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19653 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE'BALL-POINT PEN ONLY . - _. Building Protect Identification - - PERMIT NO. BuildinBA '�3 cr; G-�:.. 19653 wnen _ Phone: APPLICATION SUBMITTAL p 00 Q DPAJ sy CITY OF CUPERTINO-BUILDING DIVISION' •� Centre.N.,Pw APPLICATION / PERMIT EL Arc eR En ger.. " BUILDING- ECTRICAI;PLUMBING-MECIIANICAL CATEGORY CONTROL N Lic.No: 3On `` t�tl 1 LECT2IC PERMIT ' ,`)FEE • '" BUILD,ING'PERMITlNFO ,• •�j; ' PLUMB MECH Address �S - - PERMITISSUANCE ❑, �'" �/� ❑e +t LICENSED CONTRACTOR'S DECLARATION L J [hereby affirm that larm licensed underprovlslon9 aChapter9(rommenc- MPLIANCESRESIDENTGL . -job DFSCRIPDON Ingwith Section 70)0)of Division 3 ofthe Bus inessand Professions Code,aed my - license la in fullforce and effect. - PANELS License Class' LIC.# •• Date" Contractor LM 10 200 AMPS ARCHITECTS DECLARATION 301-1000 AMPS q�q�uuQqq'" [understand my plass shall be used as public records, OVERIf100AMPS'.' " SQ FT FLOOR'AREA - $/SOFT. Fl (� Licensed Professional - - SIGNS ELECTRICAL �. G�6 OWNER-BUILDER DECLARATION ' SPECEEV T/MLK: ZE, � I herebyafRrm that l am exempt fromthe Contractors License Law for the , O following reason.(Section 7MI.5,Business and Professlons Cade:Any city or J Z - TEMR POLE INST. Pv� countywhnch requlresapermitlomsstmeq alter Improve,demollah,arrepair. ' nystructure prior toits Issuance,aIso requires the applicant for such permit to POWS file a signed statement that he h,licensed pursuant to the proetsloss of the 3 w0 Contractors License law(Chapter 9(commencing with Sectl,n 7000)of Dlvl- SW1ML ELECTRIC sion 3 athe Business and Professions Code)or that he is exempt therefrom and - - - VALUATION _ the basis for the alleged exemption. Any violation of Section 7031.5.by any OUTLETSSWHCHF, IXTUEES applicant for a permit subjects the applicant to a civil penalty N oint more than - ' g5gc,GG five hundred dollars($500). NEW RESIDENTIALELECTR' p �n ❑L as owner of the property,or my employees with wages as their sole SQ.FL 'STOIII6 TYPE CONSTRUCTION compensation,willdothework,andthestructure Isnot intended or offered for O sale(Sec.7UM,Businessand Professions Code:The Contracim's License Law $ does not apply to an owner of property who builds or improves thereon,and who doessochworkMmceBorthrough hisownemployees,provided thatinch ., OCC.GROUP I RFS.UNITS ' Improvements arena intended orotfered forsale.If,howneer,thebuldingor TOTAL i provementissoldwithinoneyearufcompl&lon theownerbuiklerwlllh ve - ,L V trden Said of proving that he did not Sd or improve for purpose ofsak<), (7TY•:. �o + `t,'Pj.[JMBINCi PERMIT P t "^t FEE:. ,FLOODZANE 'APN "L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE - contractors to mwtroct the project(Sec.7044,Business and Professions Code: I'Loc '' - The Contractor's License Law does not apply to an owner of property who ALTER builds or improves thereau -DRAIN&VENT-WATER(EA)on,and who contracts (or ch,pWiects with a ccnactcr(s)Bernal pursuant to the Contractor's License Law, BACK FLOW PROTECT.DEVICE LI I am exempt under Sec. B &P C for this reason R AREA,GOND. SANITARY YIL' N SIUL FEES Owner Date DRAINS FLOG ROO$A WORKAN COMPENSATION DECLARATION; RECEIPT k M ❑I hereby affirm,that I have a certificate of consent to self4aure or a FB(TURFSPERTRAP SCHOOL TAX Y - N_ certificate ofW,rkere'Compensation Insurance a a certified copy thereof elec. - RECEB'T.p 3800,Lab C).- GAS EA:SYSIT7d4 INCACU7LETS PARKFEE ,Y_,N_.' Policy N. - RECEIPT# Cam any .:� GAS EA.SYSTEM-OVER 4(EA)' P' -BUILDING DIVISION FEES �CertiRed ropy is filed hereby the city - GREASEANDUSTRL WASTE INTERCEPTOR ' PLANCHECK FEE ' - .''❑Certified copybfiled with the city lnpailon division. _ CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TRAP PAID nc COMPENSATION SEWER-SANIITARYSTO RM EA'200FT - ,Date Recei [# (tBalose.) need not becompleted itthe permi[Is forone hundred dollars ($10))or less.) WATER HEATiR W/VENT/ ,ECTR ENERGY FEE Y. N Iartti ifythantheperformance ofthew.A forwhlch this permit is issued, Q — I shall na empl,.am�erson in an,YJ,jr�sooer eo as to be..subject to the WATER SYSTEM/TREATING Q Workers'Com1'�}9eyE-6n La (C I(q$Ala.Date - PAID O Z NOTICE: P NEW RESIDENTIAL PLMB. SQ.FT. Date. Recei t# Z O NOTICE Pik.. :it,aft e ma dngt la e orate of •:emptlon,you - ..F should become subject to the Workers'Com satlon provisions athe Labor - TOTAL: � W' Code,you .at forthwith comply with such provisions orthlspertNt shall be > deemed revoked. `n BUILDING FEE , W p corvsi'RucnoN LENDING AcwcY SEISMIC FEE. CL Iherebyaffirmthat there baronstmRlon lendingagenry forthe perform- ELECTRIC FEE 7 Z ance of the work for which this permit Is Issued(Sec.3097,Cle.C.)' TOTAL V O Lenders Name ., ,; ., PLUMBING FEE �' LL F" ,` Lendcre Addreaa - - Q1,Y. `"' MECRANI PA4'P,FRMITI FEE,y' MECHANICAL FEE O W (certify thatl have manthisappliwnonand statethattheabove information 1 correct lagreeto complywith all tltyand rounty ordinances and state lawn PERMITISSUANCE >6FEE$PAID: , relating to building construction,and hereby authorize representatives of ld. H 2 city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. c, (We)agree to save,indemnify an d keep harmless the City of Cupertino ", Date Receipt# against liabilities)udgmade,costsand expenses which may In anywayattme - AIR HANDLING UNIT(TO 101000 Cr M) SUBTOTAL: - against Cit In consryuen ftbe gra rating of this permit. .� _ 2' AIR HANDLING UNIT(OVER 10,000CFM) '1 CONSTRUCTIONTAX g re pplirant/C tractor I Dare EXHAUST I TOOD(W/DOCT)'.I - 11 CONSTRUCTION TAX PAID: HAZARDOUSM [ALS DISCLOSURE Will the applicant or future building occupant store or hand to hazardous HEATING UMT(TO 100,000 BTI, Date-Da .` ' nuorhifas defined by the Cupertino Municipal Code,Chapter 9.12.and the Recel t# Ilealthand Safety Code Section25532(a)7 HEATING UNIT(OVER 100,00)BTU) - e-n .,TOTAL: ❑Yes - MN. � _ _ Will the applicant or future building occupant use equlpmen[ordevices VENTILATION FAN(SINGLE RESID) ''I$roUANCE DATE which emit haeitdousair mntaroinants as defined by the Bay Area Air - - QualityManagementDistrictla BOILER-COMP(3HPOR100,0(p BTU) ?yes 4 No have read the;azar ous materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU) the California Health&Safety Code,Sections 2555,25533 and 35534.I • S y understand that if the buildingdoes not currently have a tenant,that it is my, NEW RESIDENTIAL MECH. SQ.Ff. reap,ssibility to notify the ompantof the requirements which most be met prig to issuance of a Certif cafe o(Ocapanry. Owner or authorized agent Date - - TOTAL: �7. ISSUED BYL+C' �L�ll$E.. ' C— OFFICE COPY - " " ,,4 '