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HomeMy WebLinkAbout26485 APPIICANT TO FILL IN INFORMATION WITHIN RED IINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO " ��� � rekm�rrvo. APPLICATION/PERMIT PLUM91\G�MF.CHA4ICAL /�C n H r HUIIAINGUIVISION ItU11.DIRGPMUJN,(,PIDN,NTIt1CAT1UN G0 �} v NUII.DINGAUURiS/S:� SANITARYNO. AYPLICATIUNtiUBMITTAI,DATIi IV IINITM I,OTN ( _�� OwN� 'NAMIi: PIIONB: RACTOR'S NAME: ` LIC^N'O: �� N �J'r�.Jl/�S �11[j-[��fj ITC+�y /v`�L� N/C COYI'ROI.q �ARCIIITf!CfRNGIN[EFt: LICNO: DRE55: ❑ u4� ��s4 t�a B � .�,,�— CONTnCT: aHONG: QTY. ELECI'R[C PERMIT �E BUILDING PERMIT INFO BLDG GLECT PLUMB M[CH PERMITISSUANCE � � � LICIiNSLDCONTRACI'OR'SDECLARA'1lON ppp{JANCES-RFSIDENTIAL IOBDESCRIPf10N p�z IM1ercbyaffrmNaUemlicen.dunderprovisionsofCTnpmr9(commencingwi�h �00 Senion]OOO�nIDivisiunlnfiheBvsinessundProfessiavCode.mdmylicevcisin ppN� Q�� ������R���<« , � � y6y D'alcm'Cl�v Contracmr ��; 201��OOOAMPS � � ��� L�yZ ARCIIITECTSULCLARATION OVERIOOOAMPS SQ.FT.F100kpR1iA 5/SQ.Ff. Q z_� I undersmnd my plans shall be uced ae public mcoeds. F�n F u] SIGNS ELECfRICAl � �,Jj LicenxdRolca�ional �a'6 OWNdR-oU1LDERDECLARATION SPECIALCIRNR/MISC �' X3�N 1 hertby nffem ihm I am exemp�fmm Ne Convanor's License Law for�M1e u1LO followingmasun.(5<ceon00JI.S,BusincssondProfcssionsCode:Myciiyoroounty '�EMP.MEfERORPOLEVJST. ��,�; which mquims n pn.ni�m conswa,el¢r,impmvc,dcmolish,or rcp' eny ewqum ��Y� Priurmrtrivuunce.ahnm9uiresNeapplicaniforsuchpemtluofil i8 smmmem PoWEROEVICFS �yK�p �M1aiheizliccnudpunuanno�heOrovieionsof�M1cComrvaor' ¢rnuL (Chepmr dXo�' ')(cninmencingw'nhScaion]UUO)of�ivisionJofNeBusi fess� Code) SWIMMINGPOOLELECIRIC VqLUAIION �y,_,� nr�ha�hcinezcmpnhcrtfmmandthebusisfnr�Aeepcgedenuuon.Anyvio �ionnf FIXNRFS �-.Z� Senion]OJI.Sbyanyupplic:mifurapermiiaubjecuthceccanuoacivilpentyof O ETS-SWITCHFS- � �/r' (.�� '• (� �/CJ �2 0 "��"'ore mo�r.e n��a.�a uonar.cEsno). 7 a'F- ❑ I.azuwnemf�hc y p y agcsu�hcirmlecomprnuu , NEWRFSIDFNTIALELECfR SQ.Ff. STORI 5 TYPf:CONS'IItUCTION o pmperry.orm cm lo uswi a3°- willdmhcwork,andihesimcmrcisnmimm�dcd ofPo aforeelc(Sec. Busine and Profexsiona Cale:The Commcmr's Lic Isw d�s no�appl � a pmpcnywhoFuildsorimpmvcsihcaon, wM1oJnes c�vorkh' i, ITorihmughM1is mplayees,provideJihmsuchi vcrirc ndetlo forW<.IL OCC.GROUP RFS.UNII'S howevcr,tM1ebuilAingnrimpm niemlAwil ' ycaro(co^J1�Ictinn,ihenwncrv Il buiWcr will M1avc Ihc burdc f pmving�hai h ' �buildAimRmve for puryou of �•� saleJ. � � QTY. PLUMBINGPERMIT FEE Fl-oo�ZONE qPN ❑ I.asownerof�hepmpcn xclu'v conva<tin i�Alicevdcon omo onswn iM1e O�ok��ISec.] und P f CWc:)9he Co racmr's I.iccnxlswtl«snoiapplyman � �opcnyw �Idsorimprovn �d PERMITISSUANCE � wM1mnn�mcufnrsuchpmjcctFwilhe va a(a)Iiccnud0uauentm�Fc omructor's pLTER-DRAIN&VENT-WATER EA Liccnmisw. �� � 1 FEESUMMARY ❑ 1 vm exemp�under Sec. ,13&P fnr ihis renson SANITARY OUTYIDF.FIiFS �� � BACK FLOw PROTECT.DEV ICE Owner Ome RECFIPTM DRAINS-FLOOR.ROOF,ARFA,COND. WONKMANCOMPLNSATI DECL ON SCHOOI,TA% Y N_ ❑ IhercAyeffrm�hoilh:rveecenifcmeofcu cnlmse insurt,orxcenilicaeof FlXTURFS-PERTRAP RECEIPI'N WorkcrsCompcnssiionlnsuranceoraccnifWcop (Sm.3800,IsbCJwhich PANKFGE Y_N_ rs NI cmpinyee's under�M1iz permil. GAS�EA.SYS'IEM-1 INC.4 OUTLEI'S RECEIIT X Pol cy X BUII.DINC DI V ISION Fl3ES Campany GAS-EA.SYSIEM-OVEH4(EA) PLpNCHF.CKFEE � ❑ Cenifie4copyishertbyfumishW. ❑ CcrtifWcopyisflcdwiUUuci�yinxpecuondivision SBftNDUS�TXI.PJAS'f�ET4'1'FRZ'EPI'OQ I i �� GRADINGFEF. CIiNTIPICATLOFEXFMPTIONPROMWORKERS' GREASETRAP '' "� 'T� ���� COMPFNSATION INSURANCE ; n "—' 1'� i 5011.5 FtiF ar'CssThisxctionnwJno�berompleuJifUcpumi�isforonehwdreddullan(5100) EWF,R-SANITAgY„STORhyp.r.ZbOFty^U /. ENNJ2GVFEE � � � .�'�� ,,• tl_. : Iattifyihmin�heperformanemf�heworkforwhiehNispeemitiissued,ISM1aII WATF.RIIFATLRW/vE[✓��� „ —� ( no�employ�1}person in eny mvmer so af�o su��uu�+Ne Woekers' z CnmpensnQqfUw.y[Celifnmie. Dete (O"�me ,I_' � WATfiNSYSTEFTJIRE)�',.•�:._,�,�J� •_i PAN Oae ReceiO�N Applicml \% � O NOTICH AP CANT:ILef¢rmaking�M1isCmifica¢of8mmpuon.youshould NEWRFSI�ENTIALPItnf� ! ' .roTp�; � � becom<sub� Wmkcr'sCompensotionpmvisiomoflAelaMrcCodqyoumus� � > fnMwithenmplY`"'��suchprovisiouonhiapefmilshallbedeemedmwked. BUILDINGFF,F -+ y C� CONSTRUCTIONLENDINGAGfNCV SEISMICFEE O . a z 1 M1cmby effirtn ihm iM1em is e conswctian Irnding egcnry for�M1e peAnmiunce of V Q �hcwork6rwhichihispeemi�isissuW(See.309].Civ.CJ �LECIRICFLG ` Lcndcrw Neme PLUMBING FEE � v �.cnacrsAJJress Q7'Y. MECHANICALPCRMIT FEE 1 cenify�M1ai 1 nave rcad Nis epplicalion end aum iha�iM1e eWve infnrmetinn is r�" W comec�. lagree�ocomplywii�WlcityvWwuniyordinenttsantlsumlawsmiating�o PERMITISSUANCE I. MECHANICALFEE F" � buildingconxwc�iun,andhcrtbyemhov.crtprtscme�ivnoRhieci�y�ornmruqrn�hc U z alwve-meminnedprnpertyforinsp«�ionpuryme.c. pL'IERORADDTOMECH. CONS'IRUCf10NTAX � (We)e rce�o savc,indemnify and keep M1armless Ne Ci�y ofCupenino ayuinn liabil".,�mg ms,cos�sanJexpensawhichmayinenywayaz<meegainxisaidCiry AIRHANDLMGUNIT(TOIO,OOOCFAI) c i � f iegmmingof�hispeemi�. L � p� AIR HANDLING UNIT(OVF.R IO.OW CFM) -4 SignamrcofAp ic 'ntraaor pa¢ L%HAUSTHOOD(W/DUCn PAN RDOUSMATERIAISDISCLOSURE 11EATINGUNIT(TOIW,OOOBTU) Dv¢ RccciO�N Will�hc applicum or fumrc building occupunt swrc m hendle M1azuMous mmcriul as def ed by�he Cupenino Municipal Codc,Chapmr 9.@.end Ne HW�h vM Sefey HEATING UNIT(OVEN 1 W,000 BN) yTOTAL: Codq Seciion 355JR(a)i ❑Yes ❑No VEMfILAT10NFAN(SINGLLRFSID) �ISSUAN �DATE Will�hw lican�orfmumbuildin acu cquipmrn BOILER-COMP(3HPORIW,OWBN) w PF g pemuu �orJevimswhi<hemi� hemNou..eir rnn�nminnms ae defineA M1y�hc Bay A¢a Air Qualiiy Mwagemen� BOILER-COMP(OVER IOO,OOOBTO) �o,���„ �DUI�— 2' 199q �Y°'' �NO NCW RESIDENTIAL M[CH. SQ.FT. I have rcuJ iM1e huewdnus mnmrinle reyuiremcros under CM1apmr 6J5 of Ne �In �r ��r M��ry Cali6mia Hml�h&Sakiy Codc,Scaions 8505,25513 and 2S53a.1 unJersund Nat � , I'. u i(iLc builAiny Jnc.�nnl[urzenlly hnve n�cnwi,Ihul il is my mspmsibiliry m nutify Ne cupani n(ihe mquimnknu which mus�he mn priw�o issuance of e Cenifca¢of � Owupunay. Owno-or uu@orimA ngcm Ume L: ISSUF.D BY: OFFIC