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HomeMy WebLinkAbout23796 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bultdir,i,Project Identlflcatlm PERMITNO. Building Addrex 22a ext i 0� c' TZc1-E. L4jT (o Z 3796 en ane: . n Om A[ta"� CG Id$ -23i�74t,13 CITY OF CUPERTINO-BUILDING DIVISION DL Lk.Nm —�� O mne«'Wam: _ APPLICATION �m• BUILDING-ELECiRICAL-PLUMBINGMECF MCA CATEGORY CONTROL# A Itect/Fsglneer. 'QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO n� 5- 4��� cg rets*" PERM]TISSUANCR LICENSED CONTRACTORS DECLARATI IherebyaH thatlamllc .Merpr W..fChaper9(mrmrrn APPUANCESRE9OFMIAL JOBD N OA ingwlth Section fDIVWm3ofthe Buahr dPmfes (o ode,and DA.fs/` homen Is in fun fo nd effeeL 331 / PANELS �� Lkeruc Clam Lfc# �C Date Comncto e UP TO 2M AMPS ARCHITE 1-1 AMPS µqqµ!!a0 Q7 I undersand my plans JuB u public temrda OVER 1000 AMPS SQ.Fr.FLOOR AREA S/SQ.FT. E�I"j Licensed Pmfeabrul SIGNS ELECTRICAL �i wq ONT•ER-BUILDkR DECLARATION SPECIAL CIRCNT/ML9C zl.., t'• Ihemby afBrmthat lam exempt fmmthe Contractor's Cirrose Lw forthe following mason.(Sean.7011 S,Both.and Prefnsions Code:My city or O � TFMP.METFR ORI'OI.E INSf. (y {F5 muntywhkh mqulnnapemdt tommlme,dter,lmpmve,demoWh,arrepalr —`� fit, Iy�[ any atmtlurctatemelt t1st he gaborcquhesuantt the fineudperMte POWER DEVICES ce`� Co a actors statement clot he b r9ile(con purnut it the o 700D)of the 3 0 Contractors License w C up erg(commencing with Section p0)of D W- SWIMMING POOC sion3 ofthc Buadnev andP mbns Codc)orthathebeu the mmard VALUATION the Wab for the alkged caemptbn. Any".cation efSeerb 90115 by any _y05 app0ant lora permftaubjealetheapplkant toadvll pevlty o/na NO rtnrctFun O ES LY M, froe hunama aolbn(Ston. l� j < ❑I,as owner of the pmperty,or my empbyen with wag.u tMtr sok ©' R �' SIORIES TYPE CONSTRUCTION d pcmrIoxwBorkumM ldothewandthe cturebratbdeedorofferedfor sale(Sec 7fM4,Buelrm and I'rofeabm Code:The Contneora Idceme I�w + s$ dm not apply to an owner of property who builds or improves thereon,and c whodomsuchworkhlm Uwhmughhlsownemploym,p.0N thatuch OCC.GROUP RES UMTS lmpmwem arcrotIntendedoroffemdf«tale.If,havever,thebullding« Impmvcmem beds whhln.neymra/campletbn,theavner-bullderwlll have ill try�puraen ofpmVing that he dw ra la0d or improve fm purpose.nadir.). QTY. PLUMBING PERMIT FEE LI 1�LJOD 717NE AI'N 1,as of the property,am exclusively cat and with Ilarnaad PERMITISSUANCE con Contractors mnstme thew d e(Sec9 apply to an o dna Pmferbns Cwho Theis or ice ra License Lw and not apply to u owner of property who ALTIILDRAIN&VENT-WATER(EM bum,or imp.Neuron, and who mmnee for such ptojvs with a cgn¢Pd«(a)licensed pnuant to the Contractors License Law. FEE SUMMARY LJ I am exempt under Sec B &P C for thio mason ' BACK FLOW PROTECT.DEVICE 1 DRAINS FLOOR,ROOF,AREA,CONE). SANITARY Y_ N_ Owner Date IRCtF7PT I WORKMAN COMPENSATION DECLARATION FD(7VRFS PER TRAP SCI{OOL TAX Y_ N_ ❑I herebateof orlo that I love a ceelBaa of content to self-burn,«a 39M,LaaC.Worken'Comperimtloninsunn«msarti(IM copy thereof GASEA.SYSTFM-1WG4O1_71= PARKFEE YECFBT# 3800,Tab Cd Polley#CI'/ ifierted ropy b M hereby(uehNGAS EA.SYSTEM-OVER 4(FM. BUILDINGDING DDI V#BION FEES 1 mCertfied copy b Wm filed with the city Inspection dlv . GREASE/INDIJSCIU,WASTE INTERCEPTOR PLAN C 1CERTIFICATECREASE TRAP MPO S U,ITION INSURANCE FROM WORK PAID COMPFNSATIONINSURANCE SENTFSANITARY-STORM EA.7IXIFT. Date Revel tp (Thio I..) need not be completed If the permit b(«one hundred dollar P . Icerytha WATER HEATER WfVENT/ELECJR ENERGYFEE YI N Iceedy that In performance ofthew«,for which this permit le Issued, I shall net employ any Proton In any manner n as to become subject to the WATER SYSTEM/TREATING - ( W.rken'Compensatbn Laws or Cam«nb. Date PAID Ali Z O ILOIICETO APPLICA Ff.Ifahn making this Cenillate of Exemption,you NESVR®DFN7IAL PLAIB. SQFf. Date Recti tq N should become mb}ct to the Worken'Compersatlon provbbroof the labor TO L: Coda you oust!«thwhh comply with mad provbbnu orthb pemdt shall be ( 2 j deemed revoked. W — CONSTRUCTION LENDING AGENCY SEISMIC FEE CL Ihemby Iffi that them ba corutmctlon lending agency for the perform- ELEPLUCTRIC FEE Z and of the workfor which this permit it lvues(Sec.3041,CW.C,) L' Ecrders NamePLUMBING FEE 49ex'"7_16 LL r Larder'.Md. QTY. MECHANICAL PERMIT FEE M CHAMCAL FEE U Imnifythatl have read thio spptlatbnavd Blab that thesbovelnfor nUon O W i,ce,, .lagreet.complywhhalt CRyandmuntyor iWnmsandaatelaws PFRMR156UANCE FEES PAID: t >_ N Maingtobulldingmmtmdlm,aMh mbyauthorbenepQnativaofthIs F Z city to enter upon the s eo ment1mrl property for Wpedbn purposes. ALTERORADDTOMECH. Date Recei t� — (We)agree to saw,bm dem/y an d keep harmlen the City of Cu pedba against liabilities,y dgmems,costs•rd expenses which may,in any way accrue AIR HANDLING UNIT CTO 10,000 CFM) - SUBTOTAU against mid City In consequence of the gaming of this permit. AIR HANDLING LMT(OVER IQF,MCFM) CONSTRUCTION TAX Signature of Applant/Contract« Date EXFIAUST HOOD(W/DIICD CONSTRUCTION TAX PARI HAZARDOUS MATERIALS DISCLOSURE I`��, tM•(. ' Will the appliant or future building o pant atone or handle havrdous HEATING UNIT(T01MM(]RTU) - materblasdrOnelbytheCupeel.Municipal Code,Chapter 9.17,and the Date eCe1 t ''77��ss lleahhab Safety Cad Ice 75537(p)7 IffATING UMT(OVER IOD,WO R'CU) TOT CJ Y. ��5{yNo iii the appBam d76ture building oavpant use equlpmem«device VENTILATION FAN(SINGLE REED) ISSUANCE DATE which emit lutea doulrce ambunHas defined by the Ray Area Mr • Q_i�a lky Managcmerrt glsvlp7 BOI[.ERCOMP OHP OR 10gIXD fill)) pp p ' D 4 Yc as {Nba P{ luveread salt rCode,Se requirements under Chapter of BOILER COMP(OVER 1fA,000 BTI)) the California Flahh build Code,Stolons 75505,ve aternd755M. I JUN 28199 rmpom rd that i(the bulla don oft errently veabmnL twtltbmy NEW RESIDENTAL MECH. 9OFT a( oap.nslbBity tons Rythe ort of th Nswhkh ntut be met Y P ua r.Ce ny «� #Ate CITY Ut coni-,k ,gen r ISSUEDBY: OFFICE COPY