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20583APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification Building Addre°°: PERMIT NO. 20583 Zubo �uaa D5 -`L 6-N rT' cueA a°e M -TeLcLSD1' 1 NV t YSfMw,/ CITY OF CUPERTINO-BUILDING DIVISION APPLICATION 1 PERMIT L j g Q Cant`s car° t Lk. No: Q cut -/r BMDINGELECnUCAI.PLUMBINGMECHAMCAL CATEGORY CONIR O// �O Arehitee/En nee —{ Or Lk. No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO f�T t Add-7,�r�.% G 4 iS IAJ E]E]LICF.NSEDCONTRACTOR'SD PERMITISSUANCE Q, 601;.—/i CLARATION I hereby affirm that l ano licensed under provisions ofChapmr9(comment, ingwlthSe i.o 7000)61Dlvhlon3oftheSusimmandPmfmionsCode,endmy license I. tall rce And died. , ^ 5-6 O9 APPLIANCES -RESIDENTIAL JOB ESCRR'7TON a�.q, 10 PANELS Date"Is ontractorup TO 200 AM5 101-1000 AMPS ARCHITECTS DECLARATION I understand my plans shall be used u public records. OVER 1000 AMPS SQ. FT. FLOOR AREA S/SQ.FT. SIGNSELFGTRICAL' Lhanaed Professional SPECIAL CIRCUIT/MIST OWNER -BUILDER DECLARATION I herebyalfirm that I am m exempt frothe Contractors License Lawlor the ' TEMP. METES ORIOLE INST. lollowlog reasons. (Section 70315, Buslnessand Pmfesskns Code: Anyetyar counlywhlch requtresa perecit toconstrue, alter, improve, demolish,orespair anystructure prkrtolta Issuance, also sequirestheappliant forsuch permitto file a signed statement that he is licensed pursuant to the previsions of the Contractor'. License Law Chapter 9(commanding with Section 7000) of Divi- ston3 olthe Business and Professions Code) or that he is exeeptihealrom and the basis for the alleged exemption. Any violation of Section 70115 by any civil penalty of not ore than .ppliantfora permit subjMs theapplicant to a em POWER DEVICES SWIMMING IDOL ELECTRIC Ads 1 �E.ISSWt.ICHFSFixTuREs a W l VALUATION 1.7 /y /s1 N yt ©e L V NEW RESIDENTIAL EI ECTR SQXT' five hundred dollar, ($500). ❑ I, as owner of the property, or my employ. with wage.. their sole STORIES TYPE CONSTRUCTION compensation, will dothe work, and the structure knot intended or offered for sale (Sec. 70K Stables° and Protesslans Code: The Contractors Llarae law docs not apply to an owner of property who build° or Improves thereon, and who daessuch work himself or through his own employees, provided that such O S Unprovereents an not Intended or offered for sale. If, however, the building or '. TOTAL: Improvement issold within oneyearof complatkn, the owner-builderwill have tf�urden of proving that he did not build or Improve lm purpose of sekd. LJ L as owner of the property, am exclusively contracting with licensed conkactars to construct the project (Sm 7044, Business and ProfessionsCoda:R QT. PLUMBING PERMIT FLOOD pp I � PERMITLSSUANCE The Contactors License Law does not appy to an owner of property who Wilds or improves thereon, and who contracts for such InpJaea with a cgB.t.[aamf,) Bansed pursuant to the Contractors License Law. 1_J I am exempt under Sea g & P C for this reason ALTER -DRAIN &VENT -WATER (EA) FEE SUMMARY BACK FLOW PROTECT. DEVICE OUTSIDE DRAINS.FT.00RROOF, AREA, CA SANITARY Y_ N_� RECEBT M Owner Date WORKMAN COMPENSATION DECLARATION ❑I hereby Affirenorkem that I have o artifiate of consent to py theure, ora 3800,L.bCfWorken'Compensationlnsunna ora artlfled copy thereof (Sec. 3800. Lab C.) Pollryp FIXTURES PER TRAP SCHOOL TAX Y N_ RECEIPT e GAS, EA. SYSTEM -I INCA ETS PARK FEE , Y N RECEIPT I Co�mPany GAS EA. SYSTEM -OVER (EA) BUILDING DIVISION FEES 1 ICMNed copy b herebyfurnished.the city Milled copy is (Teed with the city Inspection division. GREASE/WDUSDUL ASTE INTERCEPTOR PLANCHECK FEE GREASE 7RM CERTIFICATE OF EXEMPFION FROM WOR KERS' COMPENSATION INSURANCE COMPENSATION (TMsseelion need not be completed Bthe permit hlor one hundred dollars PAID - Date I# [^ OS BLyygR-cam Y-sroRM EA. 1f10F1'. WATER TERW/VENT/ELECTR ENERGYFEE Y_ N_ ($100),oless.) I certify that N the performance of the work for which this pemdt hblued, WA STEM/TREATING I shall not employ any person In any manner ao As to become abject to the Worker' Compensation Laws of California. Date PAID RESIDFMTALPI.MB.BQ.FT. Applicant NOTICE TO APPLICANT: If, after making this Certificate of Eaemptbra, you should become subject to the Warken' Compensation provislom of the Labor Date Recei t# Saco TOTAL:row U 1 NG FEE SEISMIC FEE O Code,you=at forthwith comply with such provisions or this perrnitehall be deemed revoked. CONSTRUCTION LENDING AGENCY Iberebyaffirm'hat there haconstruction lendingagenry forth perform ane of the work for which this permit is Issued (Sec. 3097, Civ. C.) lender'. Name !.ender'. Address I artilythat I love read this application and slate that the above Information iscorrect. lagreetocomplywithaHdtyandmuntyardinanaaand°tatelaws TOTAL: - ELECTRIC FEE PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICAL FEE PERMITISSUANCE FEES PAID'. relating to Wlldleg rorawctten, and hereby authorize representatives olthis eltyloenleruP n the abovamentloned property far inspection purposes. PA's) agrees o save, Indemnity an d keep harMem the City of Cupertino against liabilities, jadgments, costs and and expenses which may In anywayacerue ALTER OR ADD TO MECH. Dare Recei t# AIR HANDLING UNIT (T010,000 CFM) SUBTOTAL: BRA last said CitE.1h amarquena of the gnatN (this nail. AIRILANDLINGIINIT(OVFI410,000C• ) CONSTRUCTION TAX Si a .of AppBant/Con ctor EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: LEAcxoA US MATERIALS DISCLOSURE Wllltheappilantorful rc building occupant store or handle hazardous ' HEATINGUMT(T'O100,000B Date Recei t# material as defined by the Cupertino Municipal Code, Chapter 9.11, and the Health and Safety Code Section 25532(a)? Yes I] No Rill the applicant orlutom Wilding occupant use equipment or devices HEATING UNIT( OVER ,000 BTU) TOTAL: - VENTILATION FA INGLE RESID) ISSUANCE DATE which chit bacardous air contaminants as defined by the Bay Area Air Q�La,lfty Management District? - Yes -FM"j No have read the Fazars7ous rwteriala requirements under Chapter 6.95 of BOILER -COM HPOR 100,000 BTU) BOILER- P(OVER 100,000 BTU) the California Health & Safety Code, Sections 25505,25S33 and 25534. I understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be met 1 n FSIDEEMALMECH. SQFI' prior to Issuance of a Certificate of Occupancy. C, Owner or authodved agent Date OTAL: OFFICE COPY