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24545 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PE CITY OF CUPERTINO t IL LNG. :LhCTRICA PERMI'JNO. APPLICATION/PERMIT 1'1.11AIBING 24545 BUILDING DIVISION BUILDING.PROJEC r IVENI'IFICATIOry ADDRESS: �1 s� ,, SANI'1T IN Meet 'ARYNO. APPLICAION SUBMITTAL DATE 3 /Z- ,41A1J�jDLJ 2 UNIT# LOT# OWNERS NAME: PHONE: C MIRACfOR NAME: 1.1 N CA(.7-12-41VIes S porn 3 NlC CONTROL# sai ARC 1111 GINEBR: LIC NO: ADDR17SS: ' ❑ __5s CONTACT: PHONE: I QTY, ELECTRIC PERMIT FEE BUILDING PERMIT INFO FIa LrY IJta .l Z�J�j P13RMIT ISSUANCE Zb Q BLUE Lf;Cf PLUMB MECH �� El El LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL Oil I hereby affireathat Lein licensed underprovisions of aripter9(commencing with JOB DESCRIPTION WOO Section 7")of Division 3offle Businessvnd Profession.,Care,and my license is in PANELS , `- `� y� full force and effect. / �-Z PANELS AMPS 4 Litenxu Cl�ts��-.�-/I�—hic.N co�N Dale_LZ'r�—Comrec 2(ll-IIXKI AMPS ZOcbZ ARCHITECTS DECLARATION OVER IOOUAMPS r SQ.FT.FLOOR AREA S/SQ.IT. OZ Q 1 understand my plain shall Ee used as public records. /S QD ' <y F W SIGNS ELECTRICAL �a�a� LicenseJl nlessional OWNER-exempt?Rm the Co ATION SPCCIAI.CfRCUI'I'/MISC. / UTE O F I hereby affirm,(Se thou 1 vin exempt from the Contractor's License law for the �� t'3tum following rcaaon.(Section 11115,Business and Vmfessions Cole:Any city or county TEMP.METER OR POLE INST. rjof/la t tS"iJ which requires a permit to cam un,otter.improve,demolish,or repair any structure Y� retort,its issuance,alsomquiresthe applicant for such pemittofile asignedste¢mem POWER DEVICES E DO that he is licensed pursuanno lbe provisions of the Contractor's License Law(Chapter ay y 9(contmunaln with Seation]Wo fDM,ion 3ofthe Buslnes,rod Proms,ims,Code) SWIMMING POOL,ELECTRIC xCW gwl )t AI.UATIO Way orthm he is exempt herefrom and the basis for the alleged exemption.Any violation of OUTLETS SWITCHES-PI%TURES CZQ Section 7031.5 by any.pplicaat fora permit subjects theopplicarm na civil .try of t] not more than five hundred dollars($500). Wt_� ❑ I,asownerofiheprapcny,ormyempinyeeswithwagesasiheirsolecompensation, NEW RESIDENTIALELECIR _SQ.ET. STORIES TYPECONSTRUCIION a3— will do thewmk,and the stmeture is not intended or offered for sure(Sec.9044,Business and Ptofc.Wona Con,:'I he Contractors License Law docs not apply to an owner o1' property who builds or improves thereon,and who does such work himselfur through his employees,provided that suchimprovermntsare not itnemdeioroffered battle.If, OCC.GROUP RF:S.UNITS however.the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of Milli�11 sale.). ❑ bus nwnernf the pftperly,sent exclusivelyconrtactingwithlicensed ttmtracmrstu QTY. - PLUMBING PERMIT PEE FLOODZONE APN construct the project(Sec.7044,Business and Professions Cede:)The Contractor's License Lawdoes notapply to an uwnerofpmperty who builds at improves thereon,and PERMIT ISSUANCE whucomosen fmsuch projects with.contractors)Iiemsedpunmmoo,the Commctm'sgl'ITR DRAIN (FA) License Law. FEE SUMMARY ❑ 1 am exempt under Sec. ,lJ&P C for this mason BACK FLOW PROTECT.IJIiVICIi O I.IDE FEES SANITARY Y_N Owner Dole RECEIPT • DRAINS-FLOOR,ROOF,AREA.COND. WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN ❑Workers Cu affirm thnlhave vicenifcmcof rony,haud (Sed re,or Lob Cfi)vmof FIXTURES-PER TRAP RECEIPT# Workers Compensation lnsumnce oracenifieJ ropy,thereof(Sce.3800,Lab C.)which PARK FEE Y N coven all employee's under this permit. GAS-EA.SYS9'EMEI INC,4 OUTLETS RECEIPT'# Policy# BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER 4(E.A) PLANCHECK FEE ❑ Cenilied ropy is hereby furnished. ❑ Certified copy is RleJ with the city impeaion division. GREASEIINDUSAKI,WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASEIRAP SOILS FEE COMPENSATION INSURANCE (This section need not he completed if the perinitisforoom lmndreidallvrs($100) SEWER SANITARY-STORM IA.200FL ENERGY ITE or less) I certify that in the performance of the work for which this permit is issued,l shall WATER HEATER W/VENT/E:LECIR not employ any person in any manner so as at become subject to the Weaken' PAID Compensation Liw.of Cabomia. Dam WATER SYS'1'IiM/fRF.ATING Data ReceiptN 0 Z Applicant Z0 NOTICE TO APPLICANU If,after making this Certificate of Exemptim.you should NEW RESIDENTIAL PLM,. SQ.lel'. TOTAL: y bechwithc comply the Workers Compensation ermisiomof thelabor revoked, must forthwith comply with such provisions or permit shell be Jeemed revoked. BUILDING FEF. RWr Q CONS'I'RUC TON LENDING AGENCY SEISMIC PRI: .D Z I hereby of firm that there is v construction lending agency for the performance of U O the work for which this permit is issued(See.3097,Civ.C.) TOTAL: ELECTRIC FER Lender's Name PLUMBING FEE0 F Lenders Address QTY. MECHANICAL PERMIT IEE V I unify that I have read this application and state that the alloo information is FOW+ correct Iagremo comply whMill cirymd Au 1y valmancesmtdstate lwonmiaing to P17RMIT ISSUANCE MECHANICAL FEE rA building construction,and hereby authorize representatives of this city to enter upon the CONSTRUCTION TAX V Z above-mentimed pmpcny for inspection purposes. ALTER OR ADD TO MECI I. (We)agree to save,indemnify and keep hnrmess the City of Cupertino against Iiabilities,judgmentscosts mid expenses which may in any way accrue a amain d City AIR HANDLING UNIT TO 10,001)CFM) asequence thegmndngofthlsp, it. AIR HANDLING UNIT(OVER 0,000 CPM) Signature of AppliesaUContractor Date EXHAUST HOOD(W/DUCT) PAID HAZARDOUS MATERIALS DISCLOSURE IIHATING UNIT(TO 100,010 BTU) Data Reeeip,# Will The applicant or future building occupant store or handle hazardous material as definal by The Cupmt inn Municipal Code,Chapmr 9.12,and the Health and Safety 1117ATING UNIT(OVER 100.000 BT U) OT Cade,Section 45532(,)] ❑Yea 13 No VENTILATION FAN(SINGLE RISID) - Will thenpplicantnrfmurcbuildingoccupvm useequipmemor Jeviceswhich emit MOILER-COMP LET OR 100,000 BTU) ISSUANCE DATE hazardous air conmtnimo s its defined by the Bay Area Air Quality Management BOILER-COMP(OVER 1011,(00 BTU) D,,Udcfr Tpt ❑Yes ❑No NEW RESIDF.NTIA1.MECH. SQ.Fr. Ir 1 have rind the hazardous materials requirements under Chapter 6.95 of the DEC California Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that s ifthe building Jces not currently have a moor,ilia,it is my responsibility to notify the occupant /#Q(�((((jjjj,�� or the remw q itminer's which must he tier prior i. ance of a Cenilimm of lx+ C t, xilJ't Occupancy. M lllY� Owner or emhmiuA agent Dam TOTAL: ISSUED BY: OFFICE