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HomeMy WebLinkAbout20594 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN.ONLY Build Ing Pro ed]dentl(kris P� 0` 1'wLM1T NO. r Building Addma: - _ litme u Wars 3q � o � �. 20 594 Owners N.-1 67_LWt GV-©-1 CCITY OF CUPERTINO-BUILDING DIVISION (� APPLICATION /PERMIT .dear sine: �" /yC(Q.IK IK/ m B=lNr—EL IIUCALML INGMFLHANKAL CATEGORY CONTROL/ Loc.Na. `^//'� 'QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Adel. Y7"" ✓: PERM]TISAIANCE ❑ El CONTRACTORS DECLARATION I hereby affirm that l am lleensd under provWor.of Chapter 9(oomename APPLIANCES-RESIDENTIAL )OBD6C N Ingwith Sedlon7000)of DivWm3oftheBud andPmfevl Cade,and myG ry�n n Ilsnx t In full ors and effect. PANELS PANELS JTf F'V((T@.'���A.! X( D Comndor IUF� ARCHITECT ATEON 70- IS q�v tin�yy$2Z I underatad my plars.hall be used.public moods, OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT. Fi i Fj Lisnxd PrdeWorad SIGNS ELECTRICAL «<<6 'OWNER-BUILDER DECLAMATION, SPECIAL CIRCUIT/MLSC Ihereby affirm that l am exempt from the Contractor's Lkenx law for the pp felbwing reason.(Sced.70315,Buenm and Profmbns Cade:Any dtym A L E D I N O 7 I:.q TFMI'.METER OR POLE INST. r-7M manntywhLehrequbesapin., tommtmet,alter,Unpmve,dem hormpalr Y '36 anya stped statement babortqupursuant to the mmisihpermlltu POWER IXry1CFS M P U T E K U floe a algned easement that hat rowed pursuant to the proWbra or the Oy0 Con 3 ofUiusines lAw(Chapier9(rom)or theencing e6witxemptthekm W)af and SWDYMNG POOL ELECTRIC F,t50S slon3o(the Business andHdubaCde)orthathebexempttherefmmad ',f13 DATION S Y.'" thehashfar thealleged eedtsth an. Any Wolatbn of Sedbn not mreany �SSWI'mFSFU(TURESDATE a.7 .ppgontfor a permit subjects the applkattoa dull peneltydns morethan I E (W�undmd ddb.MM. NEW RESIDENTIAL ELWTR cSQ}7, STORIES TYPE CONSIRUC170N �n L_f I,as owner of the Property,or my employees with wages a thelr sok Gmpeaetoi�,w0ldoths worK and theerudu.b wt(mended or offered for PM sale(.Sec 70K Buenm and Professions Cade:The contractor.Eosins Law don not appy to an owner of property who Wilds or lmprwn therm,and •OCG CROUP RES UNTlS E who does such work himself orthwgh his own employees,pmvlded that such Improvements are net Intended or offered fee sok.If,however,the building s TOTAL: Improvement bsold wBhln one year ofcctimpletbn,the owner-0udderwW have t reien of proving the be dm net Wnd or improve fee sir,ose of.aleJ. QTY. PLUMBING PERMIT FEE Lj L a owner of the property,am exclusively co . en ntciing with licsed FLOOD ZONE APN mntndoestooanrtmd the projrd(See 70M eu.Nmand Profesbv Code: PFRA4i ISSUANCE The Cootem or'.Lfeema,Taw does rat apply to a owner of property who Wm ild.or Improves themon,and whocomnds for such mjam with a ALTER-DRAIN&VENT.WATER(EA) WIll��dor(s)Bmnaed pumnat to the Cont.cters Lisnx Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt uMv Sec B& P C for this renin OUTSIDERES DRAINSFLOOR ROOF,AREA,COND. SANITARY Y N Owner Dee a RFGF7PT WORKMAN COMPENSATION DECLARATION ercby affirm the I have a srtitkate of...txnt leo xR-Iwrt s FIXTU1 PER TRAP SCHOOLTAX Y_ N RE(:m'1'e b s (rat<¢of]JWo lee 'Cornpevadm lrsu�unn dt(led thertdlsec. GAS FA.SYS12A-1 INC{OUTLEIS PARK FEE Y_ N_ PdkYlr( 0o/C� O � GASP..SYSTEM-0VFR/EEA) RECEIPT♦ Co /f4d art �t' BUILDING DIVISION FEES Cad -illy nished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑Ce"ind copy Is filled with the dty Ivpedlon division. CERT]HCATE OF EXEMPTION FROM WOR KERS GREASE TRAP PAID COMPENSATION INSURANCEghTypR.SANITARYSIORM FA 2"T DatC Rcocf t# (Thisr 1(m need not te canpleed If the permit bfor one hundred dollars (SlMorle...) WATER HEATER w/vDvr/w.eerR ENERGY FEE Y N I sit b rthfythat In the performance ofthe work for which this permIssued, I.hall not employ any penin In any manner n u to become subjed to the WATER SYSIFA7/TRGHNG Workeri Compensation Law.of California.Date PAID PP NEW REMDETT AL PLMB. SOFT. A Rant Z ZO NDTICETO mome s'LICANT:e arkma Co this stion Certificate of Exemption,Y.bo Date Recti t# shouldbecomesu h mthenplye 'Companu provbbseofthe labor TOTAL: ~ _N deemed my oirt(adhwXh mnrpy wkh each pmvblone orchis perrNt.bull ha BUILDING `� deemed mwked. ap. CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirm that them b a meatme lm lending agency forthe perform ELECTRIC FEE 7 Z a r,r.fthewnr1,fmr h1rhthbsp1rmK is bsued(5ec 30Y7,CIv.C) TOTAL: ^ U O Lenders Name PLUMBING FEE LL F- Ieder.Addrtw QTY. 'MECHANICAL PERMIT FEE MECHANICAL FEE Icertlfy that read thbapplie,atlrnandate Ythat the O W abwelnformnlon Is corned.l.greem campy,wlthall eby.nd mirty ordlnanmana state bws PERMIT ISSUANCE FEES PAID: } N mating to Wlldingronvudlm,and hereby eithorbe.praxe b ntatNofth F Z city,to enterupon the.lotus-mentbredp far Wpedlon purposes. ALTTRORADDTOMECH. V _ (We)agrta to aammy a p rMee the Clty of Cupe"]w Date Receipt# a'alrat llebwtf ,jud t,cess exile eswhlchn llnanyw.yamt. AIR HANDLING UNIT CIO 10,000 CFTri) SUBTOTAL: agowtsald yin nsequen 9/the tingdtida It. AIR HANDLING UNT(OVER 10,000 CFM) CONSTRUCTION TAX Slgnatu.of Appli, gill oauusT HOOD(W/DLKTI CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Wwthe.ppBantorfuturt WBding ocmpant Bort orhadkhawdwa IMkTINGUNIT(T0100,000B'N) rratrbl as deBrud by the Cupertino Mu NdpalCde,Chapter 9.17,and the Date Recti t# He.1th.rd Safety Codd Seel 75537(p)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: (—I Yes '_^,a`'yH1k'�IaQo wthe applla him.b ilding.pant ux equipment or d evioa VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE which emit hanrdou. cont trios Is as de0md hythe Bay A..Air Q�allly hUnagementl itrW7 IKIILFR{OMP PHP OR 100,0(10 BTlp PAID Tn Y. 1fif�Ird No `_ L 4/ have read the mese meterlai,r<qulremems under Chapter&95 of BOILER-COMP(OVER1 W,000 BTTn the California Health&Safety Cd na 75505, and 75536.( JUL 311990 udereudthat boldin meMyth atenanithatltbmy NEW RESIDFNIIALMECFL SQFT mpm,sibili n ty the pain the nequ nis whkh most he m, prior tn ,ce ter p.ry. Cih Cf f`tl•nT}inn n 1,r,f . ror autnoArN agent (Ate TOTAL ISSUED BY: "`"'�--7 1 LTJ : OFFICE COPY