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28681A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING .ELECTRICAL MRMITNU BUILDING DIVISION APPLICATION/PERMIT PLUMRING- MECHANICAL i n O 6 O 1 BUILDING PROJECT' IDENTIFICATION Go 0 IR, v _ . o .p. 4�p 32383 S,J. ICT:PIIONI?: q. OQ_ C� qZ_t' `T3S ❑ Consultant Fees Paid by Applicant (Initial) I here',(fine that 1 am licensed under e .111 provisions of Chapter 9 cm o prov p (commencing QTY ELECTRIC PERMIT PERMIT ISSUANCE with Sectimn700Jl of Di,i,i..3.flhn Hininessand Professions Csdc and my license is in fall force and effect. � � License Class LLCM Uum Glmleoor APPLIANCIi3—RESIDENTIAh PANELS ITECTS DECLAON ARCHRATI 1 endeavored my plans shall be aced as public records MODIFICATION UPTO 204 AMT'S Licensed Padcoinnal 201-1000AMPS OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the OVER IOX)AMPS SIGNS ELECTRICAL following mama (Section 01315. Buierss and Professions Code: Any ehy m county which requires a permit to construct. alter, improve, demolish, or repair any structure SPECIAL CIRCUIT/MISC. primlervib,clacn,a).... requires theapplicom pariah Permit,, file a signed va¢ment that he is licensed pursaam 10 the provisions of the Connector's License Ww (Chapter 9 TEMP. METER OR POLE INST. (commencing with Section 7000)of Division Sof Ne Business and Professions CMe)or that he is exempt therefrom and the hasis (or the alleged exemption. Any violation of ❑ FOOD SERVICE Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of POWER DEVICES not more than rive hundred dollars ($507). SWIMMING POO). ELECTRIC ❑ I. toeweelef the propcny, or my corPloyccs with wages no their sole mmpenration, will o mhe work, and the,mcmrc is not intended or offered (.role (Sec. 7044, Business and Professions Ctda The Conuacmrs License Law does on apply tm an owner, of OUTLETS — SWITCHES —FIXTURES property who builds or improves thereon, and who does such xmk himself or through his own employees, provided that such improvements art not intended or offered for NEW RESIDFNI'IAL ELECFR SQ FT. cele. If, however, the building or improvement is sold within one year of completion, the owmantsuildeT will have the hurden of proving that he did not build or improve for par te(\C�. "'c of wleJ. 1, as owner of the property. am earl usively contracting with licensed contractors it)TOTAL construct the protect (Sec. 7044. Business and Professions Code:) The Contractor's Li. cense Law docs nor apply to an owner of pmPcry who buildsor improves thereon, and QIY. PLUMBING PERMIT who conwtts for such projects with a can ertme) licensed pursuonuo the Con escon's PERM IT ISSUANCE License law. ❑lam1. extent under Sec. ,B&P C for this reason ALTER —UHAIN &VENT — W6XR (EA) Owner Date WORKER'S COMPF.NSAI'[ON DECLARATION 1 hereby off ire under penally of pe jury ane mf the following decl...linne. I have and will maintain aCenlficate mConsent to self -ill for Workers Compen- sation, as provided for by Section 37M of the Labor Cole, for the performance of the rk for which this permit is issued. have and will Cadmium Workers Compensation Insurance, a, "Chad by Section Woof the Labor Code, for the performance of the work for which this pe it is istried. '�CuAtrcnsuti>allrsur�dT'e cunieoNlp CMrtWlrr r1a,,nlidcP CERilizIC NPROM WORrKuE RS' COMPENSATION INSURANCE (This tertian rtttd nd be completed ifthe permit is for ,,rte hundred dollars ($100) in less.) I verify that in the performance of the work for which this permit is noted, I than not employ any Person in any manner so as nubecome subject to the Workers' Compen- sation Laws of California Date Applicant NOTICE TO APPLICANT If, aft ...... king this Certificate of Exemption, you should become subject m the Workers Cnmpcnsminn provisions of the Lahr Code, you mu.a forthwith comply with such provisions .,,his permit shall be dcemW revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is a construction lending agency lir the performance of the work for which this permit is issued (See 3097, Civ, C.) Landers Native Lenders Address 1 certify that 1 have read this application and nae that he above information is license'. l agree to comply with all city and county ordinances and nate laws relating to QTY, building connection, and hereby zuthmie, representatives milli, city to emerupon the above -mem anal property for inspection proper, s. (We) agree to save, indemnify and keep harmless the City of Captain against liabilities, judgmems. coat and expenses which may in any way accrue against said City in onsegncom of the grunting of this pemrit. APPLICANT ON DERS'PANGS AN WILL COMPLY W LTH ALL NON -POINT SOU$C2REGUI. N5. Si tA of ApplicunVCommene Dae HAlARDOUS MATERIALS DISCLOSURE Will the applicunt or furore building occupant stmt a handle hazamm, material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safely Cade, Section 25532(m? ❑Yes No X91 Ne applicant or future building ..,in use le,mpreem or devices which nit hazardous air contaminants as defined by the Bay Area Air Quality Management linfirt! /n ❑Yes �QN 1 have read the haeardous mmeriol.a myuirements Under Chapter 6.95 of the Calm fomia Health & Safety Cude, Sections 25505. 25533 and 255311 undeneM tha if the building does not currently have a taoom.Chat 'it is my responsibility m nwify the mcupant j of the requirements which must he met prior m is .t. of o Cenificae of Occupanry. Owner or amherimd agent Date RACK FLOW PROTI FIXTURES—PERTRAP GAS — EA. SYSTEM -I INC. 46 GAS — EA, SYSTEM -OVER 4(17A) GREASIi/INDUSTRL WASH INTERCE GREASETRAP SEWER—SANITARY—STORM EA. 20419'. WATER HEATER WNENTNLECTR WATER SYS' I'PWRGATING WATER SERVICE NEW RESIDENTIAL PLMB. SQ. FT. TOTAL. MECHANICAL PERMIT PERMIT ISSUANCE ALTER OR ADD TO MSCI I. AIR HANDLING UNIT LTO 111.1X%1 CPM) AIR HANDLING UNIT (OVER 10.01) CFM) EXHAUST HOOD OODUC ) HEAPING UNIT (M 101,010 ITT U) HEATING UNIT (OVER VICTIM BTU) VENTILATION FAN (SINGLE RISID) BOILER —COMP (3HP OR 100.000 BTU) BOILI7R —COMP (OVER 11X7.100 BTU) AIR CONDITIONER NEW RESIDENTIAL MECH. SQ. PT. OFFICE 0 FEE JOB DESCRIPTION RESIDENTIAL: ❑SFDWL ❑ KITCHEN REMODEL C1 ADDITION ❑ PLUMBING RE PIPE C1 MULTI -UNIT ❑STRUCTURAL. MODIFICATION ❑ INTERIOR ❑ CHIMNEY REPAIR IMPROVEMENT ❑ BATH REMODEUREPAIR ❑ DEMOLITION OTHER `DRi._ �_SW a ❑DEMOLITION fid' ❑NEWBLW/ADDITION El TENANT ❑ FOOD SERVICE IMPROVEMENT ❑OTHER SQ. FT FLOOR AREA PAI@ FEE DEC 2 81995 STORIES TYPE CC OCC.GROUP BUILDING DIVISION F e ES PIANCHECK FEE ENERGY FEE GRADING FEE SOILS FEE PAID Date Receipt# TOTAL: BUILDING FEE FEE SEISMIC FEE ELECTRIC FEE PLUMBING PEE MRCHANICAI. FEE CONSTRUCTION TAX HOUSING MITIGATION HE PAID Date Receipt# TOTAL.