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24815 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY m CITY OF CUPERTINO BID LIVING-ELECTRICAL PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL. BUILDING DIVISION _ 24815 BUILDING MWEET IDENTIFICATION BUILDING AD/(DRESS a SANITARY NO. AP�PEIICATIONSUBMIITALDATE ao g© Xurelle Au` UNIT# LOT# O,,�+4ERS AMF.: / P,ryONE: CONTRAC 'S NAME: LIC NG •J Y✓C' C e�� A FCS7 9ql N- CGNTRGLN tRCIIITELT/ENGINEER: LIC NO: X9 v �—S7 Q�` �4 J ❑ CONTACT: PHONE: pCO BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE BLDG ELECT PLUMB Cf PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL LOB DESCRIPTION QWz I hereby affirmthat l am licensed underprovisions of Chepmr9(ommrn ccing with �i100 Section'/t30plof Division 3ofthe Business and Professions Code,and my license is in PANELS n / _ZW Nllforetand eff p6 C` 4,;<Z License Clan _ IBJ Lic.N ��57 yJ UP TO]OOAMPS v n-K Data — Comm 1••a/ '��` OVER MOAMP �� z FOND ARCHITECTS DECLARATION OVER IB AMASS OOR S/SQ.IT. O Z—O I undern:mA my plans shall be used as public records. FQa; SIGNS ELECTRICAL Licensed Professional Ud'Q OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC. i=1 PUTER 0.U 1 hereby affirm that I um exempt from the Comment's License Law for the O rn following remain.(Section](131.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST. / I:I:y which requires a permit to construct,alter,improve,demolish,or repair any structure K�K }� prionaiu issuance.elsortquirtsthe applicant forsuch pemniuo fileasigned stammrnt POWER DEVICES DATE 3) tp Qp that he is licensed pursuant to the provisions of the Carlin ors license Law(Chapter 9(commencin with Section of Division 3 of the Businessend Professions Code SWIMMING POOL ELECTRIC �4 Otq (commencing ) VALUATION W❑rn tor that hels1.5 by ay plimand the basis for theullegedexemption. civil plush,of OUTLETS-SWITCHES-FI%TURES CZa Sation]In.fiyanyapplicantdollars($50mmit mbjecuthe epplicannoacivil penalty of muIn.Trvethepro ry,or yemp. NEW RESIDENTIALELECR 5 .FT. n❑ Laework,aftheproleny,armycmployesdoroferadforwile(Sete compensation, Q STORIES TYPE CONSTRUCTION wiII dathework,andtheswctu tisnoti Liver.ar afendfor ale(gee.]044,comeirof and Proany h.1m Code:The,ax t emora I.icenm law does not apply 1f rt owner is properrywhobuildsor iedInto nhereomaad ernamuoeno,ma dialor selfarWmugh his OCC.GROUP RES.UNITS ownemployees,providedthat improvement sold ntserenmintendednndfemd the owner- builder e.If, billhavetie brimproprovinishathedi inot build ofcompletion,theonaeof TOTAL: willhave burden approving that he did not build or improve for purpose of ale.). ❑ Lasownerofthepropeny,amexclusivelyconimctingwiNlicemNcontmcmrsto QTY. PLUMBING PERMIT FEE PLOOD ZONE APN construct the project(Sec.7044.Business and Profeselons Cade)The Contractor's Liceme Law does not epplynm anownero(property who Duildsorimpmvea Narcanand PERMIT ISSUANCE whocammcts forsuch Projects with aconuuctor(s)liccmedpumuanua the Conwctots License Law. ALTER DEAL FEE SUMMARY ❑ 1 am exempt under Sec. ,B&P C far this mason BACK FLOW PROTECT,DEVICE TSIDF 'ES SANITARY Y N Owner Data DRAINS-FLOOR.ROOF,AREA,CONE. RECEIPT# WORKMAN COMPENSATION DECLARATION SCHOOLTAX V N (hereby affrth thatlheveucertificme of consentmselGinsurc,maartificum of I'IXTGRfS-PF.R TRAP RECEIPT# orlaus Ciana,mutWWi.losurnceoracenifiedcop thcreof(Sec.38M.Lab C.)which PARK FEE Y N covenalle ret mit^ DIVISION Policy# 4 GAS-EA.SYSTEM-1 INC. OUTLETS BUILDING DIVISION FEES Company AM e" GAS-tA.SYSTEM-OVER4 LEA) PLANCHISCK FEE ❑ Ccnified copy k hereby fumishul. ❑ Certified copy is Eled with the city inspection division. GREASrONDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (Thissectionneedmtbecompletedifthepermitisforone hundreddollars(SIM) SEWER-SANITARY-STORM FA.200FT. ENERGY FEE or less.) I ccnify that in Ne performance of the work far which this permit is issued,I shall WATER HEATER W/VENT/ELECTR not employ any person in any manner so as m become subject to the Workers' PAID Z Compensation lawsof Califamiu. Date WATER SYSTEWI'REATING Date Receipt# Applicant z� 2 NOTICE TO APPLICANT,If.after making this Cmibcate of Exemption.you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: e—I rq became Subject o the Workers Compensation provisions of the labor Code,you must tai 5: forthwith comply with such pow dons or this permit shullbe domed mocked. BUILDING FEE 0.Wi Q CONSTRUCTION LENDING AGENCY SEISMIC FEE V z I hereby affirm that hem is o construction lending agency for the performance of TOTAL: ELECTRIC FEE the work for which this permit is issuad(Sec.3097,Civ.C.) Leader'a Name Lenders Aad¢v QTY. MECHANICAL PERMIT FEE PLUMBING FEE 1 certify that 1 have read this application and-1.that the above information is MECHANICAL FEE PW. correct.l agree to comply with all city and county ordinances and atom laws relating to PERMIT ISSUANCE I S building construction,and hereby authorize representatives,of this city to enter upon the CONSTRUC ION TAX V z abov(Wa)agree to spenyfor inspection keeppurposes. ALTER OR ADD TO MECH. (We)agree m save,indemnify and kap hornless the City of Cupertino against liabilities,ju ents,cosG Tal ex n swhich may in any way reameaguinstsaid City AIR HANDLING UNIT(TO Iff"CFM) consc4 a of the grand this.77 e AIR HANDLING UNIT(OVER 10,000 CFM) Si at of Appli o/Convecmr Dam • EXHAUST HOOD(W/DUCq PAID HAZARDOUS MATERIALS DISCLOSURE / HGTING UNIT(TO 10.000 BTU) Dam Receipt N OVER It10, ��)) Will the applicant or future building coupon,store or handle Intendants methanolu defined by the Cupertino Municipal Cede,Chapter 9.12,and the Health and Safety HEATING UNIT fgp BTU) TOTAL:nT Coda Section 25532(uj] ❑Yce ❑Na VENTILATION FAN(SINGLE RESID) ISSUANCE DATE pp g pan cquipmcn BOILER-COMP(311POR 100,000 BTU) Will thea nta inapt in define by t tune muality Management hazardmui air contaminants m defined by the Bay Area Air Quality Management istricft BOILER-COMP(OVER 100,00 BTU)❑Ya ❑No NEW RESIDENTIAL ���yj//1�ra MECH. SQ.FT. -'aR 7 e I have read the hamNous materials rcquircments under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that fit It din rex not currently have a tenant,that it is my msponsibiliry to notify the It me".as ..which most be met prionm issuance of a CeruGcate of CUP O rnuthorized agent Dam TOTAL: ISSUED BY: OFFICE