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20105
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Address: —� Il �y 5. SIZA r 7.6 20105 wrsr ams: one: ; e SuHass- CITY OF CUPERTI 6UILDING DIVISION o Ca °°r'•Name: Lac,Na: APPLIC O PERMIT 13 CI,Architect/Engineer. 1O\ O Lk.Na: BUILDING_tL A M NGMECHAMCAL CATEGORY C O OG L 1 Q 1 -I� QTY E CTRIC R FEE BUILDING PERMIT INFO Adden J1 OS BIVCJ • ANC " LICENSED CONTRACFOR'S DECLARATION �FF��S�CC I hereby eethe,70ttit, iv B.0.funder prossimal of Chapter9da,and c AP ANCESRFSE L job RIPIION intivattBoomh 1.full 7000)o, Didect' ofthe BuNuE e,Pro(esslansCode,and my Boom is In full force d e.# PANELS to U License Class _ Lk.p Date C ARCCHITEHITEtor 1$ CT'S DECLARATION20]-1000 µppµ!! _�iPTO900AWS AT ail ZpO I undentend my plass aha,be need u public mremcords OVER 1000 SQ.FI'.FLOOR AREA f/SQ.F(. E z tjLicensed Professional SIGNS ELECTR(CA <<WOWNER-BUILDER DECLARATION M'ECIALCIRCNT/MLSC Z�., Iherebyatfirm tbatlamexemptfromthe Contractors Llcenx law for the following reason.(Section 7031.5,Business and Professions Code:Any city or O y: - TEMP.METER ORPOLE INST. FM countywhkh requlreeapermlt to roasWct,mler,lmprove,demoilsh,ar mpalr any structure pdorm lh hsuance,abo requlrettheappllrsnt for such permit to POWER DEVICES O c file a signed statement that he h licensed pursuant to the proisioas of the - Contnctor's License law(Chapter 9(commencing with Section 7000)of Divi- ff-..COs sion3ofthe Business and I'mfessbru Code)orthat he h exmpttherefromand SWIMMING TOOL ELECTRIC l� VALUATION O 5 the basis for the alleged exemption. Any violation of Section 7mt,5 by any OUTLET-SWITCHES-FIXTURES applicant for a permit subjects the applicant to a civil penalty of not moreth to �$ five hundred dollare($500). FF. j.+ ❑I,as owner of the property,or my employers with wags NEW RESIDENTIAL ELECTR �''as,heir sole STORIES TYPE CONSTRICTION compensation,will do the work,and the structure is not Intended or offered for p sale(Sec.70K Business and Profeesioas Code:The Contractors Llcease Law $$ don not apply toanowner of property who bunds or imprmen thereon,and OCC.GROUP RFS.UNITS does such work himself orthrough his own emplayees,provided that such Improvements are not Intended oro(fered foraale.If,howevep thebullding or TOTAL: Improvement is sold within one yearofcompletion,the owner-builderwlll have try€kardeno(provingthat he did not bund or improve forpurpox°!sale.). QTY;`. PLUMBING PERMIT "FEE FLOOD7DNE APN LJ L as owner of the property,am exclusively contracting with licensed c corn to construct the project(See.7041,Buslnemand Professbas Code: PFRMITISSUANCE s�r The Contractor.License Law does not apply to an owner d property who ALTER-DRAIN k VENT-WATER(EA) Wilda or Improves thereon,and who contracts for such penjectn with a _ - 15,,PPSS((actor(s)Ikensedpunuanttothe Contractor's Llcenx Law. BACK FLOW PROTECT.DEVICE z��U• FEE SUMMARY I am exempt under Sec B A P C for that reason �W DRAINS FLOOR ROOF,AREA,COND. SAMTARY Y N Owner Date WORK MAN COMPENSATION DEC"RATION RECEITT FIXTURES,PER TRAP SCIi0OL TAX Y_ N_ ❑i hereby affirm that I have o ceruleans of consent to copy thereof Or RECE97 N certificate J orken Compeasatlonlasunnce oracertlfled ropythereof(Sec. GAS FA,SYSTEM-1 WCAOUITLEFS PARKFEE Y_ N 3800,Lab C.) raury x ,1ZYh w 1 9- 3't g3 RECEIPT« Com any �'LO�'4v l--�g"os�j CAS G.SYSTQd-0VERd(FA) BUILDING DIVISION FEES Certified copy h herebyth the city ont. CREASE/INDUSETRL WASTE INTERCEPTOR PLANCHECIGFEE ❑' Cenl(led ropyhllkd with the city inspection dlvlelon. eY ,u1^' 1 CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID SS''��'3 1t / COMPENSATION INSURANCE SEWER-SANITARYSTORM FA.20071'. Date Recei t# II�t 1v (fhb section need Hat W completed lithe permit h(Drone hundred dollars ($111)orlesa.) WATER HEAT�W/VEMf/©,PO,I.R ENERGY FEE Y N I certify that In the performance of the work forwhich this penult is Issued, — I shall not employ any person In any manner an"In become subject to the WATER SYSTEM/TREATING Workc�Compen tion La ifomla, a PAID O Z Applicant NEW RESIDENTIAL PLMB. SQEF. Date Recel t# Z 0 NOTICETOAPPLTCAM:R,cork king Compensation Certnlraovi.1m iof'he Labor yons thou,you=at fin cttothe Works suchpsprovhinurmit s Lab be TOTAL: W W Caduca you=atcomply with such provisions or this permit shall be BU NG > deemed revokedFEE.CL G CONSTRUCTION LENDING ADMvCY SEISMIC FEE R r. I hereby afflrmthat there h a construction lending agency for the perform ELECTRIC FEE Zannottheworkforwhichthbpermlthhsued(Sec.3097,CIv.C.) TOTAL: V O Iandar.Name IL F Lenders AdPLUMBING PEE lfythdress QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Icaratl have readthhappiketlonand statethat the above Information L RA lscomed,I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE �� FEES PAID: ). IL relating,°building construction,and henebyauthorize representative,ofthls - H N city to enter upon the above-mentioned property for Inspection purposes. ALTER OR ADD TO MECIL ? (We)agree to save,indemnify an d keep harmless the City of GO NA iso Date Receipt# V against lhbi110es,judgments,co,U and expenses which may in any way accrue AIR HANDLING UNIT CFO i 0,000 CFM) SUBTOTAL: against said City in consequence of the gnnHng of this permit. AIR HANDLING UNIT(OVER IO,000CIM) CONSTRUCTION TAX Signature of Applicant/Contractor Data EXHAUST HOOD(W/DICT) CONSTRUCTION TAX PAID: ' HAZARDOUS MATERIALS DISCLOSURE Wllltheappl] torfuture building occupant store or handle hazardous HEATING UMT(TO 100,000BTU) Date Recei t# �. material as defined by the Cupertino Municipal Code,Chapter 9.]2 and the Health and Safety Code Seaton 25534(a)7 HEATING UNIT(OVER 100,000 BTU,) TFp,TOL: ❑Y. , �No p Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE PY-TD) ISJ'ANCEDATE which emit barerdous air contamlunts m defleed by the Bay Area Air ` QPPuaa�llIity Management Dssttr'iNct? BOrLER-COMP QHPOR 100,0(10 BTUs �.) .� t� f3 •1�,`�bs ThYn rho o ave read thchaza us nuterlals requiremenh underChapler 6.95 of BOILER-COMP 100,000 BTO) the California Health k safetyCade.Sectlou 2550.5,25533 and 25534. I understand that if the building does not currently have a tenant,that it is my NEWRESIDENTTALMECH. SQ.rr Ej1lY f' ma �an ility lonoti(y the oaupant of the requlrcmem,which mustbe rtat -_ prix to uance u(a Con", tvolOav,x un .Le_ 1' y-5-9c� � j�-�tWx Owner or out orizc�agen Date t•'� Q� 155UIiD ON\ TOTAL: OFFICE COPY . THOMAS A. CAHALAN Registered Civil Engineer No. 18068 1035 Vaquero Road Pebble Beach, CA 93953 (408) 375-3855 To:d 1-T a.f C1.�—(Z-ri-AU Date: / /8 1D Re: pooh rr d��A?At- St6n� SEP i b 1390 CITY OF CUPERTINA. I&ILPM DgEL Dear Sirs : Q� �oc, - �� --1 / atS�,9 ► � , hoc_ AWS R6tAt �c n/ED c 0 01ft16ZY'4 r,, N 1 p $ �, Very truly yours , � are of C ov%F THOMAS A. CAHALAN Registered Civil Engineer No. 18068 I