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HomeMy WebLinkAbout20098 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification I PERMIT NO. Building Add revs: Y�O O n O (ALV 17 . G J 'Scffamp: / 1 one: �� yl� CITY OF CUPERTINO-BUILDINGDIVISION �r 5_p6 forItas acne, Li=.Nn: APPLICATION / PERMIT 1• 1 nttr• BUfLDINGELFCTRICAL-TLUMBING-MECHANICAL CATEGORY CONTROL L'1 G • QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: I zc�_o 3l PERMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I herebyaffirmthat l am Bcensed under perwisionsofChapter9(commme. APPLIANCES-RESIDENTIAL ]OB DFSCRO'DON ingwith Section 7000)of Dlvision3 ofthe Bualnessand ProfessionsCode,and m L Y Lw licenm 1.in full force and effect. - PANELS Bear. aChas LILY Date Contractor —UP TO 2DDAMPS ARCHITECTS DECLARATION 701-1000 AMPS qqq�qqq++ec ZZ I understand my plans shag be used as public recwda. OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT. O Licensed Professional SIGNSELECTRICAL Q OWNER-BUILDER DECLARATION SPFGIALCIItCUIT/MLSC 7 r•, y Iherebya(firm that Is.exempt from the Contractor's License law forthe (allowing reason(Section 7¢)1.5,Business and Professions Code:Any city or TEMP.MECQt OR POLE(NST. mntywhia ralter,lmpmvgdemouh,orrepalr, anyatmumpdwtolUha=ealhomqul eacthe POWER DEVICES Ole a signed statement the las is Licensed pursuant to the provisions of the ' �3wt CembadmsLicense Law(Chapter 9(commencing with Section 7000)ofDivi. SWOHhBNGPOOL ELECTRIC VALUATION O the basis fo the alleged Professions Any violation f SeempHherefrom and 6 applicantfor theallegedexemphap Anyyt to of Section normoby reany OUTLETSSWITCHESFIXTURES l �•y'` O00 X55 O fiveapplicantdred delta.nubjedsthe applkantro advil penalty dnat more than J E five hundred dollars(ASON. NEW RESIDENTIAL ELECTRFT. ❑I,as owner of the property,or my employees with wages as their sole SQ' STORIES TYPE CONSTRUCTION 0 mpen 7044,Business and Professions udure hnoHnten os'o License Law g5 p sale(Sec.apply Bu sinessand Professions Code;The orimproves License law don noessuchmanmvnel ofpropertyIds onem orimprovesthateem,such f\and OCC.GROUP RFS,UNITS EEEE whadona,rdsamkhlmxgathmughhhowne.If,ho however, builaLegor Improvements arenotintended earofco !onion.If,however,sheerwill have Improvementhwldwilhinomyearofcompldion,tics owner-bugderwlll have ' thc.Wrden of proving that he did net build orhnprove for purpose ofsale.). QTY. ] UMBINGP I FEE FLOOD ZONE APN I,as owner of the property,am exclusively mntrading with licensed PERMI.I.I NCE contractors to construct the project(Sec.7044,Business and Profession Code: The Contndoes License Law don net apply to an owner d property who ALTQ4 D &VENT or Improves (hereon,and who mmreda for such ProjeN with a Cq¢t�+deals)licensed pursuant to the Contractor's License Law. FEE SUMMARY U I am exempt under Sec. B &P C for this reason BACK FLO OT C I Owner Data DRAINS R SANITARY Y NRECEIPT WORKMAN COMPENSATION DECLARATIONSCHOOL TAX Y_ ❑1 hereby affir .��$PER N_m that I have a certificate of consent to self4murs,or RECE PT Y cenl(iate o(Workera Compematlonlmurenceaacertlfled ropy lhereo((Sec. GAS EA. -1 INCA OUTL PARK FEE Y_ N _ 3800,late C.) _ Policy YDING DI p Com any G -0VER4 BUILDING DIVISION FRCS �CertlOed copy h hereby furnished. GREASEANDUSIRL WA 1 TOR PLANCHECK FEE ❑Certified copy h filed'Mth the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE7RAP PAID I-t^f—To 555 Cor W completed 9tW permit SEWER-SANITARY-STORM EA 700FT Date RCCCI t# A•0�7Q (Thhsedton need not be complded gtM perMl La(w one hundred dollars ($100)or less) WAFER HEATER W/VENT/nr FPTR ENERGY FEE Y_ N_ I rertity Nat In the pedomuntt office work(orwNch Thin pemdt la lamed, I shall not employ any person In any manner so n to become subject to the WATER SYSTEM/TRFATINIG Workers'Compensation Ism of California.Date PAID O Z Applicant NEW RESID=ALPLMB. SQX.Tect . Date Ri t# Z O NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become subject to the Workers'Compensation provhiom of the Labor TOTAL: � N Code,you=at forthwith comply with such provisions or this permit shall beUL TNG FEE c Q LU G deemed revoked. LU CONSTRUCTION LENDING AGENCY SEISMIC FEE •O Iherebyaffirm thattherehammtmd[onkndingagencyfortMperform- TOTAL ELECTRIC FEE Z anceof the workfor which this permit h Issued(Sec.3097,Civ.C.) Lender's Name PLUMBING FEE LL H Lender's Addren QTY. MECHANICAL PERMIT FEE O W Iartlfythatl have read this appgotlonand state thattheabove information MECHANICAL FEE a hmrrect.l agreeto comply with all city and county ordinances and Asia laws PERMITISSUANCE FEES PAID: >. W rehtingtobulldingcomtmdi.,andhercbyauthorircreprcnentativeao(thb city to enter upon the abovcmemimed property for inspection purposes. ALTERORADDTOMECH. ? (We)agree o e,Indemnify an d keep harmless the City of Cupertino Date Retcipt# V agai ,p g s,costsand expenses which nay in anyway accrue AIR HANDLING UNIT(T010,000 CFM) SUBTOTAL: ago dCn n o en it anti gofthbpermlt. MR HANDLING UNIT(OVER Ig000CFM) CONSTRUCTION TAX g rc a rador Dat FXHAUSTHOOD(W/DUCp CONSTRUCTION TAX PAID: HA RDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle haaardous HEATING UNIT(TO 100,010 BTU) ' Dale ROCeI t# _ material as defined by the Cupertino Municipal Cod,Chapter 9.1 7,and the Health and Safety Code Seaton 75531(x)7 HEATING UNIT 100,000 BTU) TOTAL: `{ ❑Yea No T Y Will the applicant re tore building occupant use equipment or devices VENTILATION PAN(SINGLE RESID) {' ANCE DATE which emit haeardous air mniandeanh as defined by the Bay Area Air _ Quality Mansgemeet Distrld7 BOILER-COMP©HP OR 100,000 BTU) T 'tC,,yu Ye ❑❑Na 3Ung havereadthe hazarclousmteriabmquimr maunder Chapter6.95of BOILER-COMP(OVER 100,000 BN) the California Health&Safety Code,Sedkm 75505,75533 and 75534.1 4 understand that lithe building does not amr.ly have a tenant,that It is my NEW RESIDENTIALn}hl dl'MECH. SQ.Pr I CVII� responsibility to notify the occupant of the requirements which must be met C prior to Issuance of a Certificate of Occupancy. Owner orauthorlud agent Date s TOTAL: gYV V ISSUED a 51' & Vy—r4�n OFFICE COPY '