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24251 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY . Building Pm m Identification I - PERMIT NO. Building Address: 24251 �e z 1 wners ams: one: R j CITY OF CUPERTINO,BUILDING DIVISION Contractor's Name:. Uc.No: APPLICATION /PERMIT rt� 40 BUILDINGELECTRICALPLUMBING-MECHANICAL CATEGORY CONTROL# Arch ed gimxr. Lk.Ne: QTY ELECTRIC PER FEE ELECI BUIL DING PER PLUMS h Address: PERMITISSUANCE LICENSED CONTRACTOR'Sderpr DECLARATION withS ion7Olhztlamsi=3ofhe Busi emend o(ChapisCode,(commune- API'LIANCF5RESIDE JOB DFSCRB'TION i IngwithSMlon7000)of DlWelon3ofthe Bucineuand ProlnsionaCode,and my t. - Ilcenm lain full faux end effM, p PANELS L, {P� License Clam Lac# Dale Contractor ARCHITECPS DECLARATION X11-1 PS sen 2 I understand my plans shallbe used as public eewrde. VER AMPS SQ.FT.FLOORAREA f/SQ.FL. '(Rdif GMS ELECTRICAL ` Licensed Professional OWNER-BUILDER DECLARATION IALCIRCUIT F, IherebyaBlrmthatlamexempt froenthe Contractor's Llense Lw fee the OR- following reason.6cedon7031S,B..Ie..ed Profs®tons Code:Anycity.r P,MEIiROR EINSf. 0 ceuntywhlch rcqubesa pemNttocolatroR,alter,lmprove,demolIsh,errepgr anystmmmpdortoiWWuance,alsorequlreatheappllcanttorauchpermitto POWER DEVICES file a signed statement that he Is licensed pursuant W the provisions of the Cont.d.e.Lic... (ChapterLaw 9(commendn RhSection 7000)ofDivi- 30�' alonlolthelluainessand ProfWwCode)orthaghetrexempttherefromand SWIMhENG POOL CTRIC VALUATION the bash for the alleged exemption, An violation of Section 70115 anyOIIILETSSN7 FIXTURES aQ applicant fora permit subjectaheappilcad to a civil penalty of not more tha 0v�undred dollars($5M. NEW REST AL ELECTR �Ff'. y��3yy1)IR�� TYPE CONSTR TION I,as owner of the property,or my employees with wages as their sole R�R a compensation,w0ldotMwark andthe structure boot intended or offered for _ 'V Gy Qh O sale(Sec 7044,Buairaas and Professions Cade:The contractors License Law $$ does not apply to a,owner of property who builds or Improves thereon,and A; , l � GR RES UNITS whodoeaeuchwarkhimselforthroughNso nemployeeaprovidMthatarchimprovemeMsarcnotintendedmofferedforsele.ILhomamthebuildingor ImprovementisoldwihnoeyearofcwnplebW theowner-bu0derwillhave tl�urden of proving that he dW not build or improve for purposeofnitel, QTY. PL BING tD NE APN L f L as owner of the property,am exclusively contracting with licensed PMWIT LSSU contractors to construct the project(Sec.7044,Business and Professions Code: The Contractors License Law don not apply in an owner of property who Wilds or Improves thereon,and who contracts for such ptojects with a ALTER-DRAW A VENT-WATER(ILA) contractor(s)Wend pursuant W the Contractor's License Law. FEE SUMMARY I am exempt under Sac B 4 P C for this mason BACK FLOW PROTECT.DEVICE —OUTSIDE FEES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_ Owner_ Date RECEIPT# r�--aaII WORKMAN COMPENSATION DECLARATION pp(TURFg PER•/AAF SCHOOLTAX Y_ N_ IgLI hereby sffirrn that I have a certtlicate of consent ro sd4inwrc,ora RECEIPT M erti(Icate of orken'ComperwtlonlruursnceeaedBled copythereof 6ec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N_ 3800,lab ) pp Polity# �9��a0 , — RECRIPTIf Com nv LOIJ /L (� - D CAS EA.SYSTEM-0V1iR4(EA) BUIL DING DIMS ION FE ES [ CertlOed c6py Is hereby WrMahad. I . Certified copy Is filed with the city Inspection division. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TRAP PAID COMPENSATION INSURANCE SEWER-&ANI ARY-STORM EA 200FT Date Recei t# (Thissectlonsedcotbecomplee Bthepert tIsforonehundreddollars ($lW)orless.) WATER HEATER W/VEM/ELECTR ENERGY FEE Y_ N_ I certify that In the performance of the work for which this permit is Issued, I shall net employ any person In any manner n as to become subiod to the WATER SYSTEM/TREATING PAID Woken Compensation Laws of GBfomla.Data O Z Applicant NEW RESIDENTIAL PLMB. SQFI. Dale Recei t# Z O NOTICE TO APPLICANT:Rmakingafter king this Certificate of Exemption,you should become subject to the Workers'Compensation provisions of the Labor TOTAL: N Code,you swat forthwith comply with such provisions or this permit shall be BUILDING xaaas, IL LENDING deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE d Ihereby.ffirenthat there is.construction lending agency for the pedorcry ELECTRIC FEE 7 Z ane ofthe work forwhich this permit Is lanued(See.W'Clv.C.) TOTAL: U O Lender.N.me PLUMBING FEE LL I— Iendee.Addrtres QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W ledifythatl have read thisapplicationand statethatthe above Information FEES PAID. a incorrect.I ageeeto comply with all cityand county ordinances and gate lawn PERMITISSUANCE } N relating to building coratrudion,and herebyauthorlan representatives ofthis Z city to enter upon the above-mentioned property for inspection purpoxn. ALTER OR ADDTO MECH. (We)agree to save,indemnify an d keep harmiese the City of Cu pedlno Date Reeel t# V against liabilities,P dgments,cogs and expenses which may In any way accrue AIR HANDLING UNIT(TO 10,0D0 CFM) SUBTOTAL: against said City In consequence of the granting of this /—tel perrry0, r � ,UR HA NDLING UNIT(OVER I O,ODO CFM) CONSTRUCTION TAX Sig of AppBcaDate EXHAUST HOOD(W/DIX:'D CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the defined bythe Lureruin M.rhIpantstn Ch.per9 h ..doua HEATING UNIT OO 100,000 BTU) Date Recei t material as defined by the Cupertino MuNdpal Code,Chapter9.12,and the Flealth and Safety Code Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTA RYea No ill the applica rat Auto building occupant use equipment or devices VENTILATION FAN(SINGLE RESLD) ISSUANCE DATE which emit haaardous air contaminants as defined by the Bay Area Air 6A I D Quality Management District? BORER-COMP OHP OR 100,IX0 BTU) MYea ❑No -have read the hazardous materials requirements under Chapter 6.95 of BORER-COMP(OVER 100,000 BTU) SEP 25 1992 the California Health k Safety Code,Sect lora 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it Is my NEW RESIDENTIAL MFCH. SQ.FT resporo1istuaoo ofaCeheacteof of the requirements which swat 6e met CIIy Ur t;Urc prior to Issuance of a Certificate o(Ompanry. , Owner or authmixed agent Date ISSUED BYt ✓ YV TOTAL: OFFICE COPY b