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22181APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification Build Ing Address: /LIs'8s' ,vMic�lL A � CU&JMVd �'-r PERMIT NO. " 22181 +nen i 11hons: E."'Po L,, ASO '492—* CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUfLDINC-ELECTRICALPLUMBING.MECFIAMCAL APPLICA LEON SUITMEVIAL ntrader's Name: Lk. No: t J CATEGORY CONTROL N Architect/Engineer. Li No: QTY' ELECTRICPERMIT FEE BUILDING PERMIT INFO ' Addms: - t C' ® ❑ ❑ ❑ PERMITISSUANCE L Elxl CONTRACTOR'S DECLARATIO I hereby affirm that l am licensed under provisions of Chapter mr Ingwith Section7OOD)ofDlvlslon3ofthe Businmand Pmfeisiona Code, and my license Is In fu0 effect. et' QQ /ro p LicenseChs Lic. N-4 94 Date Contactor ARCHITECTSDECLARATION ]understand myplarushaBbeused aspublicrecords. Licensed Professional OWNER -BUILDER DECLARATION I hereby aIIirenthat I son exempt from the Contractor's Limme Law for the following mom. (Section 7011.5, Business and Professions Code: Any city or county which requ lm a permit to mrutrect a ter, Improve, d euro W h, or repair anystwd mpdartoih Usuame,alsorequlreatheapphmntforsuchpermitto file a signed statement that he is licensed pursuant to the previsions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Dlvl- Moo 3 ofthe Business and Professions Code) orthat he b exempt therefrom and the basis for the alleged exemption. Any violation of Section 70315 by any ' applicant fora permit subjects theapplicant to a civil penalty of no morethan It ue undred dollars (5500. 61, as owner of the property, or my employees with wages as their sale eumperoation, will do the week, and the structure is out Intended or offered for tale (Sec- 7064, Bu flem. and Profeshms Code: The Contreciu/s Lim. Law does not apply to an owner of property who builds or Improves thereon, and who doeseuch work himself or through hisown employees, provided that such Improvements are nM Intended oroffered fwsak. H however,thebuilding or improvementbsald Mthinoneyearofcompldtorytheowner lderwillluve the burden of proving that he did not build or improve for purpose ofwleJ. Lf 4 as owner of the a pm)mt,,am exclusively contracting with Hamed Business and of preioro Cade: (Sec. 7044oapply TheconCalera to mrolmct the w does The Conor imp's License Taw does nho appty to owner such E property who Wilds t r improves thereon, and who coarsen (im such ptojecb with a theCmlracioYa License Law. pursuant Sec. cqB�+ctm exempt U I am ezemp under Sec. B k P C for this recon APPLIANCESRESIDENIIAL JOB DESCRU-MN I Oc^I L•� `S - PANELS UP TO 2DOAMPS — 2014000AMPS OVERIOWAMPS. SQ. Ff. FLOOR AREA , - S/SQ. Fr. , SIGNSELSLIFUCAL . SPECIALCIRCUIT/MLSC TE.fp,MEfEROR POLE INST. POWER DEVICES gWI,(MgNC POOL ELECTRIC OUTLE75SWI7'CHFSFIX'IURFS VA�L�1UAAVON NEW RESIDENTIAL ELECTR —SQ FT• STORIES ' TYPE CONSTRUCTION TOTAL: QEE TY. PLUMBING PERMIT F OCC.GROUP RES. UNITS PERMiTISSUANCE ALS( -DRAIN k VENT- WATER (EA) FLOODZONE APN FEE SUMMARY BACK FLAW PROTECT. DEVICE DRAINS FLOOR ROOF, AREA, COND. Fp(•I•URFS PER TRAP SANITARY Y N— N Owner Dae WORKMAN WORK MAN COMPENSATION DECLARATION �1 hereby affirm that I have • ]esu ate of consent to self-inwre, (Sa 3800,Lab of Workers Comperoatlonlsuranawaadi(led mpythem((Sec. 38110, Lab CJ Policy tl SCHOOL TAX Y N RECEIPT N GAS, EA' SYSfEM1 INCA PARK FEE Y_ N_ RECENT N GAS EA. SYSI7M-OVER (EA) C°rn ^Y BUILDING DIV] SION FEES ertified copy is hereby (umlahed. Cedifind ropy is filed with the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit isfw one hundred dollars (9100)grless.) I hardly that in the performance ofthe work for which this permit is Issued, 1 shall not employ any person" In any manner n s to become wb)M to the Workens Compenutionlaweof CaWomla. Date Applicant NOTICEco APPLICANT: If, after making thiosation Certificate Exemption, theLyou should become =at to the Workers' Compewsons mthis ns permit eLabbe Code, you eelm fMhwith comply with such provisions orthb pemdt aha] be deemed revoked. I CONSTRUCTION LENDING AGENCY I hereby affirm that the. Is. coiutwction lending agency(cribs perform- ante of the work for which this perinot b issued (Sec 3097, Cm. Q Lenders Name Lender's Addtvs a 1 dilythatl haveread this applicatlonand statethatlheaboveln(omution Is correct.I agree to comply with W city and munty ordinances and gate laws mixing to building corutwction, and hereby aulhorke representatives of this city to enter upon the above-memoned property for Inspection purposes (We) agree to save, Indemnify an It keep harmles the City of Cupediro against liabilities, pdgmente, mile and expenses which may in anywayacuue agalrist sfoIty In consequence of the granting ofperml(. ^� Stdarreo App t/Contractor Wte HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.17, and the Health and Safety Code Section 255310)7 ❑ Yee No Willlhe applicant or tore building occupant use equipment or devices Mich sent hazardous air contaminants as defined by the Bay Area Air gcent District? IBy Maram Yee have read the Maxx No ousmaeriahrequimmnhunderChapter6.95of the Ca llfmots Flrolth kSa fety, Code, Sections 15505, 25533 and 25534. 1 understand that if the building does not currently have a tenant, that 11 is my responsibility to notify the occupant of the re julremenls whkh mug be met prior to Iseuanec of a CedlOcate of Occupancy. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECR FEE PAID Dale -Rotel t# GREASE TRAP SEWER -SANITARY -STORM EA 2M WATER HEATER W/VENT/ELECTR ENERGY FEE Y N PAID Date Recei f# WATER SYS[EM/TRFAENG NEW RESIDENTIAL PLMIL_SQ.FT. t .TOTAL: BUILDING SEISMIC FEE l TOTAL: ELECTRIC FEE QTY. MECHANICAL PERMIT FEE PLUMBING FEE MECHANICAL FEE PE(LMTTLSSUANCE FEES PAID: ' Date' , Receipt# ALTERORADDTOMECH. AIR HANDLING UNIT (tO HLODO CFM) SUBTOTAL: AIR HANDLING UNIT(OVER 10,OMCFM) CONSTRUCTION TAX E(HAUSTHOOD(w/DUCT)- CONSTRUCTION TAX PAID: Date RBcel f# HEATING UNIT (TO 100,000 RE" HEALING UNIT(OVER 100,00D BTU) TOTAL:{- VENTILATION FAN (SINGLE RESID) ISSUANCEAstTE ' /+Ta '� y)1 r N _ iSSIJED OY: BOILER-COMPQHPOR100,0008TU) BOILER-COMP(OVIR 100,000 BTIA NEW RESIDENEAL MECH. SQ.FT Owner or authoslud agent Date TOTAL: OFFICE COPY - i " S ' I yet i� � ���,//�,�-•'• ... . 2A 17 `'' \ I \ \ V r %I. I F J F rr^. � APP f IN A�RDANCERW�Tfl THE 'j UPERTINO _ : CODES AND ORDIN N ®- ��-.FL�'_- D ihi el of Plans and be t on, the i0 b at sAecifications MUST pto make any c n.fimeq and It is ung 1 the d. withoop_n,.1.i�r��+�iAS^(%iYti�Li TIiR,a t e" L � of! rcn — SNA! nPmg a this plan ad Pertln0, POL`(�i1T M Ot he 116 "1 spgcificaticn 3l1PIp of Dia Da,mit Dr 1 br I r �t any o �icl_tion 11 any 0,0.1 r,• �' Q d @ince or. State tae. PLOT PLANS CRECKFD BI A -n r -- Li n �F'F10E COPY RI ECHVE'D ..MAY 2 0 M1 B , MY OE CUPERTINQ---- PN 14 17 Z4, CtO L2L I f, q ,3 - 5, "L n (rs 6 X (p _ Po STS, 4z • .• L07- l LOT � )(ex/6 Ae-ePo')K\ — /058'5 MITA—t 10 549 M i L(�Cwo, — /0537 M 1 t. -LEVE. I - 5, 1 "c, n lrs (0)<(Q. POSTS W -D .• .• Ae,eaa.s )(px16 Af-eto,*A\ Lo 7- - /05215 M!L-A-EP- LOT — io549 MIL( -VL 1-07 9- - 053 Mr"Er0. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification Build Ing Address: /LIs'8s' ,vMic�lL A � CU&JMVd �'-r PERMIT NO. " 22181 +nen i 11hons: E."'Po L,, ASO '492—* CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUfLDINC-ELECTRICALPLUMBING.MECFIAMCAL APPLICA LEON SUITMEVIAL ntrader's Name: Lk. No: t J CATEGORY CONTROL N Architect/Engineer. Li No: QTY' ELECTRICPERMIT FEE BUILDING PERMIT INFO ' Addms: - t C' ® ❑ ❑ ❑ PERMITISSUANCE L Elxl CONTRACTOR'S DECLARATIO I hereby affirm that l am licensed under provisions of Chapter mr Ingwith Section7OOD)ofDlvlslon3ofthe Businmand Pmfeisiona Code, and my license Is In fu0 effect. et' QQ /ro p LicenseChs Lic. N-4 94 Date Contactor ARCHITECTSDECLARATION ]understand myplarushaBbeused aspublicrecords. Licensed Professional OWNER -BUILDER DECLARATION I hereby aIIirenthat I son exempt from the Contractor's Limme Law for the following mom. (Section 7011.5, Business and Professions Code: Any city or county which requ lm a permit to mrutrect a ter, Improve, d euro W h, or repair anystwd mpdartoih Usuame,alsorequlreatheapphmntforsuchpermitto file a signed statement that he is licensed pursuant to the previsions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Dlvl- Moo 3 ofthe Business and Professions Code) orthat he b exempt therefrom and the basis for the alleged exemption. Any violation of Section 70315 by any ' applicant fora permit subjects theapplicant to a civil penalty of no morethan It ue undred dollars (5500. 61, as owner of the property, or my employees with wages as their sale eumperoation, will do the week, and the structure is out Intended or offered for tale (Sec- 7064, Bu flem. and Profeshms Code: The Contreciu/s Lim. Law does not apply to an owner of property who builds or Improves thereon, and who doeseuch work himself or through hisown employees, provided that such Improvements are nM Intended oroffered fwsak. H however,thebuilding or improvementbsald Mthinoneyearofcompldtorytheowner lderwillluve the burden of proving that he did not build or improve for purpose ofwleJ. Lf 4 as owner of the a pm)mt,,am exclusively contracting with Hamed Business and of preioro Cade: (Sec. 7044oapply TheconCalera to mrolmct the w does The Conor imp's License Taw does nho appty to owner such E property who Wilds t r improves thereon, and who coarsen (im such ptojecb with a theCmlracioYa License Law. pursuant Sec. cqB�+ctm exempt U I am ezemp under Sec. B k P C for this recon APPLIANCESRESIDENIIAL JOB DESCRU-MN I Oc^I L•� `S - PANELS UP TO 2DOAMPS — 2014000AMPS OVERIOWAMPS. SQ. Ff. FLOOR AREA , - S/SQ. Fr. , SIGNSELSLIFUCAL . SPECIALCIRCUIT/MLSC TE.fp,MEfEROR POLE INST. POWER DEVICES gWI,(MgNC POOL ELECTRIC OUTLE75SWI7'CHFSFIX'IURFS VA�L�1UAAVON NEW RESIDENTIAL ELECTR —SQ FT• STORIES ' TYPE CONSTRUCTION TOTAL: QEE TY. PLUMBING PERMIT F OCC.GROUP RES. UNITS PERMiTISSUANCE ALS( -DRAIN k VENT- WATER (EA) FLOODZONE APN FEE SUMMARY BACK FLAW PROTECT. DEVICE DRAINS FLOOR ROOF, AREA, COND. Fp(•I•URFS PER TRAP SANITARY Y N— N Owner Dae WORKMAN WORK MAN COMPENSATION DECLARATION �1 hereby affirm that I have • ]esu ate of consent to self-inwre, (Sa 3800,Lab of Workers Comperoatlonlsuranawaadi(led mpythem((Sec. 38110, Lab CJ Policy tl SCHOOL TAX Y N RECEIPT N GAS, EA' SYSfEM1 INCA PARK FEE Y_ N_ RECENT N GAS EA. SYSI7M-OVER (EA) C°rn ^Y BUILDING DIV] SION FEES ertified copy is hereby (umlahed. Cedifind ropy is filed with the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit isfw one hundred dollars (9100)grless.) I hardly that in the performance ofthe work for which this permit is Issued, 1 shall not employ any person" In any manner n s to become wb)M to the Workens Compenutionlaweof CaWomla. Date Applicant NOTICEco APPLICANT: If, after making thiosation Certificate Exemption, theLyou should become =at to the Workers' Compewsons mthis ns permit eLabbe Code, you eelm fMhwith comply with such provisions orthb pemdt aha] be deemed revoked. I CONSTRUCTION LENDING AGENCY I hereby affirm that the. Is. coiutwction lending agency(cribs perform- ante of the work for which this perinot b issued (Sec 3097, Cm. Q Lenders Name Lender's Addtvs a 1 dilythatl haveread this applicatlonand statethatlheaboveln(omution Is correct.I agree to comply with W city and munty ordinances and gate laws mixing to building corutwction, and hereby aulhorke representatives of this city to enter upon the above-memoned property for Inspection purposes (We) agree to save, Indemnify an It keep harmles the City of Cupediro against liabilities, pdgmente, mile and expenses which may in anywayacuue agalrist sfoIty In consequence of the granting ofperml(. ^� Stdarreo App t/Contractor Wte HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.17, and the Health and Safety Code Section 255310)7 ❑ Yee No Willlhe applicant or tore building occupant use equipment or devices Mich sent hazardous air contaminants as defined by the Bay Area Air gcent District? IBy Maram Yee have read the Maxx No ousmaeriahrequimmnhunderChapter6.95of the Ca llfmots Flrolth kSa fety, Code, Sections 15505, 25533 and 25534. 1 understand that if the building does not currently have a tenant, that 11 is my responsibility to notify the occupant of the re julremenls whkh mug be met prior to Iseuanec of a CedlOcate of Occupancy. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECR FEE PAID Dale -Rotel t# GREASE TRAP SEWER -SANITARY -STORM EA 2M WATER HEATER W/VENT/ELECTR ENERGY FEE Y N PAID Date Recei f# WATER SYS[EM/TRFAENG NEW RESIDENTIAL PLMIL_SQ.FT. t .TOTAL: BUILDING SEISMIC FEE l TOTAL: ELECTRIC FEE QTY. MECHANICAL PERMIT FEE PLUMBING FEE MECHANICAL FEE PE(LMTTLSSUANCE FEES PAID: ' Date' , Receipt# ALTERORADDTOMECH. AIR HANDLING UNIT (tO HLODO CFM) SUBTOTAL: AIR HANDLING UNIT(OVER 10,OMCFM) CONSTRUCTION TAX E(HAUSTHOOD(w/DUCT)- CONSTRUCTION TAX PAID: Date RBcel f# HEATING UNIT (TO 100,000 RE" HEALING UNIT(OVER 100,00D BTU) TOTAL:{- VENTILATION FAN (SINGLE RESID) ISSUANCEAstTE ' /+Ta '� y)1 r N _ iSSIJED OY: BOILER-COMPQHPOR100,0008TU) BOILER-COMP(OVIR 100,000 BTIA NEW RESIDENEAL MECH. SQ.FT Owner or authoslud agent Date TOTAL: OFFICE COPY - i " S ' I yet i� � ���,//�,�-•'• ... . 2A 17 `'' \ I \ \ V r %I. I F J F rr^. � APP f IN A�RDANCERW�Tfl THE 'j UPERTINO _ : CODES AND ORDIN N ®- ��-.FL�'_- D ihi el of Plans and be t on, the i0 b at sAecifications MUST pto make any c n.fimeq and It is ung 1 the d. withoop_n,.1.i�r��+�iAS^(%iYti�Li TIiR,a t e" L � of! rcn — SNA! nPmg a this plan ad Pertln0, POL`(�i1T M Ot he 116 "1 spgcificaticn 3l1PIp of Dia Da,mit Dr 1 br I r �t any o �icl_tion 11 any 0,0.1 r,• �' Q d @ince or. State tae. PLOT PLANS CRECKFD BI A -n r -- Li n �F'F10E COPY RI ECHVE'D ..MAY 2 0 M1 B , MY OE CUPERTINQ---- PN 14 17 Z4, CtO L2L I f, q ,3 - 5, "L n (rs 6 X (p _ Po STS, 4z • .• L07- l LOT � )(ex/6 Ae-ePo')K\ — /058'5 MITA—t 10 549 M i L(�Cwo, — /0537 M 1 t. -LEVE. I - 5, 1 "c, n lrs (0)<(Q. POSTS W -D .• .• Ae,eaa.s )(px16 Af-eto,*A\ Lo 7- - /05215 M!L-A-EP- LOT — io549 MIL( -VL 1-07 9- - 053 Mr"Er0.