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20249 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMITNO. Building Address: /l 2449 n O n A n l/ _ G hers one:jo - CITY OF CUPERTINO-BUILDING DIVISION Contracts{a Na Lk.No: APPLICATION /PERMIT G BUILDINGELECTRICAI.PLUMBING-MECHAMCAL CATEGORY CONTROL M Arch„ect gineer. Lk.Na ELL Qtr ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: - 0409A PERMITISSUANCE ❑. ❑ ❑ LICENSED CONTRACTOR'S DECLARATION Iherebyaffimnthat lamllcensed under provislonssr Chapter9(commene APPLIANCFSRESIDEMTAL JOB DESCRIPTION ingwith Sedton7W0)of Divieon3ofthe Buslm"UdProfeaslonsCode,and my It bin fail( anddfect. PANELS C /nin G� Lkenae�Ja Ck.N_ C�Z-Z�9 A/F.'rJ Date T Contractor UP TO 200 AMPS 201 IODDAMPS ARCHITECTS DECLARATION mO pO I understand my pleia.hail be used u public records. OVER 10(10 AMPS SQ.FT.FLOOR AREA $/�.FT. k c(� Licensed Professlorul SIGNS ELECTRICAL <�6 OWNER-BUILDER DECLARATION S)+p-CIpL CIl2CUIT/M1SC 2 p�4 I herebyaffirmt)at l am esempt from the C.ntactoh Ll¢nx Lw f¢the (.Bowing reason.(Seel(..70315,Business and Prefenians Code:My city or O TEMP.METEt OR POLE .INS FE sountywhirh raquBesa pemdttowrotros;alcer,lmprove,demolbh,orrepair a enyeuveture prl¢celas lesuawe,also rcyubealheappBaant(¢auch perMtm POWER DEVICES (E4 it ..Ifined statement that he Is licensed pursuant to the proWbn of the X3µ3. Contmeto{e License Low(Chapter 9(commencing with Section 7000)of DWI- swmh� FOOL C WW�OJ god 3 ofthe Buslnessand Pro(reeloes CodOmthat he Bexempt the¢fromVALUATIONand . < the basis for the alleged exemption. Any violation.f Section 7031.5 by any / applicant fora permit subjects the applicant to a civil perky.(not nnre than VILE IC14FIXTURES �IQ� CRa five hundred dollars(5500). kX W AL EL Z I,as owner of the property,or rey employees with wages as lheB sole SQ'FT' STORIES( TYPECONSTRUCTION K16 compensation,will dothework andthe structure Is not intended or feredfor F O sale(Sec.7066,Business and ProfeasWna Code:The Contrast.{s Ll Law �$ does not apply to an owner of property who builds or improves ther@oqry and ^ whod.eeauchworkhlmael(orthr ghhisownemploye ,provldedtlufsuch OCC.GROUT' RFS.UNITS improvements are not Intended proffered for sale.IL however,thebulldlpg¢ TOTAL: ImpmvementBwldwithinoneyearofcompidloMtheowner-bulderwill)i v th,q.tfardlen of proving that he did not build or bnproveforpurposeofsak.) PWM91NG PERMIT FEE FLOODZONE APN LJ L as owner of the property,am exclusively contacting with ll¢'need P CE contractors to ronrtruct the project(Sec.7016,Busmen and I'mfeaioro Code: The Contact.{a Lkenas Law does not apply to an owner of property, AL D N A VENT-WA (EA) Wilds or Improves thmern,and who contrasts for such Iun)ests wit FEE SUMMARY CE"tilensaW licensed pursuant to the Contractor's License Law. BACK PLOW PROTEC CE LJ I am exempt under Sec. B k P C for this reason OUTSIDE FEES Owner Data DRAINS FLOOR,R P, COND. SANITARY Y_ N_ WORKMAN COMPENSATION DECLARATION a ❑I hereby affirm that I hive a certificate of c...or to self-Insure,or a FIXNRP.6 SCHOOL TAX Y N ¢.Nene of Workera'Comperuatlon Insurance sracertlfied copy theme,f e'.. RECEIPT N 3800,Lab C.) GAS EA. 4 1 INCA OUTLETS PARK FEE Y_ N_ RECEIPT 11 a GAS G. -0VER6(EA) CoCom any BUILDING DIVISION FEES Certified copy I,hod with the cityed. CREASE/MDUSTRL WASTE INTERCEPTOR PLANCHECKFEE �Certifled copyb(0ed with the city inspection divlaion. - CERTIFICATE OF EXEMPTION FROM WORKERS GRFASETRAP PAID COMPENSATION INSURANCE SEWER-SANUARY-STORM EA.20GIT. Date Recei t# (Thies t.nneednaebecompleted ifthepermitb!worsehundreddo)lars (5100)¢Iy WATER HEATER W/VENT/E.ECTR ENERGY FEE Y_ N_ I eerily that le the performance of ahew¢k(orwhich this penult b Issued, I shall not employ any person In any manner as as ' me subject to the WATER SYSTEM/TREATING Work.rs'Com sown..Laws lfomia.Dat - PAID O Applicant Date Rece'1 t# Z 0 NOTICE T: after dug a Certificate of Exemption,you W RESIDENTIAL PLMB. SQ.Ff. ehouldbrom subj"<cl to[he Wa ra'Comperoatlon prolsi.ra of the Labor TOTAL: N Code,you=at forthwith comply with such provisions orthls permit shall be W j deemed revoked. CL CONSTRUCTION LENDING AGENCY SEISMIC FEE aST I hercbyafflrmthat there iso conatruedon lending agency for the perform TOTAL ELECTRIC FEE D Z once of the work(or which this permit b issiud(Sec.3097,C1v.C.) U O, Lendsea Name PLUMBING FEE LL H Lenders Addren QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W omet.Itagreet complemad „bappBatynandatatyordinanus ndgat saws 1 lewrmst lagrceto comptywo ,alnd hereby uthortxrepr¢eaed gate laws PERMIT ISSUANCE FEES PAID: r W cityrelat ng to oenteru pang construction, reby property orlIn represenpurpoa of this cit Wentero n theabodemnify and (dean Ion ALTER OR ADD TO MECH. ~ ? y(We)agree 1 ave,Indemnity an d keep h mien the iryo Cupertino - Date Receipt# U agaimt liabWt4ro,Ocigments,coed and expenseawhlch may In anywayamue AIR HANDLING(IMT CTO 10,000 CFM) SUBTOTAL: all _ agx lout said City in wnaequen¢of the granting of this permit. e AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX CONSTRUCTION TAX PAID: g r�( pp HAZARDOUS Date IXE3AUST HOOD(W/DUCT) HATARDOUS MATERIALS DISCLOSURE Will the applicant orthe future building occupant Code, hapten le 91Zanrdthe HEATING UNIT CM 100,000 BI1J) Date Recei f# material as Safety by the Cupertino Municipal Code,Chapter9.1�,and the Health soul Safety Cad.Section 25537(m)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: 172,EV qyes M No lllthe applicant tum conte building part use eq.the Bay Area Ai vlccs VENTILATION PAN(SINGLE MID) ara whkheManagement aurid? vents as defined by the Bay Area Air ((+ Lj Quality Management D'aMctt BOILER-COMP OHP OR 100,000 BTU) ❑Yea ❑N. q MAY Q a 1990 I have mad the haaarcloua materialarc ulrerrcnb under Chapter of BOILER-COMP 100,000 BTU) the California Health A Safety Code,Sectlon 75505,25533 and 25534.1 understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.PT resto notify the occupant of the requirements which resat be met City of of I�II�3QIU..y4'� no prior to Issuance of a Certificate of Occupancy. Owner or authsdred agent Date TOTAL: ISSUED BY:_y'_���.Q OFFICE COPY