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27069WITHIN RED LINES • USE TY OF CUPERTINO BUILDING DIVISION APPLICATION/PERMIT .DENG ADDRESS l R''yyESS�: / —©_:� sslxx:m�nr.Te 27069 9 -- s2-2, Q, SQ. PLANCHECK PEE GRADING PEE SOILS FEE ENERGY FEE PAID Data Receipt N TOTAL: BUILDING FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL FEE CONSTRUCTION TAX PAID Date t SEP 2 2 M PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION APPLIANCES- RESIDENDAL Jeez 9(conncing with Ithereby afmt that l rum licensed under Provisions al'CTape mte -J0 yUE <Ztu r <c. �yZ ivpDMI ceF• Secoon 7") of Division 3 of the Business and ions Cade, and my license is in fu 11 force and effect. Licwu Clens Lic.N PANELS UP TO 2W AMPS 0201 Dau Cwunor - MI - 1000 AMPS ARCMI7ECTS DE TIO esu VER I"AMPS SIGNS ELECTRICAL red Proreasicasl SPECULCBCCUMMISC. Y� zz< Oc. 3 p < „J Y '0 o�, OWNER -BUILDER DE LARAON I hereby eR that 1 ser exempt from the Contrwtm's Limen Law for the following reason. (Section 7031.5. Business and Professions Code: Any city mcounry which rectum a permit o conswcL aher, improve, demoliab, m repair coy summers prior bid summer. also notorious the applieantfor such permit wfileadgnedsammeat that he is Rcented pursuant to the provisions of the Concession's License Law (Chapter 9(comnencingwdl Sectio]WolofMvisimt3of Ne Budmnwd Rofessias Code) TEMP. METER OR POLE INST. POWER DEVICES SWIMMING POOL ELECGUC w -Z < R S t Y_� _3— or that he isumnpt rherefmm and the basis for the alleged exemption. Any violation OfSWITCHES Section 7031.5 by any applicant for a permitmhjeca the sppliewt o e rivil Pendry of not roam then five hundred dollar ❑ I.nowneofthepropeny,mmycmpinyeeswithwagesutheirwlecompcmadw. wil)do Ncwork.Wt ce mumisnmintendMwoffeudforWe(Sec.7W.BmiMss FIXTURES NEWRFSIDENTIALELECIR _SQ.FT. and Pofessians Code: The Conerwai s License Law does not apply an an owner of prop ertywhobuildsviimproveschimpr andwho dm:swchwok himselforthrough Ms own cmvenae immndedmaffred formic. If, cmployeuilding ' encntis r imutsuchimismid th theawnef baweer molum di inaneyear o(coprove rise of as he foron, builder will Mve Ne Auden of proving Wt he did not build or improve far purpose of will have We.). �:y:-i �"PLUMEING "c1: ❑ I.0 the por/the propmY•em exclmivelYconmening withlicensedcomm�orsto n'a Lim the projtet (5x. ]OCA, Business and Profession Code) The Contractors Licenelawsaes rotapplyowownerofpropeery whobuilds improve Norton,end Q nyP'a+a,'+' PERMITn. PFRMTf ISSUANCE r whormLaw. for such projecswithacwoactort8lammed pursuantwrote Contractors Licenselaw. ALTER - DRAIN k VENT - WATER (EA) ❑ 1 am exempt coder Sco , B & P C fm this msaon BACK FLOW PROTECT. DEVICE Owner Date DRAINS - FLOOR. ROOF. AREA, COND. WORKMAN COMPENSATION DECLARATION �Lrl Ihereby afrimtshatl haves cenifiau ofcmnwtwulf-insert,oacenifinool "w4krn' Compcnutiw Imurwtt m attvfied ropy themmf (Sa.lgW.lab CJ which FIXTURES-PERTRAP GAS. EA. SYSTEM -1 INC. A OUTLETS '•,rr"--� covers all ernPloyea't coder this pmuh- Policy N Company GAS - EA SYSTEM-OVERA (EA) ❑ Cued copy is hereby funushed. GREASEIDNDUSfRL WASTE [NTERC'EPTOR ❑ Certified copy it filed wit to eiry inspection division. CERnFICATEOFEXEMPf]ONFROMWORKERS' GREASETRAP COMPENSATION INSURANCE SEWER - SANITARY - STORM EA. 2(1 (lids sec' sed trot a complmMifiliepmmitisfm one hund�dollan(SIW) orleu.) WATER HEATER W/VF.NTIELECIR Iceni in thep .nc work for which this pewit is issued.)shall no employ person Y w as to became subject o the Workers pmsatio i -ni WATER SYSfEMITREATING 7O Applicant NEW RESIDENTIAL PLMB. SQ. FT. CE IT: If after ung this Cenifiase of Exemption, you should = (/� becmnlicel, truth er"Com 'onprovisiomofthrulan Code, you mus Y forthwith comply with such provisions or this permit shill be decreed invoked. '.2 CONSTRUCTION LENDING AGENCY 3 Z Q F t/ acomi Z 1 hereby affirm that them is s consuction lending agency for the perfomame of the wok fm which this permit is issued (Sce. 303], Civ. C.) Lender's Name aas:s estiyzt+v A. II a:r_.. aw ..t.•.:. .. ;,�. {s QTY. e z FffiCHANICAL PERMIT'S_. . >f ; "d'mEn., Landers Address I amity that I have read this application and sure that the above infomation is l agree to comply with all city and county ordimences and sat laws mining to building concoction. cod hereby authoria repmemativer of this eiry to enter upon the ebwe-mentioned l openry for inspection s. PERMTTISSUANCE ALTER OR ADD TO MECH. (Wel agree in ave. indemnify and hermdess the Ci Cupertino against liabuhnes"tol'.e .consume spene wI..,,in yw . esgainst said City AIRHANDLINGUNH(T0I0.OXICF:M) in con acme of a granting of this pea . ABC HANDLING UNIT ER 10.000 CFMI tgnamre of AphcanVComicuo Dau IEXHAUSTHOOD /DUC-D HEATING U (TO I W.I)OU BTU) HAZARDOUS MATERIALS DISCLC I Will the applicant or future building mcupam more or handle haeardour materiel ss defined by the Cupertino Municipal Costs. Chapter 9.12, and the Huth and Safety HEA T (OVER 1 W ) VPNTI TI N (S N ID Code. S,cd n 2557248" ❑ Yea ❑ No BO (J TU) Will thea licwtmfuwm buildin ere ruse tmdevieeewhich a pp goc pen squipm hwardous air comamns ss tndefined by the Bay Am AirQuality Mwagentem ❑ Yes ❑ No g BnH RFS L M H. SQ. FT. 1 have rad the hasudour material, require ocns uMer CTapar 6.95 of she California Health & Safety Code. Seetion 25505.25533 and 25576. I undersand that if the building does not currently have a tenant, that it is my mpnnsibility to notify the occupant of the ow uirerom which must be met prior o issuance of a Cmificaa or Occupancy. Ovrncra iotho oul.,em Dam WE 27069 9 -- s2-2, Q, SQ. PLANCHECK PEE GRADING PEE SOILS FEE ENERGY FEE PAID Data Receipt N TOTAL: BUILDING FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL FEE CONSTRUCTION TAX PAID Date t SEP 2 2 M