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HomeMy WebLinkAbout22971 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMITNO. Building Address: o 3"o Lq-s o W OPA (s)y 22971 nems ame: . ASUff9nT_At'l5_ATE- 060 Hrcw 1 "LS2_' beg' CITY OF CUPERTINO-BUILDING DIVISION ( ��.r�._d contra nraName: ,!D ueNm APPLICATION / PERMIT LI[I' BUILDING-ELEGTRICAI.PLUMBINC-MECIIAMCAL CAITGORY C0127S15 I Architect/Engineer. - Lk.Na: � - lJ QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: - - PERACTISSUANCE �' t� ❑ LICENSED CONTRACTOR'S DECLARATION �1 I hereby ocrion 7")olamlken3oftheunder usim andPm Chapter9(mmmmc- AI'I'LIANCESRESIDENTIAL JOB DESCRIPTION Ingweh infull force effeon3ot[he Businessand Prolesalom Code,and my W k'3 license Is in mB force and effect � PANELS v License Class - Lk.p "2_'UP TO 200 ANIPS Date -Contractor ARCHITECTS DECLARATION 201-1 WO AMPS 9Z I understand my plans shag be used as public records. OVER1000AMPS SQ.FT.FLOOR AREA S/SQ.FT. 00 Licensed Professional AGNS ELECTRICAL s� G m OWNER-BUILDER DECLARATION ` VVV G �n SPECIAL CIRClR7/MLSC f„ lherebyaffirmtlutlam exemptfmmthe Contrador'a Licenx Law for the _ 0 O N following reason.(Section 7031.5,Business and Professions Code:Any city or MAP,METER OR POLE INST. county which requires a permit to construct,alter,improve,demolish,or repair eFE.' ,�j.�.r ale prlorto its usuance,alsorequlrestheappilcant for such pemdHo POWER DEVICES E ©a file a signed statement that he is licensed pursuant to the provbiom of the px, Contractor's License LawCha erg(commencingwith Section 7000 of Divi- On Men 3 ofthe Business and Profession Code)orthahe isexempt lherefmmand SWIMMING POOL ELECTRIC VALUATION C S the basis for the alleged exemption. Any violation of Section 7(31.5 by an OUTLETS- 2.55 -� applicant fora permit subjects the applkant to a civil penalty of not more than � q. 'R live deed dollars(5M. SQ,FT. SfOWES TYPE CONSTRUCTION '4^ owor of the property,or my ernpWyees with wages a their sok NEW RESIDENTIAL ELECTR Le .ion,wnldothe workandthestmebarebnot intended or offered for 5 O le(Sec.7094,Business and Profession Code:The Contracto/s License law $ does not apply to an owner of property who builds or improves theretnand tom$^ who does such work hinvelforthrough his own employees,provided that such R Un R Improvements are not Intended or offered for sale.If,howevw,the bu tiding or improvement Lssold within oneyearafcampletiomthe owner-bullderwlll have yam/ �"� t1�u,den of proving that M did not bund or improve for purpose of sale.). QTY. PLUMBING PERMIT . FEE. FD —'pry°.=TR LJ 4 as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE D �^ Z contractors to construct the pmjeet(Sec.7044,Business and Profession Code: �' TE •V - The Contmdor's Llcene Law does not apply tom owner of property who ALTER-DRAW kVENT-WATER(EA) Wilds or Improves thereon, and who contracts for such ptojecis with a •FEE SUMMARY m,IBfacton(s)licensed pursuant to the Contractor's License Law. BACK FLAW PROTECT.DEVICE LJ I am exempt under Sec. B k P C for this reason DRAINS FLOOR, AREA,GOND. SANITARY Y N_ lTJner Date RECEII'Tp WORKMAN COMPENSATION DECLARATION FIX.CIJRES PER TRAP SCI400L TA% Y_ N MI hereby affirm that I have o certificate of consent to opytnsure,ora RpGEpp p 380,LabC.Worket%Compenationlnurance oraunified copy thereof(Sec. GAS EA.SYSTEM-1 INCAOUILETS PARKFEE Y N 3800,lab CJ RECEIPT p .Policy p GAS G.SYSTEM[-OVER 4(FA) Cam ay BUILDING OI V1510 �B n [PCertlBed copy lahereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKF`EEk/ E3Cwted iRcopy is filed with the city inspection division. I `` CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID , V COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 200Ff Date Recei t# (rhissedion need nest W completed If the permit b faron hundred dollars ($10(fmiess.) WATER FIEATER W/VENT/ELECTR ENERGY FEE Y N I certify that in the performanre of the work forwhich this permit is issued, 1 shall not employ any person In any mother so a,to become subject to the Workers'Compensation Laws of California.Date PAID SYSIIM/TREATING O Z Applicant NEW RESIDENTIAL PLMB. SQ FT. Date Rec li t# Z O NOTICETO APPLICANT:R,aher making this Certificateof Exemption,you FN should becomesubject to the Workers'Compensation provislon of the Labor TOTAL: S _ Code,you most forthwith comply with such provision or this permit shallbe -BUILDING FEE ^ W > deemed revoked. - CONSTRUCTION LENDING AGENCY SEISMIC FEE d e I hereby affirm that there la a mmutmdton lending agency for the perform- T ELECTRIC FEE Z anceofthework forwhkh this permit b Lssted(Sec.3 ,Clv.C.) (,) O Lenders Name PLUMBINGFEE LL H Lender§Address QTY.I MECHANICAL PERMIT FEE ' MECHANICALFEE O W Iced.Ia reetoc malt with alkatyndcounty untyordinances and 1 relwi.ct.lag,eetocomplyweballdherebyountytrdinancosand Mate laws PERMRISSUANCE FEES PAID: T N relaBng to building contructlon,and hereby auNodxe rcpresemativea of this - city to enter upon the abovcmentloned property for inspection purposes. ALTERORADDTOMECH. Z Date Receipt# tale)agree m save,Indemnity and keep harmless the City of a pectin O a text d meats costsandwhich man AIR HANDLING UNIT 8040,000 CFM) SUBTOTAL: 6 Y B ex y any ronsryue o( h ant' of this permit. AIR HA NDLiNG UNIT(OVER I QOf10 CFM) CONSTRUCTION TAX Gant/Contra or Date IXFTAIIST HOOD(W/DIK:T) CONSTRUCTION TAX PAID: AZARDOUS MATERIALS DISCLOSURE nt orfuture building ompant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Reccipl#by the Cupertino Municipal Code,Chapter 9.12,and the - 11calth and Safety Code Smion 25532(a)i TIFATING UNIT(OVER100,000 RTU) TOTAL: Yes MNo Will the applicant or future W ilding oavpant use equlpmrcnt or davices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE latch emit havrdous air ocn onto n,as defimd by the Bay Arca Air. �uality Management Dead"? BOILER-COMP OM'OR 100,"BTU) L�Yes (❑TI No PAID Ihhveread the th&r fusmrteeiaection remenb5533 and 25534. of BOILER-COMP(OVER 1f0,000 BTU) Y-' p+1 ' D the understand Health building Code Sections a t and25574. 1 understand that if thebuilding does not arrently have atenant,that itumy NEW RESIDENTIAL MECH. SQFI'. responsibility to notify the occupant of the requirements which most be rret (]NOV n prior to Issuance of a Certificate of Occupancy. Owner or authorised agent Date ISSUED TOTAL: OFFICE COPY