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20592 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Address: '803/ 20592 mere ams: one: - CITY OF CUPERTINOLBUILDING DIVISION �_ �� d min .Name: I,11: APPLICATION /PERMIT 0. BUILDINGELECTRICATePLUMBING-MECHAMCAL CATEGORY CONTROL N • Archtte t/ ginner. Lie Na: neareaa: P. $ p _ QTY ELECERICPERMIT FEE BUILDING PERMIT INFO 0 3�y% S.J.CA 9511 b PERh4TISSUANCE ^�iY' ❑ ❑ LICENSED EDCONTR under provisions ll-5 [hereby mftrmthsi DivisimsedheBusirov nd Pm Cha=&Cocommen APPUANCESRESIDENCIAL JOB DESCRIPTION It...is Mlon to.of Divfect. llhe BuslnemandlivfeulmsCyde,and my license is I. force and c.11 S� ` PANELS Lkeneq Class Lk.N--(��1 1�- Dab,4-�Contrator t'c L� ARCHITECTED LARAT19 1(It-1 OOO AMPS Z I understand my pkrs shall be used as pubbc records. OVER IOW AMPS SQ.FT.FLOOR AREA S/SQ.FT. 6 CO U Licensed Professional SIGNS ELECTRIC 6 C OWNER-BUILDER DECLARATION SPFCLIL M Iherebyaf8mthat l am exempt from the Contractor's License Law for the pp following....(Setion 7031.5,Business and Professions Cods:Anydtyor O TEMP.M 1 O NST. AI r carntywhkh rcqulresa permittocorsWd,alley Improve,demoWh,orrepalr y nystructure prior to its lssuance,ako requires theapplirant forsuch permitm WERD S rL file a signed statement that he is licenced pursuant to the provlsioro of the 3w Contractor's License law(Chapter 9(mm encimg with Section7000)of Dlvl- WELECTR VAton 3 of the Business and PrMemiam Code)or that he k exemptthere(romand the basis for the alleged exemption. Any violation of Stolon 703ISby anyapplicantfor a permit subjects the applicant to a dvil penalty of not more than O five hundred dollars($500). SQ.Ff. STORES TYPE CONSTRUCTION' Z 6 M I,as owner of the property,or my employees with wages as their sok compensation,will dothework,and lhestruture Is not intended or offered for q eale(Sec.7074,Butncsa and Proleson.Code:The Contractor.Lt..law ({$$ does nm apply to an owner of property who builds or Improves thereon,and OCG CROUIr RES.UNITS E who daesauch work himseforthrough his own employees,provided that such Impmvemenes am not Intended mroffered for sale.If,however,thebuildingor TOTAL Improvement bsold withinoneyearofcompleioktMe ner-bu0derwgl have 1 rdcn of proving that he did mat build or improve for purpose ofsale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN 4 as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE Kl �ar� contraclma to construct the project(Sec.7044,Buslnem end Pro(enlons Code: 1 v/ The Contractor's License law does nor apply to an owner of property who ALTER-DRAIN&VEM-WATER(EA) Wor Improversthereon,and who contracts for such ptojem with a FEE SUMMARY c7Vtm(s)Ikemed Pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE L-II am exempt under Sec B k P C for this reason • Owner Date DRAINS.FLOOR ROO$AREA,COND. SANITARY Y N_ RECEIPT N WORK MAN COMPENSATION DECLARATION FIC S-PER TRAP SCIi00L TAX Y N ❑I hereby.(firm that I have o lmur ate of convent d pythemof or a RECEIPT N certificate o(Wmrkers'Compeneatlon lrsunnce oraartltkd ropytM1ereof(Sec.3800 lab C) GAS EA.SYSTEM-1 ING4 OUTLETS PARKFEE Y N Paltry tl eRECEIPT M Com an GAEA.SYSTEM-OVER 4(EAI Y s J[d[ S BUILDING DIVISION FEES Cert edcopy is hereby fth ed. ertGRFASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE Ned copy k filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA."FF. Date Receiptil (TMssetton need not becomplied[(the permit k(Drone hundred tlollan (SlW)oify that NATER HEATER W/VENT/FLECT.R ENERGYFEE Y N Iceour thatln any phe erson rmance of the so as to b h.subis ebbo the 1 shat mol employ any person In any manner at as l0 berome objet to the Worken'Compeneatlon laws o(CallfomkWATER SYSTEM/TREATING .Date PAID Q Z NOTICE NEW RESIDENTIAL PLMB. SQ.FT. Date Recei tit Z Q NOTICE TO APPLICAM:IQ after making this Certificate of Exemption,you Fshould become subject to the Workem'Compemation provisions of the Labor TOTAL: W Code,you=at fort hwlth comply with such provisloru or this permit shall be > deemed revokedILDING FEE .W CONSTRUCTION LENDING AGENCY SEISMIC FEE (L IherebyafOrmthat there k amnetroctimn lend Ing agency for the perfomr ELECTRIC FEE D Z anceoftheworkforwhtchthb perndt6Wued ESee3097,CIx.C.) TOTAL: Jr U O Lender's Name PLUMBING FEE CV LL I— lander%Addresa QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW Imtifythatl have read this appinformationtionand tatethat the above information 1 Iscorrect.l a gree to comply with all city and county ordinances and tate laws PERMTTISSUANCE FEES PAID: >. relating to building rorutrution,and hereby authorize representatives of this H Z city to enter upon the above-menttoned property for Inspection pu rposes. ALTER OR ADD TO MECH. Dale Rxei IN V — (We)agree to nave,indemnify a d keep harmless the City of Cupertino against ikbilltks,pdgments,mts.nd expenses which may In any way accrue AIR HANDUNG UNIT(TO 10,000 CFM) SUBTOTAL: agairsI Cityinconsarycraeofth anting ofthispennit. -"L.. v AIR HANDLING UNIT(OVER 1 f1,0D0CFM) CONSTRUCTION TAX r natueof AppIIc Contrador I Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUSMATF ALSDISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UMT(T0100,00011TU) Date Recei tin material as defined by the Cupertino Municipal Code,Chapter 9.17,and the - Health and Safety Cade Section 25531(.)) HEATING UNIT(OVER 100,000 BTU) TOTAL: ❑ Yrs M No Willtheappllam oruturo building occupant use equipment ordevices VENTILATION FAN(SINGLE RESID) ISSI_7ANg DATE which emit haza rdous air contaminants as defined by the Bay Area Air YY P""9"'dpr1B�Lpt , • Quality Management District? BOILER-COMP©HP OR 100,000 BTU) 4 Yrs rd No ' I'' ( Y havereadthebaza ousmalerlabrequirementsunder Chapter 6.95of BOILER-COMP(OVER 100,000 BTU) JVI4 nl u1990 the Czlifomia Health 4 Safety Code,Settlors 25505,25533 and 15536. I understand that It the building does not currently have a tenant,that It is my NEW RESIDENTIAL MECIL SQ.FI responsibility to notify the occupant of the requirerrenb which at be met y prior to lsuanm of a Certifiatc o(Occupanry. Albar of CUpe1LI6o Owner or authorized agent Data ISSUEDBY:TOTAL: OFFICE COPY