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HomeMy WebLinkAbout26936 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ^[TY,OF CUPERTINO iuHti, -LL. 1 A PERMIT NO. .'.HUIt�DTNrrDIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. n OGg v BUILDING PROJECT IUENTIFICA'FlON G J B.•tLDING ADDRESS: SANITARY NO. APPLICA'HON SUBMTITAL DATR UNITp LOTM OWNERS NAME: I PHONE: CObG RACPOR'S NAME: LIC NO: N/C CONTROL RCI{I'ItiCT/INGINF.ER: LIC NO: A RF-_ ': ❑ vp 8 ,D �+`� 7 carvrn-: PHONE: L QTY. ELECTRIC PERMIT FEE BUILDING PERMIT.F.Cf PPUMBIUMB FO CI,{r.•(�YY- MECN PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION pppL1ANCFS-RESIDENTIAL JO D N pffi yZ I hereby orm that l sec licensed underprovisionsofaspear9(commencing with .100 Section 7")of Division 3 of the Business and Professions Code,and my license is in PANELS A tF fulll'orc Choacffcm. 6� y� FFdE License Class LIC.k 6 Jv3 PANELS AMPS to=y Dme n 1 CC1.TSDrCL 201-I(Mp AMPS S ZOyz CHITELTS DECLA ATI C/ OVER I"AMPS Q.fief.FLOOR AREA S/SQ.FI'. O Z—O 1 understand my plane shall be used as public records. N J SIGNS ELECTRICAL ���dd Licensed heal yszQ OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC. 5�5�Owu 1 hereby affirm that I am exempt from she Connector's License Law for the n13boy fullowing reason.(Section]031.5,Business and Prnfcsd.ns Cale:Any city m overly TEMP.METER OR POLL INST. �+ �or which requires a permit to construct,alter,improve,demolish,or repair any structure 24 Cn Q� prior to its issuance,also requires the applicant for such permit rile a signed statement POWER DEVICES W.-j G O that he is licensed pursuant to the provisions of she Contractor's License Law(Chapter 0- 0� 9(commencing with Section 7")of Division 3 of the Business and Professions Corte) SWIMMING POOL ELECTRIC VALUATION W--m Srthat oheisexbyany therefrom ard she basis fonheallegedeumian to civil of OUTLETS-SWITCHES-FIXTURES O ©D �zQ hot more than v any npermit subjects the applicannoecivil penalty of X � not momthanfivehundreddollars yemp. NEW RESIDENTIALELEM —SQ.IT. ❑ L the wmmoOhepmpeny,o,myempended wi offered for STORIES PE CONSTRUCTION m will d,the work,and the structure is not inendul.,.Hared for sale(Sea.9094,Businoss and Professions Cork:The Commctor s License Law does not apply to an owner of property,who builds.,improves t hereon,and who dors such wmk himself.,through his employees,prov!ded that uchimptovementsare not inendedoroffered forsele.If, I OCC.GROUP RES.UNITS hnweven the mildingor improvement is sold within one year ofcompletion,she owner- T builder will have the human of proving that he did not build or improve for purpose of role.). ❑ LmowandNepropcny,amcxdusivelycontracting with licensed coneecmrstu QTY. PLUMBING PERMIT FEE ROOD ZONE pPN construct the project(See.10N4,Business and Professions Code:)The Contractor's License Low does not apply to an ownermproperty whobuildsorimpowesshereva,and PERMIT ISSUANCE whocomracts forsuch projects with aconsractods)licensed pursuant lathe Contractor's ALTER DRAIN EA License bow. f ) FEESUMMARY ❑ I ren exempt under Sm. ,B&P C for this re.mn _ DE BAC fL0 .RE E SANITARY Y N Owner DateI RECEIPI'p WORKMAN COMPENSATION DECLARATION DRAINS-P R;ROOF;AREA,CION .� SCHOOLTAX YN ❑ IheRby affirm that l haven eaclflcm,Ofee...I toselGlrSufq Ora cariEeae of ( d RECEIPT FIXTURES- F.RTRAP .v .Workers Compensation Insurance oracmified copy shereof(See.3800,Lab C.)which - PA KFEE Y N covets all employee's under this permit. GAS-EA.SYSTEM-I IN 4OUTLE RF, Otl Policy p BUILDING DIVISIIVISION FEES Company GAS- SYSTEMMEF4(EA) PLANCHECK FEE ❑ Certified copy is hereby famished. ❑ Cemf,d copy is filed withthe city inspection division. GREASWINDUSTRL WASTE INTERCEPTOR GRADING ITE: CERTIFICATE OF EXEMPTION FROM WORKERS' GREASEJRAP SOILS FEE COMPENSATION INSURANCE rNis waive madam be completed if Ne permit is for one hundred dollars($100) SEWER.SANITARY-STORM EA.200FT. ENERGY TTI! or less.) I certify that in the performance of the work for which this permit is issued.l shut[ WATER HEATER W/VENT/FLECIR not employ any person in any mummer so as to become subjmi to the Workers' PAID Compensation Lawsof Catifomm. Date WATER SYSTEM/IREATING Data Receipt Is 0 z Applicant zC) NOTICE TO APPLICANT:IL after making this Ceolifficate of Exemption,you should NEW RESIDItIAL PLMB. SQ.FT. TOTAL: r4 became subject to the Workera Compensation Provisions ofthe labor Code,you must forthwith comply with such Provisions onhispenmilma116e deemed revokM. BUILDING FEE �• Ki L>a Q CONSIRIICTION LENDING AGENCY SEISMIC FFI! - P," z 1 hereby affn r that then is a construction lending agency for the performance of U O Ne work for which this permit is issued(See309].Co.CJ TOTAL: ELECTRIC PEE Lenders Name Lenders Address QTY. MECHANICAL PERMIT FI?E PLUMBING FEE 0 U I certify that I have read this application bad sate that the above information is MECHANICAL FEE >" WO.. correct. I agree to comply with all city ssW county ordinances and state laws relating to PERMIT ISSUANCE U z building construction.andhereby authorise representatives of Nis city ancrocrupon the CONSTRUCTION TAX above-mentioned property for inspection purpmea. ALTER OR ADD TO MECII. .-i (We)agree to save,indemnify and keep harmless the City of Cirsomo.,.last liabilities,judgments.costs ardexpeaace which meryin my way�e�ei stsm City AIR HANDLING UNIT(TO 10,"CFM) in amseyventt.(the,rendn6 of skis permit. !/ AIR HANDLING UNIT(OVER I0.000 CFM) 9,na o Ap UConeacmr� Dae EXHAUST HOOD(W/DUC) PAID HAPARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,00(i BTU) Date Receipt WilltMappliem,or future huilding owcapant store or handle hazardous maefial HEATING UNIT(OVER 10LOW BTU) T as defined by the Cupertino Municipal Corte,Chapter 9.12,and the Health bed Safety Code,Smti1Ya ❑No 25532(.)? ❑ VENTILATION FAN(SINGLE MID) t ISSUANCEIDATE Wilhhe applicum nr Powrc M1uildingncupent uscequipmenmrdeviceswhichemis BOILER-COMP(311P OR 100,0010 BTU) • hazardous an contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) AUG 2 5 Diseictl 1994 Cl Y. 13 No NEW RESIDENTIAL MECH. SQ.PT. vu I have read the huam.us material.,o alrcomma under Chapter 6.95 of the Oi.Y Ur l.Urrf f California Health&Safety Code,Sections 25505,25533 and 25534. Immense Net � if the building don not currently haves tenant.that it is my msponsibility to notify Ne occupant of the requirements which must c met prior m issuance of a Certificate of Occupancy. Owner.,au mmad.gem Data TOTAL: ISSUED 6: I/tom OFFICE ASBESTEST, INC. 1550 Dell Avenue,Suite E'Campbell,CA 95008'(408)374-3362'Fax(408)374-7269 YMP INCORPORATED Date AUG. 16, 1994 10190 BRET AVENUE CUPERTINO, CA 95014 Job No. A-13402-94 PROJECT: 21910 HERMOSA ASBESTOS IDENTIFICATION BY POLARIZED LIGHT MICROSCOPY OFFICE COPY Fibrous Other Non-Fibrous Sample Asbestos Fibrous Materials or Identification Minerals, Materials, $ Minerals, $ • FRONT HOUSE 1 UTILITY ROOM NONE DETECTED ORGANIC BINDER, 60% LINOLEUM FIBERS, 40% 2 KITCHEN NONE DETECTED ORGANIC BINDER, 60% LINOLEUM FIBERS, FIBERGLAS, 40% 3 ROOFING NONE DETECTED ORGANIC BINDER, FIBERS, 40% MISCELLANEOUS PARTICLES, 60% BACK HOUSE 4 BEDROOM NONE DETECTED ORGANIC BINDER, 60% LINOLEUM FIBERS, 40% 5 BATHROOM NONE DETECTED ORGAALC BINDER, 601 LINOLEUM FIB 6 6 KITCHEN NONE DETECTED OR CEO� 20$ LINOLEUM FI S,A,8Q Urij s04 oily nrclipir Aft PAGE 2 The materials were examined by polarized light microscopy according to Environmental Protection Agency methods. In California, positive test results indicate the sample contained 0. 1% or more asbestos, as per California Code of Regulations, "Title 8, Section 341. 6 et seg. " Reported asbestos percentages were estimated based on comparison to reference samples provided by the EPA. Respectfully Submitted, ASBESTESTT,1 IINCCC. obert M. Kumag�� Microscopist • •