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22256 APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES — USE BALL POINT PEN ONLY, Building Project identification PERMITNO. Building Address: (L) ^ ^ e ^c'1\ - r 22256 IIONA " CITY OP CUPERTINO-BUILDING DIVISION contras' sN�ame' g \ He.No: APPLICATION /PERMIT �_ `�91 af2Architect/En n w7�J tf BLRLDINGELECTRICALP-UMBINM G-MrC[IACAL CATEGORY gl ce CO.N'ptOfpFr a Lk.No:, Q'[Y'; t ELECTRICPERINTP ti '. ''. FEE,, �' 1' - + BUILDING PERMIT INFO Address: ( PERMITISSUANCE /-l.CZ � ❑ '❑ ❑ LICENSED CONTRunder provisions - - Ihthe aton7DOhatlamsionsed 3ofthe usinegand Pro Cssions odeand nc APPHANCFSRFSTDEN77AL JOB DU<KB-TON It...hSection 7000)ofd offeon3otthe Bualneaaand PmfesslansCodeend my (Jn license K1.lass (orae And erred PAM7S 1 IT b J�`�•4= License Clam Contractor �k Ir.It Date CContractor �.l ARCHI=S DECLARATION 201-1 ODO AMPS q�'+rsO zp lundentand mypiinashallbeused aspublicrecords. OVERIWDAMPS - SQ.FT.FLOORAREA S/SQ.FT. NO�O Licensed Professional SIGNS EL[C'[RICAL A" r �}� � �L✓,� .<c. OWNER-BUILDER DECLARATION SPECTATOR UIT/MISC jD`` 1'~..a(a{�V' I zr, a .Iherebyasorm5ortio 731.5,BlromiheContractor'sLieneeLaycityoe M U T t oo p county hick renuireva permit toconanem and Pimprove, ecoCodd:An city r O L H�y TPMP.Mh7FAORl'OLF.INST. �4g3 countywM1lch requlnreapermit tomnsWR,alter, demolbh,orrcpalr g '3 anystructum prlorto Its issuance,aborcgWresthe applicant for such permit to POWER DEVICES . p `S Q file a signed statement that he is licensed pursuant to the provisions of the G61 Corrector's License Law(Chapter 9(commencing with Section 7000)of Dork 30r^ slon3olthe Busmessand Profemlona Cat h ode orthebeicmpttherefromand SWIMMING POOL ELECTRIC m Sn'g the basis for the alleged eaemptlon. Any violation of Section 7031.5 by any 6 S OUTLETSSWITCHIESHXTURFS tYJ five hundred epeaM($5M)ctsthe applicant to penalty of not more than a 6 ©C?a five I,as owner of pr). NEW RESIDENTIAL ELLER SQ,Fr, STORIFS TYPECONSTRUCTION ❑compensation,owner or the property,or my employees with wages r their dole < C3c,7044will do B-Abactheworrafeathe m;Codurebnmmraconetended or offered for 5 0 doe(not Sec.7ply to an owner of property Codbu e:The C.orI paves Iharem Lw �$$ doesoeapply tornowner ofprough his one mpoyees,povided harem,and OCC,CROUP RFS.ONUS who doessuch w no tIntelf or dedoraughedow ale.If osseprovidedihat ldingrh Improvemenle arc not intended orolfered for sale.IL however,thebuliding or TOTAL: u Improvement of provi within he did nut build fo purp asofs le.), th,e�uEdenwner of the Property,am build orlmprovcfacting oseofcense ,QTY, ;i,'.PLUMBINGPERMIT '1 - "FEE " FLOOD ZONE APN IJ L as owner of the property,(m.70K Business ess And with licensed Codd contractors to construct the project(Sm.70K Buelnen aM Pro(emloru Code: PERMITISSUANCE , The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN 8:VENT-WATER[EA) bundre s or Improvm thereon,and who contracts for such p,-ja s with a cgB(rador(s)licensed pursuant to the Contractors Llcenss Law. FEE SUMMARY 51 am exempt under Sec. B k P C for this reason BACK FLOW PROTECT.DEVICE DRAINSFLOOR ROOF,AREA,COND. _ SANITARY Y_ N_ Owner - Date RECEPTN WORKMAN COMP b1VSATION DECLARATION FIXTURES.PER TRAP SCI'IOOL TAX Y N ❑I hereby orf m that I have r certofm of concent to epythsure,ora RECEIPT,N certificate o(Worken'Camper.+ationlmurance orattrtlfidmpythertnf(Sec. GAS EA.SYSTEM-1 INCA Poli Lab C.) PARKFM Y_ N PaltryN GAS EA.SYSTEM-OVER4 MA) DING Ip Coma - BUILDING DI VISION IT I'S ortined copy b hereby INTERCEPTOR mrnecity GREASE/INDUSIRL WASTE: - PLANCHECKFEE �Cetlitled ropy b filed with the city inspection division. CERTIFICATE OF E%EMPFION FROM WOR KERS' GREASE TRAP PAID /^ COMPENSATION INSURANCE. SEWER-SAMTARY-STORM EA 200Fr Date Ree IH 7 Rhos less.) need not M completed tithe permit b(Drone hundred dollen (510aftifyss.) WATER HEATERW/VENT/ELECTR ENERGY FEt� (certify thato the person manner forwhichthld permitis booed, — I shall not employ any person Tn any manner so As to become subject to the WATER SYSTEM/TREATTNC Worlicant Compensation Laws of Gll(ornb.Date PAID Z O NOTICETOMPLICt to orkeusaklnm a CertnlPro o(EnemptheLyou NEW RESIDENTIAL PLMB. SQ.FT. Retei tN should become mbjed to the Workers'Compensation Provisions of the Labor OTAL: LU N' Ae.dou must forthwith mmply wlthauch provlslom orthb pemNt shallM W j ddeemed revoked. t BU[ TNG FG• '_� Cp d CONSTRUCHONLENDING AGENCY encyfo SEISMIC FEE 6O' Z Thereby orkfrwm that them bamodtmdssamd(ion sin.3097, iv.C.)the perform- TOTAL: ELECTRIC FEE a once of the work for which this permit b tuned(Sec.3097,Civ. ' LL O Tenders Adore PLUMBING PGE LL L) lender's Address QTY. MECHANICAL PERMIT• .FEE MECHANICAL FE O O Imd.Iagreet c mplyead withal] and stacounty hat ordinances edgate tionlaws M LU Is mime.Iagreeto comply with alldtyand rountyardlnanttdand gate laws PIRMTTISSUANCE FEES PAID: W relating to building construction,and hereby authorme representatives of this F z city to enter upon the above-mentloned property for Inspection pu rpown. ALTERORADDTOM22H. Date 12 eei [# _ Me)agree to save,Indemnify an d keep harmless the City of Cupertino - P Against lbbllitied,)udgments,costsand expenses which may in anywayaccom AIR HANDLING UNIT(To 10,000CFM) SUBT TAL: age' City In con ntt of the gra rating of this �/i /1 AIR HANDLING UNIT(OVER If1,000CIM) CONSTRUCf10N TA Signature al Applicant/Contractor fDabt � EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX AID: HAZARDOUS MATERIALS DISCLOSURE Willthe applicant or future bulldingoccupant store orhandle hazardous HEATING UNIT(TO 100,000 BTU) Date RCfel materlal ad deflncd by the Cupertino Municipal Code,Chapter 9.12,and the Healthand SafetyCode Sectoon25532(a)7 - HEATING UNIT(OVER 10,000 BTU) TOTAL\ , QYes No Will the applicant More building occupant use equipment or devices VENTILATION FAN 6INGLE RESID) - ( DATE which roost hazardous All rontaMnantsaa defined by the Bay Arca Air „T 3cy�' - Iity Management District? BOILEILCOMP OHP OR 100,000 BTU) Yea No / ;P �Pa have read the hen ons matcrlals requirements under Chapter 6.95 o! BOILER-COMP(OVER l00,0008]U) 4 pl] the California I health&Safety Code,Secthrea 25505,25533 and 25534.I understand that n tifyhe the ing occupant of thcurrently equir haves tenant that it boy h'EW RFSIDENHAL MECFh. - SQ.Fr. J responsibilityriorthxa mnoUtythe oats of ccupa requirements which most be and ((t prior to Lmuantt of a Certificate of Occupancy.' s Owner or authorlud agent - Data TOTAL: ISSUEDBY � OFFICE COPY ,