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HomeMy WebLinkAbout24088 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bulldln Project Idemifbtivn PERMIT N ER ITN4 0 8 8 Bulldb�g Addrm: !G) _ S F �tL roe. CITY OF CUPERTINO-BUILDING DIVISION Con d Lic.No. APPLICATION / PERMIT BUIL[RNGELDCfRICALPLUMBING-MEHA CNICAL CATEGORY CONTROL I AmhBea/Englroer. Llc No: ' QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address PERMITISSUANCE (iu� ❑ LICENSED CONTRACTORSDECLARATION L� L7 T hereby Clbm that leu u,i,donaedhe Bull wvui Pro Chapter9fmnmm APPLIANCESRF�EMTAL JOB D6CIN Ingws,1,1.N U to. (the BuCnmand Pro(eulouCode,and license 1,1.fu0 force and Clea PANELS - LkeveClar LIC/ Date Contractor UP TO 2DOAMPS ARCHITECT'S DECLARATION 2M-IM AMPS 07. I understand my pan she]he used as public reamda OVERIWOAMPS SQ.Fr.FLOOR AREA S/SQ.FI. Fi b U�u Lkcose,l Professional SIGNS ELECTRICAL {� pry td OWNER-BUILDERLA DECLARATION /A E L © t 7 Ibereby•firmthatlamenempt fromthe Coviractori LloeruelAwf«the SPECTALCIRCUITINUSC O 7p following nesm.(Section 70115,Buslnm and Professions Cade Any city or ( I'/,l L..� G O F f' county which requires a perMt to mvtrum alter,lonprovq dennBsh,or repel IFMP.METERORPOLETNST. II Jo e CCCfff any struenne price to its esua me,also requires the applicant for such permh to �,pg DEVICES 2 �J the a signed aatement the he is Licensed punuant to the prvvbbro of the 04 Contractors Llceroe la (Clnpmr9(wnurrningwLLhSection 7009)ofDM- �03 cion 3 of the Rndnm and Pmfeesbro Cade)or that he Is exempt therefrorned SWUIMING I'OIX,ELECDUC VALUATION the bub for the alleged exemption. Any vtda en of Seaton 7th I5 by any applicant for a permX subjects the applicant to a civil perulty N not rmre thin OUTLEISSW[7CHMFLCCURES 0v as ddhn( M. �n u 1,u owner of the property,or my empbyem with wage u their sole NEw R®FIJ'ML FU-ECIR 9Q'FI. STORIES TYPE CONTIR C ION C pewtloa,wBldoths.k,andthestructun bwtinerdedorovendfor S O In(See.70K Binuree al Puci doth Code:The Contnnore Uarue Law S2 don not apply to an owner of property who bulli•or Improve thereon,and OCC.GROUP R6.[JN175 0. who don such work himself«through his own employee,provided that such ir provcmerdeam Trot IntendedoruHetedf«sale.If,howeser,thebulldingm TOTAL irnprovemea bsold withinon<yearofc«nplCbRtheowner-bullderwW have t rdenofproWngthe hedd ncebu0dorbnprovef«Nposeofad,). QTy, PLUMBING PERMIT FEE plpp ,NNE APN LJ L as owner of the Property,am euhudvety contracting woh Ilmnee i contractors to corotrua the project(Sec.70K Business and Profmlom Code: PERMIT ISSUANCE The Contractor's License Law doe nae apply to an owner ot property who ALTER-DRAIN 4 VFM-WATER(FA) builds or Improve themen, and who contracts fee such pa tvjes wW ayt(aetor(g lloenrd pursuant to the Contnctda License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY . Lj 1 en exempt under Sec B 4 P C for thio ceAws ORITSIDEFEES DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y_ N_ Owner Dae RECEIPT Y WORKMAN COFIPk SATION DECLARATION FD(T11RES PER TRAP SC7 p0[,TAX Y N_ , 01 hereby•form that 1 have a certificate of soros.to self-Insure,«aREcpE� MULlaeofWorken Compematlonlrouruca«acertlfled mpythertof(5«. GAS EA.SYSTEM-1 ING4 OUPLEfS. PARK FEE Y N 3800,ky 0 CJ T i Ca s GAS EA.SYSTEM-0VER4(EA) DING DI Y BUILDING DIVISION FEES CertBled copy b hereby furnished' eRE45E/PIDUSfRL WASE INTERCEPTOR PLANCHECK FEE certlrled copy b filed with the city IropMbn dlvtaun. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID aeCOMPENSATION INSURANCE - (Ildsctbn need net be comp)TI Nr col, 1ohundred dollen SEINER-SANITARY STORMEA 7D�T Date Reoei tN (9I W)or I. ) I WATER HEATER w/VFNr/EIECTR ENERGYFEE Y N I certify the to the perWrnunm of the work for which this pemdt is issued, I ehaB not empty any person In any manner w u to become mbjcd to the WATER SYSTEM/TREATING m Work 'Compnoatton Laws of CaBtomla.Date PAID Z Q nt NOTICE TO APPLICANT:If,after making this Cettficee of Exemptionyou NEWRMDENTIN,PLMB. SQFT. Date ReceJ tN should become subject to the Workers Comperoatlmt provbtoro of the Labor~ TOTA H Code,you cora forthwith comply with such prcvAom or this permit shall by W > deennee mwvkd. BUILDING FEE CL SEI MIC FEE CONSTRUCTION LENDING AGENCY M Z O IhembyafOrm that them Isa mroemalon lending agency for the perform ELECTRIC FEE ante of the work for wldeh this Perrot Is lssnd bee 3097,CN.CJ TOTAL- L) OTAL V O ).coders Name PLUMBING FEE IL F LendeesAddruna QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W IMA"aIhave read this application and state that theAxwe NU forrruon is correct.l agree to cemply with all enyand countyordlnenma and state laws PERMIT ISSUANCE FEES PAID: Nnhro tteg to building cotrualon,vul herebyauthociu represonhuNe of thio H U) city toenterupan the abovcmenlbrod property for inspection purposes. ALTERORADDTOMECH. V — (We)agree to save,i deme y an d keep m the City of Cupertino Date Recel tp against habitittca,y genenls,coaasrd ex rvyln any yamue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: againstsaid City e(cnn gra of his pe MR HANDLING UNIT(OVER 10,000CW) CONSTRUCTIONTAX s- ron,nnrA u /Contras\« Date USTHOOD(w/DLC.T) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE t Will the applloa«/uturc building occupant Gore or berdleh_'— HEATING UNIT(TO 100.0W BTU) Date RCCCI Ill nuterlal as defined by the Cupertim Municipal Code,Chapter 9.17,cad the I kalth and Safety Code Secdoe 75533(a)7 HEATING UNIT(OVER IDD,000 BTU) TOTAL: Ye No Will the appllraa« tumbuilding occupant useequlpmerd«devim VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE which endt haurdoua air contarttlrurds as defined by the Bay Area AU I _ Ilty Marugemea Dbtrkt3 BORER-NMP PHPOR 100,00D BTI!) P A ' Yes ❑No A shave read the h"eucas nnAerlab requinmenb underChapter6.95 of BOMER-NMP(OVER 100,000 BED) (� (� 'I rlr the Californh Health&Safety Coda Sectbro75SR5,75S73and25534. I ESI %�y understandttitif the building don nit currently hive atemnq that ltbmy NEW RESIDENTIAL MECH. SQ.FT '1907 on responsibility to nalfy the occuped ofthe requlnmeaswhkh mux be met pri ,Luuance of a Cert]fkee of Oauparuy. �s 1a7s7[ "l�I Y Ur wrcnun , Owner or autharlud agent Date TOTAL ISSUED BY OFFICE COPY i Borrower/Client OU Proeerty Address 7855 FESTIVAL DRIVE 7ity CUPERTINO Count SANTA CLARA Slate CA Zi p Code 95014 2 _PerJlsvc`_QQv`�__ .4�/sig _ �lu'�d tPetXic #k: 8/010/ ff 27. 75 CLOSET MASTER/ BEDROOM T /�C�C{tu01t 9.7 %/, . — 28.5 BEDROOM PATIO• , MASTER BATH 58.5 19 BATH -------------- BEDROOM DINING FAMILY ROOM ROOM LIVING KITCHEN ROOM 37 ENTRY GARAGE 23 12.5 O 4 . AND M$ . a� 11 flits"t4n.n� aspecificaha, 19.5 joat all times and itis un.'. pfltil A*'e any changes or atteradons' IIM a+'.if wt written permission from TI �igilS{tgg deft, City of Cupertino. ppi�y�,,u�,���� S*9z Of this Plan and `^�o �tl$ he'd tD SPaGfICatlOng �iW49YJ116Q t* Permit ar to be an; ')f "y C4 6rda�G or��Provisions luf 9u1 D 1992 • BLDG: INSPECTION DEPARTan OFFICE COPY � Df AU