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HomeMy WebLinkAbout22018 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Buildfir,Pm M Ideml/lo0on P6 MITNO. B°'bing Add ' 22018 _ o Ana-. s'- o �3 ner�hqu o �CLilF one. CITY OF CLIPERTINO-BUILDING DIVISION o/Ptra Nam: L .N� APPLICATION ( PERMIT l ^� _ Z Z ABUFUXNGELFiTRICALPLUMBING_MECHAMCAL CATEGORY CO rchBrai/Faglreer. Lk.Na Z OTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add. IFo � I(AUVe—PERMITISSUANCE © Y"� LICENSED CONTRACTOR'S DECLARATION ovWns I hereby+fl4mtkt lam Beemed under proof Chaptsr9(¢mmem ANCFS APPLIRESIDM EIA JOB DESCRO N Ingwlth Soctbn 7(Yp)ol DMsIcr3ofthe Bupwaand nn ProfessisCade,andrny hooses b b full fo,¢and dleel. PANELS � T1''� LIan�Lk.. 3 Z ��e t/ Dale Co�eaor Z .a� 12 IQ 2QQ AWft p� ARCHITECTS DECLARATION yXf 20;-1 AMPS µQ�OO I yp,'apd my pi ng ehaB�uaed BeremNa w� OVER 1000 A.V4P5 ) 0 �F F1 ARrRh I S/SQ.FT. E�(� Llan. Pmfd�L / x'66 SIGNS ELECTRICAL ALJ' �<rg OWNER-B UILDER DECLARATION n /I LicenseSPECIAL CERCUI7/MLSC. LLJ 01 t.. I hereby affirm glut lam 7 31,5,B from the Com fegdo j Code'Lew for the i folbwing noon.(Seaton 7Qft5,Buslnm ami IProlnebra Code My tltyor TEMP.METER OR POLE I ST. F cwntywhkh nequirnapemOt tomrobva,akr,Improvc,demo0sh,orrtpalr a nymm=mpnabltabsuame,•boreVub eapphntfasuapemdtto TOWER DEVICES D Ems— O 4 file a signed statement tha he b lie,med Pursuant to the pro islms of the u, Conrado',Lkeme Law(Chapter 9(mmmendng with Seaton 7000)of Dhei- SWIMMING IC)DI:ELECTRIC ` u� O s theslub slthe Bualnm and Pmfmloru My violatioat n of See Wnopt 7031Stherefby andVALUATION 4 y.' the basis for the site eel exemption. My dolalbn d Seabn 7e115 by any �5 aPpu.tfor.permit subjMatheapplkamtoatlWl penalty of not marethan OUTLzI$ �HFSEXNRES R CCCHccc rev ndna dollars($500. 6..owe,,.fthe NEW RF9DEJIIAL E.FLIR SQFT. STORIES TYPECONSIRUCTION property, esempbym wlthwagn as thekd in oompena.Bmn,w0ldothe wak+ndthe rtroaurt Is not Intended or offered for O sale(Sec 9014,Buslrcv and IRofenbro Code:Tk Comraaots LI¢rae Uw � $ dm nat apply to an owner W propenywho builds.,lmprwn therms.and OCC.GROUPRFSUM75 who doneuchworkMmeclf orthrough hbownemplo),ees,provided that such Impmvemenbannot Intendedoroffere fmaale.ILhowever,thebuildingor bop vemffl a ldwlthinom JearofcanplebNthe vn r-WiWerwW ve t)�urelenofpmvinglhet hedid n.tbuudor Mproveforpu,poaeofaak.). QTY, PLUMBING PERMIT FEEEpp ZZDNE npN u1,as owner of the pross property,+m eLuWm ely ntraaing with licensed PERMIT ISSUANCE � oantractaa to..trad the project(Sec 9044,Businm ami Prolmbm Code: The Contractor's Liceme Law dm not apply to an owner of Property who buALO�DRAQJ&VENT-WATER ffA) Wild. or Improves thereon,and who mntram !a such PRo(eae with amuwoeW 11¢naed Pursuant to the Contnaai Lke..e law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LJ I+m nempe order Sec B &P C for this reason DRAINS FIAOA ROOF,AREA,ODND. SANITARY Y N OUTSIDE F Owner ECL RFxEI'I+ WORKMAN tAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y N_ ❑1 hereby a(((rm that I here a¢M/ivb of consent to self-bsun,a a RECFF811,+ La =,L.a of Wohen'Campenrtlon Irmrnn¢as¢nBled copy th<nw(fSec. 3SOD , b CJ GAS FA.SYSTEM-1 E9C.40[II1,E75 I PAAK FEE Y N Pinky Y GAS FA.SYSTEM a(FA) RECEIPT a Co. nY BUILDING DIVISION FEES Cry ropy Is hereby,furnished. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE O'11 ii nBled ropy b filed withthe stylropeabn dlvWon. CERTIFICATE OF EXEMPTION FROM WOR.FRS GREASE TRAP PAID EXEMPTION /�', COMPENSATIONINSURANCE ( SEWER-SANTEARYSTORM EA 2)eT Date Recel ttf(This seabn need oat he<omplaed Btk permit b for one hundred dollars ME ROayth WATER HEATER W/VENT/ELEcrR ENERGY FEE Y N I¢rttfythat is the performance workbrwhtchtwp bjla Issued, I shag oat empty any person In any ori n. at u to hawrtc subject to the WATER nSTEMITREATING Wakery Compenuatlon Iasv+of GlBmnia. Este PAID O Z Appll¢nl Z O NOTICE TOAPPLICANT:B,after ma"this CertBka4ofE.emptlon,you NEW RF9DEYIIALFILM B. SQFT Date Recel tlf should boms aubjthe Waen'Compensation pmvlslon of th roM b h e[.+icor Q N Code,you mcoW rat forthwith mply with such pmbk TOTAL.:ns,or this permit shall doemed reed. QUIL12NC FEE CL vok O CONSTRUCTION LENDING AGENCY SEISMIC CL ¢Ihereby.rnrmwt them ba mrutrualon lead ufl.gerrcqy for the perform ELECTRIC FEE per. Z anof the workfor which th is permit I, e,lfie.3097,CN.C.) V O Lender's Name PLUMBING FEE _ IL (enders Add. _ QTY. MECHANICAL PERMIT FEE F l MECHANICAL FEE O w I¢nitythe l have reads aFis�ppleatlonand state that the,b.we bnlormalton bmrreetrtebcamplywWaB atyaM county ordlnan¢sand late laws PERMT'TLSSUANCE FEE$PAID: Nmating tobullding mnstnaWon,aM hercbyautheree repreaentativeaofthb �— z sty to entsruponthe ab.vo-mentbnied property for tropeabn purposes ER ALTOR ADD TO Mei. V — (We)agree to save,bdemniry an d keep harmim the Cory of Grpenbw Date Rmci tH ago Wtllab01t4a,ladg stn,me ea ezpensea whkh m.yb an ay cvue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: agai said CNy lnm gyne of gnnling of this psmdl. AIRHANDLINGUNH(OVFR10,Ece CFM) CONSTRUCTION TAX Si tun. AppO Camtnct F](I IAUSf HOED(W/DUC17 CONSTRUCTION TAX PAID: H ROOUSMATERIALSDISCLOSUR WBllheappBn mf wmbulldtngo pantstonorhardleha rds HFATINGUMT(TO10),000917U) Date Rttei I>t meenal as defined by the Cupertino Municipal Code,Chapter 9.17,and the _ HealthaMSafay Cod,_SI.14 1S532(a)7 I HEATING UNIT(OVER 100,00)BTU) 11 TOTA yesL�N Ill the appheast or future building oavpea umequlpment adevfm VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit havndous air mnbmbuma as defined by the Bay Area Mr Qnllty Management DrM? BOB.ER-COMP OMP OR 100,000 BTT() A_ I I? Yrs Th.'ereadthehav b nqulnemenb under Chapter 6.95 of BOILER-COMP(OVERIW,000BTU) the Ca Eomla 77ealth&Sa(cty Cale,Sec4bv 25505,755]3 and 25534.] APR 20 19�� .mtaMthatbfthebulldingdonn. me nttytr huve.t...rt,thatItmy NEW RESIDENTIAL MECEL SQFf {g,a,> p bEBy to notify the ceca ant of the,¢quiremenn which nus he met(1(Q CITY Ur Gurcnl Ow.e'.r4authcrtnM agent af# Date TO ($LIED BY' ' L OFFICE COPY