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23375 .,rra.INl6T1I IV t-ILL Iry INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Pra et Idemifical°^ PERMIT NO. BaIlding Address: 23375 ere ame: one: APPLICArNh MIIIA CITY OF CUPERTINO-BUILDING DIVISION9� C°" atoia ones: L+a.No: APPLICATION / PERMIT / s BUILDING-ELF TRICAI PLUMBING-MECHAMCAL CATEGORY CONTROL N Architect 11inginear. Lk.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: BLOC EErrr LICPERMETISSUANCE ❑ ❑ ❑ ENSED CONTRACTOR'S DECLARATION I herebya(firm that l am licensed under provisions o(Chapter9(commenc APPUANCESRESTDENTIAL JOB DESCRIPrI N inWthSeMon 7000)of Dlvkioo3 ofthe Buslneseand ProfesslomCode,and my � llrenxieinful rtxendeffet. PANELS // Llrenx Ckss LION �'� ©✓ / Dale Contncto ' ARCHITECTS DECLARATION 301-IODDAMPS - PQ+mOx I understand my plane shall be used as public records OVU1000AMPS SQ.FT.FLOOR AREA S/SQ.Fr. E g Licensed Profen+anaI SIGNS ELECTRICAL 6 OWNER-BUILDER DECLARATION SPECLILCB(CIRT/MLSC ' i /� pp 1�' zl., � I hereby affirm that am exempt fromthe Contracto/s License law for the I i \ II f Q following reason.(Section 7031.5,Business sad Professleas Code:Any city or I"" •' ID I r4l, countywhich requires a permit romrutrut,alter,Improve,demoliah,orrepa+r TEMP'METER OR POLE INST. ��� r-^ � rte. < Bal prlorta its Issuance,alsorequarce the appBuntforsuch permit to POWER DEVICES P✓ Ep-�•1. Om V Bae a tlgned statement that he Is Livered pursuant to the provislom of the �u,In Contract es License Law(Chapter 9(commencing with Section 7000)of DIW- OS skm3.ft1wS amlm.gd1 PemasskCcee)ortht hekexempttherefromand SWIMMING POOL ELECTRICDA A O OAthe Wale for the alleged exemption. Any violation of.Section 70312 by any TSSINTICHFSFIXTURES aPPlfant(ora pertNt eubjets the applicant to a civil penalty mint more than OU]LE p�cc five hundred dollen(5500), NEW RESIDENTIAL ELECTR �n ❑I,as owner of the property,or my employees with wages as their sok sQTr. bTORIESTYPE CONSTRUCTION compensation,will do the work and theatmture Isnot Intended or offered for O ale(Sec 7061,Business and Professions Code:The Contractors License law docs not apply to an owner of property who Wilds or improves theme,and who doeeauch work himself or through hisown employees,provided that suchOCC.GROUP RFS.UNITS improvements arc not intended oroffered(creak.If,however,thebuildkg or TOTAL: Improvement issold wltMnoneyeamfcompleton,t W owner-buOderwill have the burden ofpmv+ng that he did not Wild or Improve for purpose of sale.). QTY PLUMBING PERMIT FEE FT.00D TONE pPN []L as owner of the property,am exclusively matrembag with limned / PERMIT ISSUANCE matatan to mmt truthe project(See 7044,7061, usleassand ProfessionsCode: ^ The C.,drem is Lima.Law don not apply to an owner of property who ALTER-DRAIN&VFM-WATER(EA) Wilda or Improves Merron,and who contra for such pPjecro with a c%tietota)Bared Funniest to theCantretai License Law. FEE SUMMARY LJ I am exempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE OUTS3 QF FE-ES OwnerDRAINS FLOOR ROOF,AREA,OOND. SANITARY Y N Date _ WORKMANRECE1PT0 ARCOMPENSATION DECLATION p()(.(UgES PER TRAP SCHOOLTA% Y N Lam,I hereby a{Brm that I have a I...... ..to of consent to smbinseco ora RECEB'r N a0,LabC(Worken'Compematlan lruurana ora rerti(led mpythereo((Sec. GAS FA.SYSIFM-I INCA OUIT.EIS PARK FEE Y N .Hey b i1�Ur8n�.�—/ RECEIPT Poll Y Com any ihs_lira tee_ GAS FA.SYSTEM-OVER4(EA) BUILDING DIVISION FEES Cartinedcopy le herebythMshed. CertifiedGREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE copy k(fled with the my inspection division. CERTIDCATE OF EXEMPTION FROM WORKERS' GREASE TRAP .PAID COMPENSATIONINSURANCESEWER-SANITARY-STORM BA 200PT Date Revel t# (Teel..) need est Wcompleted BIM permit Marone Mundr ddollar (f10Worlm.) WATER!{EATER W/VENT/RLECTR v� ENERGYFEE Y N Iartity that M the perfor ance of the work for which this permit is Issued, — I shall nt employ any person th any manners,asto become subject to the WATER SYSTEM/TREATING Workers'Compensation Laws o(Callfomla.Date PAID O Z Applicant Date Re si t# Z O NOTICETOAPPLICAM:It,after making this Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQFr. , H =,I,dbecome ol, to the Workers'Compensation provislons=Labor TOTAL: WN Cade,you mu at lorthwhhmmply withsuch previsions orth+s permit shall be > deemed revoked. BUILDING FIE d G CONSTRUCTION LENDING AGENCY SEISMIC FEE _ I hereby affirm that there k a comwtlon lending agency fmthe perform ELECTRIC FEE DZ arta of the work which this p°rmit Is issued(Sec.3097,Civ.C.) TOTAL; 9n� V O Iender'sName f-i PLUMBING FEE SID 0 LU Lendcrb Addreaa QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W I artBythatl have readthisapplicati eand statethattheabove information IL kcomet.l agree tocomply,with all city and county ordinances and suite laws PERMIT ISSUANCE FEE PAID- N re)at oenterupontemtmtiogandhcrebyrtyorinrepresentatives olthk F... Z cll(WO.erupontheahave-mentand keepertyforss the Cit purposes. ALTIItORADD TD MECH. IWe)agree to ave,judgments, (y and keep harmless the City of ywaya eras Dale ReCe1Pt# against llabllitin,judgrnenb,cossand expenses which may In any wayaccrue � AIR HANDLING UNIT('TO l0,W0 CFM) SUBTOTAL: a W ay in of granting t this permit. , 3^!� AIR HANDLING UNIT(OVER 10,000 CM) CONSTRUCTION TAX 94 d Signature of AppBant/Conlnter Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfuture building occupant store at handle hmrdous HEATING UNIT(10 100,000 BTU) Date RCCeI I# material as defined by the Cupertino Municipal Code,Chapter 9.13,and the Hach and Safely Code Section 35533(a)7 HEATING UNIT(OVER 100,000 BTI!) TOTAL: Yes No Will theapplicent r rebuilding occupant use equipment or devices VENTILATION FAN(SINGLE RESID) IS I/ IgE®ATE which emit haeardmi ous air contaminants as defined by the Bay Area Air ie a llty Management Dlstrit7 - BOILER-COMP QHP OR 100,000 BTU) Yes havereadthehav19uNosnuterkbrequimmnbunderChapter6.95of BOILER-COMP(OVER 100,000 BTI)) MAR 18 1992 )the California Health&Safety Code,Sections 75505,25533 and 7SS34.I understand that iflhe bulldingdoesnmmrrenByhavea tm.rt'thetBbmy NEW RESIDENTIAL MECH. SQFr rnpomibWty,to na By the occupant of the requirementewhlch=at be met CITY OF CUrerli+isa+ ' rtoissuanm ofa rtifl eo Occupancy. neror authod>ed ager Data ISSUED BY dG TOTAL: OFFICE COPY