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20523 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Address: 20523 reCaFew l� ,�Z� CITY OF CUPERTINO�BUILDING DIVISION Contractor'sName; Lie.No: APPLICATION 1 PERMIT r htect/ neer. BUILDING-D.ECTRICAUPLUMBINC-MFGHANICAL CATEGORY LkCOM'AJ1Lj(�p+Z .No: GC.Y'G J QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add. 55,44 PF11M1A7ISS[JANCE LICENSED CONTRACTOR'S DECARATION 1] 1:1 ❑O� 'I❑ 1 harebyriffirmthatl Bernsetmdarr pofClapturg comc- MPLIANCESRE9DENTIAL InhSecbonrDivision 3ofthe Bustnessand ProtessionsCode,and my JOB DESCRDTON Ilwarse1.in full forceand effect. PANELS License Ckss p Co Date __Contractor ARCHITECI•S DECLARATION 201-IOODAMPS q�n ceO Zp (understand my plamsshaBbeusedu publlcrecorda OVER 1000 AMPS SQ.Fr.FLOOR AREA 5/SQ.FT. j Licensed Professional SIGNS ELECTRICAL ` D1 `4-7O,— OWNER-BUILDER DECLARATION SPECIAL CULT/MISC zL, Iherebyaffirce that am exempt fmm the Contractor's License Law far the qq following reason.(Section 70)15,Business and Profession,Cade:Any city or G q county which required a permit toccrutmn,alter,improve,dernalkh,creepalr TRAP.M4 OR POLE IN SI anydtrucwrc price to Its hadance,alsorequlrcslhe applicantfm such permit to TOWER DEV( S file a signed testament that he is Licensed pursuant to the provisions of the 3m� Contractor's License Law(Chapter9(mmmencing with Section 7000)of Divi- ' NG PA ELE C VALUATION SOS ston3o(the Business and ProfesekvCode)arthat hektsemptthere(romand the bask for the alleged exemption. Any violation of Section 70315 by any OUIL I{FRET �O d �a mem,applicant fora permit subjectsthe applicant to a civil penalty of not nnthan 4M: five hundred doll..(y500). I �^�n u I,as owner of the property,or my employees with wages as their sole NEW R AL Ff' STORMS TYPECONSTRUCTION compensation,will do the work,and the structure is not intended or offered for 90 ' sok(Sec.7044,Business and Profealom Code:The Commodes Liremo Taw t r3$ does not apply to an owner of property who Wilde or Improve,thereon,andNIS VA who doessuchworkhlmtdOCC.CROUP RFS.UNITSfearthrough hlsownemployces,provided that such / Improvements are not intended proffered forsale.If,however,thebuilding or OTAL: ImpmvementktoldwlthlnomrarefcompletloNtheowner-buUderwlllhave y tlR,tIurden of proving that he did nM build or Improve for purpose ofukJ. Cry. PL(7A6 INGk, IT FEE LJ L as owner of the property,am exclusively contracting with licensed FLOOD ZINE APN '—/ mntactore to construct the project(Sm 7044,Business and Professions Code: P IT ISS NCR The Contractor's License Law dues not apply to an owner of property who ALTER-EMI k VENT-WATER Wilda or Improves thereon, and who contracts for such p1e)ect,with aFEE SUMMARY �gn{Iaci licensed pursuant to the Contmemes License Law. BACK PLO PROTECT.DEVICE am exempt under Sec. B k P C for this reason OUTSIDE[ICES '- ODRAINS FLOOR ROOF,AREA,COND. SANITARY Y N Owner Date RECEIPT 0 WORKMAN COMPENSATION DECLARATION E31flpIXq,PER TRAP SCHOOL TAX Y N I hereby d .that I have a certificate of consent Endure, nt to self. or a v matflat-of Workers'Comper tlonlr mnceceacedifiedcopythereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE YECEB'Ts 3800,lab C.) Pullcy p — RECEIPT M GAS EA.SYSTEM-OVER 4(EA) Com any BUILDING DIVISION FRES Com ropy k hercbyfuMe city GREASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE Certified ropy k(Tied with the city inspection dlvblon. CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASE'IRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200F1'. Date Recei t# (TNseectbn need notbcompleted lithe permit kfororo hundred dollars MI (5100)a [certifyifythat In the performance o(the work forwhlch this permit is Issued, HEATER W/VENT/ELECTR ENERGY FEE Yed, N ' I shall not employ any person In any manner so a to become subject to the WATER SYSTEM/TREATING Workers'Compensation Laws of California. A z Z Applicant NEWRESIDENTIALPLMB. SQ11T. Date Retei t# Z NOTICETOAPPLICANT:If,after makingthk Certificate o(Exemptlon,you a mldWmtre bjOtoihe Workm'Compematlonpmvklmsofthe You TOTAL: 04 Code,you swat forthwith complywithsuch provkiomorthk permit shall b, LU > deemed revoked. •'E 3/Lr+617 aCONSTRUCTION(LENDING AGENCY SEISMIC FEE 9 . 00 Iherebyaffirm thatthemis mnstroctbn lending agency for the perform- ELECTRIC FEE D Z anm of the workfor which thkperdut is Issued(Sec.3097,Cle.CT TOTAL: 0 O T<nder't Name PLUMBING FEE IL Lender'.Addres, QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Icertltythat]have read this applicatlonand stamthat theabove Information a incorrect.l agree to comply with all city and countyiedinance,andstatelaovs PERMIT ISSUANCE FEES PAID: } W relating to building construction,and hereby authorlx representatives ofthk F Z city to enterupon the abovcmentbrud erty pmpfor inspection purposes. ALTERORADDTOMFCH. Date Rotel t# V _ (We)agree to save,ImicmNfy an d keep harmless the City of Cupertino .gabs liabilities,judgments,"sand expenses which may In anyway accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: agoi dCity i cote of the Eng of this permit AIR HANDLING UNIT(OVER 10,030CFM) CONSTRUCTIONTAX / sgnamreof pp1 ant/Cortracmr I Date IX}IAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS OISCLO RE — WilltheappllantorfutumbulldIngoccupant store orhandle haurdous HEATING UNIT(TO I00,000 BTU) Date ReceI t# material as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Ilea lth and Safety Code Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL: ❑Yn No Willthe appliantor wmbulldingoempantumequiprcntordevices VENTILATION FAN(SINGLE RESID) ISSUAp]['UpAT'F which emit hanirdous air contamlrunts as defined by the Bay Area Air �T/A�Ri`!/� Quality Management District? EOILRR-COMP Dim OR 100,000 BTU) 4Yea (.No havor ad t..Ith&r�i fdy C.eriakrequlremenbunder Chapter 6.95 of BOILER-COMP(OVIR 100,OW BN) II'1 UQ 199U the Glifornk Health h Safety Code,Sections 25505,75537 antl 25516. 1 W tP M �T undersand that lfthebullding doe,not mvrrcntly have alenane,that It la my NEWRESIDENTIALMF.CH. SQ.IT. responsibility to ratify the occupant of the requircnnnts which must be reel �j��f SUP AO I prior to issuance of a Certificate of Occo pa racy. Y Y Owner or authorlacd a gent Data TOTAL: ISSUEDBY�'/I_ �V U• OFFICE COPY