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23491 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building ProM Identification PERMIT NO. r, BuOdinhaAddrna: c,eesmu 23491 n � � I.GYnyvr✓es am�/ LEEI� .�1�1/!1/1 0�7CITYAPPLICATIONI/PERM TSION ```L13_q� Contnctare Name: - We N. BUILDINGELECTRICALPLUMBINGMECHAMCAL CATEGORY CONTROL N Architect/Engineer. LIs.Na: - OTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address I El/ L LICENSED CONTRACTOR'S DECLARATION PERMITISSUANCE I hereby olrmthatlai licensed 3oftheunder provisions Pm Gapter9(cemmen APPLIANCES-RESIDENTIAL OB DISCKI'TTON Ingweh I.Full 7000)onDlMlect. ]the ButlnnaandPm/esmonsCode,and my /am u` license le In fu0 force and d(ect. PANELS Ip 1 o Limns Clam LIC. . Date Contractor —UP TO 2DOAHM ARCHITECT'SDECLARATION XVER 10 I5 H2O Iundestnd my plsmalaBbu used spubBcrecoNa OVER 1000 AMPS SQ.Ff.Ff.00R AREA f/SQ.FT. b Licensed Professional - SIGNSELECTRICAL NL © IN 6 OWNER-BLDER DECLARATION - - SPECIALCTRCIIIT/MISC io.., Iherebyaf0rm that Iamexempt from the Contractors License Law for the 2 pp following reason.t5ection s 7011 S,9usineand Processions Code:Any city or P U T E R K E'ry county which requires a permit tan construct,alter,Improve,denellsh,or repair TEMP.METER OR POLE INSI. IIILLL any structure prior to Its Issuance,also requires the applicant forsuch permit to FJ O G ills a slgnnd&atement that he Is licensed pursuant to the proWbm of the ROWER DEVICES Z 3w Contractors License Law(Chapter9(commencingwithSection7000)ofDivi- O I'n SWRdM1NG POOL ELECTRIC OW the basis sHhe Butlnes and lxemption.0 ray)viothrt he f exempt therefrom and VALUAU Q the n for the rentalleged exemption. Any violation of Section 70115 re any. OUTLETSSWITCHFSFIXTURES S�GW7Jj applicantfora perMlsubjeabtheappllcanttoadvll penalty dnot more than live hundred dollars($500), NEW RESIDENTIAL ELECTA SQ.FT. SIORIFS TYPE CONSTRUCTION compensation, as owner of the property,or my employees with wages as their sole compensation,will dothe work,and the structure Isnot Intended or offered for Dsale f5ec.7044,Business and Profeslom Code:The Contractors Llcemc Law, $ don not apply to an owner of property who builds or improves thereon,and OCC.GROUP RES.UNITS whodonsuch work himself orthrough his awn employees,provided that such Improvement am not Intended oraffered fw sale.If however thebulidhR or Improvement bsold within oneyearo(compldion,the owner-builderwill have tFltlLurden of proving that he did not build or Improve for purpose ofsleJ. QTY, PLUMBING PERMIT FEE FLOOD TONE APN u L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE ^ contractors to comtmct the pmjed(Sec.7044,Business and Professlom Code: The Contractor's License law don not apply to an owner of property who ALTER-DRAIN&VENT builds or Improves thereon,and who contracts for such pWjmu wtt - h a WATER LEA) cq'u.ctorts)licensed pursuant to the Contractors Liens Law. - FEE SUMMARY Ll l am exempt under See. B&P C for this reason BACKFLOW PROTECT.DEVICE DRAINS FLOOR ROOF,ARRA,COND. SANITARY Y N • Owner - ECL RECEIPT N WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOLTAX Y N QI hereby affirm that I have o mniecate of scent to rpytheree,or RECEPT N 3800,Lab of Workers Compenstlonlmurance ma certified copythareo((Sec. GAS EA.9YSTEM-1 INCA PARK FEE Y N ' Polis Lab C.) RECERT N Policy N GAS EA.SYSTEM-OVER 4(EA) Com any BUILDING DIVISION FEES Certified copy Is hercbytume city ty GREASE/INDUSTRI.WASTE 94TFIZCEPTOR PLANCHECK FEE Certified ropy Is filed with the dinspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-SHAM EA X7(IFT Daft Recci IN (TMssnlon need not be completed U the permit Is Emom hundred dollars (f100)mtes.) WATER HEATER W/vENT,/ELEc'rR ENERGY FEE Y_ N_ I certifythat N the pedor anceofthe work for which this permit I.Issued, I shall not employ any penton In any manner so as to become subject to the WATCR SYSTEM/TREATING Worker'Compensation Taws of California.Date PAID - z Applicant Date Reaei til Z NOTICE TO APPLICANT:R,after making this Certificate of Exemption,you NEW RESIDENUAL PLMB. SQFf. Hshould become subject to the Workers'Comperum ion provision of the Labor TOTAL: N Code,you must forthwith comply with such provtbm or this permit shall be BUILDING FEE W 7 deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE N a Iherebyaf8rm that there Is a comtmctlon lending agency forthe perform- ELECTRIC FEE Z ante ofth.work for which this permit is bound(Scr.3097,CIv.C.) TOTAL 02 Lenders Name PLUMBING FEE LL — La.dce.Addres QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W I cart By that l have need this application and gate that the above Information .�� FEES PAID: (L iscomact.I agree to comply with all etyand county ordinances and state laws i PERMTTISSUANCE } relatingtobullding commuctlon,and hereby authortre represnstivesofthis In F city to enter upon the above-mentlocexi property for Inspection purposes. ALTERORADDTOMECH. ? (We)agree to save,Indemnify an d keep harmless the City of Cupertino - Date Receipt# V against lbbilit4v;lydgment,cotlaand e.penss which may In anywayacerua AIRHANDUNCUMTIT010,000CFM) SUBTOTAL• against said City In consaryenm of the granting of this permit. AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX Slgm/ureof AppRmnt/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date ReCel t# material as defined by the Cupertino Municipal Cade,Chapter 9.1 7,and the Health and Safety Code Section 25532(a)? HEATING UNIT(OVER 100,000 BTI) TOTAL: ❑Yes No Willtheapplicant or Fore building occupant use equipment ordevions VENTILATION PAN(SINGLE REBID) U ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? BOILER-COMP OHPOR 100,0IX1 BTO 1?� ❑Yes ❑No P A I Ihavc re ad the hasrTi Ous materials requirement under Chapler6.95 of BOILER-COMP(OVER 100,000 BTU) the California Health&Safety Code,Sections 75505,25533 and 25534. I understand that lithe buildingoccupant not erequire encs tenant.that It is my NEW RESIDENTIAL MECFi. SQFf APR 15 1992 responsibility ua to notify the occupant of the requireirent wM1kM1 muss be met pri rt Ls ancedaCertiRcate Occupancy. IC�e J]0?�tt 21*,A!4440202 '0012- G��4 curet w Owner or authorived agent Data, ISSUEDO � TOTAL' OFFICE COPY