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22229 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BuIldinX PmjIdeml(kation //'' , 1 ;{�^a� ,l PEILWTNO. Building Adds 6 Ut uxo G- �Ju t`' j 22229 e mc: C 4QQ � ��6 4 r CITY OF CUPERTTNO-BUILDING DIVISION r� Centracter'.N.nas Lk.No: APPLICATION / PERMIT l7 O L BUILDINGdBC'IRICA4PLIIMBINGMECHAMUL CA=RY CONTROL I Amhftect/Engircer. Lac Na QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address PERMITISSUANCE ❑ ❑ Imo- ❑ LIC ENS EDCONTR under SDECLARATION /I/AVN I hereby affirm that lam lkmsedunderpessand dCsionsC(commenc AI'PI]ANCESRFSIDENIIAL ;OB�JE9CR➢'TION inarnati mlon infou7 teeardlvffoet. Ne Buaravand ProfnelomCode,and tjryrgef- Lice..b. /or¢and d(cat. PANELS ' Lkxnac Cha Lk.g Date Cordncwr ARCHITECT'S DECLARATION 701- 7. I urderatard my planashag be used n public record. OVER IODO AMPS 5Q.Fr.FLOOR AREA S/SQ Fr. LI¢med Prefembrol - SIGNS ELECTRICAL L E D ' N uuuu01 OWNER-BUILDER DECLARATION SPECIALCIRCDIT/MLSC Zt,�G owin raaen. Uuton 7031mp usir he Ca oletor'ell erateode;Law fee the p U T E R following re.aon.(,Seam70xem Bwbm and Pmfeabro Code:My city or /r O I:a TEP METER OR IDLE AST. F� anytym khrequirmapemdt tomnaeud,ate capmve,dem.u&pe rtpalr anyamaure pfemtothat he i.abomry4erount to provisions of to IVIVFR DEVICES r4 5 fill.agnea aaenaeeLa that he b Ilonnedr9(commencing pumnnwt the pm,70M) f the [((( s sumCon3ftheLct.ndPC eaeer9 CammendngwHh Sempt 70M)of Divi- SWIMMING POOL FT FCT?dC ATION 01 aen3dithe Buanea and Pro/eabm Code)orthst halo exempt thertfromand Sit.•]] the baab for the.ILgN exemptfm. Any Wolatbn of Sedbn ABI5 by any a ppll¢ntforaperm bjeUtheapplkanttootl 1penaltydn¢monthan 011'ILETSSWI7CHFSFLCI"ORES Qve area doilans 05M. �n a owrcr d the property,or my employes wish wagm u thetr sole NTiW RF57DENTIAL ELFLTR SQFi. STORIES TYPE CONSTRUCTION pewtlm,wW clothe work,and Newuaure b not intended or ofeml for oh(See.7a4,Bnabm,awrmreammc�ae:rneeomrador.u¢melnw Pjs$ on not apply to an owner of propertywho builds orimprove.thereon,and OCC.GROl1P RES.UNITS C: a domwchworkhimaelf mm thugh Meownemployees,provMM that such bnprovemenb art not Ntended oroffered fmaale.If,hmerver,the building m TOTAL: bnprovernemlaeoldwlthinomrarofcm,pletb thewmerbuMerwthave th,horditm.fprovingtharthedid notbuudorlmprovefmpurpoaeofaale.). Qry. PLUMBING PERMIT FEE I,as owner of the property,am ewhuively contracting with llcesd nFLOOD"LANE APN contractma to emutruct the project(See 7034,Businma and Profeedom Code: PERMIT ISSUANCE The Cordadori License Law don net apply to an owner of property who ALTER-DRAINk VENT-WATER(RA) builds or Improves thenen, and who contracts for wen ea ppjwith a FEE SUMMARY �or(aBrensed wm punnt to the Ctractoe.Lie.Law. BACK FLAW PROTECT.DEVICE LJI am exMec empt uer SB 6 P C for this rtuon Avner Dae DRAINS AR FTOROOF,AREA,COND. SANITARY Y_ N_ WORKMAN COMPENSATION DECLARATION ��a • 71 hereby.frim,that I have a terBtkate of conaent to aeB-insure,m a FOOURES PFR TRAP SCHOOL TAX Y_ N_ W RECTIPT Y rarBBatoof orkrrs'C pewtlmlrounn¢a•¢rtRled ropy thertof Ger. 380Q L.b CJ GAS F.A.SYSTFI.I-I IN'C.40iJ'ILEIS PARK FEE Y N PeBry I GAS EA.S1'STlT1-0VER 4(FA) RE(:=# Cu ny BUILDING DIVISION FEES �Cvmfied copy b heed withmbhed. GREASE/INDUSIRL WASE INTERCEPTOR PLANCHECK FEE ❑Ccrtlfled ropy b filed with the mY Iropectbn division. CERTIFICATE OF TY MPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEW FR-SAt.TTARY-STORM EA.21N+[ Date Revel tk (Ildeeextbnneed not he ccmryleted Bthe pemdt bfarorc hundreddolhn ENERGY FEE Y N RlOO)m le.) WATER T-ffATER W/VENT/EIFL'IR I ceutRythat lythe perbrmn¢dthe wmkfmwWch WapermBis Wued, I"U not employ any person In any manner a as to become vbjed to the WATCR SYS[EM/TREIIING Wwken'Compematbn laws of Ch mWmn .Date PAID ZZ Applicant - ��.. Date Reaei tff 0 NOTICE TO APPL)CANT:If,after making lMa Certifkete a(Ezemptbn, NhVV RF9DENirAL I'I.MB. ahead become wb)tet to the Workers'Compemabn P=11 oftheLbor TOTAL: Q y Code,you must forthwith comply with such provbbro or this permit aballBUILDING FEEh LUG deemed revoked. - aCONSTRUCTION LENDING AGENCY SEISMIC FEE I henby.flim,'bar whichthere h•mmtmam bnding agency for the perform 7Z .nceot the work for which tpermitpcdt bsa lN&c.c.307/.civ.C.) TOTAL: ELECTRIC FEE V O Lender.N. PLUMBING FEE l LL F Lender.Add rme QTY.I MECHANICAL PERMIT FEE MECHANICAL FEE OW Icerttfythetl have read thhappllatbn and antethat theabove BdormaBm a bmrncf.lagrte to comply with allcttyand county oNLanm and state laws PERMIT ISSUANCE FEES PAIL .. >_ N relating to bullding comtructlm,and herby authorise reprenenadve of this IZ dty to enter upon the Grove-rrcntlomd property for 4dbP— Pone"ppose. ALTTRORADDIOMECH - V _ (We).gree to ave,indemrify an d keep harmles the City of CupertUio Date Recei ek agaWtllablBHn,NdgmeMe,costaand expenam whkh coatis anywayacvue MR HANDLINGtJNrr(M 10,000 CFM) SUBTOTAL: age d ley to mnaryuence of the gas d tMs R. AIRIfANDLINCUNrr(OVERIBOXCFM) CONSTRUCTION TAX groPpliant/Contactor Date I EXHAUSrHOODM'/Dix:D CONSTRUCTION TAX PAID: HAZA R DOUSM uLS DI SCIASURE Will eappBcardmf Wmbuddingo pantstomor Ma Icha Motu HEATING UNIT(TO 100,0D)BTU) - Date Rt'cel ell material as defined by the Cupertino Murddpal Code,Chapter 9.12 and the health andSafety Coder Sectlm 75532()7 HEATING UNIT(OVER 10B000 BTU) TOTAL: T1—UU ❑ Yn rLL��--��,�No WBlmit appllam¢r cren building as occupant by the Bayamdevfrm VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE - Quichemithnvrdmaairriet? rants as defined by the Bay Area Nr Quality Marogemera IXMrletr - BOILER-COMP DIiPDR1W,IXq BTU) -04 4 Yn a�Eb ��� have read,lash sus matedah requlrenrnLa under Cluptcr 6.95 of BOTI.FR-NMP(OVpt IOO,ODD BTU) ea thecl1U.hIieaBh ASafety Code,Section25505,75533and75534.I Ij/ undmtand that lithe building don not currently have a tenant,that It bn7 NEW RESIDENTIAL MEIN. SQ.FTv rmortonr uanc ndcertihe oavpntdUbe requlnmene whkh Bwst be met ptbrtobwy to d.y he occupafOa pa nets e Owner or authodud agent Date 755I1ED BY: TOTAL: OFFICE COPY