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24239 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification 7 PERMIT NO. Building Address: 24239_ er, xm,: 3nne: A CITY OF CUPERTIN6BUILDING DIVISION �]�� i1 • cnnt=at s y^�F�Li].�No.�: APPLICATION / PERMIT "{ l / / / HfATi�i� _7o BUILDING-ELFCTRICALPI.UMBINGMFCHTAMCAL CATEGORY CONTROL p Archite t/Engineer. Lk.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: PERMITISSUANCE E] ❑ Len that BD CONTRACTOR'S DECLARATION Ihereby thSec r700hatlamsJw3 ofheunder Busiessan provisions of Cssionsode,anene APPLIANCFSRESIDEhTIAL tOB DFSCRB•I7pN Inense I,in bit 000)of d efeon3oftheBuelneseand ProfevlonsCodesand my license I,in full a nd c.# PANELS Licen CWv Llc.p Date Contractor 4. 'tp LmL_ UP TO 2DO AMPS Pr ARCHITECTS DE Uf AT10N 201-IODO AMPS Z I understand my plans shelf be used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA L $/SQ.FT. u�O SIGNSELECTRICAL r�V Fj Licensed Profevbral <Qw OWNER-BUILDER DECLARATION I-n GT SPECIAL CIRCUIT/MISC Therebyaffirmtbar lion 0I.S,B fromthe Contractor's Llcenx Law for t he oo following reason.(SaSian 7m1.5,Business and Professions Code:Any city or O Z.. TEMP.METER OR POLE INST. P countywhkh rcqulresa permlttoconstrot,alteglmprove,demolbh,orrepair anystmMmprlortoltslvuance,alsomquirestheappliantforsuchpemdtto POWER DEVICES f5' a file a signed statement that he b licensed pursuant to the provisions of the 3u � Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi. SWIMMING POOL ELECTRIC VALUATION sum3ofthe Business and ProfevioesCodd orthat he b exempt therefromand 5 the bash for the alleged exemption. Any violation of Section 7031,5 by any OU'ILETSSWITCHESFIXTURES applicant fora permit subjecisthe applicant to a civil penalty of not morethan re Ove hundred dollars($500). NEWRESIDENIIALELECIR F11,as owner of the property,or my employees with wages a their sole SQFT. STORIES TYPE CONSTRUCTION CZa compemation,wRldothe work,and the stmturebnet Wended or offered for 5 p saL(Sec.7044,Business and Professions Code:The Contractor's License Law ( 5$ IS does not apply to an owner of property who Wilds or Improves themon,and OCC.GROUT' R[S.UNT c, who does such work himself or through his own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or TOTAL: Improvement Is sold within oneyearofcomplNbn,the owner-bu0derwiB have t"rden of proving that he did not Wild or improve for purpose of asks.). QTY. PLUMBING PERMIT FEE FT.00D ZONE APN Lj L as owner of the property,am exclusively contracting with licensed PERMIT 155UANCE contractors to consimt the project(Sec.7044,Business and Professions Code: The Contractor's License Law don net apply to an owner of property who ALTER-DRAIN&VENT•WATER(EA) Wilds or Improves thereon, and who contracts for such projects with a cgnt[ator(s)licensed pursuant to the Contractor's License Law. BAIX FLOW PROTECT. C FEE SUMMARY u I am exempt under Sec. B&P C for this reason DRAINS FLOOR ROOF, /' Y N— • Owner DatECL R EErTa WORKMAN COMPENSATION DECLARATION FD(IURFS PER TRAP SCHOOL TAX Y N_ 0 1 hereby a(@m that I have a certificate of consent melf-Insure,or a '��s,yy�� R EB' p <etlOcate ofWarkers Compensationlnsurance ora cetl(ied cepythereef(Sec. GAS FA.5YSTEM-1 INC.40UyspINE N 3800,Lab C.) — 1'aliry pRECEB'I x Com any CASE.A.SYSTEM-OVER BUILDING DIVISION FEES Cetlried cop eEbyu I e GREASE/WDUSTRL WASTE INTERCEPTOR PLANC}-IGCK PEG ¢rifled copy hi filed with the city inspection division. / CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANRARY-STORM EA.2001T. Date Recei t# (This section need net be completed 9 the permit I,for one hundred dollars (6100)orless3wnrER tiFA'mt w/vENr/ET rrI.R ENERGY FEE Y_ N_ I certify that N the perfomunceof thework farwhich this permit hs heated, I shall not employ any person U any manner an w to become subject to the WATER SYSTEM/TREATING Wmkcrs'Compcmatkm Lawsof CaOfmnLt.Date PAID OApplicant NEW RESIDENTIAL PLMB. SQFT. Date Recei t# Z ZNOUCETO APPLICANT:If,after making this Certificate of Exemption,you O should become subpt to the Workers Compensation provisions fthe Labor TOTAL: T Code,you must forthwith comply with such provisions or this permit shall be BU IN W > deemed revoked. - CONSTRUCTION LENDING AGENCY SEISMIC FEE IL IhembyafOrmthat there is a construction lendingagency forthe perform TOTAL: ELECTRIC FEE Z ance ofthework forwhichthls permits Issued(Sm.3097,Clv.C) 02 lendereName PLUMBING FEE IL h- Lcnaersndaress QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW Icedlfythatlhave itthl,applicatlon and semethatthe above information �� d bcornn[.Ica com ly with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID: } relating to Iding ce roctlon,and hereby authorize rcpresentativn o(thb FN try toent ruponthe ove-mention¢ property for inepetlon purposes. ALTERORADDTOMEWL ? (We)agree to a ,indemnify keep harmless the City of Cupertino Date Receipt# L.I against llaM In,' dgmenta,cost o xpenses which may in anyway accrue AIRHANDLINGUNIT(TO10,000CFM) SUBTOTAL: against vid it " ft grantingoftMs it. AIR HANDLING 11hTT(OVER 10,000CFM) CONSTRUCTION TAX Signatureo(AppOcant/Contractor abate EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the a ppllcant or tutu rc building oau pant store or hand le hazardous HEATING UNIT(701001000 BTU) Date RCCCI t# maims as defined by the Cupertino Municipal Code,Chapter 9.12 and the Hlnithand Safety Code Section 25532(47 HEATING UNIT(OVER 100,000 BTU) TOTA . ❑ Ye, r]No Will the applicant or future building rampart use equipment or devices VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air . Quality Management DWlt7 No BOILER-COMP CHIP ORI(XIDWBT1p'36 Yea [ AB F❑1 4havemad the hazanlous materials requircenentsunderChapter6.95of BOMER-COMP(OVEN 100,000BTU) the California Health&Safety Code,Sections 25505,25533 and 25534.1 �� understand that notify the ocgdoe,not a requirmnts tenant,that it busy NEW RESIDEN77AL MECH. SQ.FT 17 1QI+�,.�- responsibility understand hat litheb it occupant of netherequlyhave a which most it met - /� prior to issuance of a Certificate of Occupancy. Owner or authorised agent Date L. ISSUEDIRY: �e✓� a OFFICE COPY