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HomeMy WebLinkAbout27820 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.L L R'c.AL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBINGPROJECT ECTEDENTICAL 27820 BUILDING PROJECT'IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE 2 /L a O?310 Vend Le ITN X{OTM �l OWNER NAME PHONE ACTOR'S NAME: LIC NO: v` gc{S ` .4 _, O^ NIC CONTROL Y •A CI II'I C-/CIJGIN2ER�: .IC NO: -J 5 S Mai, ❑ CONTACT: NEy QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO 'ILECf RUMB MECH L PERMIT ISSUANCE ❑ ❑ ❑ UCENSFD CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOBD Metz Thereby efRrm thatlmn!tern 1uMmgvvisions ofCluger9(corirnerclnQ with WOO Section)BBII)of Div 3athe B.ona—nul Pnofcviov Ctrle,aal my liavc is io PANFLS CpJ full fora coal cRm.n`'^ t<t-.ZUW License Class ✓ Lw,0 S2Z89 Z. UPT0200AMPS tnQy Don, Contmctm 201-1000 AMPS Z.O,Z• ARCHITECTS DECLARATION OVER IOW AMPS SQ.Hf.FLOOR ARG WSQ.FT, OZ_ IuMmtnM my pluvshall beusd as public ocade. to SIGNS ELECTRICAL 6yf LiccmN Ptofc.sio,OI �Q OWNER-BUILDER DECLARATION SPECIAL.CIRCUR/MISC W I hereby utitm that l am cxam[u I.the Con.. .Licemc Taw fix,lb e NULL oo following rtesan.(Sectim 701 125,Businca aM Pmfeaaiav Cale:Any city a counly TEMP.METER OR POI-E,INST. u' which ra,Nm• ement to wrtsvucL aha,imgvove.dtmo&h.a repair any terucmre }� pri«loin applicant fasuch pmwfo rile asigircd statement POWER DEVICES K<O tMl he is licensed ponuant mthc ovvisimu of the Ccmanors Licrnsc law(Clow, 9(canmaomg with Secticto7")a Crocco Sol the Bwaisces utd Prafnsivtn Code) SWIMMING POOL ELECTRIC /) VALUATION y_y ordwh703"by thatol foi-abrins(«theellegNexemautto civilPnaltyof OUILE-SWITCHES-FIXTURES G ®�o no ttloo.03136y anyuppli"Imt apamtil aubjuta Jsc.pgimnt tuecivil penalty of < roe tn,n five nmdrea ddlua(ssao). �1="$ ❑ 1.a+owearofdegogrry,mm em b enwiN ova wrtryanetivrt New RESIDENTIAL ELL'CIR SQ,FT. y p y gaax Neirwle RI' PG CUNSTRUCT1ON a r3— will Juthe wott.un,ICott: he ottra Couitnot i,L Lava Law cil cofm.wlc(Scc.1.an of and Aofeaias CMe:The Contractor's Licaose Taw don rot app1Y to m owty of pfopmywhobuilds aimgaves thctmo,and who daysuch vo t himKlfa through his own employees,provided that such impmvamcnrs ve.lntetdN oroffertd for silo.If, KO(TRFS.UNITS however,the building a impnovcmrnl it aoki within ae year of co npletion,the co,na- thoker will have de btnden of Proving that he did not build w impove fm W t,oK of TOTAL: a). ❑ I.mowrcrMthc PaPmY,unaxclusively mntracting with liamaMmwacros:to QTY. PLUMBING PERMIT FEE H-00DZONL APN coo, t the p,oject(.Sec.7044,Busiws W Pmfa+iav Code:)The Conmctvr's LiwnK law Atce not applyoen owncrofgoq+ry whobuilJsaimpmvestMatnend PERMIT ISSUANCE Li'.Law.aw.acu fm such pnjectswitharnnvacta(a)IicensMpmuanl to Ne Conbanora ALTER-DRAIN&VF -WATER(G) FEESUMMARY ' ❑ ono exrnt)w under Sec. ,B&P C fa this moron BACK FLOW PROTECT'.DEVICE 002012th PM SANITARY Y N Owe na. DRAINS-FLOOR.ROOF,AREA,COND. RECE N ```��, WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N Iltcteby off that l have.emifcaleofcmer,to lr-insve.ma amih.c.1' REctilmN N utcn'Canp,Ys tion lreuancc ora emir i copy thnrof(Sac.3M,Lab C.)which n PARK FEE Y N rxnllcmplcv!/f and I�tuQ t� GAS-HA.SYSTEM-I INC.4 OUTLETS RECEIPT♦ Po— . TS_. T O 'V BUILDING DIV PS ConpvtY C A icy- OAS-G.SYSTEM OVER 4(G) PLANCHECK FEE ❑ CcrtiSdc pyishc yfurnkhal. ❑ C,n Gail copy is flM with the city inspection division. GREASEANDUSTRL WASTE IN"MRCEYUR GRADING PER r CERTIFlCATMPE COMPENSATION ONERAN WORKERS CRFA55 TRAP:.'�' •i- SOILS FEE � COMPFNSATIONINSURANCE dollua(Russectian eaNeta bernnWlctcd iftk pamituf�mehJrdied Oslw), -SI'� r SEWER.SANITARYRM EA.2001T. ENERGY FEE m ln I ttnJy dot thtbe perfonmarce ofthe wart fm wlJch this umil is a I II 1 U-R iR%YA77 i}/ELECIR e not.*y any prion is my racoon so m to bemea jeer t+'th t yrs' PAID z Competauia laws of Cilhomia. Date h 5 '.LTE SY G Dae Receipt Applicant 1 NE SI 91MAD. I SQ.FT. 0 NOTICE TO APPLICANT:If,alto meting dtis CcNBmtc of Ea y shoo TOTAL: t--• ba�me wbjatln the Workv'a Cwnprn.vivo pmviaiwvof theL�.y'eeriwl F' fanhwith cmtply with such govisiommtM1is pmmit slWl M1e hen itevoted. / � •i BUILDING FF. Q CONSTRUCTION LENDING AOFNCYDATE S©SMICFEE I herchy elRrm thu there iaemnshudion lending ajenyf 51 perfanwceof y s- T,�..a+...-•- U O the wort fa which this permit is issud(Sca.3119'!,Cv.C.I _ TOTAL ELECTRIC FEE lreMcr'a — La.&-r's Amltne '^"" QTY. « MECHANICAL PERMIT FEE PLUMBING FEE 1 ratify Bu I have rod t1Js appllcarim coal sale T.the,above infumYion u mm�ecL I .omotpI with al)city"co tyry imtcnarduu lh mledngto PERMITISSUANCTi MECHANICAL FTP. F" but ltlin actim,and hereby vuthmire repraerntvtivcs ofthis city tv rnta upon Jte CONSTRUCTION TAX U Z above m goPeny ho inspection WrPo+n. ALTERORADDTOMECIL f c) rte to vac,imnnrtih mtd Ray"nlns t e Gtr of upm—a�— lieblli ea,' Jgmrnts,cmu std exprmn'wM1ich nmyyy"""nanyweya agalmtwid City AIR HANDLING UNIT OD 10,LOB CFM) of the pant of try.pemti� • . ((`.. AIR HANDLING UNIT(OVER IB.OoO CFM) St ore of Appancie lhan n., Dove EXHAUSTHOOD(Wp1UC) PAID HAZARDOUS MATERIALS DISCLOSURE )BEATING UNIT(TO IM.000 BTU) Date Racai, Will the applicant or future Niiirtg nCNpNIumc a handle haaerdaa miattral HEATING UNIT(OVER 100'"BTU) TOTAL u defiead by rte Cupatim Mwicipal Code,CNga 9.12,and the Health annual Safety Cale,SccG0 25532(a)P ❑ye, ❑No VENTILATION FAN(SINGLE RBSID) ISSUANCE DATE BOILER-COMP(BHP OR 100,000 BN) Will the oppliranta fumrebuilding occupant uKequipmrntmdevl¢s whichemit s Laanr'Jma air cvnuunionnu to def cl by the Bey Ates An Quality Manngmnent BOILER-CLOME(OVER 1W."BTU) District? ❑Yn ❑No NEW RESIDENTIAL MECH. SQ.FT. 1 have reed de hao N materials rryuitments uMar Clegcr 6.95 of tha f California Ibahlb&Safety Cab,Smiav 25.505,25533 and 25534. I undmtud that if the building Jas not cunently have a tcnanl that it is my mspwuibility to notify the me gent of the Kqubenetu which m••,ta neat pia to iuwece of a CeitiBcue of Occulwrtcy. Owe(a aaNavW.grnl Date TDTAL: ISSUED BY: OFFICE