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HomeMy WebLinkAbout23479 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY _, AooBuilding Project Identification PERMITNO. Bandi o /TgST�,4 R 72r-3yo0y 23479 wnerj7sy aAPPLicAr67MM7TITAU=A O .Z/ CITY OF CUPERTINO-BUILDING DIVISION Lie.N°: APPLICATION I PERMIT �i �• •• • I BUILDING-ELECTRICA4ML BING-MECHANICAL CATEGORY CONTROL N Arch ten/Engineer. Lic.No: aI� je 7H / (� QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: poq.z N/62 a�/��F 'rr N PFRMITISSUANCE ! ❑ ❑ ❑ LICENSED CONTRACTOR'SunderDECLARATION IM1ercectionby rmtbatl Division oftheerpessand s Of Cssions9ds,,rd < APPLIANCES-RESIDENTIAL JOB UFSCRIPHON Ing with esIn fon force ofd effect. o(lheeuslnemandPmfesel°nsCode,andmy license is in(uR force and etfen. PANELS ARCHITECTS DECLARATION 201-1000 AMPS I , ftei (P gyp+±ne O I understand my plans shall be used as public records. IOVERIODDAMPS SQ: E/SQ.Fr. E (Cj Licensed Pco(essiarsl SIGNS ELECTRICAL GG�6,, OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MLSC s•vvf 3 I hereby affirrn tl at I amexempt fmm the Contmdoes Limnw Law for the op following reason.(Sediii.7MlS,Bminessand Profemions Code:Any ri or FZi"'n9� cmntywhichmquimsapermutocomtmcLOter,impmve,demoilah,orrepair TEMP.METER OR POLE INST. g �¢ oar- anystructurepdortotts issuance,also requiresthe applicant fasuch permit to POWER DEVICES EESS F O file a signed statement that he Is licensed pursuant to the provisions of the 3" Contractor'.License Law(Chapter 9(commencing with Sectlon 7000)of IRA- SW MM NG POOL ELECTRIC VALUAT ON F,�OS alon3 ofthe Business and ProfemlonsCode)orthrt hats exempttherefromand S9 the basis for the alleged exemption. Any violation of Section 70315 by any applicant far.permit subjects the a ppllcant to a civil penalty of not more than OUTLETSSWITCHESFf%TUAES c. five hundred dollars(¢500). I,as owner of the ro NEW RESIDENTIAL ELECTR SQ.FT, E TYPE CONStI4UCT10IJ 7 ❑ p perry,or my employees with wages as their sale k compensation,wBl do the work and the structure ts net Intended or offered for O sale(Sec.7044,BusUiess andProfessions Code:The Comranor's License Law '$ does not apply to an owner of property who builds or Improves thereon,and RF5.IIN'IT5 e- who doessuchwork himselforthrough hisownemployess,provided that such Improvements are net Intended oroffered for sale.If,however,the building or p Improvement ts sold within omycaro(compinlon,the owner-bullderwill have th rdenofp.A gthat he did notbulldorimpmveforpurposeof Wa.). QTY. PLUMBING PERMIT FEEAPN L as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business, Professions Code: PERMIT ISSUANCE The Contractors License Taw does not apply to an owner of property who ALTER-DRAIN kVENT-WATER(EA) builds or improves thereon, and who contracts fa such p4ojacte with a c�at(adoR9)Bansed purnuanttothe Contractor's LlanseLaw. BACK FLOWPROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. B k P C for this reason —Date— —OUTSIDE FE —- DRAINS.FLOOR,ROOF,ARRA,CONE. SANITARY Y_ N—WORKMAN COMPENSATION DECLARATION RECEIPT N ❑I hereby affirm that I have a certifiate of consent to self-Inmre,ora FIXTURES PER TRAP SCIdOOL TAX Y N RECEIPT M Lab of Workers'Compensation Wurana ora artlfled copy thereof(Sec. 38M,Gla 3800, CJ GAS EA.SYSTEM-1 ING40[IfLETS PARK FEE Y N Policy N RECET T it Com any GAS EA.SYSTEM-OVER4 LEM �CertiOed copy Is hereby furnished. BUILDING DIVISION FEES OCertlfied copy is filed with the city Wpenion division. GREASE/WDUSTRL WASTE INTERCEPTOR PLANCHECK FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE (Thisse tionneed not brdurplamd lithe permit ls(aronehundred dollars SEWER-SANTTARY-STORM EA.2WFT. Date Recei t# (SI I carify thworkat WATER HEATER W/VENT/ELFC7R ENERGY FEE Y N Isnot Nat lnthcperformance of ehanner ser as b. subject — / I shall not em y an�@�r��^In�ni manner ao as to become subject to the ' Workers' o ailomla. Date WATER SYSTEM/TRGTINT; PAID Z Applto an Date RCtX'1 t# Z Q NO T PLICANT:If,after making this Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQ9r. should bens subjecttothe Worken'COmpersation provisions ofthe Labor TOTAL: ~ N Coale,you=at forthwith comply wlthauch provisions orthts pemnit shall be WU > deemed revoked. BUILDING FEE G CONSTRUCTION LENDING AGENCY SEISMIC FEE ermit I hereby affirm that them Is construction lending agency for the perfor ELECTRIC FEE M Z ante ofthe work for which this pis Issued Cee.3097,Civ.C.) TOTAL: V O Lender's Name PLUMBING FEE LL F L<nder'nAddrena QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Iartlfylhatl lave read this applicetion and statetFattheabove lnformatlon Incorrect.Iagree to c°mplywlth all cityand county ordinances and nate laws PERMH'ISSUANCE FEE—PAID, I N almingtobulkhogconswctlon,end herebyauthorluapresentatwas°fthis I— Z citymemerupontheabove-manif nedpropertyfor Wpecllonpurposea. ALMORADDTOMECH. (We)agree to save,indemnity an d keep harmless the City of Cupertino Date Receipt# ago WtllabWiMs,pdgrmsssenb,consand expenses wM1lch may In anyway.cove AIR HANDLING UNH(TO 10,000 CFM) SUBTOTAL: .gyq/(�I sald�i{y m once°f the granting of this permit. 9-1 N[J '? AIR HANDLING UNBT(OVER IO,000CFM) CONSTRUCTION TAX R�gturc of Applicant/Contractor 7Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: V HAZARDOUS MATERIALS DISCLOSURE Will the applicant a future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Date Reefs I lealth❑ Venand giddy Code,Sedion 25532(a)7 HEATING UNIT(OVER 100ij No ,000 BTU) OTA?n, Will the applicant or fufuturebuilding ecavpant use equipment ordevices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit haeardous aircentaminite s i s defined by the Bay Arca Air #7��a Quality Management District? BOILER-COMP(3HP OR 100,000 BTU) 17' Yea I❑�I N° AID have read the hazard°usmaiedals requlrements underChapter6.95 of BOILER-COMP(OVER 100,000 BTU) APR 1 the Wlifemla Health k Safety Code,Sections 25505,25533 and 25534.1 _ ��� understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. °-QFT responsibility to notify the occupant of the requirements which must be met prior to Issuance of a Certificate of Occu pa acy. i I Y l7r VUf tI1111YV Owner or authorized agent TOTAL: ISSUED BY: \ 1 /.1►�i OFFICE COPY — l� 9 r � H I M3IA 1NOH3 r as r r o H Ct�i o [zs1 � r ' O yO rhww7 903, V o o roxroYrot-I Htzjr vii O w 1 „y z z' o oyzrom _ _ _ M M n n OL, o o 00 o n mn 0 z z roroy d 410 .j ON F z EEs'w 3sra eta �w x z H t3na d313M O n z rn m it ik r H Ln 07 38Yd ' H H w 7C M Ili 41 l1 com '1•J O ' Ir-` N O H W w O n O m v r N O O v v 7 -C v -lI'd130 3SVO O ' + 3311dS � 1awoNoa E 1. 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