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19927OZ Z0 H y i WD CL �o OF LL Ow F N Z U— C__ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Idemlicatlon ���a (,I-F,al{ '�"q Building Ad� a .5.Q �6 �L �� GV 11ry 0 VA14 / ,' �T t�15)�4� PERMIT NO. 62_3. 19927 mars ansa: - hone:MUM C_^bALLL J-t1NNA CJ/Ad CITY OF CUPERTINO-BUILDING DIVISION APPLICATION I PERMIT 3 21 O cmntrsdor'. Name:sae Neo BUILDINGELECTRICAL-PLUMBINC-MECHANICAL CATEGORY CONTROL Y�Ji� =J // Arohltect n nee Llc. No: QTY ELECFRICPERMIT FEE BUILDING PERMIT INFO Address:AjAtjO � PE6,9TISSUANCE LICENSED CONTRACTOR'S DEC TION Ihereby afftrm that l am licensed under promkionsof Chapter9(conunenc' Ing with Section 71)(0) of Division 3 ofthe Business and ProfessionsCode, and my license is In tali faro and effect. Cbss LIeY APPUANCESRESIDENfIAL JOB DESCRIPTION, sss--- Ri•�n ��Cn ^ •�Pw%� PANELS ' Dense Dale Contractor 201-1000 AMP"' ARCHITECTS DECLARATION I understand my pH ..hall be used as public records. OVERIODOAMPS SQ. Fr. FLOOR AREA .$/SQ. Fr. SIGNS ELECTRICAL Licensed Professional Q SPECIAL CIRCUIT/MISC DECIARATION to I hmebyaf mnthat I am exempt from Ue Contractor's License Law fa the TEMP. METER OR POLE INST. following mason. (Section 7031S, Business and Professions Code: Any city or countywhich requires a permitwmmtrud, alter, improve, demolbh,orrepalr any stwoom prior to its issuance, also requires the applicant fee such permit to file a signed statement that he is licensed pursuant to the provisions of the POWER DEIq CPA SWIMNUNG L E 0O�'E � 1 W Contrad.e. License Law (Chepter9(mmmench,S with Section 7000) of Divi- sian3 ofthe Rusinm and Pmfmbm Code)orthat he b exempt therefmmand the breis forthe aIle exem Ion. An violation of Section 7031.5 an appllant for a permit subjects, the applicant to a civil penslty of nos morcthan e dred dollus (5500). v I, as mer of the property, or my employees with wages as their sole m sation,willdothework;andtheatmmmisr ct Intended or offered forM le (Sec. 7096, Buainsss eM Profmtom Code: The Contrector's Llama Law VALUATION 1 O� -; �Ot -J NEW READ AL SQ.Fr. STORIES s�0 `••aa TYPE CONSTRUCTION [•' f" 11 does not apply loan owearofproperty who bulld.mimprovm thereoryand who doessuchwork himselforthrough hbownemployees, provided thatsuch Improvementsarenotintendedoroffemdfaaale. ILhowever,thebulldingaTOTAL: N 1 rhij OCC.GROUIs RES. UNITS improvement issold withinoneyearofcamplelorytheawner-buRderwgI have t"rden of proving that he did net bu0d or improve for purpose ofsale.). Lj L as owner of the property, am exclusively contracting with licensed rontracton to ronslmct the projM (Sec 7014, Bualnm and Professions Code: The Contractor's License Gw doss rad apply loan owner of propertywho Wilds or Improves thereon, and who contracts for such pRojecta with • cgWractor(.) licensed pursuant to the Contractor's License Law.. LJ I am exempt under Bee B & P C for this reason QTY. I PL IN ERMIT FEE 'FLOOD ZONE APN LTJ P LSSD CE /e1 xco 1 �s I - WA O.a FEE SUMMARY BA .D EW DRAINS RA SANITARY Y_ N_ RECEIPT Y Owner Date WORKMAN COMPENSATION DECLARATION ❑1 hereby affirm that I have a certifiale of consent to self -insure, oraTFAP certificate ofWorlha Compansadrs onlmunce or a certified copythereot(Sec, 38W,Lab C.I C is SCI100L TAX Y_ N_ RECEfPTY GAS EA. SYSTEM -1 4 U3LE15 Z� PARK FEE Y N_ ftE EP'T Y Cc Cc Com any - GAS EA. SYSTPA4-OVER (EA) BUILDING DIVISION FEES copy is hereby furnished. ❑ Certified ropy Is filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thi..acin ioneed nos be complded if the permit V m forahundred dollars GREASE/WDUS[RL WA INTERCEPTOR PLANCHECK FEE - ' f. `.- ` !M lam^4'f PAID�^'a•Vw J�'y Date Receipt OJ GREASE TRAP SEWER -SANITARY -STORM EA. 2l10P1. WATER HEATER W/VENT/ELECTR 2� ENERGY FEE Y N_ PAID 1�1 6�. .•s �s Date Recel t# 1 I sC0 ($100) or lm.) I artlfythat In the pedm oanceof thewak forwhich this pemdt is Issued, I shall net employ any person In any manner so as to become subject to the Wmkers'CompenaaHon Lawsof California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should becomes subject to the Workera Compensation provbions of the Labor WATER SYSTEM/TREATING NEW RESIDENTIAL PLMB. SQFf. TOTAL: BUILDING Code, you =at fork hwith comply with such provlsinns or this perrrdt shall be dead revoked. coNsrftucrloN LENDING ACFNcr - SEISMIC PEE'1-7 Ihembyaf km that thea b a comtmdion lcndingagency forfie perform ana of the work for which this permit is Issued (Sec. 3097, Clv. C.) lender's Name Lender'.Address I certilythatl have read thlaapplialionand statcihallheabove information is correct. I agreeto comply with allcity and county ordinances and state laws TOTAL tlz ELECTRIC FEE Q PLUMBING FEE .Q7 QTY. MECHANICAL PERMIT FEE MECHANICAL FEE 'JZ PERMITISSUANCE 2x� FEES PAID: relating tobullding construction, and hereby authorlu mpresentativesof thio dtytoenterupon the above;rdentiorad property fee lropecion purposes. (We) agree to save, N fmNfy a d keep harmim the City of Cupertino against liabilities, ptlg rats, mdse dexpan. which may In an wayacaue Date Recei t# ALTERORADDTOMECH. Z4y AIR HANDLING UNIT IO 10,000 CFM) SUBTOTAL: against said City in enao egranting olthla pe t. AIR DANDLING UNIT (OVER 10,000 CFM) CONSTRUCTION TAX gnamreot puce omrsder Date JIt EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSUR Will the applicant or futurebu0dingoavpantstore or handle havrdous material as defined by the Cupertino Municipal Cade, Chapter9.IZ and the ldealthand Safety Code Sodium 25532(a)2 ❑ Yes ,l+�, No Will the applicant cam, building occupant use equipment or devices Date Recei t# 1 HEATING UNIT (70 100.010 BTU) DadD' HEATING UNIT (OVER 100,001 BTU) TOTAL: a VENTILATION FAN (SINGLE RESID) ISSI,[®+WATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? II Ihavereadthe bar QZoueomaterials requirements under Chapter 6.95of JUN 2 v jyyJ BOILER -COMP OHP OR 100,000 BTU) BOILER -COMP (OVER 100,000 BTU) " the California Health & Safety Code, Sections 25505, 25533 and 25534. I understand that i(t bulld g does not currently have a tenant, that it B my NEW RESIDENTIAL MECH. SQ+r. responsibility to tythe pant oftherequirements is pdortoissuan ofa Ce f to ofOav Panry. ��s�4.a Yty, MYIaGY City. /a„^'��� ISSUED BY: v�� i morAra.11(oricadYgent Dat TOTAL: OFFICE COPY