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HomeMy WebLinkAbout22225 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Project Identification PERMITNO. ddrxss- B'B 0410 EAST KSTYNTES DR• coackti Yja CA 22225 ante: one:pA p CITY OF CUPERTINO-BUILDING DIVISION contrador'Nam: L .No: APPLICATION I PERMIT BUILDING-ELF-CTRICALPLUMBING-MECFiAMCALCATEGORY CONTROL Archit /Engineer. Lie.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addmsa: o a{ bPkV iZ 5ill PFRMITISSUANCE Moo LICENSED CONTRACTOR'S DECLARATION El thereby affirm thatlam Lcensed°nderprovlslons of Chapter9(rommenc APPLIANCESRESIDENTIM. iOB DC R 1p Ingwith Sedton7000)of Dwhdcn3ofthe Buslnessand ProteasionsCode,and my license is In fuR(orce and effect. a.��f� PANELS U\�^•as./lwV+a-- Llcesc nClass LIc.N •.i 1 Date Cmorador ARCHITECI•S CLARATION 701-1070 AMPS 99zC I understand my plans shall be used as public record& OVER 1000 AMPS SQ.Fr.FLOOR AREA $/SQ.Fr. 00 ^'� U Licensed Professional SIGNS ELECTRICAL �1 ' "%' % l L �< OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MLSC IhfR erebyaren that l am exempt from the Contractors License law for the - ✓ 2. following reason.(Section 7MI.S,Business and Professions Code:Any city or p a TE ^ F f' cmntywhichrequiresapermlttowmtmd,ater,impmve,demolbh,orrepair TEMP.METER OR POLE INST. Itl) ,bal(a Q sic prlorrolts Issuance,also requlresthe applicant forsuch permit to g V file a signed statement that he is licensed pursuant to the provisions,of the POWER DEVICES F,&w Contractor's License law(Chapter 9(commencing with Section 7000)of Divi- I I OS sion 3 ofthe Business and ProfemWru code)orthat he is exempt therefrom and SWIMMING POOL ELECTRIC TE UATIO o the basis for the alleged exemption. Any violation of Section 70315 by any I U OUiLE.ISSWI•fC}IES}7XTURE$ S 'r— f`© _ applicant fora permit subjects the applicant to a civil penalty of not room than L five hundred dollars($500). N'EW RESIDENTIAL ELECTR n ❑I,as owner of the property,or my employees with wagesas their so le SQ'FT' SI'OR1ES TYPE CONSTRUCTION compeneaiton,wMl do the work,and thestrucham is not Intended or offered for O ale(Sec.7046,Bus4ieas and ProfessionsCode:The Contractors License Law �r$ does not apply to an owner of property who Wilds or improves thereon,and RFS.UNTfS OCGCROUT' whodoessuch workloimrelf orthrouagh hisownemployees,provided that such a�V� ImprovemenUarenotintendedoroffered(orale.Ithowevegthebuileingor TOTAL: aW improvement Issold withinoneyearofcompleiomtheowner-bu0derwlll have the rden of proving that he did net build or improve for purpose ofsale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN Li t as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to mrotruct the project(Sec.7M4,Business and Profession,Code: L The Contractor's License Law does out apply to an owner of property who pLTER-DRAIN&VENT-WATER(EA) Wilds or improves thereon, and who contracts for such pMojecat with a ro,}pctor(s)licensed pursuant to the Contratmr's License Law. BACK FlAWPROTCCT.DEVICE FEE SUMMARY LII am exempt under Sec. B& P C for this reason OUTSIDE FIT, Owner DRAINS FLOOR ROOF,AREA,COND. -SANITARY Y_ N . Date RECEIPT p WORKMAN COMPENSATION DECLARATION FD(TURIS PER TRAP SCHOOLTAX Y— N I hereby of irm ve that I haa certificate of consent to ulbirxam,or a cent citeo(Workers'Compensation Insurance reRECEIPT M or a certified copytheof(Sec. GAS-PA.SYSTFMIINC.40UTLEB M00,IabC.�.I �a A^ PARK FEE Y N Policy M. W�/� �r-i6 �QI -06'-0 Z`tl_ RECEEN CoMany GBCt�c�l G bio T CASEA.SYSTEM-OVER6(FA) BUILDINGDIVMON FE T.S Certified copy tr herebyth the cid. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE �Ccrtl(icd copy V filed with the city inspection division. CERTIFICATE OF EXEM PTION FROM WORK FRS' GREASE TRAP PAID COMPENSATION INSURANCE ( SEWER-SANITARY-STORM EA 20117 Date Recei t# Thissedlon need not be completed if tM permit b for ane hundmd dollars ($1I .) mitia (es' Icedifythat lnthe perfomnce o(the work forwhich this permit uvedWATER HEATER W/VENT/ELECTR ENERGY FEE Y petlal , N— I'hall —I'hall not employ any person In any manner so as to be..subject to the WATER SYSTEM/,TREATING O Applicant orkCompe.nution La wsofCailfomb.Date PAID Z NEW RESIDENTIAL PLMB. 0 NOTICE TO APPLICANT:If,after nuking this Certificate of Exemption,you SQ.F7. Date ,RCCeI t# should beconnesubject to the Workers'Compensation provislomofthe Labor WN Cmdeyou most forthwithcomplywth.uhp.bi.morth(apert tshalibe TOTAL: > deered rev°ked. BUILDING •E tl p CONSTRUCTION LENDING AceneY SEISMIC FEE IherebyafRrm that there Is a conswction pending agency for the perform. ELECTRIC FEE Q Z anneoftheworkforwhichthls permit is Lsseed(Sec.3097,Civ.C.) TOTAL: C U 2 Lenders Na rre PLUMBING FEE LL F Lender's Adams' QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W I mnllythatl have read thtsappOcationandstatethattheabovelnformatimn 4 iscomed.I agree to comply with all city and county ordinances and statelaws PERMIT ISSUANCE FEES PAID: T W relating to building construction,and hereby authorize representatives of this - Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. — (We)agree to save,Indemnify an d keep harmless the City of Cu ped Inca Date Receipt# against liabilities,judgments,costs and expenses which may In any way accme AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: a air�st aid Clt consequenre o(the gamin of thi permit. p AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX 519natu mf Appticant/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PA ID: HAZARDOUS MATERIALS DISCLOSURE Will he applica nt or future building part store or hand le hazardous HEATING UNIT(TO 100,000 BTU) naerlal as defined by the Cupertino Mumcipa l Cade,Chapter 9.17,and the Date Recel t# H,At Yaannd Safety Code,Serio n 75532(&)1 HEATING UNIT(OVER 100,°00 BTU) TOTAL ❑ t W(I(Ihezppllcant°r future Wilding occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit hazardousroma air a m(nams as defined by the Bay Area Air . Quality Management District? BOILER-COMP QHP OR 100,000 BTU) '?h Yea Q No avemia the ealth&r uy Ccdeiaccttonrementsunder Chapter 6.95 of BOILER-COMP(OVLR 100,000 BTU) the Cail(ornla Health&Safety Coda Sections 75505,25573 and 75536. I understand that lithe building does not currently have a tenant that it fs my NEW RESIDENTIAL MECH. SQFf responsibility,to notify the occupant of the requirements which rrwst be met JUN prior to Issuance of a Certificate ofOavpancy. Owner or authorimd agent Date ISS .e `�• p, TOTAL: OFFICE COPY