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HomeMy WebLinkAbout24959 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINOI-DINU—H EYRMD'No. APPLICATION/PERMIT PLUMBING.MECHANUCAU BUILDING DIVISION BUILDING PROJECT IDF_YI'IFICATION 24959 BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE 10705 6FPidEL ?[ACE UNITg LOT It OWNERS NAME: PI ZONE: CONTRACTOR'S NAME_' WCNO: NtC CONTROLM V TA LoR 737- 2&40 145T WA if /96 /-WR�J/ 9/32'9/ RNTAI;CT/FNGINEE0.: PH NO 2(PO&7- CPfA1 LAAs(PIiJti /M �YuAw CONTACT: PHONE QTY. �G ELECTRIC PERMIT FEE BUILDING PERMIT INFO BLDG ELECT PLUMB MUCH PERMIT ISSUANCE ❑ ❑ LICENSED CONTRACTOR'S DECIARAger9 APPLIANCES-RPSmENTIAl pneZ Thereby effrivi"3 ofilemed under PvvuimsafCCode.acmunetcirlg with JOB lk-rllP ION to 00F. fuC1full r«cc wW)effe leion 3uf tM1e Busing.rind Pmfeuion.CMc,erM mY/reeve is in PADIn?i.¢ /� �/� I1 6Z� License C- b Ix.a 1329 UP TO 200 AMPS vi 11J!Iy1J vvii<c- Due - Contract I/ 201-1000 AMPS 7Fy ZK. ARCIII IECI-S DECLARATION OVER 1000AMP5 SQ.M.FLOOR AREA SSQ.Ief. OO�_pj lundm Induedupuhlk es'xds. q�ys� fesvwral SIGNS ELECTRICAL Sym OWNER-BUILDER DECLARATION SPECIAL CIRCUITR.9SC. O0. 1 hereby aft.Biu 1 em exemp from the Cartrocro s Liccme Taw for disc LwL i Q Moving reasml.(SMim g ]0313,Bus'vta arta Profnaiavv « Code,Any city mTEMP.METER TEMMETER OR PU E PNSI'. t_R, which nNuima a permit t0 emlFWct,BIER,IInpNVe,demolish,or Rpalf tiny moc[me E © 1 ;!1T� Prior to is issuance,also rcrea to quleppllcasu nt far ch lxrroit to fk a signed uncmmt POWER DEVICES V w_a_DO Wthe is liccmed pursues to the povisian of Jc Cmivrtor'a Lure Uw(Ot.cia) - ePo� 9(c«nmrncing with S tim7")rf NAsion With,Buninessand Pmfcui«v Cade) SWIMMING POOI.ELECTRIC ( , ALUATION or that he is esctnpt tcrefmn rind the basis for the allcgd exemption.Any vlolWmor OU'1lEfS-SWTTCfffS-Fll(TURES Z Q Seetion]0313 by any apWicant f«a pe trait subjeem the eppicant b a civil paoJry of rot roar then f vc WoRrd"IIs(S500). tz NEW RESIDENTIAL IFI FCTR S � ❑ L uuwneronddeopny,«myarurchdwithwaggrside( ee.compautm, 'TYPE CONSTRUCTION sort dotM1ewo�mon,midtie he Con iguer'. add«ufw r«.rile(sec.) . wriier a and Rokuimu code:The,Cmuect«'a urease luso Jas out apple m N owe M pmprny whobuilds«impmvn tesrnn,anJ whodoca wen work himaclm Nmugh hie OCC.GROUP RES.UNITS emWoye WiInit,or tw sten impmvcmentsaneout intendedororfertd be,own IL however,thedeeding or is roving thus,sohwiNt^«acyeso inn Veneer,Be,^wee- TOTAL: derider,will have to hvdm M paving But k did rad build a improve for purpmc M sale.). ❑ I,mnwnerofthepupxty,eat enelueivNyrnnteveting with lleenxdemvanm.m QTY' PLUMBING PERMIT FEE F1.00u LDNh APN cmmuct Ne,pol(Sec.]Ona.Business;and Profnai«u C«ae:)The Canma . U.law daeamrappy to an owwofpoperty who Wilds or improves Nncan,and PERMIT ISSUANCE wno controcte f«such projects withaamleKtot(s)licenxdpumuant to tM Connaron, ALTER DRAIN&VENT-WATER TA ucweLaw. (' ) FEE SUMMARY ❑ I am eaanpt under sec. ,B k P C fm tlu a®mi BACK FLOW PROTECT.DEVICE SANITARY Y N 0,cnm One DRAINS-FLOOR,RODE,ARE,,GOND. RECEIPT# WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N ❑ Thereby aff NU lhavcaanifatc ofemrmt mself-Insure,«acasiTinre of FlKIVRPS-PTR TRAP RECEIPT;1 to Wartm'Cmmpm.atm lnsuevree«e«nifidapy Netcof(,Sa.3800,lab C.)which PARK IEE YN mveex el etpy yLels wuk`Ni-peerPi` GAS-EA.SYST -I INC.a OUTLETS RECEIPT N Polwya /Ls9 Hf4 YJ EM BUILDING DIVISION FEES Company - M GAS-Ii .SYSTEM OVER 4(EA) PIAbla TUCK FEE ❑ Cmifd copy in hereby fumishd. IYC<rte(Id spy is filed with the city uci iestim diviaim. GREASEANDUSTRL WASTE I,NIERCFPI'OR GRADING FEE CERTIFICATE OF ENEMPIION FROM WORKERS' GREASE TRAP SOUS IEE COMPENSATION INSURANCE fllJsacctontrend.becmnpletdifthe permit is fanonehundreddallua(51001 SEWER-SANITARY-STORM EA.200FT. ENERGY FEE «Ecu) I certify that in Ne,perfmrcrce oftte work for which tJa permit is issued le hall fAjJZk I IEATTR W/VENT/ELECTR not employ any petam in any nowisesu mu to becoe subject to the m Wm PAID Cammrsamoriluwsof Californ. DueWATER STEM/IRFATING Due R vpY z Applioot ZO NOTTCETOAPPLICANT:ILePnmakingtM1u Ccttifcatc o(P gnption,you shuulJ RESIDEM'IALPLMB. SQ,FT. TOTAL E-' ^ bamefub}ect tithe Woheia Cs.tyematim pmvuima oftAclabor Cdbed. mut � > fmhwith comply wiN aneh pmWslou mtJa perrrJtJWl be dzmd rooked. BUILDING FEE F Q CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby aR dot these'a a amamrtien lending agmey f«the parfrenurce of U O the work fu which this permit is iauxA(Sec.3097,Civ.C.) TOT ELECTRIC FEE lantkr's None thiPLUMBING FIE O F LenJer'a Addrw QTY. MECHANICAL PERMIT FEE U I certify tut I lave read s avvii,mim and ante trot this inf—rens,is 0. amca.Iagrtc to cmnMy with all ciryand mu^ty ordimnm Wuudews rtlatingto PERMIT ISSUANCE MECHANICALKA'. _ hildir,cor,ruction,and m-city-tori.e mprnrnutivg of this city m atter ups Ne U abwe-rnentimd ptierry for inme:lim purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAS (We)agree w rive,vldamlify and keep hmmlm the City of Cupenim agairtu Iiabilitim judgini crus and expmsn which nay in eery way accrue against said City AIR HANDLING UNIT(TO 10."CFM) n come,,i.of to"fin,or Nin pannit. AIR HANDLING UNIT(OVER 10,"CFM) Signature of App]innt/Cmtrxvor Mare EXHAUST HOOD(W/DUCT) PAID HAJARDOUS MATFRTAfS DISCLOSURE HEATING UNIT(TO 10.11)0 BTU) Dane, R vip Will the applicant orfuNrt Wilding uccvpam more or hoolle havrdow materiel HEATING UNIT(OVER 1(p,110O BTU) ss dafnd by tine,Cupertinn Munivipd Code.CW,o,r 9.12,and to IledtM1 unit Safety CWc,Section 25532(e)t ❑Ya 7 NJ o VENMT TONFANfSINGLERESID) WBl the appiamt«fuNrt huilJlrgmmpantuxryuipmmt«devl¢swhichemit BOI.RR-COMP(3HPOR Ig),W0 BTU) ISSUANCE DATE hvard«u as cmumitunts u defied by the Bay Area An Quality Maugment,• BOILER-COMP(OVER IW,000BN1 a` `° EI Ie"NnNEW PAID � RISIDENTAh MECII. SQ.FT. I have reed the hatria a mueiale rec rements under Chill 6.95 of ithe APR 14 California Health&Serf C e. .nu«u2,505,25533 W 2,534. 1 understated tut 1993 if lhebuil ' g raw vrz tl veaawm,tlatit is my reepw'ibiliryto notify the Oe,upw f the n u mem, hie uR ha tun pi«to lssunce of a Cmifitvc of 'Guy (Tuner agem Dna TOTAL: ISSUED BY: L � 1.