Loading...
23870APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification Building Address: "%1 l o�toS r49� . PEjRMITNO. 23870 wners ante: /ne: 4t CITY OF CUPERTINO­BUILDINGDIVISION APPLICATION / PERMIT AppucATR �f�1Tl Centranera Name: LIc. No,. OW BUfLDING-ELECnUCAL.PLUMBINGMECFIANICAL CATEGORY CONTROL# Arcblted/Engineer. Lk. Na QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: PERMITISSUANCE ❑ ❑ Intl ❑ 1� LICENSED CONTRACTOR'S DECLARATION I hereby rafferentthatam licensedunder pnsof Cha - APPLIANCES -RESIDENTIAL DESCRIPTION IScctionfDv3ofthcBusincessandProlessicansCode,and my �jl It... 1s In force and fect. PANELSLicense �JOB Ja Class Lc,# Date Contractor UP TO 2DO AMPS — ARCHITECTS use d.DECLARATION (understand my pins shall be used npubllc records. OVF000AMPS 00AM OVER 1000 AMPS SQ. FT. FLOOR AREA 5/SQ. FT. SIGNS ELECTRICAL Licensed Professional SPECIALCIRCUT/M15C OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the TEMP. METER OR POLE INST. following .... (Soction70313, Beat.. arad Professions Code: Any city or county which requiresa permlttoconstruct, alter, Improve, demolish, orespair anystructure pdorty its iswance, also requlrestheapplicant forsuch permit to file a signed statement that he Is licensed pursuant to the provisoes of the POWERDEVICES . SWIMMING POOL ELECTRIC Contractors License Law (Chapter 9(commencing with Section 7000)of Divi. exempt therefroand op 3 ofthe Business and Pm ioCode) orthat he ism sleves VALUATION the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not snore than OUTLETSSWITCHESFIXTURES NEW RESIDENTIAL ELECTR SQ.FT. five hundred dollars ($500). ❑I, as owner of the property, or my employees with wages as their sole STGWES TYPE CONSTRUCTION onepensation,will clothe work and the structure boot intended or offered for .Is $cc. 7046, Business and Professions Code: The Contractora License Law does not apply to an owner of property who bulldaor Improves thereon and who doessuchworkhimselorthrough his own employees, provided that such OCC.GROIIP RFS. UMTS TOTAL: Improvements arc not intended oroffered for sale. IL however, thebuildieg or improvementbsoldwthlnoneyearofcompt&tW theowner-bullderwillhave to Jeardso of proving that he did not build or Improve for purpose of axle.). QTY. PLUMBING PERMIT FEE H.00DZONE APN Pntae oworr of the property, am exclusively contracting with licensed to construct the project (Sec. 7066, Business and Professions Code: PERMIT ISSUANCE Cum. License Law don no apply to an owner of property who The Cum. builds or improves thereon, and who contracts for such ;Rejects with a co,,IltBS�Tactor(s) Incensed pursuant to the Contractor's License Law. LJ I am exempt under Sec B & P C for this reason ALTER -DRAIN & VENT- WATER (EM FEE SUMMARY BACK FLOW IPROT[CT. DEVICE .�� DRAINS FLOOR ROOF, AREA, COND. SANITARY RECEIPT Owner Date WORKMAN COMPENSATION DECLARATION ❑1 hereby affirm that I have a certificate of consent to ul(-insure, m a certificate of Worke.'Comperestlen Insurance ora certified copythersof IS.. 38, lab C.) 00 FIXTURES. PER TRAP SCIi00L TAX Y_ N_ RECEIPT N GAS EA. SYSTEM -1 INCA OUTLETS PARK FEE Y N RECEIPT N Policy p Co GAS EA. b'YSTEWOVER 6 (EA) BUILDING DIVI5I ON FEES Many Certilel copy is hereby famished. ❑ Certified copy ls filed with the city Inspection division. GREASE/INDUSURL WASTE INTERCEPTOR PLANCHECK FEE GRFASETRAP CERTIFICATE OF EXEM PTION FROM WORKERS' PAID SEINER -SANITARY -STORM EA 2DOFf COMPENSATION INSURANCE (ThlssMien need not he completed If the permit b forces hundred della. (51M)orless3 I certify that In the performance of the work for winch RNs parmlt b blued, Date Rece1 t# WATER FIFATERW/VENT/ELECTR ENERGY FEE Y_ N_ WATER SYSTEM/TREATING I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. Date PAID NEW RESIDENTIAL PLMB. SQFT. Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Date ReceI t# TOTAL: BUILDING FEE Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEF. ELECTRIC FEE I hereby affirm that there is a construction lending agency for the perform ance of the work for which this permit is Issued &c. 3097, C1v. C.) Icnder's Name lenders Address PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICAL FEE I certify that I have read this application and state that the above Infermdtion bcorrect. I agree to comply with all city and county ordinanms and state laws PERMIT ISSUANCE FEES PAID: ALTER OR ADDTO MECH. relating rebuilding construction, and hereby authodze representatives of that enytoeeterupontheabove-mentioned Property penton purposes. (We) age save, Indemnify n d keep the City of Cupertino agaWr Ji 1 ,judgmen and'xpen Ids Ray In anyway accrue Date Receipt# AIR HANDLING UNIT (IPO /0,W) CFM) SUBTOTAL: AIR HANDLING UNIT (DYER l0,Of10cFM) CONSTRUCTION TAX aga is CI Incon r gran g this ppllcant/ omnctor t EXH USTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATER IALS DISCLOSURE Will the applicant or future building occupant store or be nd Is hazardous EIFATING UNIT (TO 100,(100 BTU) Date Recel t# material as deli ned by the Cupertino Municipal Code, Chapter 9.1 2, and the IlealthandSafety Code Section 25532(x)? ❑ Yes M No Wllltheapplicant or future building occupant use equipment ordevices HFATING UNIT (OVER 1W,000 BTU TOT -- �� VENTILATION FAN (SINGLE REBID) ISSUANCE DATE which emit hazardous air contamimnts as defined by the Bay Arca Air Quality Management District? Yes No have read the bazar ousmalerials requlrerrents under Cha pier 6.95 of ry 11 V" P9 BOILER -COMP OHP OR 100,ORD BTU) BOILER-COMP(OVER 100,000 BTU) the Gllfe mia ealth&Safety Code, SM ions 75505,25533 and 25534. 1 l i understa rad that if the building does not correctly have a tenant, that it is my rnponsibllityto notify the occupant of the requirements which must be met prior to issuance of a Certificate of Ondrpanry. 'JUN 19 1992 NEW RESIDENTIAL MECH. SQ.ET ISSUEOnriY vv Ownerorauthmimd agent Date TOTAL: OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification Building Address: "%1 l o�toS r49� . PEjRMITNO. 23870 wners ante: /ne: 4t CITY OF CUPERTINO­BUILDINGDIVISION APPLICATION / PERMIT AppucATR �f�1Tl Centranera Name: LIc. No,. OW BUfLDING-ELECnUCAL.PLUMBINGMECFIANICAL CATEGORY CONTROL# Arcblted/Engineer. Lk. Na QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: PERMITISSUANCE ❑ ❑ Intl ❑ 1� LICENSED CONTRACTOR'S DECLARATION I hereby rafferentthatam licensedunder pnsof Cha - APPLIANCES -RESIDENTIAL DESCRIPTION IScctionfDv3ofthcBusincessandProlessicansCode,and my �jl It... 1s In force and fect. PANELSLicense �JOB Ja Class Lc,# Date Contractor UP TO 2DO AMPS — ARCHITECTS use d.DECLARATION (understand my pins shall be used npubllc records. OVF000AMPS 00AM OVER 1000 AMPS SQ. FT. FLOOR AREA 5/SQ. FT. SIGNS ELECTRICAL Licensed Professional SPECIALCIRCUT/M15C OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the TEMP. METER OR POLE INST. following .... (Soction70313, Beat.. arad Professions Code: Any city or county which requiresa permlttoconstruct, alter, Improve, demolish, orespair anystructure pdorty its iswance, also requlrestheapplicant forsuch permit to file a signed statement that he Is licensed pursuant to the provisoes of the POWERDEVICES . SWIMMING POOL ELECTRIC Contractors License Law (Chapter 9(commencing with Section 7000)of Divi. exempt therefroand op 3 ofthe Business and Pm ioCode) orthat he ism sleves VALUATION the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not snore than OUTLETSSWITCHESFIXTURES NEW RESIDENTIAL ELECTR SQ.FT. five hundred dollars ($500). ❑I, as owner of the property, or my employees with wages as their sole STGWES TYPE CONSTRUCTION onepensation,will clothe work and the structure boot intended or offered for .Is $cc. 7046, Business and Professions Code: The Contractora License Law does not apply to an owner of property who bulldaor Improves thereon and who doessuchworkhimselorthrough his own employees, provided that such OCC.GROIIP RFS. UMTS TOTAL: Improvements arc not intended oroffered for sale. IL however, thebuildieg or improvementbsoldwthlnoneyearofcompt&tW theowner-bullderwillhave to Jeardso of proving that he did not build or Improve for purpose of axle.). QTY. PLUMBING PERMIT FEE H.00DZONE APN Pntae oworr of the property, am exclusively contracting with licensed to construct the project (Sec. 7066, Business and Professions Code: PERMIT ISSUANCE Cum. License Law don no apply to an owner of property who The Cum. builds or improves thereon, and who contracts for such ;Rejects with a co,,IltBS�Tactor(s) Incensed pursuant to the Contractor's License Law. LJ I am exempt under Sec B & P C for this reason ALTER -DRAIN & VENT- WATER (EM FEE SUMMARY BACK FLOW IPROT[CT. DEVICE .�� DRAINS FLOOR ROOF, AREA, COND. SANITARY RECEIPT Owner Date WORKMAN COMPENSATION DECLARATION ❑1 hereby affirm that I have a certificate of consent to ul(-insure, m a certificate of Worke.'Comperestlen Insurance ora certified copythersof IS.. 38, lab C.) 00 FIXTURES. PER TRAP SCIi00L TAX Y_ N_ RECEIPT N GAS EA. SYSTEM -1 INCA OUTLETS PARK FEE Y N RECEIPT N Policy p Co GAS EA. b'YSTEWOVER 6 (EA) BUILDING DIVI5I ON FEES Many Certilel copy is hereby famished. ❑ Certified copy ls filed with the city Inspection division. GREASE/INDUSURL WASTE INTERCEPTOR PLANCHECK FEE GRFASETRAP CERTIFICATE OF EXEM PTION FROM WORKERS' PAID SEINER -SANITARY -STORM EA 2DOFf COMPENSATION INSURANCE (ThlssMien need not he completed If the permit b forces hundred della. (51M)orless3 I certify that In the performance of the work for winch RNs parmlt b blued, Date Rece1 t# WATER FIFATERW/VENT/ELECTR ENERGY FEE Y_ N_ WATER SYSTEM/TREATING I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. Date PAID NEW RESIDENTIAL PLMB. SQFT. Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Date ReceI t# TOTAL: BUILDING FEE Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEF. ELECTRIC FEE I hereby affirm that there is a construction lending agency for the perform ance of the work for which this permit is Issued &c. 3097, C1v. C.) Icnder's Name lenders Address PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICAL FEE I certify that I have read this application and state that the above Infermdtion bcorrect. I agree to comply with all city and county ordinanms and state laws PERMIT ISSUANCE FEES PAID: ALTER OR ADDTO MECH. relating rebuilding construction, and hereby authodze representatives of that enytoeeterupontheabove-mentioned Property penton purposes. (We) age save, Indemnify n d keep the City of Cupertino agaWr Ji 1 ,judgmen and'xpen Ids Ray In anyway accrue Date Receipt# AIR HANDLING UNIT (IPO /0,W) CFM) SUBTOTAL: AIR HANDLING UNIT (DYER l0,Of10cFM) CONSTRUCTION TAX aga is CI Incon r gran g this ppllcant/ omnctor t EXH USTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATER IALS DISCLOSURE Will the applicant or future building occupant store or be nd Is hazardous EIFATING UNIT (TO 100,(100 BTU) Date Recel t# material as deli ned by the Cupertino Municipal Code, Chapter 9.1 2, and the IlealthandSafety Code Section 25532(x)? ❑ Yes M No Wllltheapplicant or future building occupant use equipment ordevices HFATING UNIT (OVER 1W,000 BTU TOT -- �� VENTILATION FAN (SINGLE REBID) ISSUANCE DATE which emit hazardous air contamimnts as defined by the Bay Arca Air Quality Management District? Yes No have read the bazar ousmalerials requlrerrents under Cha pier 6.95 of ry 11 V" P9 BOILER -COMP OHP OR 100,ORD BTU) BOILER-COMP(OVER 100,000 BTU) the Gllfe mia ealth&Safety Code, SM ions 75505,25533 and 25534. 1 l i understa rad that if the building does not correctly have a tenant, that it is my rnponsibllityto notify the occupant of the requirements which must be met prior to issuance of a Certificate of Ondrpanry. 'JUN 19 1992 NEW RESIDENTIAL MECH. SQ.ET ISSUEOnriY vv Ownerorauthmimd agent Date TOTAL: OFFICE COPY