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20814OZ �O F�F^. t�5708 4� ggg uu�� aa W��Q _�Cgggw�a.•fi]] $�O APPLICANT TO FILL IN INFORMATION WITHIN REDLINES- USE BALL POINT PEN ONLY,' - Building Project Identification -- - - 9uBdingAddrca ' PERMIT NO. - 11 20814 corer / cane: . .. �'-•"� V.a '" .CITY OF CUPERTINO-BUILDING DIVISION APPLICATION/PERMIT BUILDING-ELECTRICAL-PLUMBING-MFGHAMCAL 7 �.•L-v ono-aciors Na :' 06LIC I V N 'x �' CATEGORY CONTROL# Architect/Engineer. - • - Lir. No: ;, TX'„ t� S'. fiCSCTRIC PERIviITs t ,s€,. s',�rFEE 1, t ,..1'.,r IIUILR,ING PERMq IN 0_ ;•. 1... . _ " - PERMITISSUANCE - - Agdreas: r - -' ❑ ❑ + LICENSED CONTRACTOR'S DECLARATION I herebyaffirrnthat l ar lhcensed under prcvislonsof Chapmr9(commene. APPLIANCES SIDENTIAL ' -JOB DE 1<11-11UN PANES / ingwith Se on7000)of Dlvislon3ofthe BuslnessandProfesslonsCode, and my license lsln toil fpgx anddfert. �s ,3© / License Clase _ _ _Lic.p Date /- �d Contractor j "��,s �x . CII L \VLI,-'�� •�L�- tY� 1 V `" 201-1000 ARCHITECTS DECLARATION . I understand my plans shall be used as public records. - OVER1000 SQ. FT. FLOOR AREA $/SQ: FT. . SIGNSELECAL Licensed Professional � '� � . OWNER -BUILDER DECLARATION Thereby affirm that [am exempt from the Contractors License Law for the S LC T LSC following reason.(Section 7031 S, Business and Professors Code: Any city orTEMP countywhichrequiresapermittoconstmct,alter,impmve,demolih,orrepair OR L T. _ , nystmdureprlortoltsisseance,alsorequimstheappllantforsuchperMuo file a signed statement that he is licensed pursuant to the provisions of. the y�yypR CES • ' , gWA{MING LELECTRIC _ OUTLE'IS5W[ I-IFSH%TURES Contactors License Law(Chapter9(commencing with Section 7000) of Divi., slon3oftheBusiness and Prefeasoru Code) orthat bets exemptthemfromand the basis for the alleged exemption. Any violation of Section 70315 by any applicant fora permit subjects the applicant to a civil penalty a not more than - "1 ^VALUATIONN / ,) V D. - ' ( 1/ , RESIDENTIAL ELECT# SQ'PL five hundred dollars (S500). 'NEW F-1 1, as owner of the property, or my employees vilth wages as their sole STO ES TYPE CONSTRUCTION compensation, will do the work, and the structure B not Intended or, offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law _ - doesnotapplytoanownerofpropertywhoWildsorimproves thereon, and whodoessuchworkhinuelforthrough hisown employees, provided that such , ..00CGROUT'. ,IRES.UMTS " Improvements are not Intended proffered forsale. If,howevepthebuildingor -TOTAL: - improvementisoldwithinoneyearofcomple ion,tMowner-bugderwill have the rden of proving that he did not build or Improve for purpoa of sale ),. 6I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044, Business and Professions Code: QTY;'w+1 Ea4PLUM$ING`PERMIT`tt',?s; h';sjFEE `r, FLOOD ZONE APN ' PERMIT ISSUANCE .. TheContactors License Law does not apply to an owner of property who bullda"or Improves- thereon, and -who contracts for such projects with a on�(jactor(s) Bernard pursuant to the Contra c?, License Law. " 'LJ I am exempt under Sec. • H & P C for this reason ALTER DRAIN &VENTWATER (EA) "• t;i 4 ; `r'P.," F BACK FLOW PROTECT. DEVICEOUTSIDE FEES DRAINS.FLOOR ROOF, AREA, COND. SANITARY Y_ N_ RECEIPT# - Owner .Date 3 WORKMAN COMPENSATION DECLARATION of consent to elf-hosure, or / ❑I hereby affirm that 1 have oncertificateInsurance certificate o(Workea'CompensaOonlwurana ora rertifled copythereof(Sec. 3500. Lab C.) Policy # & a % S FIXTURES. PER TRAP - - SCHOOL TAX Y_ N_ ` RECEIPT # GAS EA. SYSTEM -1 INCA OUTLETS ' - PARK FEE Y N ' .. " RECEIPT # ' . GAS F.A. SYSTEM -OVER Com anv /1 E' -rt�INO ✓N =BUILDING DIVISION FEES '- �CertRedcopy Ishereby fumishi.' 1zCertifled copy i filed with the city ty inspection division.. GREASE/INDUSTRL WAKE INTERCEPTOR PLANCHECK FEE - GREASETRAP, CERTIFICATE OF EXEMPTION FROM WORKERS' PAID , SEWER{SANITARY-STORM EA'2WFT' _ COMPENSATION INSURANCE 'r (This section need not he completed ifthe permit isforone hundred dollars Date Rmej W WATER HEATER W/VENT/ELECTR ' ENERGYFEE " Y "" N ($1DO) or less.) - - '' I rertifylhat in the perfor nceoftheworkforwhlchlhlspemnitis issued, WATER SYSTEM/TREATING I shall not employ any person In any manner so as to become subject to the Workers'Compensation Lawsof California. Date PAID _ NEWRESID=, ALPLMH. SQ.F1'. Applicant NOTICE TO APPLICANT: If, after making this CertiHate of Exemption, you Date'. Recef t# NOTAL: should become subject to the Workers' ComperrsaHon proviiona of the Labor BUILDING F•E Code, you at forthwith comply with such provisions or this permit shall be deemed revoked. - - SEISMIC FEE '- I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a emitruction lending agency for the perform arm of the work forwhich lhls permit i i sued (Sec.31197, Clv. C ) Lenders Name Lenders Address I certilythatl have readthlsappLratlonand state thattheabove information correct.is I agree to complywith all city and county ordinances and nate laws TOTAL: ELECTRIC FEE • , -" ..,. QTY.'•., MECHANICAL; P&RMIT - PLUMBING FEE MECHANICAL FEE - PFRMIT ISSUANCE FEES PAID: ' relating to building construction, and hereby authorl,m representatives of this city to enter upon the e. above-mentioned property for inspection purpos (We) agree to save, indemrdfy an d keep harmless the City of Cupertino against liabilities, 'dgments,castsand expenses which may In acyways.mc ALTER OR ADD TO Date Reeei t# _ AIR HANDLING UNIT (TO 10,000 CFM) - SUBTOTAL' agalrutsaid Cit ' onscquence of the granting of this permit. AIR HANDLING IINTC (OVER 10,000CFM) '' - CONSTRUCTION TAX " `r' -I;iG ,9D Si a rep( ppllant/Co 'Date EXHAUST HOOD (W/DUCT) CONSTRU_ CTION TAX PAID: •, " HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health"and Safety Coder �Section 25532(a)?' 't '❑ Yea u No- - - .. HEATING UNIT (TO 10g000 BTU) Date .Reeei t# HEATING UNIT (OVER 100,000 BTU) 'TOTAL:' VENTILATION FAN (SINGLE RESID)- Willtheapplicantorfuture building occupant use equipment or devices whichemithazardousaircontaminantsasdefind by the Bay Area Air Qu a lily Management District? ." ❑Yes nNo '. ThavereadthehazarQious materialsrequlrementsunderChapter6.95of ' BOILER -COMP OHP OR 100,000 BTU) BOILER-COMP(OVFR 100,000 BTU) ' the California Health&SafetyCode, Senlons 75505, 25533 and 25534. I understandthatlithebuildingdoesnotcurrentlyhaveatenant, that it is my responsibility to notify the occupant of the requirements which most be met: - - City #a City of Cupertino NEW RESIDENTIAL MECH. SQ.F7. prior to issuance ofd Certificate of Occupancy. ISSUED BY: �- d • Owner or authorised agent ,Date TOTAL: OFFICE COPY