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27298APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - IMF RAI I POINT PFI.) nNl V CITY OF CUPERTINO BUILDING ELEMKICAL APPLICATIONIPERMIT PLUMBING MECHANICAL BUILDING DIVISION BUILDING PROJECT IDENTIFICATION —7 PERMIT NO. 27298 BUILDING ADDRESS: - SANITARY NO, APPLICATION SUBMITTAL DATE I L 'UNIT LOT IT OWNERS NAME: PILO E: CONTRACfOR'S NAME: LIC NO: N/C CONTROL# ' ARCH TELT INE LIC NO: AD R S 2p CONTACT: PH NE: QTY, ELECTRIC PERMIT FEE BUILDING PERMIT INFO . LL EL PL MEC .Z 55- L�1 (03 PERMIT ISSUANCE �.. .LICENSED CONTRACTOR'S DECLARATION 1 hereby off thatI amlicensednisimuChapter 9 (co mmencing with APPLIANCES -RESIDENTIAL JOB DESCRIPTION Section 7W0)of Division3of the Businessss and and Professions Code, and my license is in oil j Lic nse C nd c(P 0 License Class -0— Lic.N Ill iDate Contractor IzappA rl ARCHITECTS DECLARATION 1 understand my plans shall be used as public mends. j PANELS UP T0200 AMPS 201 - IOW AMPS OVER 1000 AMPS SQ. FT. FLOOR AREA S/SQ. FT. SIGNS ELECTRICAL. Licensed Professional SPECIAL CIRCUIT/MISC. OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the TEMP. METER OR POLE INST, o following reason. (Section 7031.5, Business, and Professions Code: Any city or county which requires a permit to emarm d, alter, improve, demolish, or parody stmcart q priorto its issuance, also requires the applicant forsuch Formula rite asigned statement j that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter d 9(commencing with Section 7000) of Division 3 of she Businessind Professions Code) mth r he is exempt and the basis for the alleged exemption, An g p ylPenaan of mil than vs, anydreddomtfor apermit subjects the applicenuoacivil penalty of y not more than five hundred dollies (ESW). o ❑ 1,asowneroftheproNe y,ormyemployeeswithwagesastheirsolecompemation, will do the work, and the structure isnm intendedmitffere(S dfmselees, 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of POWER DEVICES r SWI __ ¢PDGF EL�CI'IrIC �_ VALUATION f R(Z©o ISG cJ 1.1 - DUT TS=SWITCHES AFI RFS `� L E ESIDFNTIAL ELECTR V..✓ Sy. STORIESTYPE CONSTRUMON pmpenyalmlai ldsmimproves themen,md whodoea such work himselforthmughhis wnemployees, providedthat such improvementem, not intendedmoffered forsale. If, however, the building orimprovement is sold within one yeurofcompletion, the owner, builder will have the burden of proving that he did not build or improve for purpose of sale.). _ OCC. GROUP RES. UNITS TOT ❑ I, as ownerofthe Property,amexdusively con[racsing with licensed commctnrsa QTY. PLUMBINGPERMIT FEE FLOOD ZONE APN construct the pmjcct (Seo. 7044, Business and Professions Code:) The Comraames Liciose Law does not apply in an owner ofpceperty who builds orimproves Thermo. add PERMIT ISSUANCE who contracts forsuch projects with accountants) licensecipursuadnothe Contractor's License Law. ❑ I em exempt under Sec. , B & P C for this reason ALTER - DRAIN & VENT - WATER (EA) FEE SUMMARY BACK FLOW PROTECT. DEVICE OUTSID FM SANITARY YEC Owner Date DRAINS- FLOOR, ROOF, AREA, COND. R _EIPTNN WORKMAN COMPENSATION DECLARATION '11Thereby affirm that have acertificate of consent meelf-insure, orereniflwm of Workers'Compensation lnsurnnce oracettifieJ copy [hereof (Sec. 3800, Lab CJ which cover, of covers all employee's under this pemytlicy st/� LLJ Company —�. SCHOOL TAX YN RECEIPTk FIXTURES - PER TRAP PARK FEE Y N RF.CEIPf# GAS - EA. SYSTEM -1 INC. 4OUTLETS BUILDING DIVISION FEES ❑ Certified copy is hereby famished GAg-EA.SYSTEM-OVER4 EA TEAT PLANCHECK FEE ❑ Certified copy is filed with the city inspection division. GREASMNDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASE TRAP SOILS FEE (This section need not be completed ifthe permit is for one hundred dollars(SI00) al less.) SEWER- SANITARY - STORM EA. 2001T. ENERGY FEE I certify that in the pedmmae.,af the work for which thispennit is issued, Isbell not employ any person is any manner sn as beep s b�'e?t the Workers Compensation In fC on to,.s�',�-I Applicant �l Q d WATER HEATER WNENT/ELECTR PAID Date ReceiptN WATER SYSTEWREATING after NOTICE TO APP�CANT: IL afmrm mg this Certificate of Exemption, you should become subject a the Worker's Compensation provisions of the Labor Code, you muss forthwith comply with such provisions or this permit shell be deemed revoked. NEW RESIDENTIAL PLACE. SQ. PT. AL: BUILDIa�Et�CONSTRUCTION LENDING AGENCY hereby affirm that there is a conswchon lending agency for theperformance of1.the SEISMII ELECTlender's work for which this Astatic is issue,d' (lS . 309ef- ]. Civ. C.) Name CIVPLUM lender's Addre< QTY. MECHANICAL PERMIT FEEI certify that I have read this applidurs, and state that the above information is PERMIT ISSUANCE MECHAbuilding rreet. I since to comply with all city and county ordinances and state laws relating to construction, and hereby authorim repiesentwives ofthis city a emercion theabove-mentioed property for inspection purposes, (We) agree to save, indemnify and keep hmmless the City of Cupertino against liabilities,judgmema, costs and ex uses which may in my way becrueagainstasid City in cons gaining t t it. ALTERORADDTOMECH. AIR HANDLING UNIT ITO 10,000 CPM) CONST AIR HANDLING UNIT (OVER 10,000 CEM) Sg 12 t— i to EXHAUST HOOD (W/DUCT) PAID HEATING UNIT (TO I 00,000 BTU) Date Receipt # HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handleasmateriel as defined the Cupertino Municipal Cade, Chapter r 9.12, and the Health and Safety HEATING UNIT (OVER 100,IXI0 BTU) q Code. Section 25532(e)4 ❑ Yee R<VENTILATION PAN (SINGLE RESID) Will thea tournaments as defined hazardous air contaminants as defined by the Bay Area Air Quality Management by ThenBay a Arm Ainmuality Manaes gement District? J/ M BOILER- COMP(3HP OR 100,00) BTU) ISSUAN ATE P A I! Y' P� Y BOILER - COMP(OVER 100,000 BTU) ❑ Yes G NO of the 1 have read the hazardous materials5505,25533 udder Chapter understand California Health & Safety Code, Sections 25503, 25533 and 23534. 1 undersand that A10V i 7 199 s,1 N jj d a y(r NEW RESIDENTIAL MECH. SQ. FT. if the building does not rune ave a tenant. that it is my responsibility to notify the occupant of the m,mrenm s which ss be m [ p to issuance of a Cenificea pf CITY Ur Llurrn�► J ' / ISSUED BY: Owner orOwden°r dais t Date L OFFICE