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22594APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY Building Pmjse l ldemif"tion Ba�d�gAd�`golvl PFKWT NO. 22594 �mr. Name:Phone: S� LIa—1 'Z CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDINGELK-rRICAL-PLUMBING-MECHANICAL G J l p-I�j�^O Camra oName' —6,�h— \�•r Lk. N. CATEGORY CONTROL/ Arehltem/Fsglneer. LIc. Nee QTY ELECTRIC PERMITFEE BUILDING PERMIT INFO Add. PERMIT LSSUANCE 1:1 ® El LICENSEDCONTR ACTORS DECLARATION I hereby affirmthat lamlkensed under prwlelorsofCWpter9(ovronm Ingwlth Serdan 700(l)of IXvIslon3oflhe BaMm,saaad Pmlestl¢uCodq and my liear. b in full foree and dfeet. License, Cu. Lice Dale Comrsdor ARCHITECTS DECLARATION I uadena ad my pions shag be used u public reads. Lf¢ned professional OWNER -BUILDER DECLARATION IherebyaffimntlutI,maemptfmmthe Comrs orblceroe th LIAwf¢e following mason.(Section 70315, Beabmad ProfessionsCodc Anyeityor'I'FMp.METER oauntywhk requireapermittommtmu alter,bnprove,demolbh,orrepair anyMm=mprbrtoibtarar .Lsorequkeathe,ppll¢ntfWsuchp.m to Ble a signed statement that he 6licensed pursuant to the prov6bns of the airm3Contrsctoh Lkense lAw(Chepter9 (mmrrcncing whh Sectbe 7000)of IXh- Profmbru Code) cIrti he6 exempt 70315 by and the basis the alleged the Web for a e,]eged eectsth apt Any vto atlon of Section me m by any app Bondfor,perms(SW. the applk,ntto, dull pauhyofnut more than ❑I,asowner lltheproperty,d esempbyees wdhwager theredole OE]1, asrtdddbrshepr. aeorN sale C ns 700 w0almses w«k,ndtheawde; brmlat.c6e intended or Lim. sae C. 7Oµ to ar, vane Professbm Code; The Contractor'sL¢ma Taw applytoanowrarofpropercywbnempbuiWa orlmpmovided thereon, that such who dodoes reaessaut,hworkhInex1fartheaugh whoovements a orkhMtelfethrough wowne. If,ho eerothedth,touch Improvements no Intended yvarferedfar platlo thf owever,thebullding¢ Improvamem 6 add whhln one year of<omplNlon the ownerbulberw0l love ( rden'ofprovingthathedldnotbuadorlmprovef¢prrpomofue.). LI 4 as owner of the property, am ettwlvely omtnctlng with licensed mrm,,ders to nom ad the project (Sec 70µ Bualam and Professions Cade The Contractor's Llceress, Taw does era apply to ,n owner of property who Wild, or Improves thereon, and who contracts fee sucA p(ojects with , B¢nsed pursuant to the Contractor's Lkense Law. ¢,n LJ I am eump ec under SB & P C for thio w APPLIANCES -RESIDENTIAL JOB DESCRII-I)ON - \ �T PANELS 111' TO 2DO ANUS — 201-1000 AMPS' OVER 1000 AMN`.Q ZiN FE,JL` �QJ1_ REA I L D P T R T// 15 $/SD. FT. SIGNSELBC7RICAL SPECIIALCIXCUIT/M15C OR POLE WST. pOWpR DEVICES SWRANNG POOL ELECTRIC VALUATION OUD,RISSWTTCHISFIXTURES NEW RESIDFMTAL ELECTR SQFT STORIES TYPECONSttUCTION - TOTA4 QTY. PLUMBING PERMIT FEE OCC.GROUP RF5. UNITS PERMIT ISSUANCE •"h 4 ALTER -DRAW & VENT- WATER (EA) Fr.ODD 7DNR APN FEE SUMMARY BACK FLAW FROT=. DEVICE DRAINS FLOOR, ROOF, AREA, COND. SANITARY Y N RECEIPT' Owner Date WOtAN COMPENSATION DECLARATION ❑1 hereby Norfirmm that have • certl/kate of consent to uB-Inuit, «a ¢NB aofWorFeri Compavatlon Imuran¢Wacertified ropy thereof(Bee 38()(), LabCJ e FD(TURES PER TRAP SCIRX)L'IN( Y_ N_ RFfFe GAS EA. EA. SYSTEM -i INC40UTI.F-IS PARK FFR Y_ Npaiky . RST e GAS EA. S1SIQd-OVER 4 (FA) y BUILDING DIVISION FEES Certifled ropy b herttyfumbhed. ertlned ropy Is (fled with the city Inspeatbn division. CERTIFICATE OF O(VeIMON FTIOM WORKERS' COMPENSATIONWSURANCE (IT6eectbn need not he completed If the permit b fee am hundred dollen Rt 00)Wfy that I¢milte ate any pehe In ofthe nmaurk forwhlohco pemdtbbued, I shag not employ any person In ,ray men u to bemme ubjec to the W«ken'Compensatbn lAsys of California.b. Date ApplicanuNOUCEt NO"DCETO APPLICANT: a sher making this artiaa pno of Fieroµµion, you Compensebnprov6brormit shalbar dbemmeurhwit the ply with Cone. Code you rwrt forthwith comply with each provldbra orthb permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hrm1hyaffirm that then It rutuetlonledbgagencyforthepedorm anceoftheworkforwhkhthb permR 66ued l5ee 30Y7, Clv. C) Leder. ads, Icertlfyth,(Iheve readth6appB¢tbn,d,late(hatthe,bovelnformrtlon bmrrect. emcomply whh alldtyad oarntyordlnanocd roof pate laws relating to building mmtuction, and hereby authorize mpementative a this dty to enter upon the abov rnarntb¢d property f« Irapeolon purpovs. (We) agree to ave, bdemmfy keep hared. the City of Cu ped W agaWtBabN ,judgments,. a eaperaea whkhmay anyway..e agaWt Id I, eque oft Bran g ih6��w ZA Sig of AppIcmt 'ontractor FIAZARDOUS MATER DI Will the applicant or future building occupant pore or handle hanrdous materbl as defined by the Cupertino MuNdpal Code, Chapter 9.lZ and the Healthand Safety Cade Semon 25532(.)7 F-1 Yes r) No Will the-pplieum orfaham 1rIldin8 occupant use equlpmem W devkes wbkh eMt havrdous W mntauNrardaasdellrad bythe Bay Ama Air 'Quality Management District? 1� No 4Y have read the haw nus materials requirements under Chapter 6.95 of the Gldom6Heahh&Safety CWe,S«ab 25505,75.533and255U, 1 understand that 11 the building dm not rurrently have. tenant. that it is my rapcmlbWty to nalfy the«cupant of the requirement, which must be met prior to Esus ace of a Cent "to of Oce Its my. GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECK FEE ' PAID Date ReLzi t# GRFA.SE TRAP SEWERSANITARYSTORM EA. 200FI WATER HEATER W/VENT/ELFDCTR, cl ENERGY FEE Y N PAID Date R i t# WATI'R SYSTEM/TREATING 141W RESIDENTIAL PLMB. SOFT. TOTAL: BUILDING FEE SEISMIC FEE TOTAL 1 ` vC� ELECTRIC FEL QTY. MECHANICAL PERMIT FEE PERMIT ISSUANCE PLUMBING FEE MECHANICAL FEE FEES PAID: ALTER ORADDTO MECH. Date' Recei t# AIR HANDLING UNIT (TO 10,000 CFM) SUBTOTAL' ATR EIA NIXING UNIT (OVER t q" CFM) CONSTRUCTION TAX FaT USTHOODN/DUCD CONSTRUCTION TAX PAID: HEATING UNIT CM 100,000 BTU) Dail RCCeI t# F nNG UNIT(OVER 100,000 RMTOTAL: VFNIILATIONFAN(SINGLE RESID) ISSUANCE DATE - ^ ,, ) C ISSUED BY: /•c li BOILER -COMP DIV OR 100,000 BTL)) BORER-COMP(OVER 1W,0000TU) N'EWRESIDENTLALMECH. SQ. FT Avner or authorized agent Date TOTAL: OFFICE COPY . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY Building Pmjse l ldemif"tion Ba�d�gAd�`golvl PFKWT NO. 22594 �mr. Name:Phone: S� LIa—1 'Z CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDINGELK-rRICAL-PLUMBING-MECHANICAL G J l p-I�j�^O Camra oName' —6,�h— \�•r Lk. N. CATEGORY CONTROL/ Arehltem/Fsglneer. LIc. Nee QTY ELECTRIC PERMITFEE BUILDING PERMIT INFO Add. PERMIT LSSUANCE 1:1 ® El LICENSEDCONTR ACTORS DECLARATION I hereby affirmthat lamlkensed under prwlelorsofCWpter9(ovronm Ingwlth Serdan 700(l)of IXvIslon3oflhe BaMm,saaad Pmlestl¢uCodq and my liear. b in full foree and dfeet. License, Cu. Lice Dale Comrsdor ARCHITECTS DECLARATION I uadena ad my pions shag be used u public reads. Lf¢ned professional OWNER -BUILDER DECLARATION IherebyaffimntlutI,maemptfmmthe Comrs orblceroe th LIAwf¢e following mason.(Section 70315, Beabmad ProfessionsCodc Anyeityor'I'FMp.METER oauntywhk requireapermittommtmu alter,bnprove,demolbh,orrepair anyMm=mprbrtoibtarar .Lsorequkeathe,ppll¢ntfWsuchp.m to Ble a signed statement that he 6licensed pursuant to the prov6bns of the airm3Contrsctoh Lkense lAw(Chepter9 (mmrrcncing whh Sectbe 7000)of IXh- Profmbru Code) cIrti he6 exempt 70315 by and the basis the alleged the Web for a e,]eged eectsth apt Any vto atlon of Section me m by any app Bondfor,perms(SW. the applk,ntto, dull pauhyofnut more than ❑I,asowner lltheproperty,d esempbyees wdhwager theredole OE]1, asrtdddbrshepr. aeorN sale C ns 700 w0almses w«k,ndtheawde; brmlat.c6e intended or Lim. sae C. 7Oµ to ar, vane Professbm Code; The Contractor'sL¢ma Taw applytoanowrarofpropercywbnempbuiWa orlmpmovided thereon, that such who dodoes reaessaut,hworkhInex1fartheaugh whoovements a orkhMtelfethrough wowne. If,ho eerothedth,touch Improvements no Intended yvarferedfar platlo thf owever,thebullding¢ Improvamem 6 add whhln one year of<omplNlon the ownerbulberw0l love ( rden'ofprovingthathedldnotbuadorlmprovef¢prrpomofue.). LI 4 as owner of the property, am ettwlvely omtnctlng with licensed mrm,,ders to nom ad the project (Sec 70µ Bualam and Professions Cade The Contractor's Llceress, Taw does era apply to ,n owner of property who Wild, or Improves thereon, and who contracts fee sucA p(ojects with , B¢nsed pursuant to the Contractor's Lkense Law. ¢,n LJ I am eump ec under SB & P C for thio w APPLIANCES -RESIDENTIAL JOB DESCRII-I)ON - \ �T PANELS 111' TO 2DO ANUS — 201-1000 AMPS' OVER 1000 AMN`.Q ZiN FE,JL` �QJ1_ REA I L D P T R T// 15 $/SD. FT. SIGNSELBC7RICAL SPECIIALCIXCUIT/M15C OR POLE WST. pOWpR DEVICES SWRANNG POOL ELECTRIC VALUATION OUD,RISSWTTCHISFIXTURES NEW RESIDFMTAL ELECTR SQFT STORIES TYPECONSttUCTION - TOTA4 QTY. PLUMBING PERMIT FEE OCC.GROUP RF5. UNITS PERMIT ISSUANCE •"h 4 ALTER -DRAW & VENT- WATER (EA) Fr.ODD 7DNR APN FEE SUMMARY BACK FLAW FROT=. DEVICE DRAINS FLOOR, ROOF, AREA, COND. SANITARY Y N RECEIPT' Owner Date WOtAN COMPENSATION DECLARATION ❑1 hereby Norfirmm that have • certl/kate of consent to uB-Inuit, «a ¢NB aofWorFeri Compavatlon Imuran¢Wacertified ropy thereof(Bee 38()(), LabCJ e FD(TURES PER TRAP SCIRX)L'IN( Y_ N_ RFfFe GAS EA. EA. SYSTEM -i INC40UTI.F-IS PARK FFR Y_ Npaiky . RST e GAS EA. S1SIQd-OVER 4 (FA) y BUILDING DIVISION FEES Certifled ropy b herttyfumbhed. ertlned ropy Is (fled with the city Inspeatbn division. CERTIFICATE OF O(VeIMON FTIOM WORKERS' COMPENSATIONWSURANCE (IT6eectbn need not he completed If the permit b fee am hundred dollen Rt 00)Wfy that I¢milte ate any pehe In ofthe nmaurk forwhlohco pemdtbbued, I shag not employ any person In ,ray men u to bemme ubjec to the W«ken'Compensatbn lAsys of California.b. Date ApplicanuNOUCEt NO"DCETO APPLICANT: a sher making this artiaa pno of Fieroµµion, you Compensebnprov6brormit shalbar dbemmeurhwit the ply with Cone. Code you rwrt forthwith comply with each provldbra orthb permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hrm1hyaffirm that then It rutuetlonledbgagencyforthepedorm anceoftheworkforwhkhthb permR 66ued l5ee 30Y7, Clv. C) Leder. ads, Icertlfyth,(Iheve readth6appB¢tbn,d,late(hatthe,bovelnformrtlon bmrrect. emcomply whh alldtyad oarntyordlnanocd roof pate laws relating to building mmtuction, and hereby authorize mpementative a this dty to enter upon the abov rnarntb¢d property f« Irapeolon purpovs. (We) agree to ave, bdemmfy keep hared. the City of Cu ped W agaWtBabN ,judgments,. a eaperaea whkhmay anyway..e agaWt Id I, eque oft Bran g ih6��w ZA Sig of AppIcmt 'ontractor FIAZARDOUS MATER DI Will the applicant or future building occupant pore or handle hanrdous materbl as defined by the Cupertino MuNdpal Code, Chapter 9.lZ and the Healthand Safety Cade Semon 25532(.)7 F-1 Yes r) No Will the-pplieum orfaham 1rIldin8 occupant use equlpmem W devkes wbkh eMt havrdous W mntauNrardaasdellrad bythe Bay Ama Air 'Quality Management District? 1� No 4Y have read the haw nus materials requirements under Chapter 6.95 of the Gldom6Heahh&Safety CWe,S«ab 25505,75.533and255U, 1 understand that 11 the building dm not rurrently have. tenant. that it is my rapcmlbWty to nalfy the«cupant of the requirement, which must be met prior to Esus ace of a Cent "to of Oce Its my. GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECK FEE ' PAID Date ReLzi t# GRFA.SE TRAP SEWERSANITARYSTORM EA. 200FI WATER HEATER W/VENT/ELFDCTR, cl ENERGY FEE Y N PAID Date R i t# WATI'R SYSTEM/TREATING 141W RESIDENTIAL PLMB. SOFT. TOTAL: BUILDING FEE SEISMIC FEE TOTAL 1 ` vC� ELECTRIC FEL QTY. MECHANICAL PERMIT FEE PERMIT ISSUANCE PLUMBING FEE MECHANICAL FEE FEES PAID: ALTER ORADDTO MECH. Date' Recei t# AIR HANDLING UNIT (TO 10,000 CFM) SUBTOTAL' ATR EIA NIXING UNIT (OVER t q" CFM) CONSTRUCTION TAX FaT USTHOODN/DUCD CONSTRUCTION TAX PAID: HEATING UNIT CM 100,000 BTU) Dail RCCeI t# F nNG UNIT(OVER 100,000 RMTOTAL: VFNIILATIONFAN(SINGLE RESID) ISSUANCE DATE - ^ ,, ) C ISSUED BY: /•c li BOILER -COMP DIV OR 100,000 BTL)) BORER-COMP(OVER 1W,0000TU) N'EWRESIDENTLALMECH. SQ. FT Avner or authorized agent Date TOTAL: OFFICE COPY .