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HomeMy WebLinkAbout21644 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Holding Project Identification - PlUtMITNO. Building Address: 21644 203 5 STuvE s C WMr• me. an•: ( CITY OF CUPERTINO-BUILDING DIVISION Contradzao��rm s Nae: I a. a: APPLICATION / PERMIT V � .F BUILDING-E.BCTRICAI.PLUMBINGMECHANICAL CATEGORY CONT%*3N A stat/Englnrer. L .Na: (D 770 Q'IY ELECTRIC PERMIT �FE�E/� BUILDING PERMIT INFO ^ ress' PERMITISSUANCE yam/ LICF.NSF.D CONTRALTO DECLARATION I hereby affirm that l am licensed under provisions ofChapter9(commm APPLIANCES-RESIDENTIAL JOB DESCRIPTION In ease is ectlon force of d effeon3otthe8uslneuand Professions Cade,and my �`� lice..bin full force and d(ea PANELS xa % ' Lirense Claes Lic.p V Data Contractor ARCHITECTS DECLARATION 201-1030 AMPS 077 I understand my plana shall be used as public records. OVER1000AMPS 55.FT.FLOOR AREA ems$/e.Q.FT. k� Licensed Professorial SIGNSELECTRICAL <6 OWNER-BUILDER DECLARATION rn SI'ECIALCItCUIT/MISC owing rasormlhatlat7emmpt(romthe Contractor's License law fort he qqqqqq Followingeason.fSecticat tt mmtmaandpro@aloneeo le h,ymyor s' rountywhlN mrylresa permittoanstruct,alter improve,dertnllsh,ormpalr TEMPI METER 0RPOLE INST. any structure prior to its Issuance,a Lao requires the applicant for such permit to POWER DEVICES file a signed statement that he It licensed pursuant to the provident,of the O o. Contndors License Law(Chapter 9(commencing with S km 7000)of Dlvi- L�O�n SWIMMING POOL ELECTRIC � the basis for the alleged dexemption. Any)orthat violation f exempt therefrom and VALUATION g ❑ the Wab for the•listed eectsth ap Any violation o/Secpenalty o not m by any OUTLETSSwITC FS r-]_ © o appBesntfora permit subjects the applicant toe dull pevlty erns morcthan J five hundred dollars($500). NEWREiIc DENTIA SQ.FT. STORIES 7YPE CONSIRLCTION �n ❑1,as owner of the property,or my employees with wages as their sale compeneatlon,willdolhe work,and theammo re isnot Intended or offemd far Osale(Sa.7044,Buamess and Pmfeulots Code:The Contractors Darted Law $$ does net apply to an owner a property who builds or improves thereon,and OCC.GROUP RFS.UNITS who does such work him.Iforthrough his own employees,provided that such improvements am not intended proffered for sale.If,however thebullding or T TA improvement is sold within ormyearofcomplmion,the owner-bullderwlll have ttiurden ofpmving that he did no[bulld orlmprove(a purpose ofbaleJ. QTY, IN IT FEE FT.oDD ZD ArN U 4 as owner of the property,am exclusively contracting with licensed wntrcd..t..retrodthep.jed(See70KBuaffim.MP,&.s .Code: ( PERM ^ �� The Contractor's Lia..law does net apply to an owner of property,who ��g-DRAIN& ATER(EA) builds or Improved thereon,and who contracts for such p(ojects with a .t.[ador(e)Ilan.d pursuant tothe Contractor's Llc,n.Law. BA FLOW PROTIL FEE SUMMARY LU I am exempt under Sec B k P C for this mason DRAINS FLOOR ROOF,AREA,CO SANITARY Y N Owner Date - gp�pRep p WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP Lt.do SCI{OOL TAX Y_ N Ut hereby affirm that I have o lmurane of consent d self-there,ora lKL R��.N re00,Iaeof Warken'Compersatlonlnsurana ora rertlfd ropythemo((Sec. GAS EA.SYSTEM-1 INC.40I1TL PARK FFR Y N 360q lab C.) Policy p GAS EA.SYSTEM-OVER 4(FA) DING DI N Cany BUILIDVISION FEES am any copy is,hereby te ❑Certified espy b filed withh the city ivpedlan division. GREASE/WDUSTRL WASTE INTERCEPTOR PLANCHECICFEE ty CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID �� COMPENSATION INSURANCE SEWER-SANITARY-STORM RC EA.200ET. Date CCI t# IJ-0 03 (Ihb section teatime be completed If the permit b forone hundred dollars (51Mmiess.) 1 WATER HEATER W/VEM/ELECTR ��a ENERGY FEE Y N Icertifythat In the performance of the work forwhich this Permit is issued, �y I shall not employ any person In any manner so as to become subject to the Workers'Comp,nsatlonlaws of California.Date WATER SY51l➢rt/rREAnNc PAID 0Z Applicant - NEW RESIDENTIAL PLMB. SQFL .Date Recei t# Z Z NOTICE 70 APPLICANT:If,after naming this Certi(late o(Exemptlan,you _ should beam,subject to the Worknre'Compersat cel provisions o(the Labor TOTAL: CC W Code,you=at forthwith comply with such provisions orthb perrvlt shall be BUILDING 'E y deemed revoked. LU G CONSTRUCTION LENDING AGENCY SEISMIC FEE Iha.bysM.that there b a mwtructlon lending agency for the perform- TOTAL: e�o.a ELECTRIC FEE 7 Z aha of the work for which this permit b Issued(Bee.3097,Civ.C.) W 0 O Tender.Name PLUMBING FEE LL N Lceder.Addreaa Q'IY. MECHANICALPERMIT FEE MECHANICAL FEE OW I certify thatl have mad this applkatianand statethattheabove lnfoms0on L IL bmrrect.I dgree to comply with all city and county ordinances and date laws t PERMIT ISSUANCE FEES PAID: ). relating to building ecnstructlon,and hereby authorize representatives of this �•/� F Z city to enter upon the above�mentlor d property for inspection purposes. It ALTER OR ADD TO MECH. �w Date ReCel t# Z (We)agree to save,Indemnify an d keep harmien the City of Cu pertme, P against Ilitles,judpmngta,aysbandeapen.s whlchmaylnanywayaceme AIR HANDLING UNIT(TO 10,Ol10 CFM) SUBTOTAL' ,gal ea In • the gra.ting ofthlspermlt. - CJ_ AIR HANDUNGUNIT(OVER Io,0o0CFM) CONSTRUCTION TAX Signature of Applleset/Contrador Data EXHAUST HOOD(W/DUC'D CONSTRUCTION TAX PAID: HAZARDOUS MATER LS UI SCIASURE Will the applies at or future building oaupant stare or handle hazardous HEATING UNIT(TO 100,000 BTU) mDate Receipt# awrial as defined by the Cupertino Municipal Code,Chapter 9.1$and the . Heahhand Safely Code Be ion 25532(P)7 HEATING UNIT(OVER 00,000 BTU) TOTAL: — ❑ Yea Ndo Will the applicant or future building occupant use equipment ordevices VENTILATION FAN(SINGLE REBID) ISSUANCE DATE which emit hamrdousair mataMnantsas defined bythe Bay Area Air S '(pry Quality Management Dletd BOILER-COMP DE EP OR IDLOW 8TU) ETI Yea o .�ahl have read the bozo cuematerials requirements under Chapter 6.95 of BOUXIE-COMP(OVER 100,0008TU) Ifau the understand that lith building Safety Code, of cu rr 25505,ve a t and 25534. I uadertandthat llheaccupadoes nota currently awhich noustitlsmy NEW RESIDENTIAL MECH. SQ.I7. responsibility to notify the oaupant of the requlrerrenls which must be and Arlo Lesuance ora�erti(late ofOmpanry. "Alto �nSsQ Owner or auinruo,i agent ' Data TOTAL: ISSUED 8Y: OFFICE COPY