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24246 Mrrl_It JAIV I I U rlLLM IrvrUHMATION WITHIN RED LINES — USE BALL POINT PEN ONLY �^� JBBuiilldin Pr/^o'sectrat Identification LEE rr - - PERMIT NQs 4 2 4 6 Bv1110 g Id66 V..T- AVL 1--.G.0 vers ams: , _ �,` /� —I ane: ii X700 1h'VN�fQ, q'T3.OII-�.1CITY OF CUPERTINO-BUILOING DIVISION q� • Cantraccpr'sNamer1A,11 Y71Gn}y,{���^x LIC No: APPLICATION / PERMIT T E )'1V •N 61 BUTLDINCELFCnUCAUPLUMBING-MFCHANICAL CATEGORY CONTROL# Architect/Engineer. LIC N. .t-��� 'QTY ELECTRIC PERMIT FEE BUILDING,PERMIT INFO Address,1i2 �., 5 SIG c-r I,(NNyo PERMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION - Iherebyaffirm that l ao licensed under provisionso(Chapterg(ournmenc, APPLIANCESRESIDENHAL J DFSCRBrHOii ingwlthSe ton7000)of DWision3ofthe Businuaand Pm(estlansCode,and my limn.lsln ores deffect PANELS 1 \�-� Llecnae C ICN - 1 Date Cantnctor ) ARCHITECPSDECWRATION 201-1 ODO AMPS - `� q0ag 7. I understand my plane shbe used as public records. OVER1000AMPS SQ.FT.FLOOR AREA $/SQ.FT. k� Licensed PMemionalts'^ssaI.-a 1'-vy�'�I(� SIGNS ELECTRICAL �. © 1W t., DECLARATION V Spp�L{LCIRCU[T/MISC zti � Thereby.(Rmthelamexempt fromthe Contractor'e License Gw(m the T C Q o following mum.(Smtion 70115,Bushes and Profenlons Code:Ancityr f G 1 OZFa� y ° TEMP.METER OR POLE INST. cauntywhlmpr Arena pis ame,a vrequi lter,lmpmve,demolhh,erepair to a any atmclurctatemeitchat he Is alearend purehe ttothe provisions, of to POWER DEVICES /a.NSC� fS 0 F rite a signed statement that he b Iloeneed pursuant to the provlabm of the / 3w1. Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC - VALUATION BOJ alon3ofthe Busk amdProfemlam Code)orthathebeumptlherefmmand ••777 the basis far the alleged exemption. Any Nolatlon of Sectbn 70315 by any 6X applicant for a permit subjeatatheapplicanttoa civil penalty of not more than OUTLETSSWITCHESFIKIURES five hundred dollen($500. NEW RESIDENTIAL ELECTR �n F1 1,as owner of the property,or my employees with man as their sok ` Ff. STORIES TYPE CONSTRUCTION C compensation,will do the work,and the structure,is am intended or offered for 'S O sale(Sec.70K Business and Produced..Cade:The Contnaofa Limnee law $ dins nm apply to an owner of property who builds or Improves thereon,and TSC.GROUP RES.UNITS who does such work himself or through his own employees,provided that such Improvements an not intended oroffered for able.If,however,the building or TOTAL: improvementiawldwithinomycarofcampldioo,theowner- ilderwillluve tliLtprden of proving that he did not build or Improve for purpose ofsakJ. QTY, PLUMBING PERMIT FEE FLOOD ZONE APN u I,as owner of the property,am exclusively contracting with llmneed PERMIT ISNANCE mntnctms to ca.Hud the project(Ser.70K Business and Produces.Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAW kVENT-WATER(EA)Wild.or improves themon,and who mntram for such pwjests with a y1T+clor(s)Iloensed pursuant to the ContradMs License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. B Is P C for thin mason DRAINS FLOOR ROOF,AREA,COND. - SANITARY Y N Owner Date - Q' ( RECEIPT KM WORAN COMPENSATION DECLARATION 1 pIX�JRps PER TRAP 6[ 00 SCHOOLTAX Y N ❑I hereby affirm mcate na that I have a rtlBof caent m rc xl(-Inau ,ora els RFGFdrT A' cartl(Icate of Worken'ComperwHonluunnm ars certified mpytheteaf(Sec. GAS.F.A.SYSITIA-1 INC.60UTLETS PARKFEE Y N cc �• / L BBC=# PmI x` l0 Co������ca++++++env GAS B.A.SYSTEM-OVER 6(EA) BUILDING DIVISION FEES �CertiOed coPy Exh.. furnished. GREASE/WDUSTRL WASTE INTERCEPTOR PLANCHECK FEE CertWed copy is filed with the city inspection division.— i 111 q2 CREASE TRAP PAID CERTIFICATEMOP SATION IN FROM WORKERS' COMPENSATION INSURANCE SEWER-SANITARY—STORM FA 200FT Date Recei t# • IThbwctbn need rad be completed if the pemNt b(ororle hundred dollen ($100)or len. - WATER HEATER W/VENT/MFGTR ENERGYFEE 'Y N I mrtifythat in the performance of thewmk for which this permit is baled, I shall not employ any person In any manner w as to became subject to the WATER SYSTEM/TREATINGWorken'Compeneatlon lawn of Glifomla. PAID OSYSTEM/ TREATING Z Applicant NEW RESIDENTIAL PIMB._SQFI'. Date , Repel t# Z Q NOTICETO APPLICANT:If,after making this Certificate of Exemption,you Fshould became subject to the Workers'Comperesation provisions ofthe Labor QQGIAGE LVft� TOTAL: N Code,you moat forthwith comply with such provisoes orthb permit shall be C B D G eeme _ dd invoked. - W G . mCONSTRUCTIONIsaLENDINO AGENCY p(p� R F�ep,M SEISMIC FEED. IhercbyafRrthatthemem bamutmdlon kndingagency for the periomm TOTAL: B .O ELECTRIC FEE M Z ancaer'sNwork(orwhkhlhkpermBlakwed(Sec.3097,Civ,CJ NE'T2=2 UNI. LL O Leader'sAddr PLUMBING FEE _O LL H Leader'sAddress QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W, Icertt.Iagree aveto comply madtmply with allcitiananddc unty ordinances rdi aabovedgat ation —lam (L bmingtobgreetocomplywith ailcity and auhoricenanmaand gate lam PERMIT ISSUANCE FEES PAID: >. N reytoenobupont mm0udloryioned and reby property yorinrcprcsenpurpos ofthis ' f Z cityWenteree to ave,he inverandly an propertyml Inspection purposes. ALTER OR ADD TO MECH. Date Receipt against agree m rave,kdemNtts and keep harmless;the City of ammo agaWtllsbNtles,judgments,costs and expeneeswAlch may In anyway emue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL• against said City in consequence of the granting m this permit C QR' N)Ck CAAk4CU q�l$�92 OR HANDL NG UNIT OVER 10,000 CFM) CONSTRUCTION TAX Signature of Applicant/Contractor Data E)KHAUST HOOD CW/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE ' Will the applicant orfutum building occupant store or handle hazardous HEATING UNIT CM 100,Wo BTU) Date Reeei t# material ae de(Ined by the Cupertino Munldpal Code,Chapter 9.12,and the Health and Safety Codrer++--S�ection 75532(x)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: ❑Yes RJ No - , Wlllthe applicant or(fuumre building rampant use equipmentmdevicu VENTILATION FAN(SINGLE RESIDE ISSUANCE DATE - whichmahhavrdousabcontamlruntsasdeBnedbytheBayAreaAir A Quality Management District? BOILER-COMP DHP OR 100,000 BTU) A ' D Yes �®No have and the haat/us materials mquhernams under Chapter 6.95 of BOILER-COMP(OVER 100,000 BN) the Glifemla Health A Safety Cade,Sed lam 25505,25533 and 75536.I SEP 1 Op understand that it the building does not currently have a tenant,that It b my NEW RESIDENTIAL MECIL SQFT �71 respouibility to notify the occupant of the requirements which moat be mm prior tolnuanmmaCertificate ofOcmpanry. &MQ� N)O� �.��;6rize9 -TOTAL: CITY )f WWT`CfTHIVU ali�laZ Owner or authorized agent Date ISSUED BY: OFFICE COPY