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HomeMy WebLinkAbout21998 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PFRWTNO. Building .� � 21998 A Lt,rq(j.Y-y //1{gIJ1 �,Ly�'Z�;•�aJ CITY OF CUPERTINO-BUILDING DIVISION c nta155aeo• C0 i SL DA 1h Lc.No: APPLICATION /PERMIT �C �7 BUILDING-ELECTRICA PLU\IBINGMF HANICAL CATEGORY CONTROL# Architect/Engineer. Lk.No: /i QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address]]O `\y 1'�� Y , ( ppg�TI55UANCE � �� ❑ ❑ LICENSED CONTRACTOR'S DECLAAATfON I hereby affirm that l am licensed under provedons of Chapter9(commune. APPLIANCES.RESIDENIIAL OB DESCRI'iION ingwith Section 7000)of DiAson3ofthe Buslnessand Profen .l Code,and my lirnnx ls In full and d(eci. .-,�a 3 7� PANELS Lirnnx Lich 1 sA�/ 'KrAN� Date_ xe/��_Contranor T. - 'T ARCH11MLTB DECLARATI 2014000AMPS o7Oq Iunderstand my plans shag be used as public rerords. OVER1000AMP5 Is SQ.FT.FLOOR AREA b/SQ.FT. (/ Licensed Pmfeselowl SIGNSELECTRICAL 6 cW. OWNER-BUILDER DECLARATION F, j I hereby affirm that am exempt from the Contractors Llrense Law for the SPECGLCIRCUfT/MLSC QO' following lesson.(Section 7all.5,Business and Professions Code:Any city or TEMP METER OR POLE INST. F c.unywhich requircsa Permitmmnatmct,alter,Improve,demolish,orrepair auystmctum primtolb Issuance,also requirestheapplicant!..such permit to ryE + file a signed statement that M islicensed pursuant to the provisions of the POWER DEVICES License sion3 of he Business ed Professions Cod er 9 orhagith Section OS he exempt hercmEmmand SWIMMING IDOL ELECTRIC UAT ON Q 5 the basis for the alleged exemption. Any violation of Section 70315 by any OUTLETSSWITCHESFU(TURFS ❑O appl icant fora ollars subjecbtheapplicant too civil penalty ofna more than a w $ five hurt red sownerlof the W). NEW RESIDENTIAL ELECTR ❑etasownerll of property,orhe employees with wages r their dfo r-QFL S TYPE CONSTRt1CTION compensation,w0ldoth.work,and thestructurc b not intended or License axle(Sec.704y Business and Professions Code:The Contractors Lirnrue faw ©$$ does not apply to an owner of property who builds or improves thereon,and who doessuchwork hlmseBorthrough hisownemployees,provided that such OCC GROUP RFS.I1NfIS ImpmvementsamnMt tendedoroffey forsale.If,howevepthebuildingor Improvement issold withinoneyvar.fcompletion,the owner-budderwill have the burden of proving that hedidnot Wildorimprove forpurposeo(sale.). QTY, PLUMBING PERMIT FEE FLOODZONE L as owner of the Property,am exclusively memseung with limmani AIN ISSUANCE contract..t.ou.tmct the project(Sec.7044,Business and Prefesvom Code: The Contractors License Law does not apply to an owner of property who Wild. ALTER-DRAIN&VENT-WATER (TNN or Improves thereon,and who contracts for such pto)ects with a ,J6Lt..�(actor(s)ed pu mnsereuct ant to the Contraors License Law. BACJC FLOW PROTECT.DEVICE FEE SUMMARY LI1 am exempt under Sec. B&P C for this mason • owner Date DRAINS FLOOR ROOF,AREA,COND. SANITARY RECENT# WORKMAN COMPENSATION DECLARATION QI hereby affirm that I have a certificate of consent to self-Insure,or a FIXNRFS.PER TRAP SCfTOOL TAX Y N mAtRoteofWorkers Compev timlre our morarnAlftedmpythen f(Sec. RECEIPT# 3800,1.6C.) GAS E.A.SYSTEM-1 INCAOUTLETS PARK FEE Y N Policy N RECTI?N Com any GAS FA.SYSTEM-OVER4(EA) BUILDING PTVISION FEES [�Certifled copy Is hembyth the city CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE �CertBid ropy V filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRP PAID COMPENSATION INSURANCE (Thlssectionneed n.tbecompletdifthepermit isforonehundmddolla. SEYVER-SANITARY-STORM FA.200FT. Date Receipt# (St 00)orless3 WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N I cenitythat In the performance.(the work..which this permit Is issued, I shall note play any pe.wi In any manner x o pe�or�e subj.ct to ted Worken'C ton aoFEa fo nn a9 1 J 1�_,_ WATER SYSTEM/TREATING PAID Z Applicant a--i-i Z O NOTICE TUA UI AN 1:If,alts maxong this Certificate of Emunpjus,you NTWRESIDENTIALPLMB. SQ.FT. Date RBcei [# should become subject to he Workers Compensation provlalom of the Labor ~ N Code,you must forthwith comply with such provisions orthb permit be TOTAL: tshall W > dsemed mv.kd. BUILDING FEE CL c CONSTRUCTION LENDING AGENCY SEISMIC FEE = Z Ihereby affirmtiut there ut a construction lending agency for the perform ance ofhe work for which this permit is Issued(Sec.3097,Civ.C.) TOTAL ELECTRIC FEE U O lenders Name PLUMBING FEE LL H I.e.dce.Addmss_ a QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Icertifythalhavem dhls pi< ionand a[atethat theabove ln(ormatlon 1 Is correct.I agree o comply with al city and county ordinances and nate laws PERMIT ISSUANCE FEES PAID: >. N relating to building comtmction,and hembyauthonxe representatives ofthis H Z city to enterup.n the abovcmenttoned property for Wpectlon purposes. ALTERORADDTOMECH. — (We)agree to save,Indemnify and keep harmless the City of Cupertino Date Receipt# agaEutB illties,pdgments,copsandexpenseswhlchmayinanywayaccrue AIRHANDLING UNIT(To 10,000CFM) ,$UBTDTAL: t City' mnsequenrnof he ng of thbpermlt ' G AIRFIANDUNGUNIT(OVFRI0,000CFM) CONSTRUCTION TAX to Apphmnt/C.ntnctor to EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Wllltheappllcant orfuture building ocmpantstore or handle hazardom HEATING UNIT(TO 100,000BTU) materialasdefined by the Cupe oMunicipal Code,Chapter 9.12,andthe Date Reael t# -��—s�'/� HealthYea, Suety Cdr Se o 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: I:J ( V/ ❑Yrs Willthe applies rfuture building occupant use equlpmentor devices VENTILATION PAN(SINGLE RESID) I$ _,QnDATE which emit haaardom air cont wnts as defined by the Bay Arm All QI+�a I1Ty Management Dlstr BOILER-COMP PtIP OR 100,11008TU) 4 Yes o have read theh r ocs materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 ME APR the California Health&Safety Code,Sections 25505,25533 and 25534. 1 /1[ R understand that ifthebuildingd.lis not currently have a tenant,that it is my NEW RESIDENTIAL MECH. cciF prior to biu y toissuance ofaCehe.thea! .i panty.requirements which must be rrct prior ua issuance of notify the rote o rd of the rq. allc:-'MVif Owner or authorlmd agent Date }- TOTAL: ISSUEDBY: OFFICE COPY