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20092 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Pro en Identification PERMIT N20092 ' Bulkling Addre>�X.- V u 6-37 2 ter amc: one: R. tj CITY OF CUPERTINO-BUILDING DIVISION ' t Co91..aora wme �1 sees APPLICATION I PERMIT L1 --Lt--q0--Lt--q0R.QO NN ���� BUILDING-ELFOTRICALPLUMBINC-MECHANICAL CATEGORY Arch nM/ err. .• Llc No: •" BUILDING PERMIT INFO p QTY ELECTRICPERMIT FEE Add— C. O PERMITISSUANCE _p11 Z fSYI LICENSED CONTRACTOR'S DECLA ON Thereby affbm that l am licensed under provbioesof hapter9(commen APPLIAPIC6RESIDENfIAL JOB DESCRIPTION ingwith Sectlon7000)Of Dlvision3ofthe Busineuand fessiomCode,andm 11¢nse b In!uB m d dfM. �^ fl PANELS 1••� License V Lk.X sa 6 / Date Cr W l�f ARCHITECHITECTS DECLARATION OVER l5 AwDVO Iundentnd my ptuehalbe used An public records OVERT SQ.FT.FLOOR AREA 5/91.FT. Z Licensed Professional SIGNS 1/1,QW J s _ r,tt� OWNERexNLDER DECLARATION 57af0 �I. �x-t./ yH^i xj IherebyafBrmthatlam exempt Contractors License Law forth. Eppppp following reason.(Section 7031.5,Business and Profession.Code:Any city or F s" counnywhlci requima permit tommtruct,alter,improve,demolish,oreepair TFMP.METFR ORPOLE IN anystructure prlorto its Issuance,also requireslheappliantfor such permit to i /���� �� I POWER DIYdRC rEr � Rk a signed statement that he t licensed pursuant to the provisions of the � HiO w Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- •I _ VALUATION Q� 05 elon3 of the Bueineuand Pro(eubv Cade)arthan hetexempt therefromand SWNIMING POOL ELECTRIC -- the boat for the alleged exemption. Any violation of Section 70315 by any OUTLETSSWITCIiFSEIXTURES S C� papplicant for a permit subj is the applicant to a civil penalty of not more than _` Five hundred dollars(y500). SQ}T, —2-D b-TIjH(tS TYPECONSTRUCTION M I,as owner of the property,or my employees with wage,u their sale NEW RESIDENTIAL ELFOTR s OZ mmpensation,wOldothe.k,.ndthestmmmret otttendedor offeredfor Y A , C q In(Sec.7014,Buauxes sod Professioru Code:The Cont.d.e.Li¢.Law ,Y d-$ does not apply to an owner of property,who Wilds or Improve&thereon,and �.• nsuch OCC.GROUP RES.UNITS who am nothimselfdid oroughed for own..If,ho evert the building ilding orhat each 3 ' Improvement am not lntendneyear fc=ple sale.If, deer ldingw TOTAL: _ �( Improvement tsoW wlthlnoneyearofcompletion,lheowner-bulWerw111Mve 1 Nen of proving that he did nor Wlldorimprove fwpurposeofszle.). QTY. PLUMBING PERMIT FEE FLCODZONE APN u L as owner of the property,am exclusively centrading with licensed PERMIT ISSUANCE contreciges to co atmet the pmjdt(Sec 7014,Businessami Professlam Code: B O The Contme or's License Law does not apply to an owner of property,who ALTER-DRAIN&VENT-WA1IIt(Esq Wilds or Improves thereon,and who contracts for such p(ojeta with a FEE SUMMARY m0(ryctorts)B¢nsed pursuant to the Contracors License Law. BACK FLOW PROTECT.DEVICE LI I am exempt under See. B&P C for this reason OUTSIDFYEES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N Owner Date RECEIPT N WORKMAN COMPENSATION DECLARATION F.�S�.�P SCHOOL TAX Y_ N_ �1 hereby affirm Nat 1 have•certiRate of consent Ig seI-Insure,ora RECEIPT'X Moo.,ateofWorkdm''Compe�lvAatlonlnsurana wpa certified copythenro((&c. GAS EA.SYSTFM-t INCAOUTLETS PARK FEE Y N 3800,lab C.) RECEIPT X Policy X GAS F.A.SYSTEM-OVER 4(EA) Com an BUILDING DI VISION FF.ES CCertified copy t filed th the city d. GREASE/INDUSML WASTE INTERCEPTOR PLANCHECK FEE Certified copy t filed with the city lupectlon division. CERTIFICATE OF EXEMPTION FROM WORKERS' GRF'ASETRAP PAID L+-4-9t) COMPENSATION INSURANCE SEWER.SAMTARY-STORM EA 200FT Date Recet t# 7"Fa (This section need not be completed 9the permit b for one hundred dollars (StoB)orlen.) WATER HEATER W/VFNT/ELECTR ENERGY FEE Y N I¢rtlfy than lo the performance of the work for which this permit i.issued, I shall not employ any person in any manner an as to become subject to the WATER gY� /1RGTING ��a��� Workers'Compensetlon Law.of California.Date PAID 44-1`O O Z Applicant NEW RESIDENTIAL PLMB.IIA' SQ.F7. 6b, Date Recei I#�G�(.� Z O NOTICE TO esubleAM:IL fter orkersk ng om a sationCertifpro is Exemption,the F shouldde,you me eubFci to the Workers with such pruatlon provisions permit s Labbe TOTAL: ss-•�� N Coda you must forthwith comply wlnh such provi.lou ortht permit shall be BUILDING �rw W deemedrevoked. CONSTRUCTION LENDING AGENCY SEISMIC PEE CL c I hereby affirm that there t a construction lending agency for the perform TOTAL: `� ELECTRIC FEE �j11 7 Z .nwoftheworkmrw chtbtpermi tbsued 7 C C.) l05p 02 I.endee.Name uA.laP"Y.�� ti/e PLUMBING FEE ,2P H Landers Addm, _� q1v. MECHANICAL PERMIT FEE LL MECHANICAL FEE O W Treed.I Agrees c malteed is with aBaty and county statethat ordinances and tion fl tcmlatingt building comply Wnh alld hereby atee representatives and stofthis PERMIT ISSUANCE I�-I) FEES PAID. } city to enter buildirupont mmhe owe lmc,anddprop property oriurepresentativu of this HN cityto to save, an propertyfor Wpe Cit purposes. ALTER OR ADD IOMECH. ? (We)agree to save,IndemNty and keep harmiess the City o(CuPenton ' Date Recei t# V against labllltk.,Judgment,cost.and expenses which may in any way accrue AIR HANDLING UNIT(TO 10,ODO CFM) SUBTOTAL' Z aga Wt said City In consequence of the grant ing of this permit. AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX X Sig...of Apphant/C.eir.der Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX HAIR R DOUS MATERIALS DISCLOSURE Will the applicant or futu re building occupant store or handle hazardous HEATING UNIT(TO 100,010 BT U) Date Recei t# material a,defined by the Cupertlso Murdcipal Code,Chapter 9.12,and the Health and Safety Cade Section 25532(x)7 HEATING UNIT(OVER 100,00)BTU) TOTAL: , n Yes , N No ill the applicant mfuture Wilding onvpan,use equipment or device. VENTILATION FAN(SINGLE RESID) ISSUANCE DA �rTz.7(j which emit hazardous air contaminant.as defined by the Bay Area Air ality,hUwgcmum DDied7 BOILER-COMP(311POR 100,000 BTU) Yes No vemadlhehaza ousmalerfa IrementsunderChapler6.95of BOILER.COMP(OVER 100,000BTU) P� the California Health&Safety Code, lora 25505,ZSS33 and 2SS34. I undenn that lfthe Wilding currently have a tenant,that it t my NEW RESIDENTIAL MECH. a SQ.IT. lea Ilty to notify Ne q. � the requimmen(swhkh must be mM I/• q pri u lz of rtII cy. Owne grass f.d agent U Data TOTAL: LL..l ISSUED BY: OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Pro en Identification PERMIT N20092 ' Bulkling Addre>�X.- V u 6-37 2 ter amc: one: R. tj CITY OF CUPERTINO-BUILDING DIVISION ' t Co91..aora wme �1 sees APPLICATION I PERMIT L1 --Lt--q0--Lt--q0R.QO NN ���� BUILDING-ELFOTRICALPLUMBINC-MECHANICAL CATEGORY Arch nM/ err. .• Llc No: •" BUILDING PERMIT INFO p QTY ELECTRICPERMIT FEE Add— C. O PERMITISSUANCE _p11 Z fSYI LICENSED CONTRACTOR'S DECLA ON Thereby affbm that l am licensed under provbioesof hapter9(commen APPLIAPIC6RESIDENfIAL JOB DESCRIPTION ingwith Sectlon7000)Of Dlvision3ofthe Busineuand fessiomCode,andm 11¢nse b In!uB m d dfM. �^ fl PANELS 1••� License V Lk.X sa 6 / Date Cr W l�f ARCHITECHITECTS DECLARATION OVER l5 AwDVO Iundentnd my ptuehalbe used An public records OVERT SQ.FT.FLOOR AREA 5/91.FT. Z Licensed Professional SIGNS 1/1,QW J s _ r,tt� OWNERexNLDER DECLARATION 57af0 �I. �x-t./ yH^i xj IherebyafBrmthatlam exempt Contractors License Law forth. Eppppp following reason.(Section 7031.5,Business and Profession.Code:Any city or F s" counnywhlci requima permit tommtruct,alter,improve,demolish,oreepair TFMP.METFR ORPOLE IN anystructure prlorto its Issuance,also requireslheappliantfor such permit to i /���� �� I POWER DIYdRC rEr � Rk a signed statement that he t licensed pursuant to the provisions of the � HiO w Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- •I _ VALUATION Q� 05 elon3 of the Bueineuand Pro(eubv Cade)arthan hetexempt therefromand SWNIMING POOL ELECTRIC -- the boat for the alleged exemption. Any violation of Section 70315 by any OUTLETSSWITCIiFSEIXTURES S C� papplicant for a permit subj is the applicant to a civil penalty of not more than _` Five hundred dollars(y500). SQ}T, —2-D b-TIjH(tS TYPECONSTRUCTION M I,as owner of the property,or my employees with wage,u their sale NEW RESIDENTIAL ELFOTR s OZ mmpensation,wOldothe.k,.ndthestmmmret otttendedor offeredfor Y A , C q In(Sec.7014,Buauxes sod Professioru Code:The Cont.d.e.Li¢.Law ,Y d-$ does not apply to an owner of property,who Wilds or Improve&thereon,and �.• nsuch OCC.GROUP RES.UNITS who am nothimselfdid oroughed for own..If,ho evert the building ilding orhat each 3 ' Improvement am not lntendneyear fc=ple sale.If, deer ldingw TOTAL: _ �( Improvement tsoW wlthlnoneyearofcompletion,lheowner-bulWerw111Mve 1 Nen of proving that he did nor Wlldorimprove fwpurposeofszle.). QTY. PLUMBING PERMIT FEE FLCODZONE APN u L as owner of the property,am exclusively centrading with licensed PERMIT ISSUANCE contreciges to co atmet the pmjdt(Sec 7014,Businessami Professlam Code: B O The Contme or's License Law does not apply to an owner of property,who ALTER-DRAIN&VENT-WA1IIt(Esq Wilds or Improves thereon,and who contracts for such p(ojeta with a FEE SUMMARY m0(ryctorts)B¢nsed pursuant to the Contracors License Law. BACK FLOW PROTECT.DEVICE LI I am exempt under See. B&P C for this reason OUTSIDFYEES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N Owner Date RECEIPT N WORKMAN COMPENSATION DECLARATION F.�S�.�P SCHOOL TAX Y_ N_ �1 hereby affirm Nat 1 have•certiRate of consent Ig seI-Insure,ora RECEIPT'X Moo.,ateofWorkdm''Compe�lvAatlonlnsurana wpa certified copythenro((&c. GAS EA.SYSTFM-t INCAOUTLETS PARK FEE Y N 3800,lab C.) RECEIPT X Policy X GAS F.A.SYSTEM-OVER 4(EA) Com an BUILDING DI VISION FF.ES CCertified copy t filed th the city d. GREASE/INDUSML WASTE INTERCEPTOR PLANCHECK FEE Certified copy t filed with the city lupectlon division. CERTIFICATE OF EXEMPTION FROM WORKERS' GRF'ASETRAP PAID L+-4-9t) COMPENSATION INSURANCE SEWER.SAMTARY-STORM EA 200FT Date Recet t# 7"Fa (This section need not be completed 9the permit b for one hundred dollars (StoB)orlen.) WATER HEATER W/VFNT/ELECTR ENERGY FEE Y N I¢rtlfy than lo the performance of the work for which this permit i.issued, I shall not employ any person in any manner an as to become subject to the WATER gY� /1RGTING ��a��� Workers'Compensetlon Law.of California.Date PAID 44-1`O O Z Applicant NEW RESIDENTIAL PLMB.IIA' SQ.F7. 6b, Date Recei I#�G�(.� Z O NOTICE TO esubleAM:IL fter orkersk ng om a sationCertifpro is Exemption,the F shouldde,you me eubFci to the Workers with such pruatlon provisions permit s Labbe TOTAL: ss-•�� N Coda you must forthwith comply wlnh such provi.lou ortht permit shall be BUILDING �rw W deemedrevoked. CONSTRUCTION LENDING AGENCY SEISMIC PEE CL c I hereby affirm that there t a construction lending agency for the perform TOTAL: `� ELECTRIC FEE �j11 7 Z .nwoftheworkmrw chtbtpermi tbsued 7 C C.) l05p 02 I.endee.Name uA.laP"Y.�� ti/e PLUMBING FEE ,2P H Landers Addm, _� q1v. MECHANICAL PERMIT FEE LL MECHANICAL FEE O W Treed.I Agrees c malteed is with aBaty and county statethat ordinances and tion fl tcmlatingt building comply Wnh alld hereby atee representatives and stofthis PERMIT ISSUANCE I�-I) FEES PAID. } city to enter buildirupont mmhe owe lmc,anddprop property oriurepresentativu of this HN cityto to save, an propertyfor Wpe Cit purposes. ALTER OR ADD IOMECH. ? (We)agree to save,IndemNty and keep harmiess the City o(CuPenton ' Date Recei t# V against labllltk.,Judgment,cost.and expenses which may in any way accrue AIR HANDLING UNIT(TO 10,ODO CFM) SUBTOTAL' Z aga Wt said City In consequence of the grant ing of this permit. AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX X Sig...of Apphant/C.eir.der Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX HAIR R DOUS MATERIALS DISCLOSURE Will the applicant or futu re building occupant store or handle hazardous HEATING UNIT(TO 100,010 BT U) Date Recei t# material a,defined by the Cupertlso Murdcipal Code,Chapter 9.12,and the Health and Safety Cade Section 25532(x)7 HEATING UNIT(OVER 100,00)BTU) TOTAL: , n Yes , N No ill the applicant mfuture Wilding onvpan,use equipment or device. VENTILATION FAN(SINGLE RESID) ISSUANCE DA �rTz.7(j which emit hazardous air contaminant.as defined by the Bay Area Air ality,hUwgcmum DDied7 BOILER-COMP(311POR 100,000 BTU) Yes No vemadlhehaza ousmalerfa IrementsunderChapler6.95of BOILER.COMP(OVER 100,000BTU) P� the California Health&Safety Code, lora 25505,ZSS33 and 2SS34. I undenn that lfthe Wilding currently have a tenant,that it t my NEW RESIDENTIAL MECH. a SQ.IT. lea Ilty to notify Ne q. � the requimmen(swhkh must be mM I/• q pri u lz of rtII cy. Owne grass f.d agent U Data TOTAL: LL..l ISSUED BY: OFFICE COPY