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21605 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. BuilJing Addres.: 6 0 5 2©aJ--C:) � �+l"�r" �al21605 1_VL7, G I ccc' C4{s 570 CITY OF CUPERTINO-BUILDING DIVISION t Q—To COnlr,dor'.Name: Ec.N. APPLICATION / PERMIT CrP'd� NG 7S BUILDINGELECTRICALPLUMBINC-MECHAMCAL CATEGORY C .C.Ia�� Archlte</Engineer. Lie.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addhes: PERMITISSUANCE �r IGT Xj ❑ ❑ LICF,NS EDCONTRd under SDECLAMTION �/� jL1l thereby af(Irm that lam lkeneed under provisions o(Chapter9(cvmmrnc APPLIANCES-RESIDENTIAL JOB DESCRIPTION license i Sedlon fore add died.3ofthe Buslneasand Pro(nelonaCode,and my � lirense is In full force and died. PANELS , LicenseCI ss Lic p �.r 77 t, ate Contract C {ti"_' ARCHITECTS DECLARATION 201-I000 AMPS PO± ZO I understand my plans shall be used as public records. OVERIOXIAMPS SQ.Ff.FLOOR AREA $/SQ.Ff. E z(qj Licensed Professional SIGNSELECTRI Sam r I l �fn e: OWNER-BUILDER DECLARATION f SPECIAL CIRC /M15C rsO J L,�J Zp, a I herebyafind that l am exempt from the Contractor's License law for the following reason.(Section 70315,Business and Professions Code:My city or �4 muntywhichrequlmsaperMttocoma c;altegimpmve,demolish,orrepalr R TEMP.METER EI anystructure priorto its Issuance,also requlreathe applicant forsuch permit O to POWER DEVICES filo a signed statement that he is licensed pursuant to the proalIons of the O Contractor'.License Law(Chapter9(commrncingwith Section 7000).f Divi- SWIMMING POOL ELECTRIC ston3 of the Buslneasand ProfasslonsCode)orthat hats exempt therefromand VALUATION 6 5 the basis for the alleged exemption. Any violation of Section 7MIS by any OUTLETSSW[TCF3ESEJ(IVf2F5 applicant into permit subjects the applicant to a civil penalty d mo not re than five 1,as. dollars thepr. NEW RESIDENTIAL ELECTR SQFT, STORIES TYPECONSIRUCTION ❑Las owner of the property,or my employees with wages as there sole �7Q mle&c.a4ZBuldosMworkand lon,Code:The Contended ordferedfor yy q sale(Sec. pply to ainess owand f property Code:TM or improves License Law does[g$$ who does apply torn owner o(proughhison builds emoyees,pve.thareoa,and OCC.GROUP RES.UNITS CCtiti whodoementsawork tInten edoorthroughhisowne.If,however, er,thebuildirovided that noruch t� Improvementsarenotintendedoro(fec (weak.ILhowever, Uder ilI have TOTAL: Improvement usold withlnoneycaro(compldlon,theowner-bu0derwill have dlee rden of proving that he didnes build or Improve for purpose ofeals.). QTY. PLUMBING PERMIT FEE FLOODZONE MN LI L as owner of the property,am exclusively contracting with Ilrenmd PERMIT ISSUANCE contractor to mnstrud the project(Sec.70K Business and Pro(eadom Cade: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a ALTER-DRAIN&VENT-WATER(EA) 'q¢¢ad a)Rcenxdpunuamtothe Cmd.c1or'e Llrense Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY I_J I am exempt under Sec. B k P C for this masonOUTSIDE F Owner Date DRAINS AREA, M FLOOR ROOF,ARCOND. SATARY Y N RECKIPT If WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y N 01 hereby affirm that L have o lmum to of consent d spytheure,ora RECERaF M 3800,cediLab of Worken'Campensatlan Wurenreora certifkd mpytherea((Sec. GAS EA.SYSTEM-I INCA OUTLETS MRKFEE Y N 3800,Lab C.) Polity p RECEIPT GAS EA.SYSTEM-OVER 4(FA) p ComE3any BUILDING DIVISION FEES Ccrertfied copy is herebyturdG ahed. CRSE/INDUSTRL WASTE INTERCEPTOR PLANCHECK PGE ified copy V filed with the city Impaction division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Date R t# s� Rhlssces.) need not bucompletedIf1M permit bMorons hundred dollen (s100ardless.I WATER HEATER W/VENT/E.ECTR ENER(;y E yyy (certify that leehe any poisoPerformance 1. ny dvuurk so as to och beco eemdtb Ito ed,the I'C 7 aha0 not employ any person in any manner so u to become subject to Rise WATER SYSTEM/TREATING Workere'Compensation laws of California.Date PAID Z Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date eCL'I t# O N'ODCETO MR PLICANT: ,after making this CertRlcete of Exemption,you Hshould become subject to the Workers'CompeosalIon provisions of the Labor T TAL: CC N Cole,you moat forthwith comply with such provisions or this permit shall be deemed revoked. ' ELI 0 CONSTRUCTION LENDING AGENCY SEISMIC FEE CL Ihercbyat0rm that them d a construction lendingagenry for the perform- ELECTRIC FEE 7 Z once ofthe work for which this permit V bsued(Sm.3D97,Clv.C.) TOTAL: { 6 U O handers Name PLUM6INC PEE IL I— Lender'.Addrer. QTY. ' MECHANICAL:PERMIT ' +r'FEE MECHANICAL FEE O W Iced)fythatI avera.dthH.ppb.ion and stotethattheabovo information IL is de d.I agree to comply with all dtyand muntyordloancea and wtelaw. PERMIT ISSUANCE FEES PAID: } N relating to building construction,and hereby authomm representatives ofthb F. Z city to enter upon the above�mentlooed property for inspection purposes, ALTERORADDTOMECH, Date R CI t# _ (We)agree save,Indemnify an d keep harmless the City of Cu ped loo P against llabll s,fodg ots,cos .rd expenses which may In any wayaccrua AIR HANDLING UNIT 10,000 CFM) SUB OTAL: again+tr on scprence of the granting of this permit. AIR HANDLING UNIT(OVER IO,OWCFM) CONSTRUCTION tzl D9�19 a_ CONSTRUCTION TA PAID: S aturco pp HAZARDOUS Dat E%FIAl157 HOOD(W/DUCT) HA7ARDOUS MATERIALS DISCLOSURE Will ia the applicant tnedb theICpe,tidingaruptl Codstore orhandle hazardous HEAHNC UNIT HO 100,000 BTIJ) Date RCC ' t# material as defined by the Cupertino MuNcipal Code,Chapter 9.17,and the - LlealthandSafetyCodeStttlon25532(.)7 HEATING UNIT(OVER 100,000 BTU) TOT& M)s ❑Yes No Will cont applicant or core building inants oempandby the BayequipmentArea devlcet VEN"ITIATTON PAN(SINGLE RESID) ISSUANCE DATE which emit agemo ua air District? contaminants as dented by the Bay Arca Are Quality Mansgement D'uMct7 BOILER-COMPO}B'OR100,IXq BTU) I Yrs 4 No have mad Healthe h aroutrtode,Sectionsrequirements under 05,2553aChapter,1 of BOILER-COMP(OVER 100,000 RTU) the cos.OdCalifornia Health&Safety Code,Sections 75505,have tenant,and 25534,I .T i� uod sporcundthat notifyf the heodgdoas not a rrectly equirmnts whicthat hLamy NEW RESIDENTIAL MECH. SQ.FI' I po pion to Issuance of aCoheoccvpantdtherequircmenta which most he met b prior to LssuancedaCertlRcate ofOavpanry. Owner or authorized agent Date ISSUED BY: TOTAL: OFFICE COPY