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23699 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification Pli' TNO. Building Address: I MotQT 'SIA 2�-k 23699 a scot: 0a? one: APPLICA 11ON SUBMTrAlA CITY OF CUPERTINO-BUILDING DIVISION Contractor.Name: LIc.No: APPLICATION /PERMIT 9 — 2— BUILDING-MF ZBUILDING-FT.F MCAT PLUMBING-MMC MCAL CATEGORY CONTROL Arehltttt/Enginee Lie.No: BUILDING PERMIT INFO ;Y 4cP4/YG QTY ELECTRIC PERMIT FEE Add hcmresce L14aS DC 1(RACT 'S L,AAT s8, PERhIITISSUANCE _O ❑ LICENSED CONTRACTOR'S DRC ns of Ch ON ICI IhercbyaRum that)amlkm3 ofthe under inessa dPm Chapter9(commmc APPEANCFSRFSIDENTfAl ON 'sense i Section force and offeon3o(the BuslnessandlerefessionaCade,and my license Is in full form and effect. PANELS D aClass LILY D Datete m Contractor ARCHITECTS DECLARATION 201-1000 AMPS XE 2 I understand my plans shall be used as public retards. OVER IOW AMPS SQ.FT.FLOOR AREA S/SQ.FT. ZO L Licensed Professional SIGNS ELECTRICAL 6 m OWNER-BUILDER DECLARATION 3 S �n SPECIAL CIRCUIT/M p, Thereby affirm that am exempt from the Contractor'sLicense Law for the 7.9 following reason.(Section 7031.5,Business and Professions Code:My city or IV OLE' countywhkhrequlresaper twmremM;Oter,lmpmve,demolbh,orrcpalr TEMP METER OR POL I anystructure prior to its Issuance,alsorequirestheappllcant for such permit ter O0 V Ole a signed statement that he k,licensed pursuant to the provisions of the POWER DEVICES ec Contractor's LicenseCaw(Chapter 9(commerecingwith Section 7000)o1Div1- i SWIMMING IDOL ELECTRIC SOS alon3ofth¢Business and Professions Code)or that he as exempt there(romand VALUATION y.'.. the basis for the alleged exemption. Any violation of Section 7m15 by any OUTLETSSWITCHFS FS applicant fora permit aubjtm theapplkam to.civil penalty of not more than n, O five hundred arshepr. SQ. STOW TYPECONSTRUCTION five h dyed dollars r of the property,or my employers with wages a their sok NEW RESIDENTIAL ELECTS FT. cdnpensation,will do the work and the structure is not intended or offeredfor 0 vle(Sec.7614 Business and Professions Code:The Contractors License lzw $ does not apply to an owner of property who Wilda or improves thereon and ^ who does such work hbmc0arthrough his own employees,provided that such OCCGROUP RIS.UNITS improvements arc not Intended or offered for sale.If,however,the build Ing or TOA : improvement issold MthinoneyearofcompleNoNtMe nen- Oderwlll have thp*rdenafproving that ho did not Wild or improve for purposeafeak.). QTY. PLUMBING PERMIT FEE LI L as owner of the properly,am exclusively contracting with licensed FLOOD ZONE APN contractors to construct the project(Sec.70K Buelnessand Professions Code: PERMIT ISSUANCE The Contem or's License Law does rat apply to an owner of property who ALTER-DRAIN&VENT-W Wilda or Improves thereon,and who contracts for such plmjeds with a FEE SUMMARY ya4.cmr(a)ho m"pursuant to the Contractor's License Law. U I am exempt under Sec. B &P C for this m BACK AW PROTECT.D . Owner Date awn FLOW FLOGS,ROOT, Ti Y V N_ WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that I have s certlfiests of consent to self-Insure,or a FIX1°RS STRAP DATE LTA% Y N_ M00,Lab ao(Workers Compensatlanlnsurance ora certified ropy thenof(Sec. R EBT_ 3800, C.) GAS EA.SYSfEM-1 LITLET$ PARKFEE - N RECEIPT Coliry p GAS EA.SYSTEM-OVER 4 A) Cm any (EtlU1LDINC DI VISIONI'EE$ Certifieded copy It hereby tum Certified copy lafiled with theecity Wpedian division. GREASE/INDUSIRL WASTE INTERCEPTOR PLANC14ECK FEE ❑ ity a V CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Date Remi t# (fhissectlon need not be completed lithe permit isfor one hundred dollar P (9100)orlm.) WATER FIFATFR W/VFM/ELECTR ENERGY FEE Y N_ I certify that In the performance of the work forwhich this permit Is issued, I shall not employ any person In any manner so as to become abject to the WATER SYSTEM/TREATING Workers Compensation laws of California. Date PAID 0 Z Applicant NEW RESIDENTIAL PLMO. SQ.FT. Date Remi t# Z U NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should beconp tub ect to the Workers'Compensation provisions of the Labor TOTAL: N Code, must forthwith comply wlthsuch provisions orthtt permit shall be LU j deemed revoked. PY Pe BUILDING TNG FC•' OQ LU g CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby afflrtthat there is a construction lending agency for the perform- TOTAL- ELECTRIC FEB 7 0 an of the work for which this permit is Issued(Sec.3097,CIv.CJ <ndeh Name PLUMBING FEE LL F ).enders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE U Icertilythatl haveread this application and matethattheabove Information O W bcorrect.lagreetocomplywith all cityand countymelinanduand statelaws PERMIT ISSUANCE FEES PAID: 1 } N roytoenteru upon the rcprese Purposo(thb ,. city to enterupon the above-mentioned property(m Wpectlon Purposes. ALTEROR ADD TO MECH. Z (We)agree to save,Indemnify an d keep harmless the City of CupeNna Date Receipt# U against liabilities,' g ots,coatsexpe ldhmaylnanywayacrus AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL' against sea Ci 1 ming of this perNt AIR HANDLING MIT(OVER 10,0)0CFM) CONSTRUCTION TAX CONSTRUCTION TAX PAID: Ignsmrc of Appli n Date IXIiAl15'T HOOD HA2AR SMATERIALS DISCLOSURE Will the applicant or felons building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Receipt# material as deftned by the Cupertino Munidpal Code,Chapter 9.12,and the Flcalth and Safety Code�+.-S�ection 25532(x)7 HEATING UNIT(OVER 100,000 BTU) TOTAL 71 Y. u No Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit hazardous air contamlnsnts i s defined by the Bay Arca Air • Quality Management District? BOILER-COMP©HP OR 100,000 BTU) 4YesI1�No havercadthe hazaQusmaterials requlrcmentsunder Chapter 6.95of BOILER-COMP(OVER 100,000 BTU) the Gli(ornla Health&Safety Code,Sections 25505,25533 and 25534.1 GI �1 understa ed that if the building does not currently have a tenant,that it htmy NEW RESIDENTIAL MECH. SQ.FT responsibility to notify the occupant of the requirements which must be mN Nl/!, prior to issuance of a Certificate of Occupancy. fL Ownerorauthorizedagent Date ISSUED s.• D BY!.2f .TOT / ..� OFFICE COPY