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HomeMy WebLinkAbout20668 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY Building Project Identification PERMTND Building iAddre� I3qoi3! orA-G 20668 0 n8 I nets a°� one; - , twy CITY OF CUPERTINO-BUILDING DIVISION G° '^ C a� cm.N°: APPLICATION I PERMIT DD bb 1 M6,ir(�F� � BUILDINC-IB.ECTRICA4PLUMBINGMFCHAMCAL CATEGORY CONTROL p Architect/Gglneer. Lk.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: PERh4TISSUANCe 'ISI 1:1 El ❑ LICENSED CONTRACTOR'S DECLARATION /� I hereby rmtot lamlkensed under provisions of C9°(co,mmon APPLIANCESRESIDENTIAL JOB DESCRIPTIONIngwithSection700Q)ofDvitlan3oftha Businessandlro(ese.c.Cdeand my license Is in y�( d c.0 PANELS IMI M'�_'\/ RVA 1\ License Clae(,� _Corp_{-.���J /I /7 y R Date Contnctar — UP TO 200AM!S CPARCHITECT'S DECLARATION 201-]000 AMPS qq��vv D CO l understand my plans shall be used as public records. OVER 1000 AMPS SQ.17.FLOOR AREA S/SQ.FT. Fi () Licensed Professional SIGNS ELECTRICAL G OWNER-BUILDER DECLARATION SI'Ff_]ALCIRCUIT/MLSC Z I herebyaflmethat lam exempt fromthe Contractor's License Law for the following reason.(Stolon 7 nit to Business and 1,impssions Code: h,o city it O ti9 TEMP.METUR ORIOLE INST. p� chuntyctore requirosa Issuantoconstmuires iheapmve,dem°Wh,oroutto a any.signercprlorcroto hathe6alwrcquircslheappBont(orsurh permit to POWER DEVICES U file a signed Yatement that be is licensed pursuant to the provisions of the 13w� Contra or'sLicenseaw(Chaper9(commencingwlthSectlon7000)ofDvl- SWIMMING POOL ELECTRIC VALUATON SOS slon3ofthe Butlneaaand ProfesslonsCode)°rthatheisexemptth.mfromand ' the basis for the alleged exemption. Any violation of Section 70315 by any /Y� 1' .4 applicant fore permit subjectsthe applicant to a civil penalty of net more than OUTLETSSWITCHESFIXTURFS r (/ © `d $ five hundred dollars(SM. Lan owccr.fth.property,or my employees with wages as their sole NEW RESIDENTIAL ELECTR_SQFT, RToFjEs TYPE CONSTRUCTION t. compensation,will do the work and the structure is nor Intended or offered for j n sale(Sec 7044,Business and Profeadoes Code:The Contractors License Law � $ does not apply to an owner of property who builds or improves thereon,and OCC.GROIII' RFS.UNITS "i, who does such work himself or through his own employees,provided that such _ improvements are not Intended oroffered forsak.If,however,thebulldinger - TOTAL: ImprovementewldwlthinoneyearofcompletioNtheowner-bullderwlllhave 1 th�*rden of proving that hedld net bulldorimproveforpurpowofsale.). QTy, PLUMBING PERMIT FEE FLOOD ZONE APN L j I,as owner of the property,am exclusively contracting with llmnsed PERMIT ISSUANCE to construct the pmject(Sec 7044,Business and Professions Code: The Contractors License Law does not apply to an owner of Property who ALTER-DRAIN&VENT-WATER(EA) buide or improves thereon,and who contracts for such projects with a FEE SUMMARY actorte) Bansed punuantmthe Contnctora License Law. BAIX FLOW PROTFOT.DEVICE 1 am exempt under Sec B&P C for this mown DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N Owner Date RECEIPT 0 We WORKMAN COMPENSATION DECLARATION FEXTURES PER TRAP SCHOOL TAX Y N hereby fitorkem that I have• I numne of consent to self-there,or RECEU7 a rt0,Lab of Warken'Compersatlonlnsurance ora cenified copy thereof(Sec. GAS EA.SYSTEM.1 INCA OUTLETS PARK FEE Y N 3800,Isis CJ Policy p 0-7F4 3 RECEIPT M C. any GAS.F.A.SYSTEM-OVER 4/LA) BUILDING DIVISION FEES �L�C1Certified copy is filed with t lCertiBe copyisherebythted ehed.city inspection division. GRFASEANDUSTRLWASTE INTERCEPTOR PLANCHECKFEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SAMTARY-STORM E.A.200PI'. Date ReCei Ip Ohlssectlon need req be compiged If the permit is forone hundred dollen (Sl menlesa') WATER HEATER W/VENTIELECTR ENERGYFEE Y N Icenet that loran Porter In an counter so as t ob Wspesubjec issued, — I shall not employ any Tenon In any manner w as to become subject to the WATp(SYSTEM/TRFAT[NG WorkerCompensation laws Of California.Date PAID O Z ApplicantWATER Remi tN Z 0 NOTICE70APPLjCat.t U,after .-Co lhle Certiflcaleof Exemption,you NEW RESIDENTIAL PLMB._�.FI', should bemmh subject to the Workers'Compensation provisions of rhe Labor TOTAL: N Code,y...tfonhwlthmmp)yMthwchpro i..orthkper tshallbe IL � > deemed revoked. BUILDING FE' C CONSTRUCTION LENDING AGENCY SEISMIC FEE - IL I hereby alfirm that there is a meamcieh kndingagenryfortheperform 7 zon anof the work for which this permTOTAL: ELECTRIC FEE O it is Issued(Sec.3097,Civ.C.) ELECTRIC FEE V _ Lender'.Name LL H Iandcr'e Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O WImAifythatlhavemadthisappliatlonand statethaitheaboveleformetion iscoreco.I agree to comply withal]city and county ordinances and state laws PERMIT ISSUANCE FEES PAID: } S relat oenteruponthe above-mtify an d Property for inspection purposes, ALTER ORADD TO MECH. ? (We)agree to cove,Indemnify an d keep harmless the City of Cupertino Date Recei tN against liabilities,judgments,costsand expenses which trey in any wayaccrut AIRHANDLINGUMT(TOI0,0DOCFM) SUBTOTAL: gales id 1 kmn mo(tbegnntingofthispermIL a en AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTIONTAX Sign tureo Appllcem/ maractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occepanbtom or handle hazardous HEATING UNIT(TO 100,00()BTU) Date Recei tN material as defined by theSupenlno Municipal Code,Chapter 9.12,and the I leallh and Safety CodC,Zeection 25532(a)7 - HEA TING UNIT(OVER 100,"BTU) TAL: 171 Yesr�wu No _ Will the a pplicent lure building occupant use equiprrem or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which cMt haezrdous.u- nomd.rt...defined by the Bay Area Air Pt�U 199A Quality Management b Ict7 BOILER-COMP OTU'OR 100,DM BTU), 8199.0 ?by No have mad the h us materials requirements under Chapter 6.95 of BOILER-COMP(OYER 100,000 RTU) the Callforela Health&Safety Code,Stolons 25505,75533 and 25534.1 City Of rgnn){ipn undersn rad that if the building does not correctly have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT. responsibility to nNIfZthc occupant of the requirements which must be mer pri°r Iss°�apmora n kale of Occupancy hF Ois �(j(3 �l1 ICDUS f, wner or avthorize agentnt Dom ISSUED BY: TOTAL: OFFICE COPY