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HomeMy WebLinkAbout28338 PLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ^( ITY OF CUPERTINO HU1LDING-ELECTRICAL. ITRMI'No 28338 8 3 3 8 BUILDING DIVISION APPLICATION/PERMIT rING PRNGCT IDENN'IFIC L BUILDING PROJECT IURN'PIPICATION ILDINO—A^/DDRISSy: '7 r { SANITARY No AIYLICATION SUIMUTALUA"Ili �r ©/�(J �( (� L INIIp [,Or Of OWNERS NAME: PUONE: CON I RACFOR'S NAME: LIQNf^�/�,, AKQ �1LL /M ILFOAVIA i7e0O -1 ^^//Q / NX C'UN'I RUI.x 1111ECT'/El"GINEER: LIC NO: ADORES /Y✓ (T ❑ 2aj�6z cI atei ft2 Aka'.tw ` CON TACT: PUONe: a i �• ,,'., .I , - ` ;•z� ,�S( '--' BUILDING PERMITINFO QTY..• -ELECTRIC PERMIT,I� I, PEE Lt. tied - CO-83 - 47 " "moo' H�i E?F-LECT PLUMB Mld❑OI PERMIT ISSUANCE N' LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RISIDPN'I"IAL. py,Z Iherehyaffmnbot l em loamedtiaerimssiomof Cnala<,9(comnsendig with IUB UESCRII'IION tq 00❑ Section JlMro)of Division 3 of the Business anti ProfeWons Cralc,and my Icema is in PA NLIS TUU nm Pavemal effect. 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ARCHITECT'S DECLARATION OVER 10100 AMISS SV.PI'.NAME AREA S/SV.PI'. 7-1Z 1 understand my Plans shill be used as public records. ,,,t W SIGNS CLECIRICML, 5� Licensed Pnr2vional 'K6 OWNER.BUILDER DECLARATION SPECIAL CIRCUIT/MISC. ow,F. 1 hereby affirm that I am esempt Co.the Contncun'a License Law for the 3LLy following Coosa.(Section 703I5,Business and Prnfession%Cake:Any city or County IPM 11.METER OR IDLE INS 1. a.0 I which re9uires o pcnrlil to construct,alter,improve,demolish,nr repair any.structure Cyt sur$ poor to its issuance.also mroirea the applicant for.soch permit o rile a signed%cammenl POWER DF,V ICIiS KQ0 that he i%licensed punuan to the provi.aiomv of tire Contractor's License Law(ChaMer O SWIMMING POOL ELECTRIC VALD IN ao�' 9(cmnmencing with gmtinn]fMMllaf Division 7mf the Business and RalcuionxCMd U W_,n or that he is exemptlherefrnnr and the basis for the alleged exemption.Any violation of 011 LEI S.SWI'fC1 I CS-IIXTURES I= Y Section 70313 by any applicant for a Permit robjecd the applicant In a civil penalty of Q am marc than rive hundred dollars(Ssf i. E O NEW RESIDENT IAL IiLf:CBt —SQ.FT. S10RI C2S I YPE CONS'IRUCI ION CCS ❑ Lmowrrcrofthcpropcny.onmyempeadedwiffered aasthcirsm 7(lP1.Business will dorhewory sick: heCotfarmrrt i License Law docs nor applySee.to an owners and Pity ish nna Csale:The ve%Immon.License Law ostia nor apply to an owner pmpetywinboildovi improvc%lhempro andwhoamssuch wad himxlred for sale.If..employea,pmvided lin xuchiml+nvemenuarcnwimendedmnfereA for vle lL IX:C GROUP RES.uNI15 h Ww,ver.Ilse building or imp commem is sold within one Year of completion,lheowner- TOTAL: builder will have the holden of proving that he Aid not build or improve for parTme of %ale.). Qjry: 'tt'.,pLUA1B1NO PFRI%4IT. "a,i"',''FEE I ruwD ZONE APN ❑ Lamwmrofroe Pmpcny.anssxcluslvekyeommectingwilh Bc<nxdcomractmam Construct the project(Sec.]Hoa,Business mrd Professions Cask,I Ilse Cmmrectnr'a Liceo,Law does not apply to an owncrolppenm y who builds imirmweathereon.and PERMIT ISSUANCE m who contracts for tvh projecm with aammacmr(a)licensed pursuant lathe Commctor'.a „ Licen¢L LawACT'IiN-DRAINh VT;NT-WA"TER Died FEE SUMMARY ❑ I am excerpt maker Sec. .H R P C fm this lemon BACK ROW I'NUIECT.DEVICE oil'ISI)1: '3'S SANITARY Y N Dale DRAINS-FLOOR,ROOF.AREA.COND. RECIiP`1'N WORKMAN GUMrCNSA"RONDEGIARAI'IpN SCHOOL TA% Y N Ihereby'Compef,mothat lhmv<s aAB,amnf copytherof(See3e.m aah C.)whi of pIXTURPS-PIiR TRAP RBClill?N odm'Comptnaarinn lnsumntt nrearifed copy thereof(See JBIXLIsb C.l which PARK lrlil? Y N RFCHIPI Of DIVI cover,all employa'su J� pe L y Zb GAS-EA.SYSIThf-I INC.aOIffLEfS BUILDING DIVISION IONIti13 Pnlnyn Cnpuny Cest C L{Is �II GAS-EA,SYS ITiM"OVRR4(EA) PLANCIIECK"111. (n MJ7 ❑ Certified ropy I%hn<byfumeCity ❑ Coifed copy is filed with the city im%pttrion division. GRI'lsSp/INDUS'IRL WASIIl INTERCEPTOR GRADING FEF. CERTIFICATE Op E%EMPDON FROM WORKERSGREASRTRAY SOILS PIPE COMPENSATION INSURANCE IThisxctirmrreed nmbecomplemd ifthe Permit isfrnone hundrddollam(SIM) SEWER-SANITARY-STORM EA. ENERGY PEF. or less.? I certify that in the Performance of the work for which this permit is issued,l shall WATER HEATER WNENTBiLECIR not employ any person in tiny former s m st o as become hject it)the Warkera' PAID Canpemmimn Lawsrrf Calilnmia. DaleWAIT ER SYS IEMIT REAT INC, Date Reocipr0 > Z ARrlicam 0 NOT'ICE TO APPLIC'ANT:lfafar raking this Certificate of Caaroprion,yco should NEW RESIDENT IAL PLMB. SQ p7k. G TOTAL: : q became subject In the Worker'%Compensation Provisions of the Labor Gale,you must u� � ' fonit hri comply wirhsuch Provisionsm this permit shall be deetimilmnkM. BUILDING FTE Q CONSTRUCTION LENDING A(TPNCY SEISMIC FEEV L Iherehyaffrm chat thele is a emsmmmimr lendingagerf ency for the pmmancn of J z 'IUTAL; IiLECI'RIC ITC O @a �. � c work ht which this pemrir is is.a¢A(Sec.3097,Civ.C.I .r Isndes,Name [(•,-' Lndve,Address QTY. MECHANICAL PERMIT FEE PLUMPING FEE p] I anify that I have real this Offlicati,m and slam that the above information is MECIIANICAL HE r 0. Cam,,.T agree to comply with all city and county ordinances and time laws relating to PEEVE I'ISSUANCE 0 building,ontruaion,and hereby mtmori m mpm,aCnatives of thiseity in tine,upon the CONS'IRIIC 10N'TAX J z abnvementimneA rmpi for inapecrion purryoes. ALI TIR OR AT)])10 MSCI I. Ewe)agree In vve,inJenmify end ke nnrmlea the City of Cupeninn again% Iiahilirio,juJgmena.costs and expects w Ch any of why accmeagaintvid City AIR IIANDLING UNIT(IO I40110CPM) hi emrne anlingafm; lir. _ AIR HANDLING UNIT(OVER IO.fM)I CFM) Signature of/smrlicmnVCnmmc Dam BXHAUSTii R)U(WR)UCD PAID I IAZARDOUS MAT FR1Al S DISCLOSURE HFAI INC.UNI'I'(TO 1410.010 BTU) Data Receipt N Will the al9dichnt or furore building occur nm tore or handle hnmdous inamrinlIIIiA I LNG f TNI P(OVER I(XL(XN1 H'1111 1 IT AL: as defied by the Cupertino Municipal Cede,Chapmr 9.12.erre the Imnhh and Safety Cae,Section 235321x)' V ENT(LAI TON PAN(SINGLE RESI DI ❑Yc' ❑No ISSUANCR UA'I'E Willrnee licmmar lmumbuilJin ruxeui mrAevias whicnrndr ItOILIiN-!"^ '[I GOT IIX1dXMl 111111 erca d by he I prom gg ,(S Jnus air mamo frRd Try inans AeReY Amo Ail Quality Management BOILER"C 100,IXp ITT ITT I'+7 nT 9 _ ❑Yes ❑No NEW RliSll 'I. SQ.lel'. 1 loot real the hmudoms material%equirerrten,made,Chaprcr 6.95 of The SEP — 81995 CNlifonria Ifcallh R Safety Code.Sections 25505,25533 am!25534. I mNcmaal thm dire building dms nm currently have o mount,that it is my responsibility Irl notify the !! occupant of the rNuir mens which must he nor Prior to issuance M a Certificate oI 4� I VI- (.(f-'C i�I T VI) Occupancy, ll Uwncr or autlunimA agent Dam IO fAl.: ISSUED OFFICE