnroughhia ever,the ebuildivideJ that such impravememsaenot eiona l cmoffereJ thefroludie. mnIr, OCC GROUP RES.UNITS builder ,theavetheburden mpmentissold within oneyear of completion,thrower builder will have the burden ofproving that he did not build or improve for purpose of tele.) q - ❑ las ownerofthe property, m aexdusivdycontracuwith contracting contranorst Q fiatt.3 jPhUMBIN4 PCRMIT F '. FEP,S Ft00DLONE APE construct the Project(Sec 9044 Business and Pmfcssars Coded'The Contractors s'"'� #' '''"'z' ' License jaw doesnot apply loan ownerofpropery whobuildscrimprovestereon,and PERMIT ISSUANCE who contracts far such project-witha comnemr(s)licensed pursuant to the Contractor's License Law, ALTER-DRAIN&VENT.WATER BR,) FLU SUMMARY,= ❑ 1 am exmnp'under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICP. Owner you SANITARY Y N � WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,CONED, RFCEIPT#❑ I herehyafrirm that l have a certificate ofc.nsmaself-insure.ora certificate of SCHOOLTAX Y__N__ Workers'Cnmpensation lreurance orneenified copy tuwf(Sec.3gW,lnb CJ which FIXTURES-PER TRAP RECEIPl'# coven all employee's under this pcnnit' PARK FEE N Policy# GAS-ESYSTEM-1 A. INC.4 OUTLETS ECEI# Company U D '10 .Eg ❑ Certifiedco mmianee. GAS-EA.SYSTEM-OVER 4(EA) PLANCHE py is nereny ❑ Certified copy is filed with me city inspection division. GHF.ASIWNDUSTRL WASTE INTERCEPTOR GRA CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP © �� COMPENSATION INSURANCE SOILS (This section need not be completed if the pemtit is fm one hundred dollats($11) .rl s.) SEWER-SANITARY-STORM E.A.20FT. ENERGY FEE .� I cenify that in she perforenceufte work for which this permit is issued,I shall WATER HEATER WNENT/ELECfR not employ any person in any manner to as to become subject to the Work.' z Compenaetionlawsof Califnmia. Date WATER SYSTBM/I'REATING PAID Applicant Data Feed I# z .0 NOTICE TO APPLICANT:If,After making this Certificate of Exemption,you should NEW RESIDENTIAL PLMH. SQ.FT. [-t 4 become subject o the Workers Compensation provisions of the Labor Code,you must TOTAL: fir , forthwith comply with such provisions or this permit small be deemed revoked. BUILDING IgiF. ❑-I D CONSTRUCTION LENDING AGENCY SEISMIC FEE z I hereby affirm that there is a construction lending agency for the performance of V O the work for which this perms issued(Sec 3000,Civ.C.) TOTAL ELECTRIC FET! L1r Lenders Name gg - .. a v r p landcrs Address QTY, I �f'MECI IANICAIaPERMIT-_�'- x} t zpEF.: PLUMBING FEE LSI T certify tat 1 have read this Application and sate tat the above information a L e" ' . '.. r �" 6s conedl once m comply withal)city and county ordinances and state laws relating'. PER ISSUANCE MECHANICAL FEE � huildingcoruhumi.n.and hereby authorize represcnutives oFhie city mercer upon We ' U z louse mane ned m,.y for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX (We)a ve,indemnify and keep h e Cit'of Cupcni o"no .ast hilities,ju enls,c. . dexpenscswhic inon by. no again sold City AIR HANDLING UNIT`10 How CFM) nsequeReofW rentin this pe '1. it 9 AIR HANDLING UNIT(OVER lit,"CFM) Signor ApplicanVConvuct.r Date EXHAUST HOOD(W/DUCn PAID HAZARDOUS MATERIA ISCLOSURE HEATING UNIT(TO 100,000 BTU) Do¢ Reccip'# ill the applicant or future building occupant same or handle hazardous material m defined by the Cupertino Municipal Code,Chapter 9.12, it the Health and Safety HEATING DIED(OVER IW,WO BTU) TOTAL: Code.Section 25532(x)7 - ❑Yea ❑No VENTILATION FAN(SINGLE RPSID) Will the applicant or future building occupant use equipment or devices which emit BOILER-COME JHP OR 10.0L`O BTU) ISSUANCE DATE ANINhh.'tl<ro,dous It tcontaminant.,its defnA.ed by the Buy AAir Quality Menugemem BOILER-COMP(OVER 100,01)) p O BTU) P A. 1 y' ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.PT. Lof�e read the hmenbus meurish requiremems under Chapter 695 of the NOV 241993 ealth&Safety Code,Sections 25505,25533 and 25534. I understood this' g Wxs not currently hove a unapt.that it is my ruPonsibiliry to notify the /sl I y to mquimmenas which must be met prior to isswmce of a Certificae of V 1 Vt (/Ilf CI'1 f tnnsed agent Dom AL: ISSUED BY: OFFIC