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20153 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Addms: 20153 MYUUAIlUNhUb A nme ante: aeufi©ne: A gaTrzl-� CF12S t EWs 412S-7727 CITY OFCUPERTINO-BUILDING DIVISION t� Conlnctofs Name: � f ,� � Lic.No: APPLICATION / PERMIT a QIOG• . qr H Wd ra,f9lt.5' . BUILDINC,lE RICALPLUMOINGMECHAMCAL CATEGORY CONTROL s r Architect/Engiker. Lk.No: J�� C57 '1/$2396 QTh. ELECTRICPERMIT FEE BUILDING PERMIT INFO Aaareaa:� CxJ_ C Swain u oG0 PEtMITI55UANCE ❑ ❑ ❑ -LICENSED CONTRACTOR'S DECLARA ON I herebyaf(irmthat l am licensed under provisions o(Cha erg commer, APPUANCESRESrDENTIAL P o ( JOB DESCRIPTION It...1SeMon 7000)ofd efect the Buslnneand Pro(essioneC.ode,and my It IB In lull for¢and c.# PANELS A , Licenx lass(ax,0 Ic.R or 1239 Co Data t Con[raRor�a�.�.e xJ�Uan�tae72 TO 200 AMPSeGr�— ARCHITECPSDECLARATION 201-IODO AMTS aO Zp l understand my plain shallbe used as public records. OVER 1000 AMPS - SQ.FT.FLOOR AREA $/SQ.FT. b6Lu Licensed Professional SIGNS ELECTRICAL 6 N OWNER-BUILDER DECLARATION SPECIAL CULT/M Zs, 4 thereby affirm that l am exempt from the Cont ractor's License Law f¢the O /oilowing reason.(Section 70315,Business and Professions Code:Any city orJp, OR POL pE[y countywhkh rcquireaa perMtta comutmt,alleq Improve,demolhh,orrepalr �e T anystructure pnortolls issuance,also requlrntheappliant lorsuchperMtto �yygRD +1 Rh a signed statement that he h licensed pursuant to the provhloms of the 3w� Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING C f,�Os ston3ofthe Businessand Pr =WmCode)orthathehexemptiherefromand VALUATION Y.' the bash for the alleged exemption. Any violation of Section 7031.5 by any r o OUTLETSS FIXTIIR applicant fora permitsubjects theapplktroom HES five hundred as owner anhepro NEW RESIDENI ELEC STORIES TYPE CONSTRUCTION p••�n �I,as owner will the property,or my employees with wagon r there sole compensation,goal the work and lhuuude:Th not Intended or offeredLaw O sale(Bee 7049,Bualness and Professlom Code:7he ContnctoJs Llcenu LaIf w 3� does not apply to an owner of property who Wilds or improves thereon,and OCC.GROUP RES.UNITS EE whodoe such work himself orlhrough hlsown employees,provided that such tmprovemenla are not Intended oroffered forsals.I(,however thebullding¢ TOTAL: improvement hsoldwithln omyearofcompldbn,theowner-budderwlll have the urden of proving that he did not build or Improve for purpose olsah.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN LJ L as owner of the property,am exclusively contratling with licensed contaton to coretructthe project(Sec 7094,BuaIness and Professions Coae: PERMIT ISSUANCE TheContradoes License Law does not apply to an owner of property who ALTER-DRAIN A VENT WATER(EA) bola or Improve thereon, and who contracts for such pipjects with a FEE SUMMARY ogp3Tactor(Olicensed pursuant to the Contractor's License Law. BACK FLOW PROT[CT.DEVICE LJ I am exempt under See B k P C for this reason Owner ----Data DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N RECEIPT If WORKMAN COMPENSATION DECLARATION FEMME&PER TRAP SCHOOL TAX Y_ N_ ❑I hereby affimt that I have o certificate of content to op thereof ora ' RECEIPT M 3800certiLabcate of Workers Campewtloniruunn¢¢e¢stilled copy thereof(Sec. GAS,EA.SYSTEM-1 INCAOUTLETS PARK FEE Y N pwio .b ca4b So 23y 'S - RECEIPrp Policy p GAS EA.SYSTEM-0VER d(FA) Cpppppp���1ppppaaa�aanv A E w J BUILDING DIVISION FEES Certified copy h heed with the city GRIASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE Cetllled copy h filed with tM city inspection division, �. CERTIFICATE OF E(EMPIEION FROM WORKERS' GRFASE7RAP PAIDtk18 S COMPENSATION INSURANCE SEWER-SANITARY-STORM FA 20081• Date RCC21 [# (Thiess tion need not be completed If the permit 1s fmcme hundred dollen (5100)orfess.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y N Ill net crotify that emIn ploy anyhe person i any m work for to be Na s,Bumfrmit ct to be, I shall not employ any person In any manner n as to become subject to the Workerv'Compennllon Laws of Callfomla.Data WATER SYSITM/TR ATING PAID Z Zplicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you NEW RESIDENTIAL ELMS. SQFr. Date Rfeel I# should become subject to the Worken'Comperurtlon provlslorsofthe Labor TOTAL: 9q Code,you must forthwith comply with such provisions or this permitshall be B L G W > deemed revoked. - FEE CONSTRUCTION LENDING AGENCY SEISMIC FEE a Iherabyaffirm that there is a construction lending agency for the perform- TOTAL: ELECTRIC FEE = Z ance ollhe worklar which thh pemdlh Weed�eec.30Y/,CIv.CJ (,) O larder's Name PLUMBING FEE' LL I— Landers Addreu QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Imrllfythatl have mad thisapplicatlonand datethattheabme Information ' 6 bromci.lagreatocomplywith all city and county ordinances and mate laws PERMIT ISSUANCE FEES PAID: W relating to building construction,and hereby authorize representatives ofthis F Z city to enter upon the above-mentioned property for Inspection purposes. ALTERORADDTOMECH. Dale ReCCIPf# — (We)agree to save,Indemnify and keep harmless the City of Cupertino against liabilities,judgments,cosroand expenses which may in anywaya¢rus ATR HANDLING UNIT(TO 10,000CPM) .SUBTOTAL: against said City In consequence of the granting of this permit. ' AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX Signature of Appllczru/Contractor Date EXHAUST HOOD(W/DUCD CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or hand Is hazardous HEATING UNIT(TO IO(IODO BTU) Date Recei t# material as defined by the Cupertino Municipal Code,Chapter 9.17,and the Health and Safety Code Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) JTOTAL: I%-]Y¢ No ilsoul applicant dous a tore building as defined ndby the Bay Area devices VENTILATION FAN(SINGLE RESID) Y I�S(IIgPJC.EbATE whichsoul air contaminants anis as defined by the Bay Arca Air . Quality Management Dhttt7 BOILER-COMP pHPDR 100,IX3 BTU) /� 4Yes No City. of(;B havamad the han?us materials requirements underChapterb95of BOILER-COMP(OVEi100,000BTU) 4IRf(gIQ the California Health k SafetyCode,Sectlore 25505,25533 and 25534.1 understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.rT mespomuiblity to notify the occupant of the requirements which at be reset v or to Issuance of a Certificate of Occupancy. ILI- 1g- So Mrrr.r.whmixrd.gara Date - TOTAL: ISSUED BY: OFFICE COPY