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21935 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALLPOINT PEN ONLY .Building project Identification PERbtiT NO. Bea0ubL 2A � 21935 wwwVVV...d(((!!or�time: one: CITY OF CUPERTINO-BUILDING DIVISION Con aaor'sNa a I uc:No,. APPLICATION / PERMIT U C' BUILDING-E"ECTRICALPLUMBING-M HANICAL CATEGORY CONTROL X fire Ilea/ fie r. Lk.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: lop iff, PERMITISSUANCE O ❑ ❑ LICENSED CONTRACTOR'S OF ATION Ihereby affbm that am licensed under provisions Of Chapter9(commenc- APPLIANCES-RESIDENTIAL JOB DESCRIPTIONingwith Section 7000)Of Divlsicn 3 ofthe Business and PrefessionsCode,and my Ilcenes 1s in full force and effect. PANES t t1 I/ License Class LM.X <v \V I Date Contractor VV��!!! ARCHITECTS DECLARATION 201-1000AMPS q�q�nn ot00 ;�,�}�a�[�d�J(ryq/1�Lps�gF 11 be used as public records. OVER 1000AMPS / FT.FLOOR AREA F/SQ.Fr. i e 'prOTe' oas7 mI a SIGNS ELECTRICAL ^I i N OWNER-BUILDER DECLARATION SPECIALCIXCUIT/h115C c 7 � 1herebyatfirm thatlamexempt from the Contractor's License Law for the o following reason.05ookn70'31.5,Business and Professions Code:Any city or //�� rcounlywhichrequiresapermittommtmct,alter,improye,demolleh,orrepair 7E3\1P.METCR Oft LEINSXA7 any.t E rocturepmmitsiss rivance,. qulrestheapplicantforsuc learehpermitto go file a signed statement that he is licensed pursuant to the provisiom of the POWER DEVICES 3,6 i• Centrad ' License Law(Chapter 9(oo ncing with Section 7000)of Dtvl- SWIMMING POOL ELECTRIC O slon3oft eBusinessand Profmss mCode)orthathetexempttherefrom.nd VALUATION the basis for the alleged exemption. Any violation of Section 70312 by any '� /`�r^ applicant fora permit subjects the applkant to a civil penalty a not more than OUTLETSSW[TCHFSFl%TURES V V 1 . five hundred dollars(8500). '9..' I,as owner of the NEW RESIDENTIAL ELECTR_SOFT, STORIESTYPE CONSTRUCTION �n ❑ property,nd employeeswithwages theirease compensation,Businwill ess and the work,fessim,Code:Thee is C mmolintendr'or License Law d for � sale(Sec.7f194,Buelmne and ProfesslOns Code:The COntractols Llceme law does net apply to an owner of property who builds or Improves thereon and OCC.GROUP RFS.UNITS E who doessuchwork himself orthrough hlsownemployees,provided thatsuch improvementarenoH tendedorofferedfwsale.If,however,thebulldingor TOTAL: improveme 11wIthirmse yearofcompletion,the owner-bulWerwill have t ofprovingthat he did not build or Improve for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE lar on to construct the project(Sec.7064,Business and Profetuom Code: The Contracto's License Law time not apply to an owner of property who ALTER-DRAIN k VENT VT-WATER(EN builds or Improve.thereon,and who contracts for such p\Ojecta with a FEE SUMMARY cglitraaor(s)Rmnsed pursuant to the Contractor'.License Law. BACK FLOW PROTECT.DEVICE Ll I am exempt under Sec. B k P C for this reason OUTSIDE FEES Owner DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N Date RECEB'I X WORKMAN COMPENSATION DECLARATION 01 hereby affirm that I have a certificate of consent to self-Insure,or FIXTURES PER TRA SCHOOL TAX RECEIPT certificate of Worker Compemabon Insurance ora certified copythereof(Sec. CAS FA. INCA OUTLETS 38W Lab C.) PARK FEE " Y_ N_ Policy X RECE@T X Com a GAS EA.SYSEEM-OVER 4(EA) BUILDING DIVISION FEES ertified copy t he withby the city GREASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑Certlfietl copy t9 with the city Inspection division. CERTIFIC,4FE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID' C PENSATION INSURANCE SEWER SANITARY STORM EA 20WE - Date Remipt Qhiseccuonneednot complaeditthepemdtttoromhundmddollam (8100)orless.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y N Icertl(y that In the pert nceo(the work(arwhich thio permit la issued, — I shall net employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING Worker Compensation Lawaof California. Date PAID O Z Applicant Z O NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQ.FG Date Recei t# should become subject to the WorkersCompensation proislom of the Labor - TOTAL: N Cade,you must forthwith comply with such provisions ortht permit shall be U N FEE \ j deemed revoked. d C COSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirm thatNthere is a constmaton lending agency for the perform- ELECTRIC FEE 7 p ance of the work for which this permit t Issued(Sec.3097,Civ.C.) TOTAL: ELECTRIC EEE V lender's Name LL ~ Iendcr'.Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W IecI certifythatl have nmdtht applicathmand statethatthe above Information mrect.IagreetOcomplywithaildtyand countycodmitnmand state laws PERMIT ISSUANCE FEES PAID: } IL relating to building construction,and hereby authorlu representatives of this H W city to enter upon the above�mentioned property for Inspection purposes, ALTERORADDIOMECH. ? (We)agree to save,indemnify an d keep harmless the City of Cupertino Dateeipt# V ago st liabilities,judgments,cmtsand expenses which may,In anywayaceme AIR HANDLING UNIT(TO 10,000 CFM) TAL, agai taid CityInco equence of th granting of this permit. AIR HANDLING UNIT(OVER 1o,o0o CFM) CONST N r1matedal ruffian,of r /Conn `i -_ a ate EXHAUST HOOD(W/DUCT) CONSTRUCTIONT ID: HAZARDOUS MATERIALS DISCLOSURE Will theapplicant or future building occupant store or handle hazardous HFATING UNIT(TO 100,000 BTU) DBF as de0ned by the Cupertino Municipal Code,Chapter 9.17,and the ll hand Safety Code Section25532(z)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: L pp Yns M No 'tel ill the applicant or future building occupant use equipment or devices VENTTIATION FAN(SINGLE RESID) ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air QZ.Iity Mawgcment Dist ct7 BOILER-COMP OHP OR 100,0M BTU) AV4 Yes No have read the hazr ore material requlrerrentundcrChapter 6.95 of BOILER-COMP(OVER 100,000 BTU) the California Health k Safety Code,Sections 25505,255.533 and 75534.1 understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.I•T. mponsibllity to notify the occupant of the requirements which must be not prior to issuance of a Certificate of Occupancy, - ''''d�ryryss��a Olt or authorized agent Date ISSUED BY:3.I/)F'Z TOTAL: OFFICE COPY F1VnQ 11H 4;9�tll N M M gfz R Ilk 1 REAM', -No. 888 fi r tr (( rcttttr This certificate issued pursuant to -the -requirements of Section 307 of the Uniform Building Code certifying that at the time of issuance-this structure was in compliance with the ,various ordinances of the. city -regulating building construction or use. For the following: Use Classification COMMERCIAL BUILDING Bldg- Permit No. 21 93 r) Oroup oup B-2/A-3 -Type Construction .. U-N Use Zone 21ann-ed Deuelopment Ni Owner of Building .-2aci f ic Gas and Elect. CO. Address.10900 N. Blaney Avenue Building Address 10900 North Blaney Avenue Locality -4. CupPrtino.-�California By: jop Ani-onbcci nt� Date: Pph -uary 8 , 1993 Building Official POST IN -A CONSPICUOUS rLAcr j 7 01.111- jut-- .4A