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23019 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project ldc ea0on PEIMIT NO. Butkiing Address. PLz 2301.9 TE , �. a an A A A on-�O CITY OF CUPERTINO-BUILDING DIVISION. L1 � • ContraderaNane- LIc.No: APPLICATION / PERMIT O BULDINGELECTRICAL-PLUMBING-MECIIAMCAL CATEGORY CONTROL'N Architect/Engineer. Lic.Na QTY ELECTRIC P RMIT FEE BUILDING PERMIT INFO- LUG UELI PLUMB__yrMTT___ Addrcsx - - PFRNUTISSUANCT El 1:1 ❑ 'LICENSED CONTRACTOR'S DECLARATION - Iherebyaffirm that l am ecensed under provIslonso(Chapter 9(commwc ArPLIA C E JOB DESCRIPTION ingwlth Section 7000)of Division 3 ofthe Business andPes/esalonaCode,and license Is In full form and effect. z,r� License Cha LIc.N ' Date ' Contractor 1 ARCH DEC 'S DECLARATION ` NI-IOW AMPS I understand my plans shall be used as public records - OVER 1000 AMPS SQ.FT.FLOOR AREA f/SQ.FT. !e IvJ Licensed Professional - SIGNS ELECTRICAL GG 6 w OWNER-BUILDER DECLARATION IhruSPECIAL CIRCUIT/MISC s, a owing raftornthatlam31,5,B/romtheContractorslicense Law fort he 9•.❑q�y iuuntyng reason.(Section 7 Ito Business arta Professions Code:My city or ' 'moot hlchrc ulreaa rmlttocoratru altepim demaibh,orrcair TEMP.METERO LI ' e Ya" 9 P ui prove, p as Y� anystmtlure pnorm lm Issuance,also requlresthe appBran[fosuch permitto PDWF.R DEVI . file a signed statement that he Is licensed pursuant to the provisions of Me ' O I., Contractor',Liceme law(Chapter 9(co..drg with Semon 7000)of Divi- El slon3ofthe8usineaaand Pro.e mCode)orthatheheaempitherefromand SWIMMING R VALUATIOys� Sc'S the basis for the alleged ssemptlon. Any violation of Section 70315 by any OUTLE I TC Fl)CH1RE5 - b© CA �a•�r� oapplicant for a permit subjects the applicant to a civil penalty of not more than 2 a live hundred dollars(¢500). NEW R AL EL STO fs TYPECONSTRUCTION �n ❑I,as owner of the pmperty,or my employees with wages as their sale i-. compensation,will dothe work and the structure Isnot intendedor offered for Osale(Sec.7044,Bunions and Profealoro Code:The Contractors Lirerse]aw , ♦�j�$ does not apply to an ownerafpeopertywho bulldsor improves,thereon,and OCGGROIRs RFS.UNITS as who does such work himself orthmugh hisown employees,provided that such impmvemenharenMH tendedoroffendforsele.If,however,the building or TOTAL: improvementIswldwithinoneyearofeompleti theowner-bufderwillhave thLkurdenofpmving that he did not bund or improve for purpose of sale.). QTY, PLUMBING PERMIT FEE LI L as owner of the property,am exclusively contracting with licensed FLOOD ZONE AI'N TheotoCo tra o constructtheLaw JM(Sec.7044,applyBusiness and Pf propouserty Code: rERMITISSUANCE Wild. Contrector'a License law aces not apply to an owner of property who ALTER-DRAIN VENT-WATER(EA) builds or Improves thereon,and who contram for such piojech with a FEE SUMMARY c'gLf acins)licenssd pursuant to the Contractor'.License Law. BACK FLOWPROTECT.DEVICE L_J I am exempt under Sec. 9& P C for this mason DRAINS.FLOORROOF,AREGOND. NITARY N_ Owner Date A, - SAY_RFiCEIT N WORKMAN COMP aNSAT10N DECLARATION FIXTURES.PER TRA SCi00L TAX Y_ N ❑1 hereby affirm that I have•certlfiote of consent to xlGinwrc,ora RECEIPT N 38W,Lab CJ of Workers Comperwtlan Insurance oracertifled copy thereof Wee. GAS F.A.SYSTEM-1 IVCAOU LETS PARK FEE Y N 38 W, — Policy N GAS EA.SYSTEM-OVER 4(EA) DING DI'p Com any BUILDING DIVISION FEIiS Certified copy Is hereby furnished.. CREASE/INDUS[RL WASTE INTERCEPTOR PLANCHECK PGE ' 0Can mcA copy b filed with the city inspection division. CERTIFICATE OF EXEMPTION FR OM WORKERS' GREASE TRA PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Date RCCCI t# (Thlssection need mat be completed Ithe permit Is for ane hundreddollars (91W)ar less.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y_ N I unify that m the performance of the work for which this permit 1.Iswed, I shall not employ any person in any manner was to become subject to the WATERSYSI.EM/TREATING Workers'Compensation laws of California.Date - PAID C' Z Applicant - NEWRESIDENTIALPLMB. SQF7. Date Remi t# Z O NOTICETO APPLICANT;If,after making this Certificate of Eremptlon,you should became subject to the Workers'Compensation pecvhinro ofthe Labor IOTA CC W Code,you most forthwith comply with such provisions orthls permit shall be t j deemed revoked. BU DING FE• LLICONSTRUCTION LENDING AGENCY SEISMIC FEE _ Q. a Ihereby affirm that there la a construction lendingagency,for the perform- Z ante ofthe work forwhichthis permit b Issued&c.3097,Civ.C.) TOTAh U O < Mena Name NELECTRIC B FEE ILL F Lender'sAddress - QTY. MECHANICAUPERMIT - ME HA LFEBO W 1urtifythat l have read this application and statethatthe above informationW burretl.Iagmc to comply with all city and county ordinances and state laws PERMITISSUANCE EE IR } N rehting to building comwctlon,and hemby authonu mpmentatives of this F city to enter upon the abaw,mentlo for impaction purposes. ALTERORADDTOMECH. Z (w ar eCiry of Cupertino Datc R eipt# V not liabilities, nb,coetsan a Mich rtuy In anywayacaue AIR HANDLING UNIT(TO IO,OOD CFM) SUBT TAL' co egra,nin perm; 2 AIRHANDLING UNITUNIT(OVER l0,000CFM) CONSTRUCTION m rco Appli Dae EXHAUST HOOD(W/DUC) _ CONSTRUCTION T X PAID: HAZARDOUS MATERIALS DISCLOSURE _ WBltheappllcantorf.m.rc ilding.pantetoreorl6ndlehav .l HEA77NGUhTT(TOIW,000BTU) Date CCei t# material as defined by the Cupertino Municipal Code,Chapter 9.12,and the - — I i,.hh and SafetyCad,Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) OTA ❑ Yes j]No Will the applicant orfuture building occupant use equipment or devices VENTILATION FAN(SINGLE RESID)„ ISSUANCE which coat haaanlom air contaminants as defined by the Bay Area Air Qua lity Ma ragcment District? BOILER-COMP OHP OR 1 W,OW BTU S yes ❑❑No 4haveread earth aSafet materials requirements25505, 5533 under 25546.95 of BO LER-COMP(OVE 1W,OW BTU) PAID p I D the Health&Safety Cods Sections25505,25533have tenant,that Ir IY V understand thatn notify thldimgdocs not t of erequi meats Mich that it is my NEW RESIDENTIAL MECH. SQ.FT. responsibility ns,Rytheicate o Occupancy. rcmems which must be met NOV prior to issuance of Certificate of Occupancy. � 1 Owner or authodnd agent _ Data P ,sAll Ir - TOTAL: , .' v OFFICE COPY