No preview available
25053 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BI LL PERMTr No. ^COC O APPLICATION/PERh1IT "�� PLUMIIING-MF.CIIANICAL L J J J BUILDING DIVISION BUILDING PROJECT IDEN'T'IFICA,ruisi BUILDING )DRESS: SANI'T'ARY NO. APPLICATION SUBMITTAL DAg33 / AJ UNIT# LOT ` CK rRE. PH)NE V LIC N0: ` N/C CONTROL# th 'I :C'/ GIN." LIC NO: `� ��' ❑ CONTACT: + PHONE: 'g' - 7 FEE LECTRIP - BUILDING PERMIT INFO OFT' MIT LDGJELECT .PLUMB MECH PERMITISSUANCE %lizr' LICENSED CONTRACTOR'S DECLARA9']ON APPLIANCES-RESIDENTIAL TOB DESCRIPTION no&Z I hereby affirm Nat l are licmoseci ode,limoisionsofChapmr9(commereingwith W00 Section 90110).(Division 3 ofthe Business and Professions Code,and my inside is in PANELS yUF full fnteeandeffect UPTO200AM �/G 44 Z,VV Licensee and Lic.# �lY F 60•vo Dem Connaclm 201-1000 AM11 1Y A I 1'-'D ARCHITECTS DECLARATION SQ.Pr.FLOOR AREA $/SQ.FI'. ZO.�- OVER 1000 OZl'O Iundeaand my plans shall be usedmpublic records. ��� O Z F 0 SIGNS ELBqCW If Licensed Profesi...I 4411 OWNER-BUILDER DECLARATION SPECIAL CI TT / as �jO yf 1 hereby affirm that 1 um exempt from the Contractors License Law for the 1 �00 41 tai}+cont¢ following reason.(Section 9031.5,Business and Professions Code:Any city or county TEMP.METE OR T.� ` V � o,, which requires a Permian construct,alter,improve,demolish,or report any strucstructureu �N}� prion.its issuance.also requires lheapplicant for such Nmilto file a signed statement POWER DEVIC Q 0C the,he is licensed pursuant n the provisions of the Continuous License Taw(Chapter S eco 9(commencing with Section 9000)of Division 3 of Ne Business and Professions Code) SWIMMING , LE CRIC VALUATION ,may or that he is eamniumerel'tom and the basis far thenlleged exemption.Any violation of UTLETS-SWIT {ES-FIXTURES O�_�� < Scum,91131.5 by any applicant fora permit mhjects the applicant ma civil penalty of t more than five hundred dollars($500). C E CIR _m ❑ 1,mosnarofthepoupory.ormyemployxawith wages astheirsolecompensNEW RESIDAL[LESQ.PT. ation, S'1'ORI TYPECONS'IRUCT10N y3— will do the work,and thestmearcisma immudedorOffered for mile(Sar.7044.Business and Professions Code:The Cotnmcror's License Law does not apply to an owner of property who builds or improves thereon,anti who does such work himselfor through his OCGGROVP RIiS.UNITS ownemployces,pr.videdlhat such improvements urenmimended orofferedforsale.IL however,the building crimprovement is sold within one yearofcompletion,rhe owner- builderwill have the burden ofproving that he did no,build or improve for purpose of "' L le). 1,mownerofthepmperty,amexclusivelycunvactingwith licensedeomructonsto QTV. , ?PLUMBING PERMIT FEE FLOOD ZONE APN cons mct the projnt(Sea.71114,Business and Protocol...Cale:)The Ctmtrommr's PERMIT ISSUANCE /^' License Law doesnotapply to an owaerofproperty whobaddsor improvesthereon,md whocontmcisforsuchprojemswithacontncto(s)licensedpursuatiothe Conimct.ea ALTER (FA) License Law. FEE SUMMARY ❑ 1 am exempt under Sn. ,B&PC for this reason BACK FLOW PROTECT.DEVICE: T pEF_S SANITARY Y N Owner Date DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT# WORKMAN COMPENSAq'ION DECLARATION SCHOOLTAX YN ❑ I hereby affirm that l have a certificate ofconsent m self insure,ora cenilicate of RItCUIPI'# / �Workm'Cnmpensetion lnsumnce orecrnifcA copy thereof lSec.3800,Lab CJ which XTURES-PERT RAP PARK FEB Y N covers sell employee's undenhb permit GAS-G.SYSTEM-1 INCA OUTLETS RECIiIn N Policy# BUILDING DIVISION FEES Campnny GAS.IA.SYSTEM-OVER 4(EA) PLANCIMCK FEE ❑ Certified copy is hereby furnished. ❑ Cenilied copy is filed with the city inspection division. GRFASEBNDUSTRL WASTE IN'TERCEPT'OR GRADING FIB? CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASETRAP SOILS COMPENSATION INSURANCE (This section need not hec.mpleted ifthe permit is fortune hundred dollars SIf10) SEWER-SANITARY-STORM HA.200FT. ENERGY PRE orlex1.) I y r nc rwtieh lhispermit'gqisued.l shall WATER HEATER WNENT/ELEMR not c lu ny m name td orken' PAID qrj Com sa nli . Drce WATER SYSTEM HEATING pate R t (_JV'J1 Z APPlica NOTIC . t isC ,irate ofofth Exemptiode,you mull NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: G7 become suM1jem to Ne Wnrkcr's tum tons of the Labor Code,you must a , forthwith entPly with such Provisions onhis mdi shell be deemed revoked. BUILDING Il?I? 6 {2.1 Q CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirm that is a construction lending agency for the performance of !TO jF :fiE V U O�+ the work for which this permit is issued(See.3097,Civ.CJZ El. t-' Lender's Name "'-' ,.* ' FEF. U Lender's Address QTy': - r MECI IANICAL PERMIT' FEE I certify that I have read this application and sate that the above information is �# �-' correct. l agree to comply with all city and county ordinances and sure laws relating to PERMITISSUANCI3 AL FEE building concoction,and hereby authorize representatives of Nie city to enter upon the U2above-mentioned property far inspection purposes. ALTER OR ADD TO MECH.(We)ngrca to save,indemnify and keep harmless the City of CUPenino against liabililles,judgments,costs and expenses which may in any way accrueagainst said City AIR HANDLING UNIT(TO 10,000 CFM) ( / � ..—. FT t in amuqucne of the ki. AIR HANDLING UNIT(OVER 10,000 CFA) Si more IicanV ntrudo S Det EXHAUST HOOD(W/DUC) 1 HAZARDOUS MATERIALS DISCLOSURE HFA'FIND UNO(TO I00,00d)B'FU) Dote B Will the opplicamour future building essupont store or handle hazardous material HEATING UNI9'(OVGR IW,OoO BTU) �►' as defined by the C.Peni Municipal CWc'Chapin 9.12,and the Ilealth and Safety Code,Section❑Yn32(aI?�/ o VEM'ILATION FAS(SINGLE BUSED) , ass Will thea licantorfl'u�lVu arc'rhuildin BOILER-COMPOIIPOR 100.000 BTU) ISSUANCE DATE pp Ba�'uPant use equipment ordcvices whichemil zaie us air Ionamin Bos defined by the Bay Amo Air Quality Management BOILER-COMP(OVER 100,000BTU) -trim? 13 Y. I$No NEW RESIDENGAL MECH. SQ.FT. R1 A ' �' 1 have read the our tom materials requirements under Chapter 6.95 of the P D f Califomio Health&Safety Code,Sections 25505,25533 and 25534. 1 undersand that occupant ofthdoes not curt<n0y heveatenent,that it is myrcsponsibility to nmify the MAY accupmtt of a iumme of a nift f Oce / C//Y�� Own t - Dae � ISSUEDZMplia y ADDITIONAL PERMIT FEES BUI LDI NO PROJECT I DENTI FICATION VALUATION NAME"AME / ice_ (/. 0 FEE SUMMARY ' DxE g y� coxrxacrona BUILDING -NAME ��// uc.no,�P( �-+ ' PLAN CHECK oxrn•croP's FEE -f�S• ; nn WEISMIC FEE a OTV. ELECTRIC PERMIT FEE UTLETS-SWITCHES-RECEP ELECTRIC ° LIGHTING FIXTURES PLUMBING APPLIANCES-RESIDENTIAL ' PANELS MECHANICAL SIGNS Qy7 SIGNS TRANS. TOTAL a!E SPECIALCIRCUIT EMP.METER OR POLE INS. _r PE"MIT vnuonnory . MOTORS - SEE FEE.SCH. Y•A' �(}ti,.ve CI ` SERVICE CHANGE z H ° TOTALCC } - LU. ISSUANCE DATE> DTV. PLUMBING PERMIT FEE aLoc. EEEcr. cic. MECN. 2 - ALTER-DRAIN&VENT-WATER (EA.) © ❑ ❑ ❑ L, OLL BACKFLOW PROTECT.DEVICE - - 0 U DRAINS-FLOOR,ROOF,AREA,COND. w FIXTURES-PER TRAP I- ? GAS EA.SYSTEM-I INC.4OUTLETS P.A i D (J GAS-EA.SYSTEM-OVER 4(EA.) , INDUSTRIAL WASTE INTER. MAY (J(J - LAWN SPRINKLERS.1INC 5V.0. MAY 25 1•L993 ® LAWNSPRINKLERS-O5(EA.) - IIt UI" vurrhim SEWER-SANITARY-STORM RM EA.2001t/ WATER HEATER W/VENT - WATER SYSTEM WATER TREATING EQUIP. - TOTAL OTV. MECHANICAL PERMIT FEE ALTER OR ADD TO MECH. APPLIANCE - AIR HANDLING UNIT(TO 11) C F rw - AIRHANDLINGUNIT(OVER I0,000C.F.M.) EXHAUST HOOD(WITH DUCT) . HEATING UNIT(TO 100,000 B.T.U.) - HEATING UNIT(OVER 100,000 B.T.U.) VENTILATION FAN(SINGLE) MOILER.COMP(3 H.P.o 1100.000 B.T.U.) MOI LER-COMP loloo,000 Hrul sss FEE sell. . ... TOTAL