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29945APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING . ELECTR BUILDING DIVISION APPLICATION/PF.RNIT PLUMBING. MECHA BUILDING PROJECT [DEN CONTACT: ❑ Consultant Fees Paid by Applicant (Initial) WO O OZ aacUU tiZW ZOy? O Z 4 O F .N..F. a1 C Q L 06 U 3 R'y¢ F'LL0.4 to ily fydC�0 ILK e C ,MV, L=< p. Q T 3 m lhcmb Term 'hat lam licensed entero provisions of Chapter (commencing ues.lnoav y a with Section 7010)of Divldon3 ofare Businessland PonfessionsCode,andmy licensees in full furca end c[fat. License Clan. Lic.p Dam Contractor QTY. ELECTRIC PERMIT PERMIT ISSUANCE APPLIANCES — RESIDENTIAL ARCHITECTS DECLARATION I understand my plana shall he used us public records PANELS UPT0 2M AMPS LieneeP ,[ mfeasional OWNER -BUILDER DECLARATION 1 hereby vffrnn that 1 ant exempt from the Contract.'. License Law for the following moson. (Section 7031.5. Business anal Profevame, Cade: Any city or county which centric, a #email m co luenct, race Improve, demolish, or repair any stmcture prior to its issuance, also requires the applicant for such permitto file a signed damment that by is licensed pursuant it) mm the pvrsnsi of the Commerce's License Law (Chapter 9 Bnmmencing with Section ]IKKgnf Division 3 ofthe Business and Professions Code)or that he is exempt Iherefmm and the basis for Ne alleged exemption. Any violation of Section 7031.5 by any applicant fire a permit subjects the applicant to a civil penafy of n more than five hundred dollars ($50 ). ❑Las owner ofthe pmpcny, or my emplmyen wilt surges ns their sole compensminn, wN Jo the cions and the he Corr s not eme, Law doesof apply to an Business Code: The over dwhrt.. Llama Law does urn apply s if owner of end enyProwho property who builds or improve. thereon, and who does such work himself or through 2111-1(X18 AMPS OVER HXMAMPS SIGNS ELECTRICAL. SPECIA L Cl RCUIT/MISC. ` TI7MP METER OR POLE INST POWER DEVICES SWIMMING POOL ELECTRIC OUTLETS-5WITC .S—FIXTURES FEE his own employees, provided that such improvements arc not intended or offered for NEW RES A i 1 ELECTS SQ FT. able. If, however, the building or improvement is sold within one year of camplcumn, the ownwintoulder will have the burden of proving that he did not build or improve for par - pee of sale.). TOTAL ❑ 1, as owner of the property, am exclusively contracting with licensed contractors u, mramort the project (Sec. 7014, Business and Profession. Code:) The Contractor's Li- QTY. PLUMBE censeLaw does red apply ill unowner ofproposy who build or impmvcs thereon. and who contracts for such projects with a commissions) licensed pursuant to the Commences PERMIT ISSUANCE License Law. ❑ I vat exempt under Sec. ,B&PC for Nis mason ALTER — DRAIN & VENT —W Owner Doc WORKER'S COMPF,NSA'1'ION DECLARATION 1 hereby offer under pastry of perjury one of the following decloralma : BACK FLOW PROTECT. DEVICE DRAINS— FLOOR, ROOF AREA. GOND. ❑ Ihxve and will mainaina Certifcam ofConsen, to.ell'-encore Tia Worker's Compen- codon, as provided far by Station 37M ml the lab,. Cdr fee the performance of the FUTURES — PER TRAP work for which this penal, is issued 1 have and will maintain Workers Compensation Insurance, ns required by Section 3710 offle Labor Code, for the performance orthe work for which this permit is issued. GAS — EA. SYSTEM -I INC. 4 OUTLETS My Work roppee k�p,N :yan<e carrier and Polmyq ^py z' GAS — EA. SYSTEM -OVER 4(EA) , Currier:O.Ness ls.�aJ. Policy No: �Y{ Cn,'k� CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE(INDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE (This section lived not be completed iffle permit is fur one hundred dollars ($1 W) W less.) GREASE TRAP O Z z � I certify hat inthe performance ef,hc walk for whichthis prom, i.s,swell, Is hall not employ any person in any manner m as to become subject to the Workers' Compere cation Laws if California. Date Applicant SEWER—SANITARY—STORM EA. 200 FT. WATER HEATER WNENOELECTR sN.. D.1 NOTICE TO APPLICANT: If. after making thin CeniEs:ue of Exclusion. you shoat,[ become subject to the Worker's Compensation provisions of the labor Cork, you must forthwith comply with such provisions or this permit.hall he deemed revoked WATER SYSTEM/TREATING WATER SERVICE 0. Q �Z V O LL H CONSTRUCTION LENDING AGENCY (hereby affirm that there is a construction lending agency for the performance of the work for which this preen is issued (See 3097, Civ. C.) Lenders Name NEW RESIDENTIAL PCMB. SQ. FT. Q L) F 0. N L) Z Lenders Address 1 certify that I have read this application and state that the above information is correct. l agree m comply withal) city and county ordinances and slate lows relating to building construction. and hercbyauthoriu representatives ofthis city tocmerurym the TOTAL. QTY, MECHANICAL PERMIT above mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless ,he City of Cupertino against PERMIT ISSUANCE "'.,'cel t.,n..rsandexpense, which may in any may accrue against said City inconsequence e6rianin, of this permit. ALTER OR ADD TO MECH. APPLICANTUN STANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGUL, TI NS. AIR HANDLING UNIT(TO 10,000 CFM) AIR HANDLING UNIT (OVER 10,00(1 CFM) Signature 'ontranor Date c HAZARDOUS MATERIALS DISCLOSURE EXHAUST HOOD OYMUC) HEATING UNIT (TO 100,000 BTU) HEATING UNIT (QVIiR IW,000 BTU) Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chirpier 9.12, and the Ilevlth and Safety Code, Section 25532(x)'! ❑Ycs ❑No VENTILATION FAN (SINGLE RESID) Will the applicant or future building occupant use equipment or devices which emit transitions air contaminants as defined by the Bay Area Air Quality Management BOILER—COM(' (3HP OR W,(Xp BTU) District? BOILER— COMP (OVER 100.000 BTU) ❑Yea ❑No AIR CONDITIONER I have read the hazardous materials requirements under Chimer 6.95 ofthe Cali- Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if the building does not currently hove a tenant, that it is my mrponsibility to notify the occupant of the requirement which must be met prior to isof a Certificate of Occupancy. L: NEW RESIDENTIAL MECH. Uwner or vuthmnred agent Dam TOTAL: OFFICE 1 DESCRIPTION „.29945 ❑SPOW. SANITARY NO. APPLICATION SUBMITTAL DAT Z1q� ❑PLUMBING RE -PIPE. El MULTI -UNIT BIC CONTROL# MODIFICATION El INTERIOR BUILDING PERMIT INFO IMPROVEMENT BLDG ELECT PLUMB MECH ❑ ❑ ❑ FEE 1 DESCRIPTION RESIDENTIAL: ❑SPOW. ❑ KITCHEN REMODEL ❑ADDITION ❑PLUMBING RE -PIPE. El MULTI -UNIT ❑STRUCTURAL. MODIFICATION El INTERIOR El CHIMNEY REPAIR IMPROVEMENT ❑ BATH REMODEUREPAIR ❑ DEMOLITION ❑ OTHER COMMERCIAL ❑ NEW BLDG/ADDITION ❑TENANT IMPROVEMENT ❑OTHER ❑ DEMOLITION ❑ FOOD SERVICE f .a FEE MAY 28 1996 Gil yUr_ STORIES TYPE CI OCC. GROUT' BUILDING DIVISION FEES PLANCHECK FEE ENERGYFEE fFEFG FEE EF, I Receipt# 'TOTAL PEFEE FEFC 'E' , FEECALFEE MITIGATION PAID Date Rectips4 ITYIAL: /1ISSUANCE E ISSUED BY: $/SQ. IT.