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22051 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Pro est Identification PERMITNO. . 'B. I AaeI MIT t � _ 22051 nen• ante: Phoran . Ag4—dr&a CITY OF CUPERTINO-BUILDINC DIVISION e" vaso .Name: I Lic.No: APPLICATION /PERMIT l U L BUTLDINGELECTRICAL.nL BINGMECHAMCAL CATEGORY CONTROL/rl—zG rchltect/Engineer. Lac Na C9_l• , FEEE E "" -,BUILDING PERMIT,INFO'ces'�' ,, .QTY, 'wELECTRICPE Address: PLUMB M�h PERMITISSUANCE h�P(-� LICENSED CONTRACTOR'S DECLARATION `--� I herebyaffirm that l aml:ceved under provisional Chapter9(mmmenc APPUANCESRESID L JOB DFSCRFMON ingwith Ss Ioo 7000)ofDn6swr3.fthe Businessand ProfmionsCode,and my PANS I , license iCl.. force and c.#ff. 11 II ? LI rase Cbss LLCM � )V 1\ J ate Contractor 2VIARCHITECT'S DECLARATION d )a pp ne 2 I understand my plaro shall be used a public records =Oyu 1000 ML'S SQ.FT.FLOOR AREA �7$/SQ.FT. zU Licensed Professlovl \ SIGNS EL �,�,e 1 OWNER-BUILDER DECLARATION SPECIAL Z ?hercbyalirmthat l am sectmgrfrom the Contredor'sLlrense Law for the '� Qp following reason(Section 70)15,Business and Pro(mion.Code My city or Gsy county which requires a perouttomvtruct,alter,4npmvq demollsh,orrepalr TEMP.METER O POLE INST. 77 anystru=mprlortolle Lsaamc alsomquimtheappB..tf¢suchp.r ito )pW,pRO O F U file a algned statement that he is licensed pursuant to the proWlons of the SO Contractor's License law(Cha a 9(co .can with Section 7000).!DIA. VALUATION S slon3ofthe BusInmand ProfmbaCode)arNrt heberempt Nertlromand SWIMMING POOL ELECTRIC I 1 C the basis for the alleged exemption. Any Aoladon of Section 7015 by any OUTLE7SSWrICHESpTXNRES 2`�L,.0 / �Q C yam fNehu diorapermit$SM.bthe applicant too tivil pesky.(not more thin 1 O J (� s �•V flue hundred dollars(S°iWl. NEW RESQ7ENTLU.ELECTR SQFr. STORIES TYFECONSITIKTION F11,as owner of the property,or my employees with wages as their sole C7.t mmpenertlon,will do the.,k,.nd thestrocturs b not intended or offurd for O 5 O sale(Sec.7044,Business and Profeaela s Cade:The Contractors License Law 52 does nmapply to an owner of property who builds or improve thereon,and OCC.GROUP RFS.UNITS a'^ whodoeseuchworkhlmsslforthrwghhisownempluym,providedthatmch Improvements are not Intended.coffired finials.ILhowmagthebulldingor TT Improvement hwldwithlnoneyearo(compleB mtheowner-builderwill have _ thq,kurdenof proving that he ardent build or bnpnve for purpose of sI CITY. °PI. 'IBINGPE6Mit :.FEE LJ L as owner of the property,am esclely contracting with ommad FLOOD ZONE APN vlv contraciorsto¢rotact the project(See 70M Bvinmand Pealmv bCode: PERMIT ISSUANCE The Contractors License Law dm not apply to an owner of property who ' Wilds or Improves thereon,sod who mnmrts for such projects with a ALTER-DRAIN&VENT-WATER(EA) �scUs )licensed Pannone to the Committees Line.traors LLaw. _ ' 'FEE SUMMARY LJI am exempt under Sae B J,P C for this reason BACK FLOW PROTFCf.DEVICEOUTSIDE FEES Owner Data DRAINS FLOOR ROOF,AREA,COND. SANITARY Y _ N_' COMPENSATION DECLARATION RECEIPT a WORKMAN COM S� FIXNRES PER TRAP SCHOOL TAX Y N— OT hereby affirm that 1 have o lmu.e of consent d pythn art,ora RECEIPT cenlflvteofWorkeri Compevatlonlvurw¢¢a¢rtikd wpythereof(Scc. 3800, ab C) GAS EA SYSTEM.1 INC4 OUTLETS PARK FEE Y N RECE Policy p DING D[1 Com any GAS EA.SYSTEM-0VER4CPA) BUILDING DIVISION FEES IRed¢pyb hereby tumished. GA.eCC/INDUSIRL WASIEIMFRCEPTOR PLANCHECK FEE Certified cagy b(did with the city Inspection dlWalm. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCESEWER-SANITARY-STORM EA.201 Date RCCeI LM L (11lssee lin need not be c¢nplemd Bthe permit Is!¢one hundred dollen (5100).rlm.) WATER HEATER W/VENT/E.ECTR ENERGYFEE Y_ N— I certdythat In the performance of thework forwhich this permit is Weed, I shall not employ any person In any runner so as to became abject to the WATER SYSTEM/TREATING jFL D Workers'Compevatlon Lawsuit Cahiornia.Data Z Z Applicant NEW RESIDENTIAL Pum SQFT. Date Rete) tp /L+" NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers'Compensation provbiov ofthe Labor TO s N Code,you crout forthwith comply with such provlsiov orthb permit shall be ,� > deemed revoked. CONSTRUCTION LENDING AGENCY MIC FEE a Ih.mbyafR mthatthemba mrotactlon leMing agency for the perform Op CTRIC FEE Z a nceaftheworkfor which thuya rmrt b awed(See 3097,Cl,C.) LL O Lender's Name MBING FEEH Lendcr'aAdareat 41� TY. MECHANICAL PERMIT FE<L HANICAL FEE U Icertifythat l havereadthb application and stamthat Neabtion W It. a.Iagree tocomplywith all city and county.rdlnanme laws PERMIT ISSUANCE FEES1 relating to building construction,and hereby authorize repreof thisZcityto enterupon the abovrmentloned progeny for Wpectlo . ALTERORADDTDMECH. DatC Reeei(We)agree to save,indemnify an d keep harMess the Cien lnoagalnath bilitles ' dgmenI mtsa expenmwhi maylnceras AIR HANDLING UNIT CTO 10,000CFM) SUBagainst said Clcnnsequence� Itgranting. spermiAIRHANDLINGUMr(OVEx1go1)BCFM) CONSTRUCTION TAX u pp ¢n earEXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: ATERIALS DI SUR Will thea Iia ` tuarebuildin . ant reorhadcus HEATING UNTT(TO 100,000 BTIn PP R P Date RCcefplN matedata defln the Cupertino Municipal Code,Chapter9.12 and the Iicalth and SafetyCade Seniors 25532W)? HEATING UNIT(OVER 100,000111 TOTAL: ❑Yes r�No Willthe applicant or tuturebuilding occupant meequipment ordevicca VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit hoz rdous air mnt.mianna denned by the Bay Area Air Quality Management District? BOILER{OMP Oki'OR 100,0(10 BTU) TT�� a� 4Yin F�No T'- A ID havemadthe hazar`hiousmaterlabrequirements under Chapter 6,95of BOILER-COMP OVER IM,001)BTU) the California Health&Safety Code,Sections 75505,25533 and 75534.I -JULunderstand that if the budding does not currently have a tenant,that It is my NEW RESIDENTIALMECH. SQ.FT Jf]Iy �^ responsibility,to notify the oraupam of the requirements which must be H v` FII L9 prior to issuance of a Ccmficate of Occupancy. -Cr4�.�'T{L� l•II t , , 1.. (Tuners aiib.nu agenr Date , ISSUEDBY: U TOTAL: OFFICE COPY