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22061APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification """i'© 5-0622061 Vv� �►�. � s+�- AlAti PERMIT NO. ante: //�� one: Rr rard`ky 2 F -a lCOS�4vj(eb CITY OP CU R BU ISION APPLIC 10 / E IT p q^ 22� Contractors Name:: °f;7 No: BUILDING -EL CALPL IN FCHANICAL CATEGORY CONTROL. '65 7 C Archlten/En r. LI No: G. QTY EL C ERM[T FG^^E�� BUILDING PERMIT INFO PERkU AN J�"P LICF.NSEDCONTRA OR'SDECLARATION Ihth Soy ffirm on7Dthat DiWaloam n3oftheunder uMpe..odI ofChapter9 (mmmn IngwlihSectlon7010)of Dlvislon3o(the Buslnessand professions Code,andmy Ilcense la In full force and effect. License Clam Lk. p WANCESREE L JOB DFSC ,iI K - -f-�-- ANELS Date Contractor L-- 201-1000 PS ' ' ARCHITECTS DECLARATION I understand my plaro.hall be used as public records. Licensed Professional OWNER -BUILDER DECLARATIONA I hereby affirm that I am exempt from the Contra "oes License Law for the DVER1 AMPS SQ. FT. FL X)RABFA 5:_-a,0 X109 P Y�l l' j] p9.c.tCf G I l / S/SQ. FT. 7q' Q i Yee 9G SEL.EC'IRICAL PFCIALCEtCUIT/MISE TEMP. METER ORPOLE INST, POWER DEVICES following matter. (Section 7031.5, Business and Pmlesslnn. Code:Anydtyor countywhich requires a permit tomrutrud, alter, improve, demollsh, orespair any structure pectin Its ldauance, also requlresthe applicant fonuch permit to foe a .[good statement that he Is licensed pursuant to the provisions of the Coutranora Llceroe Law(Ghapter9(mmurencingwlth Seniors 7000).( Divi- elon 3 ofthe Business and Prafeaeloru Code) or that he is exempt therefrom and 6119 13.42 Iff-9'% SWIMMING POOL FLECCRIC VALUATION the basis for the alleged exemption. Any violation of Section 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of next more than five hundred eome, of hepr. ❑ as owner of the property, or myt employees with wages as them dale l) ! OUTLETSSWHCHESFIXTURES C D � a 2 O NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPECONSTRUCTION e theworkandthestrunurebnot Intended orofferedfar rompcns70K _ sale (Sec. B.si Co TheC Llcene la an to owner don nottauch torn owner ofp rough whonemporimprovnthereoryand apply f property build. Improves d who or his ownemIf,lum,provided that OCC.GROUP RES. UNITS oveme tswork tintelf edorough lefingsuch Improvements we lnlendedoroticredfor ion,thh ner-g doer illhavr Improvement beold within.neyoarofcompletion,tbeowmr-bullderwlll have tenofprovingthathedld not build or improve for purpose of sale.). as owner of the property, am exclusively contracting with licensed Etas to construct the project (SEC 7014, Business and Pentagons Code: The Commences License law don not apply to an owner of property who bulMs or Improves thereat, and who contracts for such ptojects with a m,R(fac1cros)II¢m nd pursuant to the Germane'. License Law. Ll l All exempt oder ee d B k P C for this reason TOTAL: ?(� QTY, PLUMBING PERMIT FEE PERMIT ISSUANCE eJ�✓, ALTER -DRAW kVENT-WATER (EA) FLOOD ZONE APN � � 2$ FEE SUMMARY BACK FLOW PROTECT. DEVICE DRAINS. FLOOR ROOF, AREA, MND. SANITARY Y_ N_ RFCEPI'N nor Dale ' WORKMAt COMPENSATIO pECLARA O ❑1 hereby affirm thi 1 have a certificate of consent to self -macre, or a certificateofWorkere'Compevatimlrouvnce ora certified copythereo!(Sec 3500,LbC.) FIXTURES- m SCHOOL TAX RECEIPT X GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N ' Palley # RECEIPT a GAS EA. SYSfEM-OVER 4 (EA) Cam ny BUILpING DI VISION FE S ❑Certified copy b herebyth the hid. ❑Certified copy V flied with the city inspection division. GREASE/PNDUSTRL WASTE INTERCEPTOR PLANCHECK FEE GREASETRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID SEWER-gANUARY-STORM EA 200111• - COMPENSATION INSURANCE (This aealon need eta be completed tithe permit Is tureen hundred dollam ($1 laorlemJ Laved, I mnot that emin ploy become ncelt Is P .hail not employ an/ person In any manner an g to become subject to the an yearn In an /mannerhework an As to Workcm'Campenmtlon laws of California. Date ApplicaNOnCnt NOTICE TO APPLICANT:e orkful nukingperctionlPM13Exemption, you the Wortwit Cmmp Lab Da[e - Remi t# WATER HEATER W/VENC/RLECTR ENERGY FEE Y N _ Q PAID Date Recei t#shoul/ WATER SYSTEM/TREA1INO NEWRFMDEN71AL PLMB._SQFT. TOTAL: Code, you Code, you must forthwith comply with each provmloro orthm permit shall be forth it rovislnproWlarormit s be deemed revoked. BUILDING FEE SEISMIC FEE 11. D CONSTRUCTION LENDING AGENCY I hereby affirm thatthere lsacomtruction lendingagnnryferthepMmer, sere of the ..,it for which this permit is Issued (Sec. 3097, Civ. C.) Lcruice. N. IcadceAAddreg I cerUfythat l havereadthisappliatlonand state that formation bmnea. I agree to comply with all cityand county exrdoanoro AauIaws TOTAL: a6 Oo ELECTRIC FEE 8d Y. MECHANICAL PERMIT FEE p ve MECHANICAL MECHANICAL FEE a.' �"7 PERMITLSSUANCE `. PEE$PAID. ' relating tobuilding mrotroalon, and hereby authorize erpreeentatives of thisa..y city to enter upon the above-mentor�M property for Inspection purposes. (We) agree to save, Indrmnlfy an d keep harrrd m the City of Cupertlno agalrotllabNties,pdgnenb, mNsand expense. which may In anywayaccrue .gairo d City in cons en of the gra Ingot this permit. Date Recei t# P ALTERORADDTOMECH. aL� AIR HANDLING UNIT (TO 10,0D0CFM) SUBTOTAL" MR HANDLING UNIT (OVER 10,aw CFM) CONSTRUCTION TAX Igo ire Applicant/Con or I Datc F.XHAUS'C How (W/DUCT) CONSTRUCTION TAX PAID: HAZARD S MATERIALS DISCLOSUR E Will the applicant or future building p.at store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the Ile❑alt Ynnd Safety Codl,er�-Sealoon2Tx532(a)? ' 'Date Recei t# HEATING UNIT (TO 100,000 BTU) HEATING UNIT (OVER 100,000 BTU) TOTAL: } VENTILATION FAN (SINGLE REED) '-ISSUANCE DATE Will the applimntar(uture building occupant use equipment ordevices which emit hazardous air contaminants as defle d by the Bay Area Air Quality Management District? Ye. R� No ave read the our materials is r 95 of 255enls underChapter ^ }a#a^ 1 �es BOILER -COMP QHPOR 100,000 HIM BOILER -COMP (OVER 100,000 BTI)) the Health k Safety C th & S t.. urr 25505, 25534. I - NEW RESIDENTIAL MfiCH. SQFT that. understand doesnet currentlyhave a tenant, that ltBmy usponsindt at if to hfy the ogdoet eta a require encs which to notify the occupant re the requirements which must be reset responsibility to issuance prior to Lssuanre of Certificate of Occupancy. /sltv as} Cum. 1!1 ISSUED BY-. Owner or authorized agent Date - TOTAL: OFFICE COPY