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24441 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT N 1 Building Addmss: 24441 , zs A neva ` CITY OF CUPERTINO-BUILDING DIVISION Onfredur'sName: Lie.No: APPLICATION / PERMIT 2-a-3-9 £ hl P'.5 p Iry CATEGORY CONTROL NNU Architect/Engineer. Lk.No: p OOP�l2n 'Qif ELECTRIC PERMIT FEEBUILDING PERMIT,INFO Address: E Gw r iTah C GPERMITISSUANCE ❑ ❑ E:1LICENSF.00ONTRACT R'S ECLA TION Iherebyafflrmthat l am licensed under provisions of Chapter9(commene. APPLIANCESRESIDENfIAL ]OB DESCRIPTION Ingwe I.I.fun7000)of Dlvielon3oHhe BuelnesundProfeselone Code,and my �� Nr/ ©p.rRl license is In fu died. PANELS I /� N V �I v�---�'// Limn::gqC LIc.N Date` UPTO200AMPS��� ARCHITECTS DECLARATION 211-1000AMPS ex Z I understand my plaru shall be used as public reavrds OVER 10DO AMPS SQ.FT.FLOOR AREA $/SQ.FT. z I IN � Licensed Professional SIGNS ELECTRICAL 6 OWNERexULDER DECLARATION ro a SPECIAL CIRCUT/MLSC - ZL, IherebyafBrmthatfamexemptfromthe Contrador'e Licenm hwfor the p following reason.{Section 7M S,Business and Professions Code:My city or rvt qµ9 TEMP.METER ORPOLE INST. TER � countywhkh requires permit to construct,alter,lmpmve,demolbh,orrcpalr O ,n anystmeturepriortoIts issuance,alsorequlreatheappllantforsuchpermit to POWER DEVICES ATE file a signed statement that he is Bceneed pursuant to the provisions of the WOE Contractors License I--IChapterI(commencing with Semon?Mint`Divi- SWIMMING ELECTRIC slop 3 of the Buslaesaand I'mfenlom Cade)orthat he V exempt therefromand VALUATION the basis for the alleged exemption. Any violation of Section 7MIS by any h }� applicant fora permit subjects the applicant to a civil penalty of not more than OUTLETS-SWITCHES-FIXTURES-SWITCHES-FIXTURES five hundred dollars($5001. p ❑I,as owner of the property,or my employees with wages as their wk NEW RESIDENTIAL ELECTR SQFf. STORIES TYPE CONSTRUCTION compensation,willdothe work and thestmcture is nor ntended or offered for q vile(Sec.7044,Business end Pro(emions Code:The Conlradora Lkeme Law S docsnot apply torn ownerofpropertywhobuildsorImprovesthereoryand C, whodonsuch work hlmuBw orthrgh hleownemployenRES.,provided that such OCC.GROU' R .UNI IS improvements are not intended omffered forsale.If,hawever,the building or TOTAL: Improvement is sold within one yearofcompldion,the owner-bullderwill have tl6iien of proving that he did not build or Improve for purpose ofeakJ. QTY, PLUMBING PERMIT FEE b'LOOOZANE APN L,f I,ae Owner of the property,am exclusively contracting with llmnaed PERMIT ISSUANCE.rotn nctms to comtmct the project(Ser.7044,Business and Pmfesslms Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) builds or Improves thereon,and who comrade for such ptojects with a do a)11momd pursuant to the Contractor's License Law. BACKFLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. B k P C for this rcawn Owner Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y Nr RECEB'I N XSUTOWORKMAN COMPENSATION DECLARATION IV('fU2ES PER TRAP OL TAX Y N- hereby affirm that I have a certificate of consent to self-Insure,or a a of Worken'Compensatlon Insurance or a renmRECEIPTte Bied copy theof(Sec. GAS EA. INCA OUTLETS PARK FEE V N P Icy ab CJ a'I/Q���—`rO RECEIPT PC, a 04 D J Com an e _N r.Z`-4� GAS F.A.SYSTEM.OVER 4(EA) BUILDI NG DI VI SION FEES ` Certified copy In hereby filed the city GREASEANDUSTRL WASTE INTERCEPTOR PLANCI-IECK FEE Icy ropy V filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.XIOPT. DatC RCCCI IN RNssemon need not be completed tithe permit V foroM hundred dollars (s100)otifyth WATER HPATERW/VENT/ELECTR ENERGY FEE Y N Icem(y that in the person sin any mannerhework forwhichco pemdtic Issued, 1 shall not employ any TAM in any nnnner m ea to become subject to the WATER SYSTEM/TREATING Worlicra'Compensatlon lJws of California.Date PAID licant Z Z NOTICETO APPLICANT:ILa&er ma king this CerUficam.i Exemption,you NEW RESIDENTIAL PLMB.__SQ.HI'. Date RRCei till should become subject to the Warkero'Compensation provlslom otthe Labor TOTAL: f/1 Code,you must forthwith comply with such provisions ortMs permit shall be sOD j deemed revoked. BUILDING FEEE LU CONSTRUCTION LENDING AGENCY SEISMIC ITE t a Ilu,ebyafl that there is a construction lending agency for the perform ELECTRIC FEE 7 Z ance ofthe workfor which this permit is Issued(See.3097,Civ.C.) TOTAL: 00 Lenders Name - PLUMBING FEE LL Lenders Address QTV. MECHANICAL PERMIT FEE MECHANICAL FEE OW I mnlfy that l haveread this application and watethattheabove information C Is correct.Iagree to comply with all cityand county ordinances and state laws PERMIT ISSUANCE FEES PAID: . N relating to building construction,and hereby authorize representatives ofth:s .. F Z . city to enter upon the above mentioned property for inspection purposes. ALTER OR ADD TO MECH. Dale Reeol t>f _ (We)agree to save,Indemnify an d keep hamaess the City of Cu ped Ino alnst liabilities,judgments,mete and expenses which may In anyway accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: � J Irut said City �ni�ftn ofR Ihls perml City in n thl AIR HANDLING UNIT(OVER IO,000CFM) CONSTRUCTION TAX I tureofA cant/C r to EXHAUST HOOD(W/DICT) CONSTRUCTION TAX PAID: HAZARD S MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazandous HEATING UNIT(TO 100,000 BTU) Date RCCCI tN material as defined by the Cupertino Municipal Code,Chapter 9.13,and the 11,Athand Safety Cade Section255324)? HEATING UNIT(OVER 100,000 BTU TOTAL: i RYes M No ill the a pplica nt or future building Occupant use equipment or devices VENTILATION PAN(SINGLE RESID) ISSUANCE DATE which nut harardous air is mutant.a a dented by the Bay Area Air A I d Quality Management District? BOILER-COMP OHP OR 100,OM BTU K 4Y's o havemadthe haz.9Nmaterials requlmmentsunder Cha peer 6.95of BOILER-COMP(OVER 100,000 BTU Q the California health&Safety Code,Sediaro 75505,25533 and 25534. 1 NEW FEB �i4 understand that if the building dote not currently have a tenant,that it l9 my RESIDENTIAL MECH. SQ.FT 1993 re pookbllity to notify the occupant of the requirements which must he met / prior to issuance of a Certificate of Occupancy. CITY Ur L•Uern I INV Owner or authorized agent Date ISSUED BY:-j TOTAL: OFFICE COPY