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21053 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Buildln Project Identification - - PEItMITNO. Building Addr¢es:�,7 !Yr �EGti�rZ C �.�. �.121vE• - 21053 Tywnem o M b-)I nl� 2 n1 7 CITY OF CUPERTINO-BUILDING DIVISION ContradersName: ya Lie. o: APPLICATION / PERMIT C R `QG• ` BUILDINGELECTRICA4PLUM3INC-MECHANICAL CATEGORYCONTROL NC'•x I O Architect/Engineer: Lie.No, i I -. •1' - - - BUILDING PERMIT INFO :QTY ,ELECTIi1PERMIT ;�=' FEE t Addeese: PFRhITISSUANCE -.� ❑ El El CONTRACTOR'S DECLARATION I hereby afOrm that l am licensed under provisions of Chapter9(conemene- APPLIANCES-RESIDENTIAL JOB DESCRIPTION Ingwith Scctkm ML0)of Dlvision3ofthe Buslnessand Professions Code,and my - \ license is in full force and effect. - PANELS Q License Com Lk:# Data Contractor UP TO 2WANIPS ARCHITECTS DECLARATION 7014000AMPS 00 Z•- 1 understand my plan shall be used as publle records. OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT. p� ❑O❑ (/ Licensed Prmeesmnal , _ SIGNS ELECTRICAL OWNER-BUILDER DECLARATION SPECIALCI4CUIT/MI9C Zt, 3 Ihe.byafBrm that l am exempt from the Contractor's License Law for the _ lollowing reason.(Section 70)1.5,Business and Professions Code:Any city or O j. TEMP.METER OR POLE INST. p� countywhlchrequi saperrnitt6mmtmd,alteglmpmve,den lg h,ormpair g anystructure prlortoW issuance,alsorequiresthe applkamfor such permit to POWER DEVICES PJ file a signed statement that he o licensed pursuant to the provisions of the - Ou Contractor's License Law(Chapter9(mmmendngwithSection 7(00)ofDivi- �,�0 s1on3 of the Business and Profemiom Code)or that he Is exempt theretromand SWIMMING IDOL ELECTRIC - VALUATION , �yyp+ a the basis for the alleged exemption. Any violation of Section 7071.5 by any OUTLEISSWITCF[FSFIXfURES ©Q 0 applmnt fora permit subjects the applicant to a civil peruity of net rtnre than i I ive hundred della.($500). $ T'� NEW RESIDENTIAL ELECTR N-� SQ.FI'. STORIES TYPE CONSTRUCTION' I,as owner of the property,or my employees with wages as their sole compensatlon,wBldolhe work andthestructure once Intended or offered for a O sale(Sec aptly to owner w and f property Code:The or Improves mpr oes theme, e me Law {d5$ docs noessucht apply loan ownerofthroug ywhonemporimproovidedreoryand such ,OCC.GROUP RFS.UNITS w whodvementsaarkhlmeededorough hlsow d for ale.Ityeeever,tebuildlgor _ _ Improvements amnotwithendneyearferemplatile.them er-budderwill have TOTAL; improverrcn[oeaW wlthinoneycarotcompletkPM theowner-budderwlli have &.o of proving that he did nm build or improve for purpose of sale.). QTY, PLUMBING PERMIT �'- .'FEE „ F1OODZONR 'APN owner of the property,am exclusively convaning with licensed PERMITISSUANCE es to constmet the project(Sec.7044,Business and Professions Code: 11hContractor's License Law does not apply to an owner of property,who ALTER-DRAIN&VENT (EA) Wilds or Improves thereon, and who contracts for such ppejects with a - - ',mai' .,FEE SUMMARY t' or(s)Bamed pursuant to the Contractors Llmose Law. BACK FLOW PROTECT.DEVICE I_J I am exempt under Sec. - B&P C for this region DRAINS.FIAOI{ROOF,AREA,OOND, SANITARY Y N OUTSIDE Owner Date _ RECFlIPf= WORKMAN COMPENSATION DECLARATION FC(IVRESIPPR TRAP SCI TA)( Y_ N ❑I hereby affirm that 1 have o Insurance of consent to copy ythereof ore RECEIPT# 3800,Lab of Worken'Compensatlonlnsurana eraartiflnd iopythereo((Sec, GAS FA.SYSTEM-]INCA OUTLETS PARK FEE Y N 3800,[ab CJ Policy# GAS.EA.SYSIT.M-OVER 4(247 RECEIPT# Com any BUILDING DIVISION FEES Certlkcd copy is hereby furnished: GREASE/lNDUSTRL WASTE INTERCEPTORPLANCHECK FEE Certified copy o filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TRAP . PAID COMPENSATION INSURANCE SEINER-SANITARY-STORM EA.700F1'. Date RC 1 t# C/o (rhlsaedlan need not be completed if the permit o for one hundred dollars ($100)Imetifyth WATER I RATER W/VENT/nECTR ENERGY FEE .Y Isnot that in toe person In an thenner work an as to opesubjrmit is issued, 4celpt# L I shall not employ any person In any manner as as to become subject to the WATERSYSTEL.t/TREATING L .1� Workers Compensation Laweb(GBfomo.Date PAID }}-- O Z NOTICApplicaE NEW RESIDENTIAL PLMB. SQ.PT. ate Z O NOTICE TO APPLICANT:If,after making the Certificate of Exemption,you,. should become subject to the Worker'Comperoat ton provisions of the Labor OTAL: CC N Code,you most forthwith comply with such provisions or this permit shall he BUI drerrad revoked. tD CLCONSTRUCTION LENDING AGENCY SEISM ' Ld I hereby affirm that there Is a construction lending agency for the perform ELECT 7 Z anceofthe work fmwhlch this permit o kmed(Sm 3097,Civ.C.) TOTAL: ' 02 Lender's Name - PLgMawcFEE IL I- Lendersnddersa .. 4TY. . .'''INEGHANICAC'PBRMIT , FEE M iA CAL FEE OW Iani(ythatl havereadtho application and state thattheateve Information - a orormet.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEE T• relating to building construction,and hereby authorize representatives ofthle V 2accity to enter upon the above-mentioned property for inspection purposes. ALTER OR AUDIO MECH. -- - (We)agree to seen,Led actually a d keep harmless the City of Cu pen[no ate R CCIP[# tuallyml against Bab11i11a,Iudgments,costs and expenses which may In any way accrue At HANDLING UNIT(TO I0,ODO CFM) SUBT TAL' against said City in maratuence y(ths granting of this permit. if AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIONTA - gtuturcolApplcant/Contractor to ondausTliooD(w/DUCT) - CONSTRUCTION TAX AID: RA?ARDOUSMATER DIS( SUR _ Willlheappllcant or future building occupantstore or handle hazardous HEATING UNIT(TO 100,0D)BTU) 'DRIB Race t# material as defined by the Cupertlm Municipal Cade,Chapter 9.12 and the - Ileahhand Safcty Cade Section25537(a)7 HEATINGUNTT(OVER100,0001ITU) TOT L: s . M Yes In No Will the applicant or futum building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSWANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? BOILER-COMP OFIP OR 100,0(70 BTU) .11 4YesI''I No C(,� 4@ haverred the haear�mousmaterials requirements under Chapter 6.95of BOILER-COMP(OVER 100,000B1V) Sep .1 (� n the California Health&Safety Cod9 Code,Sections 25505,25533 and 75534.1 IwO understand that lithe building does em currently have a tenant,that it is my NEWRESIDENTIALMECH. SQ.FT. responsibility to notify the occupant of the requirements which at be metOf - prio�totxseanceof3c�rtifl to o(Occupanry. , Owner or authorized agent Date l%UED B OFFICE COPY