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23951 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Pmject Identification PERMIT NO. ulldin Address: �y n 7L/ S /'N Cn- 23951 [Owone: / `V1•J1' A A A TE 117 CITY OF CUPERTINO-BUILDING DIVISION _may w cont r " L1ic �r� APPLICATION I PERMIT QCATEGORY (h� EDINGS.ECTRICALPLUMBINGMECtiANICAL CATEGO Y CONTROL p rchlten neer. Lie.No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION 'PIERMITISSUANCE Ihereectionrm that)amsion3oftheorder proved onsOfChapteC(e,andm MPLIANCESRESIDENTIAL JOB DpSCRB'T(ON — ingwllh5mlo 7000)ol DiW,ion3otthe Bu/ainessand Pmlesslom Code,and my �N�� 1^(��a,�\►f Zaraaa IClas,I y dLl ec � J �t�irU PAN12S Date Contractor Ir ARCHITECTS DECLARATION 201-1000"I'S CC' I understand my plans shall be used as public records OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT. Z() Licensed Professiowl SIGNS ELECTRICAL G�< OWNER-BUILDER DECLARATION S[rF-CIALCBtCU1T/M15C ,7t, � I hereby affirnthat lam exempt fromthe Contramrs License Law for the pp following reason.(Scsslon 0 t to Bust and Profenkna Code:Any my F t'W rountywhich requimapermltmromtanoud,niter,lmprove,demolth,orrepait ir 'IEMP.MECER ORPOLE INST. '°� anysuussure prlorm its beeance,alwnqulmthe applicant for such permit to 3 F file a signed statement that he t licensed pursuant to the provisions of the POWER DEVICES u, Contractors License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC L,� g skn3otthe Bustnessand ProfeasbroCods)orthat he b exempttheretromand VALUAT70N the haat for the alleged ncts the n. Any violation of Se tion 703 L5 by any w IVY_ five hundred aperrs(S5 ess,theapplkant toss null penalty o(nt mom than OU'li'ET""V✓fiCtffS}7XTURFS (./va five 1,as of he pr. NEW RESIDENTIAL ELECTR FT. �n ❑1,as Owner of the property, i my employees with wages as there sok _SQ.Fr. TYPE CONSTRUCTION C < compemation,wBldess and k,and rhes Code:The rdractIntendedoronse d for Law D vie(Sec.7046,Bwlrmas and Professore Code:The Contrassora License law p5� don raft apply to an owner Of property who builds Or improves thereon,and OCC.GROUP RES.UNITS 0. who does such work himself orthr°ugh hisown employees,provided that,arch Improvement are not Intended oroltered lormk.1f,howeveq thebullding or i— impmvement bsold within one ycarofcompletio4 the owner-budderwlll have In,.¢urden Of proving that he did not bund or Improve for purpose of sale.). QTY. PLUMBING PERMITFEE FTAODZANE APN U L as owner of the property,am exclusively contracting with licensed PERMIT LSSUANCE contractors to rorotrun the project(Sec 7064,Business and Profmic rs Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VFM-WA]IIt(EA) builds or Improves thtron,and who co rnscis for such ptojets with a FEE SUMMARY otator(s)licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE LJ I am exempt under Sec. B k P C for this reason • Owner Date DRAIN(+FLOOR ROOF,AREA,GOND. SANITARY Y N WOR RMAN COMPENSATION DECLARATION RFCEPTN [:]I hereby of un,that I have a certificate of consort to self-Insure,or a FTXTUBES PER TRAP SCHOOL TAX Y N_ Mtlflute Of WOrker4 COmperuatlOn Insurance Ora cenifted copy thereof(Sec. RF-CEPT N 3800,)ab C.) GAS FA.SYSTEM-I INCA OUTLETS PARK FEE Y N I'ollry N RECEIPT M Com any GAS FA.SYSfEh1-OVER4(EA) ❑PCertified copythereby furnished. _ BUILDING DIVISION PEGS ❑"Rifled copy isfiled with the mSE y inspection division. GREA /INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE (Ihissessionneed ntbecomplted tflhepermit tforom hundred dollars SEWER-SANITARY-STORM M.200FT. Date Rec'el t# (E100)mlev.) WATER HEATER W/VFNT/E.ECTR ENERGYFEE Y N_ I certify that o the person in anf thework so as to b ecuhis permit cbooed, I shall not employ any person In any manner m u to become subject to the O WATER SYSTEM/TREATING Worcant mpen,ation laws of Calilornla. Date PAID Z npplilian Z NOTICE TO APPLICANT If,after making tht CertBicate Of Exemption,you NEWRESIDENTTALPLMB. SQFT. Date RettPl t# should became subjeco the Workers'Comperuation provisions of the Labor TOTAL: W ttCode,you must forthwith comply with such pmvlslmaorrmileall be thta peh W > deemed revoked. BUILDING FEE a c CONSTRUCTION LENDING AGENCY SEISM tIC FEE Z I hereby affirmthat there b a coruwnion lending agency for the perform- anceoftheworkforwhichthtpermlttL ed(Sec.3097,Civ.C.) TOTAL: ELECTRIC FEE V O Lender,No PLUMBING FEE LLt- Ienaera Aaarev QTY. MECHANICAL PERMIT FEE O W Iiscertltythatl have read thisappliation and statethatthexbovelnformation MECHANICAL FEE 4 corre .I agree to comply with all cityand county ordinances and state laws PERMITISSUANCE FEES PAID: W relating tobullding construction,and herebyauthotre rapresentativesafthb )— Z city to enter upon the abovcmemionei propertyfw inspection purposes. ALTER OR ADD TO MECH. � — (We)a to save,Indemnify an d keep harmless the City Of Cu portion Date Receipt# agaimth it lepmdgment,m ex which ylnanywayactue AIR HANDLING UNIT(To 10,0DO CFM) again id Itylm.sryuenc oft ingotlh rrnit. SUBTOTAL, ,-1 AIR HANDLING IINIT(OVER IB000CFM) CONSTRUCTIO"Recei n of Applicant ntrat°r Date IX1iAO5T HOOD M'/DUCp CONSTRUCTIO �—�5 Ha DOUS MATERIALS DISCLOSURE `y , Willtheapplicant° wmbu3dinga pantstoreorhandleha rdous HEATING UMT(I0100,000 BM l J0 material as defined byt aCupertiu0Mu,dclpal Code,Chaptsr9.17,and the Date II❑ Yesd Safety Cade, No 25532(a)2 HEATINGUNIT(OVERIOE,OODBTU) as I r T Will the applicant or future building occupant use equipment or device VENTILATION FAN(SINGLE it RESID) u , which emha,eardous air contaMwnts a,defined by the Bay Area Air I$$UANEDA2 1AN �aQuality Mawgement Diurit7 BOILER-COMP(3tIP OR IWDM BTU) JUL J 4have Ye, Nreadthehaaa u,omaterlabrequlmmentunder Chapter6.95of BOILER.COMP(OVER]00,000 BTU) y UP the Calilomla Health&Safety Code,Session,25505,25533 and 25534.1 GII Uf understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL mMECH. SQ.F7 responabdity to notify the occupant of the requirements which must be et prior to issuance a a Certificate of Occupancy. O Owner or authomed agent pate TOTAL: ISSUED BY:_ _ OFFICE COPY