Loading...
HomeMy WebLinkAbout22195 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERIUTNO. Building Address /I 22195 �nvmer one A A �j CITY OF CUPERTINO-BUILDING DIVISION conte APPLICATION /PERMIT 1 BUILDING-ELECTRICALPLUBING-MFGHANlCAL CATEGORY CONTROL It 1 rch+ten/Fsg+neer. LIc.No: M ELECTRIC PERMIT FEE BUILDING PERMIT INFO I'FJRh9TIS5UANCE ❑ ❑ ❑ LICENSEDCONTRACFOR' .CLARATION I hereby affirm that l am licensed under provisions of Chapter9(comment. APPLIANCES-RESIDENTIALOtl DESCRIPTION inense 1 Semon 7000)of DlWslon3o(the Busine'and ProfnsionsCode,and my license 1.m mu'roe aha erfea. e/// rAN©s LI¢nsrrCl !// Llc M Date Contnetor 2(PTO2 ANIPS ARCHITECTasp RATION OVERIOOOAMPS SQ.TT.FLOOR AREA $/SQ.ITL o:2. AMPS I understand my plansshag W usedsed.pco ubtic rerds °° INVj Licensed professional SIGNS ELECTRICAL rx {Y D ¢' OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MLSC P T E R L., p owing rafBrmthatlamexem)Mfromthe Cantractorb License law fort he 'ppa Tatlowingrcasequimsaper i1.5,Businests ttommmdand Pimp vede=le h,ycatyir TEMP. OR POLE INST. °Lf'u1 countywhich rcqulresa permittomnstrust,alteq Improve,demnlbh,or repair q^ 41 < anystrutture priortolts begance,also requlrealhe applicant far each permit to POWER DEVICES $`/� /i l m V file a signed statement that he la Located pursuant to the provlslons of the IATE Contractor's License Law(Cha er 9(ecuranancin with Sectbn 7000)of Divl- f.30�' sion3 ofthe Businesaand Professions Code)orthatt he is exempt therefromand SWIMMING POOL ELECTRIC VALUATION < the basis for the alleged exemption. Any violation of Stolon 70115 by any OUTLETSSWITCHF_SFIXTURFS OO applicant Lora permit subject,the applicant toa cavil penalty of not more than five hundred dollars($SON. NEW RFSTDwHAl ELFGTR SQ.F[. STORIES TYPE CONSTRUCTION I,one owner will the property,or and he employees with wages r thele dole 7 compensation,Baudsothe usinal kfrado structure ode:Th not Intended orofferedl mose Lafor O vk(Sec.70Kpply Busine�andf proptrty Code:TM or improves Licaherein law $ docs not apply to an owner ofproperty who Wilda orimprovestherron,and _ OCC.CROUP RFS.UNITS y 5.. whodo�de.chworkhimselforlhmughhisownemployees,prov+dedthat.uh T Improvements am not intended or offered for sale.If,however,the building or TOTAL: (/ Improvement bwld wBMnone)earofcomplelbrytheowner-W Bderwill have 1. rd ofpmv+ng that he did not Wild or Improve for purpose afsileJ. QTY. PLUMBING PERMIT FEE FLOOD ZONE APN t�I,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE rontrad..to conscttruthe project(Sec.7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Wilds, or Improv.Hereon, and who contract, far such lupjecta with a ALTER-DRAIN Is VENT-WATER(EA) ra4actor(s)licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY cul am exempt under Sec. B k P C for this reason ' DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N . Owner Date RECEIPT_ NNN WORKMAN COMPENSATION DECLARATION HXTIIRFS PER TRAP SCHOOL TAX Y_ _ F_11 hereby affirm that I have a art10a[e of consentsentto to seV-insure,ora RECEIPT N cedflate of Workeri Compensation insurance ora certified copythemof(Sec. GAS EA.SYSTEM-I WC.4OUTLETS PARKFEE Y N 380),lab G Policy GAS EA.SYSTEM-OVER4(EA) DING IN Cram any BUILDING DIV] FRES ffrM fled copy in hereby mrd,nea. PLANCHECK FEE E]Certified copy b filed with the city inspection division, CREASE/WDUSIRL WASTE INTERCEPTOR CERTIFICATE OF EXEM IFTION FROM WOR K CRS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 2001 Date Recd t# (fhlssection need not be completed tithe permit la forone hundred dollars ($100)or less,.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_ I artily that In the performance of thework(orwNch this perm is Issued, I shall not employ say person in manner so as to the WATERS,gT[IM/TRpAnNK3 PAID Weelers'Compen is. D 7 0 Z ApplicanrNEW RESIDCNTIAL PLMB. SQ.FT. Date Recei t# Z O NOTICE APPLICANT.If,after making this Card"m of Exemption,you HW should become subject to the Workers'Compensation proobimat of the Labor TOTAL: Cade,you mast forthwith cons mi comply with such provisioa,this pert shall be BUILDING L j deemed revoked. W — coNsrgucrloN Lwowc ncwcY SEISMIC FEE a I hereby affirmthat there is a constmction landing agency for the perform, ELECTRIC FEE TOTAL: Z anceo(the work far which this permit blswed(Sec.3097,CIv.CJ PLUMBING PEE (� O Lender's Name lyF Lender's Addrcaa QTY. MECHANICAL PERMIT FEE MECHANICALFEE U I certllythatl have read thlsapptiatlonand statethauheaboveinformation 0 W Inromrect.lagrec to comply with all chyand county ordlnanccsand Mate laws PERMIT ISSUANCE FEES PAID: } IL relating to building ronstructbn,and hereby authorize representatives ofthb it t entero upon above-mentioned ro forW Ion ALTERORADDTOMECH. Date ReeelPt# I— Z city o Po P pe MY Inspection Purpose% (We)agree to judgernds,"antuddly an expenses whicharraleas h In any Cu pertbo AIR HANDLING UNIT 10,000 CTM)V against llabilitlns,judgmenb,"a and expense,which may In anywayaa,,,e SUBTOTAL: against said City in consequence of the granting of this permit. CONSTRUCTION TAX AIR IiANDWNG UNIT(OVER 10,000CFM) Signature of Appliaat/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applla at orfulure building occupant store at ha ad le hazardous HEATING UNIT(TO 170,LQ BTU) Date Recel t# material as defied by the Cupertino Municipal Code,Chapter 9.1Z and the Ilealth and Safety Code Section 25532(a)T HEATING UT(OVER 100,000 BTU) TOTAL: l E]]Yes u No Will the applicant or intone Wilding occupant use equipment ordevicns VFNDLATION FAN(SINGLERE5ID) ISS N DATE which emit hazardous air contamimnts as defined by the Bay Area Air Qua lily Management Dlstrict7 BOILFR-COMP OTR'OR 100,070 BTU) - 4Yea E❑do No hye.read He havrdaas mater) rcmrcnls under Chapter 6.95 of BOILER-COMP(OVE2170,070 BTU) MAY { /if �gq� the California Health&Sa(etyC '75505,25533 and 25534. I '1 understand that lfthe bulldin "corren+lyhave a tenant,that It is my NEW RESIDENTIAL MECH. SQ.FT. responsibility to anti rat of the requirements which at be t 11-- prior to ensu to of rauthorlvd agent yData 4 ISSUEDBY: TOTAL: OFFICE COPY