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HomeMy WebLinkAbout24980 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO 1711-61NC..' CITFICAI. PER lII NO. APPLICATION/PERMIT MUNISING-MECHANICAL N' 24980 BUILDING DIVISION BUILDING PROUEC IDRISTIRCATIO BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMOTALDATE e�PER T/NO � � � o/ e.j� uZ0/o.s$ 6A RpE ds rpE CIRCLE UNRN LOT# k_-j'0.q3 OWMQ N I.. 18 L NPI ONeE� �� CONTRACTOR'S NAM' LIC NO: NA] CONTROL# 1, O�, �Inw AWR�C[ILIEC 1HAIGINERR: LIC NO: ADDRESS: El C ,• .lON'TAC: PHONE QTY. ELECTRIC PERMIT FEE g BUILDING PERMIT INFO E Cf PLUMB MEOI PERMIT ISSUANCE ❑ _ El LICENSED CONTRACIOR'S DECLARATION APPLIANCES-RESIDENT_ woo, IMeby alBamtiutl amfMCBroutda prosisio.i.,Cpa9(cm yl iced g wish TOB OESCIUPf1ON 1+100❑ Smlm TtordnrlAvislon3nf the Busimv uvd Rofcssions Code..td my llcenrt is in PANELS amU frOb Licfmccaddfca. \/ FZuI Licmx Clens Contractor UP TO 2q1 AMPS —� mQy De¢ ECTSD XII-I(Mq AMPS ZOr"i,� ARCHITECTS DECLARATION OVER 1000 AMM SQ.Ff.FLOOR AREA S15O.FT. OL_,) IaMasmvlmypW"I be urd n public rccmds. N FrnFw SIGNS F,IECTRICAL I/ © f < C Li¢nxd lhof_iord `� OWNER-BUILDER DECLARATION SPECIAL.CIRNITOMISC. I-� Oa0 1 hacby"Rmn that 1.m eecmpt from de Ctmincmr's Lican,Lew for tie U I ty34 followi ng rmvva.(SenWn 70315,Buun—and Profadous Cale:Any city m county TIiMP.METER OR POLE INST. which reyuiro.permit a NrWtucl,d a.improve.demolish,or m*r dry svucturt It.to forivw.ncx,tlsorey.i (Ieepplicsnt for h pmnit to flee siJ grc "..I POWERI VICES <O Met he is licrnsc,!Nt,umno the povidoMi of Me Cnna.cmrS Lic—,C Law(Cmeper SWIMMING POOL P1ECfRIC G.YX � 9(camemm�g with Seeman 1000)a Dim ivi. J of the Bled .atd Porf.im,Codc) VALUATI(Jb6, , Ma, or tha he it Cxcmfel rrcm.nd INC breis fee ikalicged cscmptron.Any violaion of ((,,ice{// t:ZQ Section 1031.5 by Conyopplicunt for a peri,subjacte the epplic.nt to.civil prod,aF OU7LI2TS-SWITOIIS-FD(T1_RI15 OO ,2 Cod codDurd Mon, n Bve M1urxbJdWs(55)0). NEW RESIDEN'D -Elt ALLI SQ.FT. STORIES P, N U fF� ❑ mown rofthc ,�,1C� pmPenY.ormYatRvloYsuwiM w.gnnlhnrsdecoropwtiam y3_ and dumewnek,aMm Thc,CoeodouriS UcCea, tew r not owner Ptufnslons Code:Ile ConEtacmr',littm,Lew don rn npply no rn owMr U lstoletry whobuildsorimpmvathacon.W wlwdon duh woh Wmxlfm Nmugh his rntpl��ttsAmvidWtha w,himpovctmnuartawtimadcdoroRcrtdf«xIe If, OCC.GROUP RIS. Il however,the building or improvcmCnl is sold within mc,rear ofcmoplctinn,Me Courcy- TOTAL: ( builder will love tie beardt tefpmving Mo be did m build or lmpmve for poposea mk.). ❑ I,mowncrnf Mepmpctty.ems,clusivdyrnntmcning withliccnwlcontr.ctonm QTY. PLUMBING PERMIT FEE P DL NG APN coreareet tie pmject(Sac 71)44,Busiresa.td Pmleuimt.Code:)The Ucwe wduesmiaMlyio.n ofpmpasywM1obui mimpnvalMc .trod PERMIT ISSUANCIE who Conote.for ouch pnijecnswilh a cantmcta(t)littncdpunuw to the C..Mr'. ALTER-DRAIN AVFM-WA'ITR(FA) FEE SUMMARY mu sou. ❑ I mn exemptunder Sx. B k P C fa This train BACK FLOW PRO=.DEVICE OIJTEOIDI'11.PS SANITARY Y N Owner D.ne DRAINS-FLOOR.ROOF.AREA.COND. ECEIPI' RI WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N ❑ Itwvcby efOmnM1onl M1evc.crnihcam ofcrosnn to xlGinsurt,oro ttnif mof RECEIPT# FIXTURES.PER TRAP Wgt,n'Comperu.tiao ltbunnc<err.ttrtiBM ropy lhertof lga.3800,Lab C.)which PARK FEE Y N m Jl emtrdo es tancl Mu'rod'. GAS EA.SYSIF,M-1 INC.4 OUTLETS RE('EIPT# Johey N BUILDING DIVISION FEB Co-fa,oy GAS-E.A.SYSTEM-0V M 4(EA) PLANCUECK FEE ❑ Cmifsd copy is hcrtby fumishd. ❑ Ccnifed copy is filed with the oily impcaion Jivi.ion. GREASEONDUSTRL WASTE IN MCFRfOR GRADING FTE CIMTUCA'IE OF E%EMPHON FROM WORKD GRFASETRAP SOILS FEE: COMPENSATION INSURANCE (This SEWER-SANITARY-SI'ORMEA.30017. INERGY FFE m Rv) I eCrOdy don In the perf.cC.f ON,wo-k for whkTi nhi. CMdt i.ids d,Ishmdl WATTA IEATER WNENI'/1l 1R cot employ any person in any m n no Isec�sohjal to Me Wohrn' PAID Compvuationluwsof CJlfsrnla Due so WATTIR SYSIFN/IRFATING DUC RCcCiN# 'O � NOTCH 10 APPLICANT:If,Jler making rMs Cen10cae of Exemption,you should NEW RESIDENTIAL PI-MB. SQ,FT. TOTAL: become xbjat to lk W.Mote,Camp,nsahm powisiun of th,labor Cost Intal a > fonhwinh mnply with such roviziona or Mii permit stud)bC aearcd revokW. BUILDING FEE d (] CONSTRUCTION LPNDING AGENCY SEISMIC FEE I hetchy Off.th.t Ilene is.rwt,W.iim leMine egaey ray tkperfor ttof V O the work fou which this peM...is i.rod!(SCC 31)O)1,Cr,C.) TOTAL: ELECTRICHM . C[. .r Lcock .Note [U� lrndcr,Amrcn QTY. MECHANICAL PERMIT FEL PLUMBING ME I crnify a I have reed Nis City suod County end dart Muft.hove i,trel itw is r�" L1a cvrxcc le a curly Icity.m cowry aNiwrn and sate lewd rtletingb PI:RMRISSUANCE MECHANICAL FF.E I, building ion aaMaia< hotivnof thiscitytr.Mrar or the CONSTRUCTION TAX (,.j Z entree- It pro y faI ALTER OR ADD TO MEO I. (W) to m I i es de City of Cupatim.g.irm Il.btiti jud t caw nenywtyr .SJtws.iJCty AIR HANDLING UNIT(TO IO,q)O CFM) in coucy oft ming ^O l„ AIR HANDLING UNIT(OVFR 10.1Mq CTM) 'i'M q he. t nor •I• D,tc-� EXHAUST BOO) W/DUCI) PAID lEAL1 DOUS MATERIALS DISCLOSURE HEATING UNIT TO TOO."BTU) Due Raeip. W Ithe applicentmfuturt Wilding accap.nt dart wM1Wle n....dm,m.nenJ 111?ATING UNIT(OVER 100,IMp BE GO f N by the CupCnim Municipal Code,Chapter 9.12,tool ON,health eM Safety Code,Semon 255J2(.Il VPNIILATTOEc FAN(SINGLE RFSIDI Cl Yes ❑No Willthc i� tarfutum iWm tort BOILER-COMP(JIIP OR IM,000 BTU) ISSUANCE DATE aPp1 goccupen equvpmeu md,vieawhichemiE '�"�ihuydous Jr mmwvivv.na u defu�by INC Bay Am Air QuJity Maugarcnt BOILER-COMP(OVER Iq),OOp BlU) D enf ) ' ❑YC, ❑No NEW RFSIDENTAL MECIL SQ.Ff. A 1 D I1 Mse mal the harardms coronal,teyui.cco s under Cnsptef fi 95 of Ne CJifomia HnIth h Saftry Code.Seedoru 25505,25533 read 25534. 1 ur CronatW that APR rr0 }gg3 if tie builJindoes nn g .1,lave a wwit.Elva it is my tnpminbi lny no notify the O CeCo m of the TNMrC enu which must he con poor to lesuuvs of e Cenifatm of aawtmy. IIY ) r r'I�rt1yl11VU Owner m euthonxd ag,nt Dat, TOTAL: ISSUED BY: �(