22831 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
Building Address:
2283
/n�ets ante: �a,R� one: f
`F rT1I�rL��,S - CITY OF CUPERTINO-BUILDING DIVISION
ZG°n' 'aNarS LIcNc APPLICATION /S�PE ID '8
1�
Architect/Engineer. Llc No: �O LL BUILDING-ELECTRICAI.PLUMBfN HANTCAL . CATEGORY - COr."`T.
QTY ' ELECTRIC PER - p BUILDING PERMIT INFO '4
i= �ECI PLUMB MhLI-i
Address: PFRMITISSUANCE ❑ ❑
LICENSED CONTRACTOR'S DECLARATION '
(hereby affirm that l am licensed under provisions of Chapter 9(comenerm APPLIANCE L - JOB DESCRIPTION
IngwlthSoctim 7000).1Div1alon3ofthe Rualneseand ProleaslonsCode,and my 51`� {• �.._..�.
R¢nmisinfuBf necandeff.d. 1. PANELS Ti1.CV4
I,lanse Clam Lle,g
Date Contrador -
ARCHITECTS DECLARATION 201-IODOANOS I/
asI understand my plans shag be used as public records. OVFJjj WAMPS SQ.FI.FLOOR AREA S/SQ.Fr.
00
k I=j Licensed Professional ELBC L
OWNER-BUILDER DECLARATION IAL SC
Z9. hereby a!(Imnthatlam exemp !corollas Contractor)Llnnse awfo e
p following mason.eartion 70313,Business and Professions Code'Any city or
F ,� c.unlywhich requires a permit to construct,alter,Improve,demolish,orrepair CME A OR LE INST.
anystmrture priortolts Issuance,also requlrestheappgcant for such permltto
file a signed statement that M is licensed Ferment m the provisions of the DEV]
Ow Contnnor's Llcens LAA (Cl pter9(commendngwlth Sedlon 7000)of Divl
COs cion 3ofthe Businnsani PoefesslonsCede).rthat he a.xemptiherefromand NG POOL ELECTRIC ^ /s.1ar� VALUATION
Sn the bean for the alleged exemption. Anyviolationtola civil
.f Section not name
by any V •� ^.
G 5 the basis fora Ferns ed exe prion.the applicant vioation of Section
n not by anyhan OUTLETSSWITCIIESFIXTURES
flue hundred1,asod r of
pro NEW RESIDENTIAL ELECTR SQ.FF.
I,as dolls (S roe STOWES TYPE CONSTRUCTION
❑ property,rly,or my employees with wages r thele dale
�a compensailon,w0ldothe wmkand thestmrturebnm Intended or offered for
O sale(Sec. pply to alnowandf property
Cobuilds
:The or Improves
mpCarron Law
5$ docenotapplytoan ownerolthroug ywhonemp.rimproovidedeatsuch OCC.GROUIP RES UNHS
3 whodve entsaorkhlmse ciedomffered owns.If,ho ever,the building
gor
Improvements ithindneyearfoomprsale.themvevegiRler ill have -
' Improvement lssold within oneyearofcompletion,theowner-bugderwlll have
thig*rden of proving that he did not build or Improve for purpose of saw.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
u L as owner of the property',am exclusively contracting with licanted pp ITISgUANCE
contractors to construct the project(Sec 7614,Buslnesa and Professions Code:
TheContractors License Law don not apply to an owner of property who
bull or im
pmvn thereon,and who contracts for such pcojertALTER-DRAIN&VENT•WATER[EA)
s with a FEE SUMMARY
'gB(pctor(a)Ilmnsed pursuant to the Cmmucime Lkenr Law. BACK PLOW PROTECT.DEVICE
LI I am exempt under Sec. B &P C for this mason
DRAINS FLOOR HOOP,AREA,GOND. SANITARY' ' Y ,N
Owner ECL RECEIPT N
WORKMAN COMP ETVSATION DECLARATION
N FDiTIJRFS PERTRAP SCHOOL TAX Y_ N
❑I hereby a/firm that 1 have a nm6cate of consent to self-insum,or a RECEIPT N
3800,Lab
Workers Compensailonlnsurann oranrtlfled ropy thercof($ec. GAS EA.SYSTEM-1 INCA OUTLET'S PARK FEE Y_ N
Policy
Isis CJ
Calm an GAS FA.SYSTEM-OVER4(EA) DING DI
Y BUILDING DI VISION FEES
ECertified copy is herebyfurnished.the cit. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECRFEE
E]Certified ropy V filed with the city Inspertlon division. '
CERTIFICATE OF IO(EMPIION FROM WORKERS' GREASE TRAP PAID '— s+
COMPENSATION INSURANCE SEWER-SANTTARY-STORM EA 200FT Date Recei t#
(Thlslaxa.) need not be completed lithe permit bforone hundred dollars
(E7I Ali mJ WATER HEATER W/VENT/ELEC7R ENERGY FEE Y N
Inrtl(yihat lntha perlormunn of thewrnk(or which this permit is 4suM,
Ma11
Workers!
not employ any person In any manner n v to become aubfed to the WATERSYSIFM/TREATING
orkera'Compnnsadon Lws of Gll(ornla. Date Pplp
Z Z ApplicantNEW RESIDENTIAL PCMB. SQFT. Date Recei t#
Z O NOTICETO APPLICANT:If,after making this Certificate of&empllon,you
should become Workers'
aubject to the Compensation provisions ofthe you
TOTAL:
03 Code,you must forthwith comply with such prollawas or this permit shall be
W > deemed revoked, - BUILDING FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE _
a Z IherebyafOrm that there Is ammtruction"Ing agency for the perform- TOTAL: ELECTRIC FEE
ana of the work!or which this permit is Issued(Sce.3097,Civ.C.)
p O Lmder.Name PLUMBING FEE
LL I— Lenders Address QrY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW Icertl(ylhatl have read thio appEcatbnand statethat theab.ve ln(ormatlon
4 Iscorred.l agreeto comply with all city and camtymalwaxec.colslate Is. PERMITISSUANCE FEES PAID:
} W relating tobuilding construction,and hereby authorize representatives alibis -
Z city to enterupon the above�anraloned property for inspection purposes. ALTER OR ADD TO MECH. pate Rt#
_ (We)agree to save,Ind cmnlfy as d keep harmless the City of Cu pert Ina 2Ce1 P
against liabilities,Judgments,"sand expenses which may In anyway acme AIR HANDLING UNIT CIO 10,000CFM) SUBTOTAL'
�1 e
4(1 RFIANDLINC UNIT(OVER IO,OJOCFM) CONSTRUCTION TAX
a r of Ap /C tact pate EXIIAUST I IOOD(W/DUCT) CONSTRUCTION TAX PAID:
A R O US MATERIALS DISCLOSURE
Wil hes pt o aria re building occupant store or handle hazardous HEATINCUMT(T6100,000BTU) pate Recei t
ma las de ytteCupertino Municipal Code,Chapter 9.1 2,and the
I watch and Safely Code Sion 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTA E
F1 Yeak_I No, -
Willtheappllcaatorfuturebuildingoccupantuseequipment or devices VENTILATION FAN(SINGLE REBID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air pp�� p
Quality Management Distrid2, BOILIiR•COMP OHP OR 100,000 BTU) . P A I D
4hYn n Na
ave read the haza'r3 oautcdale requirements underChapter 6.95 of BOILER-COMP(OVER 100,000 BTU) ���
the Czlifomla linith&SafetyCane,Sn ectal aiorw 25505,25533 and 25537. I 199
understand that 11 the building doem have a tenant,that it is my NEW RESIDENTIAL MECIi. SQX-T -
responsileflity to notify the occupant of the requirements which at be and
prior to issuance of a Certificate of Occupancy. - CITY►�ur wrI:h III
Owner or authodrad agent _ Data ISSUED
k /Y
TOTAL:
OFFICE COPY