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HomeMy WebLinkAbout25020 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL. BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 25020 BUILDING ADDRESS: ,Q SANITARY NO. APPIJCAIJONSUBMTITALDATE / 103©O 6148;B "'OAD UNIT# LOT# 1 OWNERS NAME: Pf10 ' CONTRACTOR'S NAME: LIC NO: N)C CONTROL# giF C 1 CT/EiNGINEER: LIC ^ ADDRESS: El�/ SG< Z 07 CONTACT: PHONE: '��/y2s��// /w.f/n�w l/�f .fir// ��(J/ QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO • ' �•••^I ^" ✓'0—�� 'J I• PERMIT ISSUANCE ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL LOB DESCRIPTION QWz I hereby affirm that l am licensed underprovisims of Chalor9(ecompocingwith 1� p�k�f A�/ u pA 1400 Section 7")of Division Sof the Business and Professions Code.mad my license is in PANELS /(C'CMIG' RITC(T0 r`•4ou OF FK full force and effect. ,I I<,Z UmmeClus Lie.It UPTO2WAMN '� �R uIP�EN m 6 ti Dem Co.,.mr 201-1000 AMPS F v7i ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.FT. Ozo.Z—M OVER IOW AMPS I O Z.Q I understand my plans ahtll h used as public rerorda. rrvntt SIGNS ELECIRI L M_, Licensed Professional < OWNER BUILDER DECLARATION SPECIAL CIRCUITIMISC - ) 1 gOaF 1 hertby affirm that 1 em exempt from the Comrector's License Low for the s_ ts�3my following mason.(Section]031.5.Business and Profeadmxs Code:Any city or county TEMP.METER OR POL. Fp fS�; which requires a permit to construct,alter,improve,demolish,or repair any swaure prior m its issuance,also requires the applimmforsuch Perrono file a signed statement POWER DEVICES t�1i�i O that he is IiunsM pursuant to the pmvisions of the Conuaao/s License Law(Chapter a ex.o 9(commrncing with Section 7")of Division 3 clubs Business and Profesvimr Cade) SWIMMING POOL IC VALUATION W❑m or that he is exempt hcufmm and the breis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES t F¢ Section]031.5 by any applicant for a permit subjects the applieant to a civil penalty of $Q not moren five hundred do[[.($500). Cm ❑ I,esownerofNepmpeny,ormyemploymswithwagnastheirsoleconi enation, NEW RESIDFNTIALELECTR _SQ.FT. STpRIES TYPECONS'FRUCI'ION w 5t_, willJmhework,endthe rtmdurtis notimended ornf(ened forsale(SecJ0a4,Business and Profeaslons Code:The Contractor's License Law does not apply in an owner of property whobuddsorimpmves income endwhodressuch work himselforthmugh his MC.GROUP RES.UNITS son employees,providedth n such improvements are not inundedm offmcd formle.If, however,m<huilding mimprovemem ie sold within one year ofcompinion,theownm- TOTAL: builder will have the burden of proving that he did rmt build or improve for purpose of sale.). ❑ Las owncroFlhe property,mnexdusivelycomracsingwiNlieenud comrecmmo QTY. PLUMBING PERMIT FEEF1O DZONE APN mmmum the project(Sec.7144.Business and Professions Code:)The Contractors License LawdmsnotapplymunownerofMm nywhobuildsorimpmvestheuon,and PERMIT ISSUANCE who contracts rmsuch projects with acanlrnnor(s)Iimmed pursuant to the Contractors License Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY ❑ 1 am exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICEOUTSIDE FEES SANITARY YN Owner Dam RECEIPT # DRAINS-FLOOR,RO0I+,AREA,COND. WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN ❑ Io'Cina mats mihrance or.certified of im,then sal(See 38or Lm C.)which RECEIPT Workers employee's mlm'his eoracenifed copy NereoF(Sm.38W,lsb CJwhich FlXTURES-PF.R TRAP PARK FliE Y N covers VI employee's under Nis pertniL RECEIPT# Policy# GAS-EA.SYSTEM-I INC.9 Olffl.EfS BUILDING DIVISION FEES Company GAS-FA.SYSTEM-OVER 4(FA) PLANCHECK PER O ❑ Certified copy is hereby furnished. C3Certified copy is filed wiNme city inspection division. GRE.ASHIINDUSI'RL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF F- EMPHONFROMWORKERS' GRFASETRAP SOILS FEE COMPENSATION INSURANCE (Thisswtion need not he completed iRhe permit is butane hundred dollars($IW) SEWER-SANITARY-STORM EA.200FT. EREROY FEE infers.) Immlythat o filo ar onamare of the work for which Nir permit is issued,l shall WATER HEATER W(VENT/ELECTR not employ any person in my manner so as to become subject in the Workers PAID CompensatmLmvsof Califomia. Dem WATER SYSTEM/TREATING Data Receipt# Q Z Applicant z NOTICETO APPLICANT:if,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMEL SQ.FT. TOTAL: L--1 U) become subject o Ne Workds Compensation provisions of the Labor Code,you most LLa^^ forthwith comply with such provisions or this permit shall be deemed revoked BUILDING FEE I� W O ffirNCONSTRUCTION LENDING AGENCY SEISMIC FEE �,- I hereby am at there is a construction lending agency for Ne performance of the work for which this permit is issued(Sm.3007,Civ.C.) TOTAL: ELECIR IC FEE Lendee,Name OU ' Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE U I unify Nut 1 have read this application and state that me above information us MECHANICAL.FEE correct. I agree in comply with all city and county ordinances and rate laws relating to PERMIT ISSUANCE. building construction,and hereby auNarim representatives ofmis city to enter upon the CONSTRUCTION TAX et U Z above-mentiproperty oned for inspection purposes. ALTER OR ADD TO MECH. (We)agree m save,indemnify unit keep harmless the City or Copenino against liabilities•judgments,costs and expenses which may in any way accrue against said City AIR HANDLING UNIT(TO 10/000 CFM) in c fNe gnming of Nis permit. UP AIR HANDLING UNIT(OVER 10.000 CFM) Signe re a( / ter tcEXHAUST HOOD OVIDUCT) PAID H OUSMATERIAIS DISCLOSURE HEATING UNIT(TO IW,0005TU) Dau Rmeipt# Will the applicant or wrc building occupant some or handle hazardous material O as defined by the Contemn, anicipal Cade,Chapter 9.12.and the Health and Safety HEATING UNIT(OVER IW,IX#IBTU) Code,Sermon 23532(e)7 13 Ya ❑No VENTILATION FAN(SINGLE RESID) ISSUANCE DATE Will the opplicanmrfuwrcbuildingoecupantuucquipmcnmrdevicm whichemit BOILER-COMP(JIIP OR 100.00(i minor 00,000 BTU) minor our conamirana as defined by the Bay Area Air Quality Management BOILER-COMP(OVER IN,"BTU) jfTsmmp !� - ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT. A 4 D I have read the haeardom mammals requirements under Chapter 6.95 of the ��� _ Califomia Health&Safely Code,lemons 25505.25533 and 25534.1 undersand mat if the building does not,n remly have s unam,that it is my responsibility to notify Ne occupmt of the requirements which must be met prim to issuance of a Certificate of Occupancy. Ci Owner or amhmized agent Data TOTAL: ISSUED BY: