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24261APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Pro'ed Identification Building Address: 3 CSC. r:� 'aw PER [IT NO. 24261 .e7. came: one. APPLICAT , A josponw CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT —` `� a Contractor's Name: _ Lic.No: BOLDING— MECTRICAL-PLUMBING-MECLIAMCAL CATEGORY CONTROL N Architect/Engineer. Lie. No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address:_ sI��N,, f1A %% '—P Lll,� PERhIITISSUANCE LICE:NSEDCONTRACTOR'SDECLARATION I hereby affirm that l am licensed under provisions of Chapter 9(commenc ingwith I. in all force of anDlvfect.ion (the Business and Prolea4onsCode,and my license b In fail furca and died, APPLIANCESRFSIDENTIAL JOB DESCRBrDON Ra1k_—N��O•, ,�J PANELS Chss Dansc Date Controntr actor , 20I-1000 AMPS • ARCHITECTS DECLARATION I understand my plans shillbe used as public records. OVERIDOUAMPS SQ.FT.ILOORAREA S/SQ. FT. SIGNSELECTRICAL Licensed Professional - SPECIALCIRCUIT/MISC / a h OWNER -BUILDER DECLARATION I herebyaffirmthat l am exempt fremthe Contracture License Lawforthe following reason(Section 70315, Business and Professions Code: Any city or county which r yulresa permlttomnstruc[, alter,lmpmve, demolish, orrepalr F\ I ` I' I! i TEMP. METER OR POLE INST. - any structure prior to lbsua issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the POWER DEVICES �..� )` I /I —� �� �� TER 7 `V SWIMMING POOL ELECTRIC - Contractor's License Law (Chapter 9(commencing with Section 70(0) of Divi- slon3 of the Business and Professions Code) or that he b exempt thercfrom and VALUATION the basis for the alleged exemption. Any violation of Section 70315 by any stheapplicant to a civil penalty of not than applicant fora permit subjens. m OUTLETS -CARES rind dollar (5.500). s owner o! the property, or my employee with wage as their sole NEWRESIDENDALELECTR SQ.FI. SIORIES TYPECONSTRUCTION mpensatlon, wiRdo the work andthe structure b not Intended or offered for s le (Sec. 7044 Business and Professions Code. The Ce nlranols License Law ' does net apply to an owner of property who builds or lmprevn thereonand who doessuchworkhlmself orthrough hlsownemployces, provided that such OCC.GROIR' RFS. UNrrS Improvements are not Intended proffered formic. If, however, (hebuilding or TOTAL: improvement u sold within oneycarofcompletion, the owner -builder will have tl,,e,�a�rden of proving that he did not build or Improve for purpose of sale.).- LJ S ro as owner of the property, am exclusively contracting with licensed contractors to ronstruct the project (Sec. 7044, Business and Professions Code: QTY. PLUMBING PERMIT .FEE ZON FLCODE APN PERMIT ISSUANCE The Contractor's License Law don not apply to an owner of property who or Improves thereoM and who contain for such plojecis with a WRlfactor(e) licensed purausm to the Contradors License Law. LJ I am exempt under Sec. B k P C for this reason ALTER -DRAIN 6 VENT - WATER (EM FEE SUMMARY BACK FLOW PROTECT. DEVICE S DRAINFLOOR ROOF, D. AREA, SANITARY Y N— RFL©PI N Owner —Date WORKMAN COMPENSATION DECLARATION ❑I hereby affitece that 1 have a rtiBate of consent to self -Insure, ora certificate of Workers Compereatlon load rano or a certified copy thereof(Sec. Mail, Lab C) Policy X FIXTURES. PER IRAs — SCHOOL TAX Y— NRECE NN GAS EA.SYSrFM-1 INCAOUTLETS PARK FEE Y N — RECP E.A.. SYSTEM -OVER 4 (FA CaAS BUILDING DI VX IBION FEES MrilRed copy b hereby famished. F-ICenited copy Is filed with the city Inspection divlsloo. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE GREASE TRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID' COMPENSATION INSURANCE (Thissection need not be completed lithe permit b forom hundred dollars Date Receipt# SEWER -SANITARY -STORM EA. 200FT. WATER 1tEATTR w/vEvr/.I.R ENERGY FEE Y N — (s100)or Ica.) I cortRy that In the performance of thework forwhich this permit is issued, WATIT4 SYSTEM/TREATING I shall not employ any person In any manner so as to become subject to the Workers Compensation Laws of California. Date PAID NEW RESIDLNTTAL PLMB. SQ.Ff. Appbcant NOTICE TO APPLICANT: IL after making this Certtfiate, of Exemption, you should become subject to the Workers Compeoaatlon provis1 of the Labor Date RCCCI t# TOTA BUILDING FEE Code, you must forthwith comply with such provbioru or this permit shall he decrrcd revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE I hembyaffirmthat there ha construction lendingagenry forthe perform ance of the work for which this permit b issued (Sec. 3(197, Clv. C.) Lenders Name Lenders Address certtlythat I have madthelappllationaMnate thatthuabovc Information iscorred, I agree to comply with all city and county, ordinances and gate laws - TOTAL: ELECTRIC FEE PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICAL FEEI PERMIT ISSUANCE FEES PAID: relating to building construction, and hereby authorlaa representatives of this city to enter upon the above-mentioned property for trupectlon purposes. ' (We) agree to save, indemnity an d keep harmless the City of Cu ped lm againstlbbllitles, sandeapenseswhkhmayinanywayamue ALTER OR ADD TO MECH. Date Receipt# AIR HANDLING UNIT (TO 10,O30CFM) SUBTOTAL: agabot ty' ft acting of this permit. //n �r3�'�' AIR HANDIJIVG 11N1"1'roVER IO,OWCEM) CONSTRUCTION TAX .!�I1l�V� nanr"ornpp am/Contradm Date EXHALsTIIOOD(W/DUCT) CONSTRUCTION TAX PAID: , HAM RDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 HIM - •Date ReceJ Will the a ppBam on future building occupant store or handle hazardous nuterbl as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the Healthand Safety Code Senion2S532(a)7 MYes M No HEATING UNIT (OVER IN," BTU) TOT aaaa­ VENTILATION FAN (SINGLE RFSID) Will the applicant or future building occupant use equipment or devices ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management Din❑sWNo h[.?have read the hazardoNmalerias requirements under Chapter 6.95 of - A D ' H BOILER -COMP 0HPOR 100,IXq BTU) BOILER-COMP(OVER IW,000 BTU) the California Health k Safety Code, Sections 25505,25533 and 25534. I understand that lithe building does not correctly have a tenant that It is my SEP 24 1992 NEW RESIDENTIAL MECH.. SQ.1-F responsibility to notify the occupant of the mquimersnb which must be and prior to Wuanm ofa Ccroficate of Occupancy. Dc- V Caj!�r Ownrr agent DateISSUEDBY: TOTAL: , OFFICE COPY