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99110106APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING - ELECTRICAL P MIT NO. BUILDING DIVISION APPLICATIONIPERMIT PLUMBING -MECHANICAL BUILDING PROJECT IDENTIFICATION CONTACT: hereby °OZ with Sation]q F in full force and License C�((aaa�,� �A� y¢L Dram Fo" H Z 4Iderst PMt4I F .y. f�a W I LiccmcJ I'rufex affirm that 1 am licensed under provisions of Chapter 9 0) o(Division 3 ofibe Business and Professions Cote, an n ❑ Consultant Fees Paid by Applicant (Initial) ELECTRIC PERMIT I FEE PERMIT ISSUANCE p Imcmr' ��j �yyyy��kka��`�Ijpppp�...� APPLIANCES—RESIDENTIAL DEC • - x �� PANELS as public recoNx UP T0200 AMPS OWNER -BUILDER DECLARATION 1 hereby affnm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Gale: Any city or county which requires o permit to construe, alter, improve, demolish, or repair any structure prior m its issuance, also requires the applicant for such Permit to file a signed statement that he is licensed pursaant to the provisions of the Commeoex License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business end Professions Cricketer ,hut he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a Is mrii mbjects the applicant o a civil Penalty of not more than five hundred dollars 15500). ❑ Las oncrarof the property, or my employees with wages as their sole compensation, will do the work, and the stmetute is not intended or offered for sale (Sec. 7044, Business and professions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such inmmvenimas we not Intended or offered Test sale. 11', however, the building or improvement is sold within one year of completion, the owner will have the burden of proving that he did not build or improve far poo pnsc If aide). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to crou met the project (Sec. 7044, Business end Professions Cede:) The Contractors Li- cense law does not apply to an owner of properly who builds or improves the on, and QTY, who contracts for such pmjecu with a contractions) licensed purmanuo the Contmeorx License law. ❑ 1 am exempt under Sec. B & P C for this mason er Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjuryone of the following dedmmions: 1 foulard will maintain a Cenlflcaro of Cnnscut on self -insure for Worker's Compete nation, .a provided for by Section Tulip of the Labor Code, for the perfommnce of the work lou which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 37fN) of the Labor Coe, for the per(nrmmce of the work for which this permit is issued. My W001.4CMIP11119m h}grypa"ier and PnlicyLVmpef nota, __._ COMPENSATION INSURANCE (Otis section need not rte completed ifthe permit is forone ha dreddollarsP IWI or less.) 1 certify thin in the performance of the work for which this permit is issued,) shall no employ any person in any manner so as m become subject m the Workcn' CompKn- O Z minim Laws of Califomia. Date 77 Aptilamn r7 y NOTICE TO APPLICANT. If, after making this Ccnlficam of Exemption, you should became subject to the Worker's Compensation provisions of the Labor Code, you most fonhwah comply with such provisions or this permit shall be deemed revoked. a Uz CONSTRUCTION LENDING AGENCY agency L) Q liar which pehal Here is. sued(m.3097,leading agency for the peRormancc of U. F' the work rte which this Permit is issue.) (sec. 3097, civ. CJ Q :.1 F aminex Name h<nderAddress G I certify that 1 have read thirty and coup and store thin the above information relating is h building I agree to comply with all city riz county ordinances and state laws relating he QTY_ (.) z building cnnarediogand hereby authnrizereprexemutives of this city to enter upon the nM1nve-mentioned property fnr inspection Purposes. (We) ogres to programers, cove. and expen and keep hay in an w City of Cnpenino agalrw i ncoi sequnceofthcosts and expenses which may in any way uccme againm snit City in APPLICANT ofthegranting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. Signature of ApplicantrContmetor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant more or handle harmonious material as defined by the Cupertino Municipal Crde, Chapter 9.12, and the Health and Safety Code, Section 25532(.)7 ❑Yes E] No l1 Will the applicant or furore building occupant use equipment or devices which ot ba.mod... air cmnaminams as defined by the Bay Area Air Quality Managenent DistnrtY ❑Yes ❑No 1 have read the hazardm ex timer 15 requiremdna under Chapter 6.95 of the Cxli, fomia g does ne Safety Code, Sections 25505, 25533 and 25534. I understand that if the building date not currently have a central,p thin it is my msof. C airy m eolfy thr ancy. of the requirements which must be met prior m ixsuaae of a Cenificam of Occupancy. Owner or authorized agent Date SIGNS ELECTRICAL. SPECIAL CIRCUGUMISC. TEMP. METER OR POLE INST. POWER DEVICES SWIMMING POOL ELECTRIC OUTLETS — S W 1'rc11ES — F NEW RESIDENTIAL ELECT'R PLUMBING PERMIT PERMIT ISSUANCE ALTER— DRAIN & VENT— WATER (EA) BACK FLOW PROTECT. DEVICE DRAINS— FLOOR, ROOF, AREA. COND. FIXTURES — PER TRAP GAS — EA. SYSTEM -1 INC, 4 OUTLETS GAS—EA. SYSTEM OVER (EA) GREASE/INDUSTRL WASTE INTERCEPTOR GRF.ASETRAP SEWER—SANITARY—STORM EA. 200 FT. WATER HEATER WNEIUMLECTR WATER SYSTEMOREATING WATER SERVICE NEW RESIDENTIAL PLMB. SQ, FT. MECHANICAL. PERMIT PERMIT ISSUANCE ALTER OR ADD TO MECIL AIR HANDLING UNIT (TO 10.000 CPM) AIR HANDLING UNIT (OVER 10,000 CFM) EXHAUST HOOD(W/DUCT) HEATING UNIT (TO 100,000 BTU) HEATING UNIT (OVER 10(.00) BTU) VENTILATION FAN (SINGLE RESID) BOILER—COMP (311P OR 100.000 BTU) BOILER — COMP (OVER I00,INN) B'IT) AIR CONDITIONER NEW RESIDENTIAL MECH. SQ. FT. OFFICE I ❑ ❑ J, ❑ JOB DESCRIPTION RFSIDENTIAle ❑SFDWL El KITCHEN REMODEL ❑ ADDITION ❑ PLUMBING RE -PIPE C3 MULTI -UNIT []STRUCTURAL MODIFICATION ❑ INTERIOR ❑ CHIMNEY REPAIR IMPROVEMENT [ISWIMMING POOLS ❑ BATH REMODEUREAIR CIDEMOLITION [D OTHER Lj8 COIIIJMOERCIAI�, ❑NEWBLDG/ADDITION []DEMOLITION El TENANT ❑ FOOD SERVICE IMPROVEMENT ❑ OTHER SQ, FT. FLOOR AREA $l: FEE pit[ V7VAALUATI4N/,S— STORIES N a STORIES TYPIICONSI OCC. GROUP APD BULLRING DI VISION FEES PLANCHECK FEE ENERGY FEE GRADING FEE SOILS FEE PAID Date Receipt x TOTAL: BUILDING FEE FEE SEISMIC I.LECTN PEP (_--�11 PLUMB GFE MECH CAL CONS UCITON TAI HOUS CTION FEE PAID Date Receipt# TOTAL: ja ISSUANCE DATE /(/- ld-9�