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26691APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING DIVISIONAPPLICATION/PERMIT BUILDsns: - BLhU I KWAL PLUMBING -MECHANICAL BUILDING PROJEC"1' IDKNT'IFICATIUN PERMIT NO. (]vl J 1 BUILDING ADDRESS: L/©CJ W L LOT SANITARY NO. APPLICATITISONSSUUBMITTALDATE s`7 e O PHONE: CONT OR'S NAM LIC NO: NIC PARK FEE CONTROL Is 'ARC IT'EC'UHNGINEEI: LIC NO: ADDRESS: coNTACT: ONE: tit /\ a - A'y t " ; QTY ;, . yCGECTRICIPERMIT FEE ��� / ' '� -^_ ' S •-'� I PLANCHECK FEE BUILDING PERMIT INFO BI DO Ft F(T Pt ONCE MECH I herebyaffirm that I suricensed underprovisions of Chaptv9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. N Date Contmen" ARCHITECI'S DECLARATION I understand my plans shall be used as public words. Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 um exempt from the Contractor, License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city or county which on dre v Permit to construct, alms, improve, demolish, or repeal any mucmle pr iour its issuance. also squires the applicant for such permit to file. signed autenem that he is licensed pursuant to the Provisions of the Contractors License Law (Chapter 9(commencing with Secdon 7000) of Division 3 of the Business and Professions Code) or texempt hat he is exempherefrom and Ne basis for the alleged exemption. Any sonto on of Section 7031.5 by any applicant for a .it subject, the applicant m. civil penalty of not mare than Eve hundred dollars (5500). ❑ I,vsawnemfmhepmperty,ormy<mployaswith wagesmtheirsolewmpwmtion, wiIIdodmwork,andthesnucumisnotintendedoroffeedfor3ale(Sec.704 ,Business and Profeemas Code: The Contractors License law does not apply to an owner of property who builds or improves thereon• and wh.deessuch workhimselfordmroughbis own employees, provided that such improvements are not intended or offered forsale If, however, the building or improvement is sold within one year of completion, the own builder coil I have the burden affirming ring that he did not build or improve for Im 1 sale.). [1I, wownerofthe promv property, aexciusively contracting with liceW con mem consumer she project (Sec. 7014. Business and Profissions Code:) The nnector'. License law d«snonepplY manowner.fpropeny whobuildsmimprov thele.n, and .1mem newforsuchprojeceswith.contramr(,)licensedpursuanu cContructor's License law. ❑ 1 nm exempt under Sec. , B C for Nis reason ❑ IM1ucby affirm thetlheve eccnificaie of consent muff-instarm a cenificereof Worker' Cmnpensaion Insurance or. certified copy thereof (Sec.38 ey b C.) which en all employee'. undo shin permit. \ Policy It Company ❑ Certified copy is hereby famished. ❑ Candied copy is filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ttdssection need.mbe completed ifthe,.Gromit is foroneh rrica ddollses (SIM) .acts.) I cenify, that in the performance of the work for which Nis permit is issued, l shall nm employ any penton in any roamer so as to become subject to the Wallin' z Compensation Laws of Califemia. Date Applicant z C, NOTICE TO APPLICANT:ILafter making this Certificate of Exemption, you should forthwith comply y she Workers Corns at this Permit ov of she Labor evoked. must foMwith comply wish such provisions of this permit shell be leaned revoked. i2a CONSTRUCTION LENDING AGENCY z I hereby affirm chat there I.. crmtrumian lending agency for the performance of U 0 rhe work for which this permit is issued (Sec. 301 Civ. C.) LL Lenders Name IV C) Lenders Address 1 certify that 1 have mad this application and state that the .base infamudon is r%" W correct. l agree to comply with all city nrWcounty ordinarom and state laws testing to E" y building construction, and hereby authorice rcpresenulives of this city to enter upon the U7 above-mentioned property, for inspection purpmm. G7 (We) agme to save. indemnify Did keep hvmlew the City of Clpenino against liabilities• judgment, costa and expense. which may in any way aeeme.,drat said City in co�n„sw�uenc jwf the Bmnti^g of vpermmn • — / _ L IIAZARTSOUS MATERIALS DISCLOSURE the applicant or future building occupant some or handle hoenrdous material rued by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Seen. 25532(.)? ❑ Yee ❑ No.. Will the applicant or furore building occupanluse equipment or devices which emir acendons air cnnundnanu as defined by the Bay Area Air Quality Mamgemem ixmct7 ❑ Ya ❑ No I have lead the hnerdom materials mquiemenu under Chapter 6.95 of the California Health & Safay Code, Sections 25505, 25533 and 25534. 1 undersand 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 prior m issuance of a Ceniffeme of Occupancy. Owner or umhmied agent Dae PERMIT ISSUANCE APPLIANCES -RESIDENTIAL PANELS UP TO 200 AMPS 201 - IOW AMPS OVER IO00 AMPS SIGNS ELECTRICAL SPECIALCIRCUIT/MISC. TFAVINICII%kGOR POLE INST. OWER DEVICES WIMMING POOL ELECfW OUTLETS - SWITCHES - FIXTURES NEW RESIDENTIAL ELECIR _SQ. OTAL: PI. - � PER l FEE PF.RMITISSUAN ALTER - DRAB -WA ) BACK FLO\ PR CT. DEVIL DRAINS - OR, ROO A , COND. FIERTRAP GAS- -I INC. 4L;I 7S GAS - EA. SYS -OVER 4(EA) GREASMNDUSTRL WASTE INTERCEPTOR G TRAP SEW ER-SANITAR - .21 WATER HEATER W/VENT/ELECTR WATER SYSTEM/TREATING NEW RESIDENTIAL PI -MB. SQ. PT. TOTAL: '. MECHANICAL PERMIT PERMIT ISSUANCE ALTER OR ADD TO MECH. AIR HANDLING UNIT (TO 10.000 CFM) AIR HANDLING UNIT (OVER 10,000 CFM) EXHAUST HOOD (W/DUCT) HEATING UNIT (TO 100." BTU) HEATING UNIT (OVER 100,00) BTU) VENTILATION FAN (SINGLE RESID) BOILER - COMP (3HP OR 100,000 BTU) BOILER - COMP (OVER IN." BTU) NEW RESIDENTIAL MECII. SQ. FT. TOTAL: FEE JOB DESCRIPTION SQ. FT. FLOOR AREAS/SQ. FT `7 ov t Z 13S 2l 191 - FEE 912 BUILDING FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL FEE CONSTRUCTION Ti PAID Dam r -4 1,0 ✓U� ci'y�r Iz�9� FEE SUMMARY O SANITARY Y RECEIPT N _ SCHOOLTAX Y REC PTO PARK FEE Y RE .5,T01 BUI ENG DI ISIONI PLANCHECK FEE GRADING SOILS EAA E PAE Dale Rettimp BUILDING FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL FEE CONSTRUCTION Ti PAID Dam r -4 1,0 ✓U� ci'y�r Iz�9�