Loading...
S 3043 APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CITY OF CUPF,RTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATIONIPERMIT PING PROJECTB NG IDENT'HANICAL S 3043 BIIILDINf.PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY N(s. APPLICATION SUBMI'ITAL DATE III � C (� rt ow v f . y�o� 7K/66 y e © -2� �f OWNER'S NAME: �� PHONE: ��^ C RACTORS NAME: LIC NO: Qt Txr? NIC CONI'ROLA & �ervfc cS I • ARCHIT CTMISGINEER: LIC NO: A DRES C✓ �� L/� ❑ CONTACT: PHONE: fY A&)3 BUILDING PERMIT INFO / Consultant Fees Paid by Applicant(Initial) HL ELECT' PLUMB MECH 3t 2C�s3 ❑ ❑ ❑ LICENSED CONTRACT'OR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby from mal 1 am Basad ander posromn,td Chapter 9 Icommencins JOB DESCRIPTION OaZ with Section 7011)of Division Sol'the Businessund Professions Cnle,und my license is RESIDENTIAL; O PERMIT ISSUANCE aW0 in ful)force snit if 6 ❑SFDWL ❑KITCHEN REMODEL U Liccnsc Class Lic.p Q U APPLIANCES-RESIDEN 1Ah ❑ADDITION El PLUMBING RE-PIPE, yQa Da,c Contactor) WHITE=DECL 'Do, PANELS [I MULTI-UNIT [I STRUCTURAL Z O z 1 undersea d my plan,shall W used as public rwords MODIFICATION OZ`- UP TO lM AMPS C]INTERIOR [I CHIMNEY REPAIR ad Licensed Professional 201-1000AMPS IMPROVEMENT []SWIMMING POOLS y2; OWNER BUILDER DECLARATIONOVER 1(NIt1AMPS El BATH RfiMODHLJREPAIR ❑DEMOLITION C Q 1 bmfeby affirm Thal 1 um exempt from,he Canlmcwr's Licrnec Law for the fiy(O G V fallowing reunan.(Section]0)1.5,Business and Professions Code:Any city or county SIGNS IiLF.C'IRICAL ❑OTHER /p IY W y which requires n permit re construe,alter,improve,h permit t or repair any structure COMMERCIAL� OQ prianais issuance.atm requireslM1nnpplicvnl for such pemtil In EleasigneJ statement SPECIAh CIRWIT/MI$G' -A K m. that he is licensed Pursuannome Imi,kiens oI the Contracto's License Law(Chapter9 g00 (cummenciog with Swnion 7000)of Division 3 ufthe Buxin,ssand Professions Code)nr TEMP.MEIER OR POLE INST. I, d e y thin he is exempt mention unit the basis for the alleged exemption.Any smImion of ❑NEW RLDGIADDITION ❑DEMGLRION ^It Scninn]031.5 by any upplicdm for apermi,subjects ry the applicanoacivil Penalty y of POWER DEVICES TIiNANT ❑FOOD SERVICE r" Znot mcthan five hundred dollars(1100). rt etion, SWIMMING POOL ELECTRIC � Q ❑Im ,as owner of the property,or my employees with wages as,heirsole compoIMPROVEMENT E�O will Jo the work,aadnhesuucmm it imm�dedorotfered Imitate(Site7044,Business ❑0'THIiR L a and Professions Code:The Contractor's License Law does not apply ns an owner of OUI'LLTS-SWITCHES-FI%TURF_S pnrycny who builds or improves thereon,wd who does such work himself or through his own employees,provided that such impmvements are nm intended or varied for NEW RESIDENTIAL ELECT R SQ FT. sale.If,however,the building or improvement is sold within one year ofcompletion,the SQ.Ff.FLOOR AREA SISQ.FT. wne-builder will have the hurden of proving that he did not build or improve for pur- pose of sale.). El 1,as owner of the property,am exclusively contracting with licensed commai m TDTAL. construct he project(Sec.70,14,Business and Professions Code:)The Couractor's LI- cruse Law does not apply man017,1.fpropenyw ilds of improves,bene ,and QTY, PLUMBING PERMIT FEE whocontrams forauchpoli,.wilhacomracIn icensei nosuom oche Contractors License Law. PERMIT ISSUANCE El 1 am exempt under Sec. .B&P C for this reason ALTER-DRAIN A VIiN'I'-WAFER(PA) VALUATION Owner Dam WORKER'S COMPENSATION DECLARATION BACK FLOW I'R01'ECT.DEVICE I hereby uffirm under penally of perjury one o' allowing declarations: ❑Those and will maintuine Ccnilicam of Comae naelGin,urcfor Workers Compcn- DRAINS-Fl.00R,ROOF.AREA,COND. STORIES TYPE CONS'fRUCfION onion,as provided forhy Section AW of th tabor Code,Iia the performance of the work for which this permit is .wed. FIXTURES-PCRTRAP (] 1 have uod will maintain Workers Co pensmion Insurance,as required by Section 3]Mofthe Latin,Code,for the perfo nceofthe work for which this permit is ismcd. GAS-EA.SYSTEM-I INC.4 OUTLIU OCC.GROUP APN My Workers Compensation luxuriant, artier and Policy number..: Cartier. Policy Nn: GAS-EA.SYSTEM OVER 4 EA) CERTIFICATED a EMPTION FROM WORKERS' GREASI%INDUSTRLW INTF.RCE CDM . SA'FIONINSURANCC BUILD)NODIVISIONFli phis seNonneed not he completed iOhe permit for one hundred dollars(S)W) GREASETRAP or less.) LANCHECK FEE I certify that in the prrfontimur.Ohe work for which this urea is issue ,I"H SEWER-SANITARY-, E not employ any proton in zany manor o p ,r �yhjectmthe Workerx'Com n NIiRGV FET? z onion Laws of Califyymix.Da 6-Tk2J� WATER HEATER WNE 1LECIR Q Applicant /i'NT u v Lad/' Q RADING FEE NOTICE TO APPLICANT:IL after loniiing this Cer ifiwte of Exemption,you should WATER SYSTIWG`REAI (^; become subject m the Worker's Compensation provisions of the Labor Code,you mus, OILS EtiC Whenhwim comply with such provisions or this Fermi,shall W deemed mvuked. WATCR SERVICE Y Qa' CONSTRUCTION LENDING AGENCY NEW RISIDGM'IAL PLMB. SQ.FL PAID Dam Rveriptg V kforcwhicaffirm,hnhcre is. sued(Sm.309ending agency for mepM'ormance of the work for which this peo,h is issued(Sm.3M],Civ.C.) V. (" lenders Name TOTAL: U Lender's Address TOTAL: 1 renify ma,l have mail this Pitcairn and sate that,he show infnrmmion is PUI N TEF. ,F. y correct I agree to comply with all airy and county ordinances and site laws relating to QTY. MECHANICAL PERMIT FEE V Z building construction,and hereby authorize representatives of this city m enter upon the SETS I E above-mentioned propeny for inspection purposes. PERMIT ISSUANCE (We)agree,o save,indemnify and keep harmless Alm City of Cupertino again, EI. IS EEIi liabilities,judgments,costs and expenses which may in anyway accrue against said City ALTER OR ADD TO MECH, PI RING FF.E in consequence of me gmnling of this permit. APPLICANT UNDERSTAND ND WILL COMPLY WITH ALI,NON-POINT AIR HANDLING UNIT(T0140MCFM) MP HANICAL FEE SOURCE.REG ILATIONS. wd � AIR HANDLING UNIT(OVER 10,000 CPM) C S'TRUCTION TAX Signamr,of Applicam/Cminscmr Dam EXHAUST HOOD(W/DUCT) HOU. NG MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO IMdgkI BTU) as defined by the Culsenlao Municipal Code,Chapter 9.12,and the Health and Safety Code.Section 25532(a)'f HEATING UNIT(OVER 100.000 B'TU) ❑Yea ❑No VENT)LA'TION FAN(SINGLE RESID) PAID Dal, Receipt# Will the applicant or future building occupant to equipment or devices which ahazardous T(YfAardous air contaminants as defined by the B Area Air Quality Management HOILIiR-COMP(iHP OR IM.11(10 B'Nl snte D District? : ❑Yes ❑ AIR CONUII'IONIiR ISSUANCE DATE- No BOILER-COMP(OVER IW.UfIO BTU) I hothr:h e readurardwsmahmals uirements under Chaps,h95 of the Cali forma Hcu1m tit Safey Csde.Sxaions 25 5,25533understandd 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.ET. 1 building docs not currently have a tenant, r it is my responsibility to notify mcu e ocpaL nt / l7 indite remimments which must he met po to issuance ora Certificate of Occupancy. l/ Owner or umhoriud agent Dam TOTAL: ISSUED BY: OFFICE