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22743 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Protect Identification PERMIT NO. Building Address: 22743 LIMD NN caner. one: DAD CITY OF CUPERTINO-BUILDING DIVISION Sj- tre �<` Llc.No: APPLICATION /PERMIT 4 �'//� / CA RY CONTROL p p A�It�/EnBUILDINGELECTRICALPLUMBINGMLCIiAMCAL , Bines^ Lt.No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Addreac PERMITISSUANCE ❑. ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under powedoss ofChaptAr9(commeno APPLIANCES-RESIDENTIAL Ng h on 7f00)ol -n-3-oafth<BuNsandlrolestloaCode,andm � JOB DESCRIPTION As 1.full . n4Affec � PANES L Ck.p F. UP TO 200AhTS a . Date Confnctor ARCHITECTS DECLARATION 201-1000 AMPS Z ZO I understand my plans shall be used as public records. OVER IODO AMPS �`� Q.�q QITFTA p p $/SQ.FT. Licensed Pmofesloml SIGNS ELECTRICAL 111 51,._� RVI U�Tdp G OWNER-BUILDER DECLARATION 7a by SPFOIALCIRCUIT/MISC is bb Iherc afflrmthatlam exam lromthe Con[ractar'e Llrens<Lew far the 1VY B following hrequiSesapermit moonstruck, and Professions Code: city or , s�_•sV ORcounty y ty TFMI'.METFR ORPOLE INSf. K� anystr ctureTdortoia Issuance, uuireatheapmve(fors ch,ermit to ^w d anystructure prlementehaa eis also sed pursuant t the rovisions of the POWER DEVICES OAT file a Wgned statement that he b licensed pursuant to the provisions of the 6 OConlranotaLicerue law(ClupmrI(commencing with Scott..7000)of Dlvi- SS Won3ofthe Ruslnessand Pmf<sWmCode)orlhat hebexempt Merefromand SWIMMING POOL ELECTRIC VALUATION yd the basis for the alleged exemption. Any violation of Section 7031.5 by any GS applIant for a permit subjects the applicant to a civil penalty of Act more than OUTLETSSWITCHES.FIXfURFS �ol,� five hundred dollars(SSM, NEW RESIDENTIAL ELECTR - I,as owner of the property,or my employees with wages as their sole —SQA' STORES TYPE CONSTRUCTION C compensation,will dothe work and the structure is nalntended or offered for 5 O sale(Sec.7004,Business and Professions Code:The Contractors Lt..La. (yl�$ does not apply to an owner of property who builds or Improves thereon,and OCC.GROUIs RES.UNITS CF.. who docs suchwork himself or through his own employees,provided that such Improvements are not Intended oroffered forsale.If,however,thebuilding or TOTAL: Improvement baold withlnomyearofcompletion,the owner-budderwill have thgkurden of proving that he did not build or improve for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN I If,as owner of the property,am exclusively mntrading with licensed PERMTC ISSUANCE. contactors to construct the project(Sec.7014,Business and Professions Code: 'I The Contractors License Law dm not apply to an owner of property who ALTER-DRAIN k VENT-WATER(EA) builds or improves thereon; and who contra. for such ptapcta with a FEE SUMMARY m,Btfct aor(s)licensed pursuant to the Contractor's License Law. RACK FLOW PROTECT.DEVICE L�1 am exempt under Sec B k P C for this mason OUTSIDEFFFS OwnerDRAINS FLOOR ROOF,AREA,GOND. SANITARY Y N_ Dale RECEIPT 0 WOR"AN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y_ N_ 0 hereby affirm that I have a mrOfkate of consent to self-Insure,ora R—ECEITT p cemfiate of Workers'Compensation Imuran.m a rertifind copy the.[(See. 3800lab C.) GAS EA.SYSTEM-1 INC.40UTLEIS PARK FEE Y N , Polity# 00 1—I RECEPTN Cany GAS EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES omFCe ed copy is hereby furnished. GREASE/INDUS[AL WASTE INTERCEPTOR 'PLANCHECK FEE enifted copy h filed with the city impaction division. CERTIFICATE OF IXEMPION FROM WORKERS' GREASE TRAP PAID INSURANCE NSURANCE Rhbsectkn need nM completed Nifthapermit ts m forohundred dollars SEWER-SANITARY-STORM EA.20OFT. Date Recei t# ($10()orless.) WATER HFATER W/VENT/ELRCTR ENERGYFEE Y N I comfy that In the performance of thework forwhlch this permit is Issued, I shall not employ an/person In any manner so as to become subject to the WATER SYSTEM/TREATING Workcri Compensation Lawsof Gllfomb 0Z Applicant NEW RESIDENTIAL FLAIR. SQFr. Date Recet t# Z O NOTICE TO APPLICANT:If,after nuking this Certificate of Exemption,you should become subject to the Warkers'Compensation provisions ofthe Labor TOTAL: N Cade,you roust forthwith comply withsuch provisions orthis permit shall be Wj deemed revoked. - IN FEE CL G CONSTRUCTION LENDING AGENCY I hereby a(ISEISMIC FEE mtthat there b a comtmetlon lending agency for the perform ELECTRIC FEE Z ance ofthe work for which this permit is bsund(Sec.3097,CIv.C.) TOTAL: 2 o2 I.endera Name PLUMBING FEE IL F LendersAddrcs QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW I cenllythat l haveread thbappllcatlonand Matethattheabove Nformatlon 1 bcorret.Iagre<to comply with all city and county omdiranam and state laws PERMITISSUANCE FEES PAID: >. to retailing to building construction,and hemby authmiae representatives ofthb Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. Date Rece1 [# _ (We)agree to save,Indemrdlyan d keep harmless the City of Cupertino agalne Miles,judgments,cottaa xpenan which rosy inanywya AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: 0 rug st City In cons o a I ofthls permit. 01 / AIR HANDLING UNIT(OVER IQODOCFM) CONSTRUCTION TAX S;fnitum of Appll on a or Date EXHAUSTHOOD(W/DUCn CONSTRUCTION TAX PAID: ZARDOUS MATERIALS DISCLOSURE Will the appliag At or Ncom building occupant store or hand le havrdous HEATING UNIT(TO 100,000 BTU) Date RCCCI t# material as defined by the Cupertino Municipal Code,Chapter 9.12,and the A' Healthand Safety Code Sectim,25532(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL: ❑ Yes NN. Will the Applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE READ) ISSUANCE DATE which emit harardous air contaMmnta as defined by the Bay Area Air Iity Management District? BOILER-COMP OHP OR 100,000 BTU) ❑ Yes W Na PAI D have read the haze ous mawrlab requirements underChapler6.95 of BOTLER-COMP(OVER 100,000 BTU) the C.Ifomi.Health h SafetyCode,Sections 25505,75533 and 25534. I understand that lithe building does not currently have a tenant.that It is my NEW RESIDENTIAL MECH. SQ.PT DEC - 4 1991 respomibfilty to notify the omvpast of the repumments which mat be met , prior to Issuance of a Certificate of Occupancy. CI I V jJr UI I IIVU Owner or aulhodred agent Date TOTAL: ISSUEDBY: Y OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Protect Identification PERMIT NO. Building Address: 22743 LIMD NN caner. one: DAD CITY OF CUPERTINO-BUILDING DIVISION Sj- tre �<` Llc.No: APPLICATION /PERMIT 4 �'//� / CA RY CONTROL p p A�It�/EnBUILDINGELECTRICALPLUMBINGMLCIiAMCAL , Bines^ Lt.No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Addreac PERMITISSUANCE ❑. ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under powedoss ofChaptAr9(commeno APPLIANCES-RESIDENTIAL Ng h on 7f00)ol -n-3-oafth<BuNsandlrolestloaCode,andm � JOB DESCRIPTION As 1.full . n4Affec � PANES L Ck.p F. UP TO 200AhTS a . Date Confnctor ARCHITECTS DECLARATION 201-1000 AMPS Z ZO I understand my plans shall be used as public records. OVER IODO AMPS �`� Q.�q QITFTA p p $/SQ.FT. Licensed Pmofesloml SIGNS ELECTRICAL 111 51,._� RVI U�Tdp G OWNER-BUILDER DECLARATION 7a by SPFOIALCIRCUIT/MISC is bb Iherc afflrmthatlam exam lromthe Con[ractar'e Llrens<Lew far the 1VY B following hrequiSesapermit moonstruck, and Professions Code: city or , s�_•sV ORcounty y ty TFMI'.METFR ORPOLE INSf. K� anystr ctureTdortoia Issuance, uuireatheapmve(fors ch,ermit to ^w d anystructure prlementehaa eis also sed pursuant t the rovisions of the POWER DEVICES OAT file a Wgned statement that he b licensed pursuant to the provisions of the 6 OConlranotaLicerue law(ClupmrI(commencing with Scott..7000)of Dlvi- SS Won3ofthe Ruslnessand Pmf<sWmCode)orlhat hebexempt Merefromand SWIMMING POOL ELECTRIC VALUATION yd the basis for the alleged exemption. Any violation of Section 7031.5 by any GS applIant for a permit subjects the applicant to a civil penalty of Act more than OUTLETSSWITCHES.FIXfURFS �ol,� five hundred dollars(SSM, NEW RESIDENTIAL ELECTR - I,as owner of the property,or my employees with wages as their sole —SQA' STORES TYPE CONSTRUCTION C compensation,will dothe work and the structure is nalntended or offered for 5 O sale(Sec.7004,Business and Professions Code:The Contractors Lt..La. (yl�$ does not apply to an owner of property who builds or Improves thereon,and OCC.GROUIs RES.UNITS CF.. who docs suchwork himself or through his own employees,provided that such Improvements are not Intended oroffered forsale.If,however,thebuilding or TOTAL: Improvement baold withlnomyearofcompletion,the owner-budderwill have thgkurden of proving that he did not build or improve for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN I If,as owner of the property,am exclusively mntrading with licensed PERMTC ISSUANCE. contactors to construct the project(Sec.7014,Business and Professions Code: 'I The Contractors License Law dm not apply to an owner of property who ALTER-DRAIN k VENT-WATER(EA) builds or improves thereon; and who contra. for such ptapcta with a FEE SUMMARY m,Btfct aor(s)licensed pursuant to the Contractor's License Law. RACK FLOW PROTECT.DEVICE L�1 am exempt under Sec B k P C for this mason OUTSIDEFFFS OwnerDRAINS FLOOR ROOF,AREA,GOND. SANITARY Y N_ Dale RECEIPT 0 WOR"AN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y_ N_ 0 hereby affirm that I have a mrOfkate of consent to self-Insure,ora R—ECEITT p cemfiate of Workers'Compensation Imuran.m a rertifind copy the.[(See. 3800lab C.) GAS EA.SYSTEM-1 INC.40UTLEIS PARK FEE Y N , Polity# 00 1—I RECEPTN Cany GAS EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES omFCe ed copy is hereby furnished. GREASE/INDUS[AL WASTE INTERCEPTOR 'PLANCHECK FEE enifted copy h filed with the city impaction division. CERTIFICATE OF IXEMPION FROM WORKERS' GREASE TRAP PAID INSURANCE NSURANCE Rhbsectkn need nM completed Nifthapermit ts m forohundred dollars SEWER-SANITARY-STORM EA.20OFT. Date Recei t# ($10()orless.) WATER HFATER W/VENT/ELRCTR ENERGYFEE Y N I comfy that In the performance of thework forwhlch this permit is Issued, I shall not employ an/person In any manner so as to become subject to the WATER SYSTEM/TREATING Workcri Compensation Lawsof Gllfomb 0Z Applicant NEW RESIDENTIAL FLAIR. SQFr. Date Recet t# Z O NOTICE TO APPLICANT:If,after nuking this Certificate of Exemption,you should become subject to the Warkers'Compensation provisions ofthe Labor TOTAL: N Cade,you roust forthwith comply withsuch provisions orthis permit shall be Wj deemed revoked. - IN FEE CL G CONSTRUCTION LENDING AGENCY I hereby a(ISEISMIC FEE mtthat there b a comtmetlon lending agency for the perform ELECTRIC FEE Z ance ofthe work for which this permit is bsund(Sec.3097,CIv.C.) TOTAL: 2 o2 I.endera Name PLUMBING FEE IL F LendersAddrcs QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW I cenllythat l haveread thbappllcatlonand Matethattheabove Nformatlon 1 bcorret.Iagre<to comply with all city and county omdiranam and state laws PERMITISSUANCE FEES PAID: >. to retailing to building construction,and hemby authmiae representatives ofthb Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. Date Rece1 [# _ (We)agree to save,Indemrdlyan d keep harmless the City of Cupertino agalne Miles,judgments,cottaa xpenan which rosy inanywya AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: 0 rug st City In cons o a I ofthls permit. 01 / AIR HANDLING UNIT(OVER IQODOCFM) CONSTRUCTION TAX S;fnitum of Appll on a or Date EXHAUSTHOOD(W/DUCn CONSTRUCTION TAX PAID: ZARDOUS MATERIALS DISCLOSURE Will the appliag At or Ncom building occupant store or hand le havrdous HEATING UNIT(TO 100,000 BTU) Date RCCCI t# material as defined by the Cupertino Municipal Code,Chapter 9.12,and the A' Healthand Safety Code Sectim,25532(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL: ❑ Yes NN. Will the Applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE READ) ISSUANCE DATE which emit harardous air contaMmnta as defined by the Bay Area Air Iity Management District? BOILER-COMP OHP OR 100,000 BTU) ❑ Yes W Na PAI D have read the haze ous mawrlab requirements underChapler6.95 of BOTLER-COMP(OVER 100,000 BTU) the C.Ifomi.Health h SafetyCode,Sections 25505,75533 and 25534. I understand that lithe building does not currently have a tenant.that It is my NEW RESIDENTIAL MECH. SQ.PT DEC - 4 1991 respomibfilty to notify the omvpast of the repumments which mat be met , prior to Issuance of a Certificate of Occupancy. CI I V jJr UI I IIVU Owner or aulhodred agent Date TOTAL: ISSUEDBY: Y OFFICE COPY