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HomeMy WebLinkAbout27386 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING F:LF.cTRI AL PERMIT NO. BUILDING DIVISION APPLICATION/PERMITBUPLUMBING-MECHANICAL 2 7 3 8 6 ILDING PROJECT IDENTIFICAT'I(IN IS 1 0 BUILDING ADDRESS: /gyp /� � �s/�/� ft-��} /y SANITARY NO. APPLICATON SUBMI/TT/AL DATE s CO U-y�bLIS I ve UNITp LOT# OIrNAM PHONE: TC ACTOR'S LIC NO: !! �J nq _ � N/C CONTROL W N RCHIlTCT/ENGINEER: LIC NO: ADDRESS: 1 ❑ CONTACT: PHONE BUILDING PERMIT INFO QTY. ELECTRIC PERMIT BEE BLDG ELECT PLUMB MECH PERMIT ISSUANCE Z�Q`' (fQ X ❑ LICENSmli ONdRACTOR:Siomof RATION APPLIANCES-RESIDENTIAL 9� �` Ihereb ffmhthm lamlicerredunder of Che ur9gommencin ith LOB DESCRIPTION �tiZ Ya pmviaiov p gw 00 SediorceandofetDivision3of the Business eatl Professions Code,and mylicemeis in PANELS pdA_ full force end effect. ^ _ p <Z License Class Lic.N UP T0200 AMPS + h�eC` LLQ - ,,6 a Date Contractor 201-1000 AMPS I Z OZ)t'i ARCHITECTS DECLARATION understand my plans OVER 1000 AMPS O Z—pq SQ.FT.FLOOR AREA $/SQ.M. ans shall be used as public records. r-1-cc SIGNS ELECTRICAL Qio Licensed Professional C oll OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. N06 V I herby affirm that I em exempt from the Contractors License Law for the t�aa, following memo (Section 7031.5,Business and Professions Code:Any dry or county TEETE MP.MR OR POLE MST. which nquirea a permit to construct,alter,improve,demolish,or repair any machine Y� uanrequires prior to its issuance.also res the.pplicaret forsuch pemtirio file.signed statemem POWER DEVICES W^ 0 thin he is licensed Pursuant m the provisions of the Contractofs License Law(Cheptw 9(commeacing with Section Wlo))of Division 3 ufthe Businessand Professions Code) SWIMMING POOL ELECTRIC VALU[tl7pN W�H or that he Neeempuherefrom and lbe basis for the alleged exemption.Any violation of FIXTURES 0 D i-Z Q y any applicant Penni subjectsapplicantPenalty o OUTLETS-SWITCHES- i. not mom nfi tfsre ttheo.civil h f Q ot more than five hundred dollars($500). NEW RESIDENTIAL ELECTR S .FT. ❑ Lasowrk,andthropeny,ormyemtended utteregesasthe(Sec.compensation, Q STORIES TYPE CONSTRUCTION will dmhewons Code: cture Comanor's License Law doesed not apply in an Business and Professions Code:The Contractor's License Law does not apply lf an owner of propmywhobuilds ovidedravestremor, pmve whodmssuch tintmdkhimsfemdfwughhisownOCC.GROUP RES.UNITS howemplayebuilding orri atsucprovehimprovemeuann a ew d comp)fend furcal n If. however ilt havtaurs en of pment is solthat he within in one yew ofcomove foJ purpose f TOTAL: 3 00 builder will have the burden of proving that he did not build m improve for purpose of sealed' . ❑ Loa ownerofthe progeny.amexclusivelyconvacting with licemrdcontrectnrs to QTYPLUMBING PERMIT FEE FLOOD ZONE APN construct the project(Sec.7044,Business and Professions Code:)The Contmetora License Law does nntupply to anownerofpropey whobuildsorimprovesthtram,and PERMIT ISSUANCE whocontmets forsuch projma with a commensals)licensed purmanuothe Contractors ALTER-DRAIN&VENT-WATER HA) FEE SUMMARY License Law. ❑ 1 sm exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE SANITARY Y_N Owner Dau N DRAINS-FLOOR.ROOK AREA.COND. RECF.IPI' WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN ❑ Irs'Co affirm that lhave acenifcmeelectrical .pyth.f(Snsure,o.Lob C.) hick FIXTURES-PER TRAP RECF.IPI'# Worked.,[ .'i madwr.ncermit. sed copythereof(SttJgfp,Lob C.)which PARK FEE Y N covers all employer's undenhis permit GAS-PA.SYSTEM-1 INC.4 OUTLETS RECEIPT DIVISION Policy N BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE ❑ Cenif ul copy is hereby furnished. ❑ Ceofud!copy is Blind withhhe city inspection division. GREASEBNDUSI'RLWASTEINTERCEPTOR GRADING FEE CERTIFICATE OF EXEMVN RK GREASETRAP SOILS FEE COMPI NSATI(Thiosectionneetl not be compinetlihuntlred slurs SEWER-SANITARY-STORM FA.20014. ENERGY FEEor less.)Iceify thminthe performance of thilrmit is Mlahell WATERHEATPR W/VENT/ELECTRnot employ any person in any manner I. to he Worked PAID Compensation laws of Califuml.. Date / WATER SYSTEM/IREATING Dau Receipt# O Z Applicant 20 NOTICE TO APPLICANT:ILafler making this Cotlificaterd EE.emption,youshould NEW RESIDENTIAL PLM&. SQ.FT. TOTAL: F' Cl) become subject to the Worker's Compensation provisions ofthe Labor Code,you most 7 forthwith comply with such provisions or this Permit shall be deemed revoked. BUILDING FEE aQ CONSTRUCTIONLENDINGAGENCY SEISMIC FEE VZ I hereby action that hen is a construction leading agency for the performance of TOTAL: ELECTRIC FEE ,�sNerfa O the work for which this permit is issued(Sec.3099,Civ.C.) W Isndcr'x Name O F LenderFE s Address QTY. MECHANICAL PERMIT PER PLUMBING E ' LUQ I certify shot I have read this application and state that the abve oinformation is MECHANICAL.FEE Z.CO >h R. correm l agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE dQ building construction,and hereby authome representatives ofthis city tomecr upon the CONSTRUCTION TAX V 7 above-neembeed property for inspection puryosea. ALTER OR ADD TO MECH, ©O G (We)agree to save,indemnify and keep hornless the City of Cupertino against limil'hea,judgmenn,rosts and expenses which may in anyway accrue against said City AIR HANDLING UNIT(TO 10,000 CFM) n n 'a voting or rmit. i c�.s�tce F7111T{ 11� (M1ij cam' �I� 1 AIR HANDLING UNIT(OVER IO,I/Ip CFM) ./gnaw}cofff APpli{icrroCwCommrT.1 �' aA•HII Dau EXHAUST HOOD(W/DUCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.000 BTU) Date Receipt# Will the applicant or future building occupant store or handle larardous martial dV as dcf nod by the Cupertino Municipal Code,Chapter 9.12,and the Health and SafetyHEATING UNIT(OVER IINI,(XN10'TU) TOTAL: Code,Becton 255320d? VENTILATION FAN(SINGLE RESID) ❑Yes ❑No ISSUANCE DATE Will heapplicant w Nature buildingoccupam useequipmewrdeviaswhicheant BOILER-COMP UHP OR IIX,00f)BTU) Y'� A B ua dous air conformationsconformationsas defined by the Bay Ana Air Quality Management BOILER-COMP(OVER 103,000 BTU) istrin? QQ ❑Vee ❑No NEW RESIDENTIAL.MECH. SQ.Fr. FEB 1 /�+21995 Lhave read the hmardous materials nquinments under Chapter 6.95 of the ia Health&Safety Code,Sections 25505.25533 and 25534. 1 understand that uilding does not currently have a mount,thin it is my responsibility to notify the C,IIr ur wrtrU INO nt mf the nquir mens which must be ma prior to issuance of a Certificate of ncy.ornmhwcmdagent Dau TOTAL:I NJ.00 ISSUED BY: OFFICE