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22923 APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES — USE BALL POINT PEN ONLY Buildin Project Identification PERMIT NO. tlullding Addreu2 �� 22923 . t'ntee. CITY OF CUPERTINO-BUILDLNG DIVISION I I Contr rta'.Na U.No, APPLICATION / PERMIT BUILDINGdEC MCA4PLUMBING-MECHANICAI. CATFLORY CONTROL# Arebhea/Enereer. Lk,No: QTY ELECTRIC PERMIT FEE_ BUILDING PERMIT INFO Addre,d t,1" I PLUMB MELH PFRb9TISSUANCE E] ❑ ❑ LICENSED CO.NTRAROR'S DECLARATION I hereby affirm that l am hemaed under provWonsaf Chapter 9(mmmanc APPUANCESRESIDENTIAL' JOB DRIaCkd7n N Ing with Section 70(10)of Dlvlgon 3 ofthe Bu,ine.and ProfemonsCade,and rry license te In full force and effPANELS.e t. PAD LimnClara Llc# Date Cortrador La!TO 200AMPS ARCHITECTS DECUBATION -]WO AMPS µppµ!! Z I uMerataM my plan ahaB be used u publle rtmrda OVER 1000 ANTI'S SQ.FT.FLOOR AREA f/SQ.Fr. E 0 Licenced Prof®bvl SIGNS ELECTRICAL, #� 1 w �.�a co � C OWNER-BNLDER DECLARATION SPECIALCIRCUIT/MISC I.., Thereby affirm that lam esemp franthe Contneare Llcen.e law(a the OO 9 t- following rtaon.(S a p 7 to B and aM I'r pf k Code:h o city or SMP,METEROR POLE INST. r a muntywhkh requ4napermRtomMrun,ilter.impmve.aermwh orrtpalr 7` anyatrudurt prinm WLwanca oleo requlrothe appeont farwch permit to POWER DEVICES K e a algned Mm—t that he licensed pursuant to the provisions rovisns of the O {-� Nb Contractors License Law(Chapter 9(mmnencing with Sea[Ion 7000)of Dhv SWIMMING POOL ELECTRIC nbn3ofthe Builnessand PramsiovCode)orthrt heisnernpttIumfmmard VALUATION y <.••5777 the ha,b for the alleged emn,pcbn. Any violation of Section 70315 by any �T ��e eppEantfor a permit,subjects d the applicant too v0 pnultydd mthan OUTLElSFI SW17CESFIJCNRFS //`/ 4010 y fMehundmddollan W. ti�� ❑I,a owner of the property,or ery employee wuh wagesu thelr wk NEW RESIDENTIAL ELECIR $�RIES' TYPE CONSTRUCTION k < c'orricran im wlllaothe work and theaveom b rot wended or offered for L(5 5 D auk CSec 7011, Professions and Professm.Code The Conarmtors LTcxroe Law doe not apply to an owner of property who builds or impm es thereon andcam e- who daawchwehhimeUalhrwgh Maownerrtployees,provided Uut wch C. RES.UMTS Mprovemed.am out Intended oroffer<d forule.If,however,the building or TOTAL 'I. I 1 Lmproverrent baold withbomrarofcompletbnthe er-b Merw have y the burden of proving that he did raa build or improve for purpose oleak.). QTY. PLUMBING PERMI-PATE Rasa; M I,as at of the Property,am exchulvely contracting with licensed APN contrartnratoaovbud the project(See.7011,Buelnesard ProfessionsCode: PERMIT ISSUANCE The Contractor'.License IAw dm not apply to an owner of property who ALTER-DRAW 4 VENT-WATER(EA) builds or improves contract,and who contrafar wdi ptojem.wish a C'Mor(s)livened!pumunt to the Conradeas License Law. BACK FLOW PRO=.DEVICE FEE SUMMARY LJ 1 am ezemp under Sec B k P C for this reninOUTSIDERFS ' prom Date DRAINS-FLOOR,ROOF,AREA,GOND. SANITARY Y_ N_ RoPh Ch. A ca ttTION DECLARATION RF.Cm'f 1 IVRVRFS I'ER TRAP SCiaOq,7AX Y_ N ❑I here a Ire a 1Bate d sent to self-lwn,(Sa RECEIPT mrtl(lmte o rarpe tl nl cerW4dcopythertol(Sac GAS FA.SYSTEM-t INCA OUTLETS PARR FEE Y N RECGASEA.SYSIUI-OVERl(EAI DING DII BUILDING DIVISION 4YPS TME`di w fuMshed. CREASE/WDUS1AL WASTE INTERCEPTOR PLANCHECK FEE Certl(Iedm b filed with the city inspection dlvWon. CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAP PAID COMPENSATION INSURANCESEWEt-SANITARY-STORM EA.700F1' Date Recei [# (Thlesetlbn need notbe completed If the pemdt is for one hundred dollars 310D)or ler) WATER HEATER w/VENT/EIECTR ENERGY FEE Y N man I certify that In the perforce of the wort forwhich this pemdt b issued, I.IuB rot employ any person in any manner n as to become object to the WATER SYS-1FM/TREATING Waken'Compewtlon lJM of Gefomb. Due PAID OZ ApplicantNEW RESIDENTIAL MB. SOFT. Date Repel t# Z O NOTICE TO APPLICANT.U,after making this CenRiam d Eaemr pd. you ,holdbeaone.ub*dtothe Warten'Compew provbbvdtMMbar TOTAL: H (n Cade,you mrnfuthwkhmmptywlthwchprovbbvorthbperMtahallh W ] deemed r,olned. t d O CONSTRUCTION LENDING AGENCY SEI IC FEE t I hcmby of .that there It a construction tending agency for the perform ELECTRIC FEE Z anmoftheworkforwhlchthb tbiawed(See309'/,CIv.C.) TOTAL 00 Leaver.Name PLUMBING FEE LLF. Ierder.Ada QTY, MECHANICAL PERMIT FEE MECHANICAL FEE O W Icetify I vereadl .'Plicanm andatatethatthe abweinfaratlon a bmrren.I gree ty hall and mvntyordtrunas.nd mate law. PFRMTTISSUANCE FEES PAID: relating ild d and Ruth otb aempmaentimofthb W Z dtyto to t ntb "for pedoa lonpurpe. ALTUORADDTOMEFL C _ (We , ora 1 amt] the city of Cupetiro Date Recei t# ag.Wtl ties,pd e, a pen wh y sry y.ocu, AIR HANDLING UNIT(TO IOp00 CFM) ag.inst. HYb e t ad at SUBTOTAL: il ALR E3nnNDUNc tmTr(OVER 10,000CFM) CONSTRUCTION TAX W o ppu t att a Date EJDLAUSTH0OD(w/DUCD CONSTRUCTION TAX PAID: !AZARDOUS MATERIALS DISCLOSURE Wllltheappil nt afuturc buddingamrpant,tort or handle havrdou, HEATINGUMT(MIO0,00013717j) Date Recei t# material as dcOncA by tM Cupen]w MuMdpal Code,Chapter 9.17,and the Lo I Ekalth and Safny Code SMIon 7S537(p)7 HEATING UNIT(OVER 100,000 RTU) OTAL: l ❑Ye ,1+�—�I No Wlllthe.pplkantorfuW.building aavpant u,e equipment ordevta•, VFNRLATION FAN(SINGLE RESID) ISSUANCE DATE which eMthanrarm akrict? nta as defined by the Bay Area Ak OCT 30 1991 A Iity hfavgcrrcnt District? BOILER-COMP©EB'GR100,IXU BTU) Y, ❑No a hnifomad the ealth&S mterbb rticm 25rcnbundernd255M..95 of BOILER-COMP(OVR 100,00D BTU) the e,Rt.nmbIieahh4Safety Cads SccWcorm25505,75533andt,that I CHIINU urdentailayto Bthebuilding doe nota requirhaveatmantthatb bmy, NEW RE9DEKDALMECH. SQA C1TM Of �Ur repovlbBitytoa ctheoccupantccthe rnpnirerrcntawhich rmartbe ret prior to Isuaruc d a CMlliate olOauparty. Owner a aulhalud agent Date TOTAL ISSf1ED BY: OFFICECOPY I C- K" FT 21",kam= \ 1 T p'II'& b _ C>o i G — O° N c_ 11 -- - - - x Z CN tn IC � b 3 o .y I7 ,