Loading...
99110111 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CSIPERTINO BUILDING-ELECTRICAL. AFPLICATION/IaERMIT PLUMBING MECHANICAL BUILDING C D EWFIN �,I/J q', ' ��y) BUILDING PROJECT IDEN"1'IFICATION BI1��AD,77 (��/Vt •w ©4,k Cts SANITARY NO. LDAT 66// Q UW NE IS NAME: a z 1 I'IE,NL: 5kr COM 1C R'SaNW IC S ri� NIC C NTROL p iR HITF,CT/ENGINEER: LIC NO: AD lei O ❑ CONTACT: PHONE: JS j !a. BUILDING PERMI'I'INFO �� S 3 , / ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MF,CH LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm mat Earn Bxenxed ender porskii sof chapter 9(commene.g JOB DESCRIPTION ,aZ Ih Sv,1iu i7UU11)nf Uivisinn5ol'mc Rosiness mull'rofexxinm Code. 1 licco'e., RPCI LLOO wa PERMIT ISSUANCE F�_ n full force and eB'wt. D ❑SFDWL El KITCHEN REMODEL GUU Liccnm Clan Lica APPLIANCES-RESIDENTIAL ❑ADDITION C1 PLUMBING RE-PIPE ZZLLI Uwe Leeme nr []MULTI-UNIT ❑STRUCTURAL RCHITECI"S UF,CLAR TION ZONZ I understand my plansshall 6e umd av public mentis PANLIS MODIFICATION OZ`=S UPT0200AMPS ❑INTERIOR [I CHIMNEY REPAIR W Licensed Pruf,xsionul 201-IMOAMPS IMPROVEMENT C]SWIMMING POOLS C Q I hereby affirm OWNER-that I am a¢Impt fromtheConuacior' s License Law far the OVER EXIO AMPS L Dpi TH REMODEIJREPAIR DEMOLITION LV fallowing onus...(Scctlnn 7131 5,Brines and Pmo,xions Code:Any city or county SIGNS ELECTRICAL ❑OTHER 3 LL- which reVtire.x a permit to construct.altar,improve,demolish,or repair any structure OPd.,1.it,is....en,ols.reclaim,theapplicant for such Pomona file a signed sutemem. SPECIAL Cl RCUIT/MISC. }� that he i%licensed pursuant to the provisinns of the Contractor's License Law(Chapter 9 Wap0 luUmmmn,ing with Scx'lloo]INq)Vf Ulv'ninn3oline Bulinc,x sand ProfenxinmaCde).r '1'f?MP.METIiR OR POLE INST COMMERCIAL . ION a d e�: that he is exempt merefmm and me basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑FOOD Sl RVI Way Section 7131.5 by any applicant for a Permit subjects the applicant to a civil penalty of POWER UF,VICES []TENANT FOOD SERVICE rn more Ihun five hnvdoed dollars($5M). IMPROVEMENT =QQl,as ownendthe proFleny.ormyentploycexwithwages astheiradncompcnnaion, SWIMMING POOL ELECTRIC b., will do the work.and the.tenure is not intended oroncmd formic(Ser.'1014.Business ❑OTHEk W 3 m amt Professions Gyle:The Commeror's Liccnm Law does not apply to an owner of OUTLETS-S_WITCHI3_FIXTURES prUperty who huilds or impnxvex thereon,and umbo docs rich work himself or Ill agM1 his own employees,provided that such improve noes art not intended or offered for NEW RE.SIDEN'1'IAt,ELECTR SQ F . sole.If,however,the building or improvement is sold woo inane yemofcompl,xian.the SQ.FT.FLOOR AREA E/SQ.FT, wnrr-bnildvr will have the burden of mm he did not build or int for a proving improve wr- ryUsc of xalc.). TOTAL: Fl 1.as Ironer of the pmpeny,am exclusively contracting with licensed contractors to consumer the project ISce.744,Basi nes,and Professions Gde:)The Contractor's Li- snLaw does eraapply connnwnmofpr.pony who fail Ids or improv es thereon.and QTY. PLUMBING PERMIT sE who contracts for such pmjects with a contractor(s)licensed pursuant m the Contractor's License Law. PERMHT." T ISSUANCE ❑ I mu vxmpi Under See. ,B G P C for this reason ALTER-DRAIN&VI?NT-WAITE(EA) a VALUATION Owner Date WORKER und-.S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE n. Z--bercby elfnn under'lenalty ofpaYjuryoneal,he Ildlowing Worke,,C.ovidedfortion37fireLrCohn.forth, WorkersCnmPen- DRAINS-I LOOR.ROOKARBA.GOND, PE C(INSTRUC'1'1@ satin,as lack thi for ri Section J700.f me Lahor CnJe,for the Performance of thework Ino which ria Permit Ix rowed. PI%TURES-PER TRAP I have and will maintain Worker's Compensol on Insurance,as required by Section3700nf me Lao de.forI epertorm cof limismkforwhic thisPeteryy1 GAS-EA.SYSTEM-I INCA UUTLES f� APN My Wor n t �'tya�c br and Policy. • t GAS-F.A.SYSTEM-OVER 4 I EA) / 3Z Currier:A.l� PION Nn.: CERTIF CATG OPIi%IiMI'fIDN FROM WORKERS GRFASFIINDUSTRL WASTE INTERCIiPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES (1'hissec,initeed not b:amtpletedifthepermit is mann,hundred dollar IS 100) CREASE'[RAP r Icss) PLANCfiECK EEE 1«dify that in are perfrnmanceofine work for which this permit is issued,l shall SEWER-SANITARY-STORM EA.200 FT no,employ any person in any ouirmer w as to become subject to the Workeri Compeer- CoENERGY FEE Z sation laws of California.Date WA'I ER HEATER W/VENTIFLECTR GRADING THE ZO Applicant y NOTICE TO APPIACANI':If,after making this Cenlficate of Exemption,you should WATER SYSTEmn REATING SOILS FEE a ; become subjeel m the Worker's Congscnmilon provreionx of me Labor Cale,you must forthwith comply withwcli onsi,ion,a,this Penni,shall he created mvnk,J. WATER SERVICE _ Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL TIME. SQ.FT. RAID pate Receipt s U O I hereby amoatbmnmmrs a,onstranilcost.,ageacy for the p,di'mirle of /,_� t t r LL F the work for which this Penni,is issued(Sec.NAR.Co.C.)enU 11 u Ld,e,Name 'IYYTAL�, V TOTAL: IaodNUIL x Address r I certify that 1 have read npplwatan and state shot he alone mamnnalion Is M mix M f' Z corrcct.lagree mcomply wim all city and countyordinancesofaodstute law stattin the QTY. MECHANICAL PERMIT FEE SEISMIC FEE Uz building construction,and hereby authorize representatives of thiscity 10 en¢rupon me ,Nn .aaminned property Tor inxpnefinn P-P..xex. PHRMI'IISSUANCE f LECTRIC RIF (We)agree to save,indemnity and keep M1aamlcss the City of Cupcnino against liabilities judgments.costs and expenses which may in any way accme against said City ALTER OR ADD TO MECH. PLUMBMG'FB mxI'Leare of Ie granting onhi,permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITHAiL NON-POINT AIR HANDLING UNITTO RL"CFM) MECHANICAL PEE SOURCE REGULATIONS. I /q/� ! AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCf10NTA% Signmum.f APp> mnao / Doe C%HAUS'I'HOOD(W/DUCT) HOUSINGMITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will,Moppli,an,or l entre building occupantsore or handle hamrdouxtmtenal HEATING UNIT 0`( 100.U(XI RTU) as defined by the Cupcnioo Municipal Code,Chapter 9.12.and the Health and Safely HEATING UNIT(OVER 100,0110 BTU) Cole.Section 2553200 ❑Yes ❑No Vl NTII,ATION PAN(SINGLE RESID) PAID - Date Receipt# Will the applicant or future Wilding Uwcupant use equipment or devices which BOILER-COMP(JlIP OR 1fp,000 BTU) 1/7I unit hazardous air comminution,as Jcfned by the Bay Area Air Quality Management TOTAL p[ 011,611? IIOTL17R-COMP(OVER 10M,000 B'I'U) E]Vies No I have read he hazardous materials requirements under Chapter fi 95 of the Cali AIR CONDITIONER //IS$ ANCC DATE fnmiu Haulm k Safety Cade.Sections 25505,25533 and 25534.1 understand that if the Ni;W ITS I DEN'TI AL MECI I. SQ.Irl'. //— / y, Wildang rncurently le,comnant.mat it is my respmsibit",rano fythe pant / .f Che r�, which must Foe met'nor m issuance of a C ryl`a� i a�G Owneroramhmmd.g,ot " l ¢ [ / TOl'AL: ISSUED RY'�eg OFFICE