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HomeMy WebLinkAbout24777 APPLICANT TO FILL IN INFORMATION WfTHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELEOPRICAI PERMITNO. APPLICATION/PERMIT PLUMBING.MECHANICAL 24777 BUILDING DIVISION BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATIONSUHMUTALDATE Cybu2.6p15, 2- 1"3 WNr SNAy R �T�Ri %IONB: CrTA(.T _ M rl LOI Wit NIC CONl1tOLY .RCHOTIT(111ACINEER: LIC NO: ADDRESS: lots CDrrrncr: PHONE: I LEU BUILDING PERMIT]NPO QTY. ELECTRIC PERMIT FEE BLDG ELECT PLUMB MECH PERMITISSUANCE ❑ ❑ ❑ LICTIJSED CONTRACTOR DECLARATION AP%,LANCES-RESIDENTIAL JOB DESCRIPTION psz I hereby affirm JW l am liansW mdu poviu«nm Chapter 9(commencing with � �� +1100 SeNm00)l]0Eh,kim Sof Ik Bmi.saw Prof.Cumrd mme te, y liceu in PANELS F FF pillFiorehimand cRm. UPTO3 AMTS EG.L1s0. Lignac Clan Lk.MUniFT yQy Dulc Cantmclor 101-1000 AMPS ZOyZ ARCUfT:CTS DECLARATION OV IOOp AXfPS SQ.Fr.FLOOR AREA SISQ.IT. I tmdnslan d my plants shell be used as Public occondr, f.n fO SIGNS CLECIRICAL I /I © I 1 Licensed!Pmfc.aimul i/_1! OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. I q�(0iF0F I hereby ion.Jut 1 em exempt foam Ne Cuumclda Licrnsc Lew for Ne M P T E R ut'3 LLy following..(Seensan 7031.5.Busineu and Prefenions Cede:My city or caulty TEMP.METER OR POLL INST. I'-0¢ which rtquira a permit to con.tract,ilrv,iml+ove.Jumlish.or repair any wuuure YS prior to itsieauarxv:.ulso rtyuirca line applicant for such samil to rile a signed stetcmcat POWliR DEVICES � <C tins,he is licensed puruwnt In the provisions m one,Cormactafs License la.(Chxpser as E! 9(ammencirq with Seeman 7")of Division 3 of Ne Buvaus and Pmfewaa Cosee) SWIMMING POOL ELECTRIC or that b,is cxcmptiherefmmand the bends or the illegal exemption.Any violation of a Seetim]031.S by any ..icem farepemrin aubjeur he applicant I..m civil peRy of OVfIPIS-SWITCIIGS-FIXTURES / a�O Oma^ M rut nerc Lan rive hundred dollurs(S.."). NEW RESIDENTIAL PI FOR —SQ.FT.❑ I,uowusrofNeprapetty.ormyemployem withwagemNeirwleampemntim, STORIES TYPECONSTRUCTION y3� willdo the wont.aMCosta: he,CentswtimerdedmTad apply Bunds and anysebobo ldnor The ves thenana Chemo taw docs ran apply lf rt owner of prnpmty antro Wilde«impmvcs thereon,ve who iMnsuch wont hinuclf«through his' i or Nawab imptovcrenaunc not imcnJcd«offcml Its,ow - OC .ROUP RIS.UNITS howwtt.Jeavbuilding file, oimpmvcmcm ishatJwithin cme,build or imroueaor Its,owa TOTAL bustler will bends Je burden o(pmvin8 Net he did rt«build«Impovc far pmpox o{ .role). w❑hommsOwanerj . conowithlieencmvac ' QTY. PLUMB ING PERMIT FEE FLOOD .ONE APN 1 -1 Incpm*cT(Sm.7 .HuAnavi smd wafievimCede:)Toe ams Liamaw « welomowuofawwaseotinrtend PERMIT ISSUANCE f«much precaa with acmtnabi Irnpiruantin the Caunactds Liave law. ALTER DRAIN&VENT-WATER(EA) FEESUMMARY ❑ em exempt aorta Sec. B&P C(or Nie TegisonIIO SID BACK ,OW PROTECT.DEVICE SANITARY Y N Owner RECEIPFY WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR.ROOF.AREA,COND. SCHOOLTAX Y N ❑ I hereby JRrm Our l haves cmifuteofmuemuem,lf.inawe,«aaniis to of RI:CEIPT♦ pe Workers Comnaatien lmmueeor a ceniferl copy co therf(Sec.38(y,Lab C.)which FIXTURES PER TRAP PARK FEE Y N rn all employees under Nie pantie GAS-G.SYSTEM. INC. O VHEfS RECEIPT N poi 0 BUILDING DIVISION FFFC Company GAS-]1ac SYSTFlAFOVFR 4(EA) %ANC IECK FEE ❑ Ccmfidmpyishuabyfum dhi ❑ Cmifed copy Is filed with the city inspection division. GREASIONDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP' SOILS FEF. COM%NSATTON INSURANCE, (This section used nm be completed if Ne permit is fume hundred dolWa(S IW) SEWER-SANITARY-STORM PA.100FT. ENERGY FEE tr ImeJ lcmifythm in thepMormwecufine work forwhich Nie pcmJtul...,,.,tknell WATER HEATER W/VENTIELECTR. ort empty any Pee+sn m any mwrar as.become subject to the Worsens' PAID Cu%smetion laws of CJifmnsie. Due sa WATER SYSTEM"fiATING Dan, Receipt# App Ozp NO CF TO APPLICANT:If.after mAing this Cmi6alc of Exemption,you should NEWRISIDENTIAI.PLMB. SQ.FI'. TOTAL: V] becoane subjalto me Wmkcr'sC«npcmeJm prnvivowu of thelabm Code.You must fiest empty wiNsltchpmi.siwu or Nis ramor shall be dcemsd revakM BUILDING FEE D'1 Q CONSTRUCTION LIND]NO AGENCY SEISMIC FEL' Z I hereby uffmr that Noe ion v.inn lending tiger Y for the perfimwnce of TOTAL: ELECTRIC FEB U O the work for which this pimtit is iswd(See 309],Co.CJ Luala's Name O Lender'.Admen QTY. MEC]I ANICAL PERMIT FEE PLUMBING FRE I certify that I have read this applicwim and awe that the above information is RW. carom. Iagree to cooly with al city and won,ordinwace ural state lawn mlati gto PERMIT ISSUANCE MECHANICAL FEE _ building c«utmaim,anal hereby auth«ive rtprumativn afth9 city.enter upon the U z above-mvNo y for impaction FsvIR pose" ALTER OR ADD TO ME". CONSUCTIONTAX (We)aV6 to u e,irrduwify and keep hmmleu the City aCotem to ageimt IiaMlllin,j gm std cxpcmcs which may in any way vccmc sgeirw mCI id City AIR I]ANGLING UNIT O IO.f(C CFM) n uxuc4u granting of Nis pcnnil. f g� IIt HANDLINGy` HANDLING UNIT(OVER W.00(1 CFM) :tgmmrto(A Ian Dye FXIIAUST HOOD(W/DUCO PAID I. US MATERIALS DISCLOSURE HRV1 INC UNII'(10 M,0(11 BTU) W. Receipt# anti Nc Iicamorfu rtbuiknng«cape u«e«MMk berardou mesial HEATING UNIT(OVpt II%l.t}10 BTU) T L u deBnaal by s upan t sompr'Cade.ITaptu 9.11,aM ole HuIN and Safay case,scum 255. ❑Yes ❑No VENTILATION FAN(SINGLE RPSID) Will Joe locant«forme buildim occv BOILER-COMP(JIIP OR IW,0(0 BTU) ISSUANCE DATE app g pwUnucquipmmt«okvlmwhichanit tvandou.and conamWnu u dcfnd by the Bey A.Air Qued,ty Management BOILER-COW(OVER IW.WO BTU) DislrinP ` A ' ❑Ya ❑Na NEW RIffiIDEiNTIAL MECH. SQ,FT. IFO` f1 I neve red Joe hervdous ass iels requbemaRs«du Chapter 6.95 of Jtc FEB 1 Y Cilie buil Hmlth&SefcureCode,yh.s,,au 25505,Jed yb15S}1. Ituduyud this 8 sa ifthe buildingdnanmr«nandyneveaslum,That it is to rtxpanaiof it Ccs«ify Nc cope err the rtyuircmcna wnicn mural nc ren nal«rt.lesuenre of v Ccnif¢vm or pwrsr«auNoriud agrnt Uuc TOTAL: ISSUED BY: NNU OFFICE co �4 v_ W �o R=� la. cnZ t7 ' n o. • � w � A3 V� v � c' O � � a alX St - i e. J � s v LPV - i�'es ml5 / a s