No preview available
30193 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DWISION APPLICATION/PERMIT PLU.MBI.NC'MECHANICAL. 0 I BUILDING PROJECT IDENTIFICATION 1 93 LUINGADDRESS'. SANITARY NO. APPLICATION SUBMITTAL DATE loa90 �'��o V,,5 r,9 C N K'S NAME.:a� PHONE: COp�ACTOH';NAMP: LIC NQ ✓fielc AA T%-1/�� ��/' ?i !i' NIC CONTNOLa RCHITECT/FiNGINL'ER: b'G IAC NO: A�IID`RIi35: 0AI G . 60 W� ❑ /� CONTACT: PHONE: 072 �, V BUILDIN(©IO PERMIT INTO j0#/l) �f✓/S 25'�3385 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT� PLUMB MECH LICENSED CONTRACTOR DECLARATION QTY ELECTRIC PERMIT FEE 1 nerehy affirm thea 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION "Z with Satim.70W)ofDivisian3pf Nc l{usiness and Prnfesaiom Code.and my lineae is I TJAL F,,= full fume and effat. PERMIT'ISSUANCE. FOWL [I KITCHEN REMODEL �UU hianac Lice APPLIANCES-RIiSIUIiN'1'IAI. ADDITION El PLUMBING RE-PIPE NQ6 Date CunlrsClm Fly ARCHITE(.T'SD RA 10 PANELS ❑MULThUNIT [I STRUCTURAL z O,`,'j K I code nuand my piens shall focused uhlic records MODIFICATION OZ-G UI'T02W AMPS ❑INTERIOR ❑CHIMNEY REPAIR F'W Licensed Promi,imet) 201-3000AMPS IMPROVEMENT me OWNER-BUILDER DECLARATION OVER 11)00 AMPS ❑BATH REf�I*PjPITTR ❑DEMOLITION CC'' 1 hereby affirm Thal 1 um exempt form the Contractor's License Law far the VV X1�1( i U following reason.(Section 7031.5.Business and Professions Cale:Any city or county SIGNS ELECTRICAL ❑OTHER B13 W F which require,a permit n construct,eller,improve,demolish,or repair any structure prim to its issuance,also requires the applicant for such Permit o file a signed smtement SPF.CIALCIRCUIT/MISC. �Q(IQ E } that he is licensed pursuant to Ne provisions of the Contractors License Law(Chapter9 / �Q (eommcneingwlth Section 71A10)ef Division Sol he Buaineasund Pmfmsions CuAv)or '1'17MP.METER OR POLE INS R 116x o C that he is exempt therefrom and the basis for the alleged excmPLion.Any violation of 7 B fl�s�1 D'jpN"-�I DEMOLITION W^m Section 7031.5 by any applicant for a permit smig,cs the applicant to a civil Penalty of FEWER DEVICES ❑TENANT �fl ' FOODSERVICE 1-Z not mune than live hundred doll...(551X0.Y OTHER IMPROVEMENT Q ❑ Lo the work,the property,remyemployas with wages ed for their See compnssines, SwIMh11NG POOL ELF.CfRIC W=I] and Prohewon%and c: swaureisherintended e awdos of apply to an Business [I OTHER F S and Iat,who Crsfe:The Cpn therevs License law Jaen not apply m if owner of OUTLISIS_SWI TCHES-FIXTURE. propny who builds or sided tfiramen therein,and who docs such work himself or IMmgb his awn however, the building rtes such improvements am not intended or offered for NEW RISIDF.NTIAL ELECfR tpf-l_ sales I M1nwever,Ne huildingnrimprovmncm is sold within nuc year of centplelien.the II�A ,SQ.FT FLOOR AREA 5/SQ.F1'. awnerbullder will have the hu den of leaving that he did not build or improve for put- W pose of sale). q7A 1,asowner ofthe propny,,Bexclusi very conwNng wid:)Theedaanchara m "ii ecric athe es not (SO.]IXW.Businessand rty who bei Code:)The Camrecmre and c eLawdasnalapprymanawnarommetunywcesedpds orimt to fig ourseunJ QT"Y. PLUMBING PERMIT FEE 11 lozz .a wan mmraclx forxuch pmjalswilhvamwdnr(s)lianscd putsuommlha Comrwume —\\v �/IILI] License law. PERMIT ISSUANCE ❑ 1 mat exempt under Sec .H&P C far this reason ALTER-TRAIN&VEN T-WATER IEA) LUATION Owner Date (st WORKER NzOz,ul.p COMPENSATION DECLARATION HACK FLOW PRUTECf.DEVICE I herebyaffirmunder penaltyteperjuryaneofthefollowing orkeasCo L]Ie,as and Nrovidll maintaina Certificate if f he LatueCodensurcfor Workers Continent- TRAINS-Fi(XIR.ROOF.AREA,GOND. STORIES TYPE GDNStRHCT1QN cause, hick this fpr by Scotian 3]1X1 n[the labor Crxlc,for the prfonnaace of 0c work for which this permit is issued. FIXTURES-I'LR'fRAI' n I have and will maintain Worker's Compensation Insurance,as required by Section 3910 of the Labor Code.for the performance of the work for which this permit is iswed. GAS-IiA.SYSTEM-I INC.4 OUTLETS OCCGROUP APN My Workers Compensation Insurance carrier and Policy number ort: Cartier. Policy No.: GAS-EA.SYSTEM-OVER 4(EA) CURT'IFICA'I'11 OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASUINDUS'IRL WASTE IN1 ERCHPIUR BUI VISION Ri1S fUtissmtimsmadnot becomplctediftim,armit isforonehunJoadvidlvs(51W) GREASETRAP or leas,) [PAID NCfIECK FIi" I leenify Nat infleperformrnecoflhewnrk mr which Ilius Permit is issued,IshdI SEWER-SANITARY-STORM P.200 FF not employ any person in any manner m as to become subject to the Workcrs Campn- RGY PEE I'• Q Z mmon Laws of Califinnia.Dam WATER IIEA'I'ER WNENT/ELEC(R AO1NG F ' Z O Applicant N NOTICE TO APPLICANT:IL after making this Corti fcme of f emption,you should WATER SYSTEMRREATING LS HE F Mneme subject to the Worker's Cows nsatinn F."i'i is of Ilan Lahur Cade,yon ntust forthwith comply with such pmvisionsor this l'crminhall bedccmed revoked. WATER SERVICE / Q 50.7. z CatthemRUCTION L1tNDINGAGENCY agency NEW RESIUF.NI'IALPLMB. SQ.FT Dale R 'eipp U O Iherchy affam lhauhcre isacunswaion lending agency forttle Performance of E-' the work for which this permit is issued(Ser.3097.Civ.CJ Under,Name O TOTAL: Le C) Lender's Addmss ty I certify thea 1 have reed this opplicaion and stale that the above information is BUILDING FEB r cmca.I.,reel,,comply ,in all city and county onllnances and state laws tclaing et QTY. MECHANICAL PERMIT FEE U Z building construction,and hereby authorize representatives of this city to enter upon the SEISMIC FEE those-mentioned propny for im,clion purl...... PERMIT ISSUANCE (We)agree m save,indemnify and keep harmless the Cit,of Cupertino radius, ELECTRIC FEE liabilkies,judgmemx.costs and expenses which may in any way income against mid City ALTERORADDTOMHCH. in consequence of the granting of this permit PLUMBING FEC //` APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000CFM) MECHANICALFEB y SOURCE REGULATIONS. 57 AIR HANDLING UNI'I'(OVER 10.001 CFM) CONSTRUCTION TAX 5 Sigtmnre of Applicam/Cammemr Daze BKHAUST HOOD OVIDUCTHOUSING MITIGATION HE I(AZAR DOUS MATERIALS DISCLOSURE Wdiffic applicant or fmarc buildingaiupantsmre or handle hazavinus namrial HEATING ON I'T(TD IIXOM 111 U) as def ted by the Cupnino Municipal Code.Chapter 9.12,and the health and Safely Ctxlc.Section 255R(a)! -L HEATING UNIT(OVER 100,000 BTU) ❑Ycs ILJNo VENTILATION FAN(SINGLE RES1D) PAID '\ Dam Receipt p Will the applicum or future building occupant use equipmmnl or devices which ,it bazarduus air contimrmid,as defred by the Bay Area Air Quality Mtnogemem BOILHR-COMP(3HPOR Im%000B'IU) Nance 'IOl'AL: L]Yes BOILER-COMP(OVER 100,0(10 BTU) ` hu reads fiats read coon rChzpmr6.95 ofthe Cali- AIR CONDITIONER ISSUANCE DATE fomi e It&S ly C c ase 2550 5533 an 5534.1 understand thatif the NEW RESIDENTIAL.MECH. SQ.Ef. buil as nestu yh tan iilism .pnsibilitytonoriytheiecapsm oflh hi It a ramorwinoulcof.Ccruffiesm"IfOrcar Ly ' authom<d.gem /Dal7e _J ISSUED BY: OFFICE