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19647 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification - PERMIT NO. Building Address: 19647 r s s Phone: A neva //!pl/fa o� ` CITY OFCUPERTINO-BUILDING DIVISION to p • Contractor's Name Lk.No. APPLICATION /PERMIT _2— �-- 7 40 s BUILDING UFCTRICALPLUMBINC-MECHANICAL CATEGORY CONTROL M Architect Engineer. Lk,Na: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addrcac PERMIT7SSUANCE Z,� ❑ �y (� LICENSED CONTRDECLARATION I hereby affirm that lam Bcrounder sed under provisions of Chapter9(mmmenc APPEANCESRESIDENT'NL ON ingwith Section 7000)of DiWkm3o(the Buelneseand Pmfe imsCode,and JOB DF�^ .O i• �n license is in full force and effect. - PANELS 11 �--•V ( -1 License Clam Lic.M DateF Fa Contractor —UP TO 2EQAH�S ARCHITECT'S DECLARATION - 201-IODOAMPS q 2 Iundmaland my plarsshall be used as publicreca da OVERIOWAMPS SQ.FT.FLOOR AREA $/SQ.FL. O k Licensed Professional SIGNSELECTRICAL In c� OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MIST ' 7" � 1hembya(Ormthal lam exempt fromthe Contractors LicenseLawforthe FQ foilowing reason.(Sorion70H.5,Business and Professions Code:Any city or TEMP.METER OR POLE INST. Z. K � county which requires a permit to constructalter,improve,demolish,or repair any structure prior to Its Wuance,also requires the appBcant for such permit to �Mµ file a signed statement that he b licensed pursuant to the provlatons of the POWER DEVICES OµI- Contractors License Law(Chapter 9(commencing with Section 7000)ofDivi. �O:J sion3 of the Business and ProfemiwaCode)or that he is exempt therefrom and SWIMMING POOL ELECTRIC - VALUATION o.•533 the basis for the alleged exemption: Any violation of Section 7011$by any 16 OUTLETSSWITCHESFIXTURFS O(� A appBcenl fora permit aubjectsthe applicant to a dvil penaltyof not more lban Henperoation, five hundred dollars($500).1,mowneroftheproperty,or my employees with wages as their sole NEWRESIDENTIALELECTR SQ.FISTORIES TYPECONSTRIX:T'ION wBldothe work,and thestmaure is nm Intended or offered for le(Sec.7044,Business and Prf.ioro Code:The Contractors Lkerae Law es not apply to an owner of properly who Wilds or Improesvthermn,andOCC.CROUIaho does such work himself or through his own employees,provided that such Improvements are not Intended oroffered forsale.If,however thebullding w L Improver nt IsaoldwlthinoneyvarofeampldioktheownervbuBderwill have tlLkurden of proving that he did not Wild or Improve for purpose of sale.). QTY. - BI ER I FEE FLOOD ZONE APN u I,as owner of the property,am exclusively contracting with licensed PERMIT ISS C I a 1. contractors to censtmct the pm)ad(Sec.7044,Business and Professions Code: V The Contractors License Law does nor apply to an owner of property,who ALTER-DF(/i1N& -W Wilds or Improves thereon, and who contacts for such pio)ecis with a av onactor(s)licensed pursuant to the Contractor's License Law. CK T.DEVICE FEE SUMMARY L�I am exempt under Sea B&P C for thin reason rq NS ROOF; REO,COND. SANITARY Y N , Owner Date RECEIPT WORK MAN COMPENSATION DECLARATION .mss, D SCHOOL TAX Y N ❑I hereby affirm that I have o Infra to of consent to sell-Inure,ora •U RECEIPT M certificate C.) orken'Comperwtlonlruurance orawrlilied copy thereo((Sec. GAS RA STEM-1 FLS PARK PEC Y N 3olicyI CJ ' Po11ry N RECEIPT M Com any GAS STEh1- 9 BUILDING DIVISION FEES ffCcrtiON copy bhereby(umlehed. CREASE/ ASIS WLFRCEI'TOR PLANCI-IECK FEE F-1Caddiedcopy is filed with the city,Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE PAID Cob c.en COMPENSATION INSURANCE SEWER-SANITARYSTORM FA.2001sT. Date ReceI t# (Ihlssectlon need no M completed I(Me permit V(Drone hundred dollen D ($k00)or less.) WATER HEATER W/VENT/ELCCTR ENERGY FEE Y N I certify that In the performance of the work for which this permit is kwed, — I shall not employ any person In any manner w m o me sub'ct to the WATER SYSTEM/TREATING Worken'Co ensaUpn sof Ca orni�Date •�� Q PAID OZ NOIICnt NEW RESIDENTIAL PLMBDate Recel tN App Z O NOTICE TOAPPMRma LICA : ,afterkingthisCertifi�ateo .fExemption,you �'FT' Fahouldbecomesubkctto the Workers Compensation provisions of the Labor TOTAL: CCN Code,you moat forthwith comply withsuch provlslommthb permit smilhe W j deemed revoked. 11ILD111C FEE CONSTRUCTION LENDING AGENCY EISMIC FEE CL Ihembya(Rrmthat there is aconstruction lending agency for the perform, TOTAL VD ELECTRIC FEE D Z an.of the workfor which this pe rmitbimued(Sec.3097,CIv.C.) - 04 Q2 lenders Name PLUMBING FEE LL LenaweAddrcm QTY. MECHANICAL PERMIT TEE. MECHANICAL F'EE O W I mrtffythat l have read lhisappliotlonand datethatlheabove information IL incorrect.Iagreetocampiy with allcityand rounty orllnanmand state laws PERMIT ISSUANCE aD F ES PAID: >. relating tobuliding mnslruction,and hereby authorize representatives of this F- 2 city to enter upon the above,menlioneiproperty for Inspection purposes. ALTER ORADDTOMECH. syr — (We)agree to save,Indemnify an d keep harridan the City of Cupertino atC KCCCI}7I8 against liabilities,judgments,costsand expenses which may in anywayacnue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: OO agaivt Haid City in consequence.1 1,granting of this permit. AIR HANDLING UNIT(OVER 30,010CI•M) CONSTRUCTION TAX Signature of Applicant/Contractor Date EXHAUST HOOD(W/DUCT) t CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE _ Wllllheapp0cant or future building ouvp.at store or handle hm,ardous HEATING UNIT CFO 100,000 BTU) material..defined by the Cupertino Municipal Code,Chapter 9.12,and the Date RCCCI tq Healthand Safety Codre�--S.edion25532(a)7 - HEATING UNIT(OVER 100,000 BTU) ' TOTAL: _ EI Y. Li No 01 Will thespplicantorfuture building occupantuse equipment ordevimx VENTILATION PAN(SINGLE RF.SID) ISO .DATE which colt hazardous air contanbants as defined by the Bay Area Air U Quality Management District? BOILER-COMP QHPOR 100,000 BTU) Yee n No APR R H P 4have read the h.9 us materials requirements under Cha pier 6.95 of BOILER-COMP(OVER 100,000 BTU) '1 the California Health&Safety Code,Sections 25505,25533 and 25534. I understand that if the building does not currently have a tenant,that It l9 my NEW RESIDENTIAL MECH. SQ.EI• p(yaa .aL Gsu responsibility to notify the occupant of the requlremcnts whlche ust be met Goy,oS prior to issuance of a Certificate of Occupancy. Owneror aulhwlzed agent Data :�• L' 4,y TOTAL: ISSUED BY OFFICE COPY