20194 APPLICANT TO FILL IN INFORMATION WITHIN,RED LINES USE BALL POINT PEN ONLY
Building Project Identification
Building Addrow- ;+ PERMITNO.
'
20194
were ame
Apple CoVn�u'` Qv/ �na. CITY.OFCUPERTINO-BUILDING DIVISION LA A
Contmetor'.Name: 'uc.Ne:, APPLICATION'/'PERMIT. - q-a7L`q_`�'h
Archlt��tt/Engtweer. a I�,` BUILDING ELECTRICAL PLUMSING-MECHANICAL CATEGORY, ' CO
Gj'Fudlos' Avc -C of 5., 2•jNm x'. ' '- + � ; Y ?; ,•BUILDING PERM[T,'INFb
U� I
po� 'Qtr`s:,' �`,... ELEGTRICPlRh1IT t..}FEE
fiadl&�r Gre4tvl s4 . .5. F• ��1YY) , U .. PLUMB. M ,+
'
LICENSEDIDCONTRACTOR'S DECON
PERMIT
ISSUANCE
Imthat I am licensed
undrronsolChr9nc- APPLIANCESRESIDENITAL
In ithSctian7O00)ofDivlio3.fth.B.in.andlofmionsCade,and my }
]OB DECR1IIIION
license 1.1.hill force and ofPANES
License Clam Lie.#
'
Date Contractor # `
't ARCHITECTS -100
DECLARATION 2010 AMPS
W ZO I understand my plsns,hall be used as public remNw ' OVER 1000 AMPS 'SQ.PT.FLOOR AREA 5/SQ.FT. '
(Gj Licensed Prolesskmal - SIGNS ELECTRICAL
OWNER-BOLDER DECLARATION z SPEC4ALCIRCOT/MIST fL /20 I heisby afBram exempt I aexempt fromthe Contractor'sLlcence Law for the 3 �p� 77
pp following reason.(Section 70313,Business and Profession.Code:An tl
O Z w y city or
„TEMP.METER OR POLE INST. /
county which requires a permit to construct,alter,improve,demolish,or repair
y anystruclure prior to its Issuance,also requires the applicant for such permit to r - POWER DEVICES
(ti+ file a signed statement that he Is licensed pursuant to the provisions of the
Otc Contractors License Law(Chapter 9(cammancing with Section 7000)ofDivi.
(-�0 cion 3 ofthe Business and Professions Code)or that he is exempt therefromand SWIMMING POOL ELECTRIC - VALUATION.
the bast,for the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSW[TCHESFIXTURES
applicant fare permit subjects the applicant to a civil penalty of net rrorethan �"7�Pr O v'D
m flue hundred dollars
rofthe500). NEW RESIDENTIAL ELECTR SQET. STORIES TYPECONSTRUCTION
owner of the property,or my employees with wage, thele sok
comper
.Is(Sec.
7U44,wW Business
ad rk Pmfnd sheat ode:Th not ranractoe or ice..cifor
Law
O sale(Sec.apply
to alness and f property Code:The Contractors Llceme Law
does notapply torn owner of throng his own
n emparimproves,
ovidedreoryand that such I OCC.GROUP - RES.UMTS
whodue.
rnme,a netintelf or dedoraugh hlsowne.If,ho ever,the building
or
improvement is sold within
earofcomplr offered far tion If,however, aider ill haw TA -
improvement is sold wlthinoneyxarofcompletlorythe owner-Wilderwill have '
t rden of proving that he did not build or improve for purpose of sale) QTY:`i:,'„},i pi:[JMI ''p$RMI,�I i Flppp 7pNE APNi
I 4W as.owner of the property,am exclusively contracting with licensed ,
contractors to construct the project(Sec.7044,Business and Professions Code: PERMIT ISSU CE
The Contractor's License Law does not apply to an owner of property who '
Wilds or Improves thereon, and who contracts for such p(ojects with a ALTER-D IN ATER(EA)
ad.Ks)Bcensed pursuant to the Contractor's License Law. - X'•:XFEfi SUMMARY
am exempt under Sec. B k P C for this reason HOW PR DEVICE
IF FEES
SANITARY Y N'
Owner Date D SFIAO P.AREA; RECEIPT#
WORRMANCOMPENSATIONDECLARATION SCHOOL TAX Y_+N
I hereby affirm that I have a xrtiflcate of consent to self-Inure,ora RECEIPT__IOM
ificate of Worken'Comperistatlan Insurance cracertifled copy thereof(Sec. GAS -1 INC.40 ” PARR FEE Y N
3800,Lab C.) - -
'Policyp GAS-AEA. SMM.OVgR4(EA) RECEIPT#
Com anyBUILDING DIVISION FEES
�Certlfled copy b hereby famished. GREtwasEPtk PLANCHECKFEEMCertified copy b filed'Mth the city bwpedlon division.CERTIFICATE OF EXEMPTION FROM WORKERS' GREPAID
COMPENSATION INSURANCE SEW -SIO EA.200E1'. Date R i t# 2'z7 G
(Thl.section need not W completed if the permit bier ane hundred dollars t7
510))or leas.) WATER HEATER W/VENT/ELECTR ENERGt Y
.Icertifythatln the performance,(the work farwhlch this permit ie t,wsed, —
I shall not employ any person In any manner so as to become subject to the YV t
Workers'Compensation Laws of California.Date WATER SYSTEM/TREATING - PAID
I' O Z Applicant - NEW RESIDENTIAL PLMB. - to ReceI t#
Z O NOTICETO APPLICANT.If,after makingthis CertBicateof F-areptim,you `'�"F1' �Oa�
should become subject to the Worker,'Compensation provisions of the Labor - T AL:
W Code,you must forthwith comply with such provisions or this permit shall be
deemed revoked. BUIL ING FEE Z 5bqSOe
j
W
CONSTRUCTION LENDING AGENCY • SEISMIC.FEE Q C O
I hereby afilrmthat there ls a mvtructlon lending agency for the perform- ELECTRIC FEE
Z) Z an ce of the work for which thl.permit is Issued(Sec.W97.Clv.C.) TOTAL
V O Lender's Name PLUMBING FEE
♦• Lender's Add
¢'IY:}X�: X MECHANICAL"P.ERINIT :);FE6,i'r
O W 1cortifythatl have read this appbaationand nate thattheaMwinformatlon - MECHANICAL E
1 .IS correct.I agrestocomplywlth all city and county ordinances and state law, PERMITISSUANCE FEES PAID:
} relating to Wilding caragmetion,and herebyraidamize representatives ofthis '
Zdty to enter upon the above.menHoned property for Inspection purpom. ALTERORADDTOMECH.
(We)agree to save,Indemnify an d keep harmless the City of Cupertino Date Aeceipt#
against liabilities,judgments,costsand expenses which may In anywayamme AIR HANDLING UNIT(TO 10,000 CFM) SU TOTAL:
against said City In consequence of the granting of this permit.
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION AX
Signature of Applicant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTIO TAX PAID:
. HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future buildingoaupant store or handle hazardous HEATING UNIT(TO 1(0,(00 BTU) Date eel t#
material as defined by the Cupertino Municipal Code,Chapter 9.1$and the
Health and Safety Code+Section 25532(a)? HEATING UNIT(OVER 190,000 BTU) TO Q
Yea
❑Wllthe applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE EESID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air -
Illy Management District? BOILER-COMP(THE OR 100,((X0 BTU)` -
�u�JYes FI No - .
I have read the bars'Health
&Saauxfety
Code,Sections
255 5,2553 ,Chapter.95 of BOILER-COMP(OVER 100,000 BTU)
PAO
the Caltclta Health b ildin Coesnot currently
untlyh have
at tenannd t,
it - - :'r,,
understand that lithe building does not artently have atenanL that it NEW RESIDENTIAL METH. . S(j.Ef. e � 1 p
rnpomlbilityto ctifytheoccap oftheiequ mentswhic mumbemet ,( 1J
prior to Isis of a Ce"flca P.
ssl1� 90 - -
IYcI ' �
Owner ora tho ge Date - 1SSUEDB �•
- TOTAL:
OFFICE COPY