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S 1324APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILD NG - ELECTRICAL PEI IT NO BUILDING DIVISION APPLICATION/PF,RMIT rl,Dmnnncc mEC'x^rvlcAbrefnx1 1 - 1324 ADDRESS ❑ -^3/o ALPed11: AA LA {/edDA lD ` — (- Pu y� R I ❑ Consultant Fees Paid by Applicant (Initial) LICENSED CONTRAC'TOR'S DECI.AKA I]ON QTY I hereby affirm that 1 um licensed under provisions of Chapter') (commenting with Section 7000) of Division 3 of me Basins, end Profit,, ansCME, and my license is in full mace one e License Class Lia# Ddm Currentr ARCIIITEC'I"S DECLARATION - I undersand any plans ,bell be used us puhl Ic records Licenacd Pml'essionel OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Low for the following reason. (Section 9031.5, Business and Parnassian, Cade: Any it, or county which requires a permit to construct, once, improve, demolish, or repair any structure prior to its issuance, also requires mo applicant for such permit to file a,imed,....emend that he is licenced pursuant to the provisions of We Contrach rs License Law (Chapter 9 (commencing with Scwtion]Gulp of Division Sof the Buaira, and Pro l msinns Code) or that he is exempt mcrefroon and me basis far the alleged exemption. Any ....Intern rf Section 90315 by any applicant ford permit subjects the applicant to a civil penally of are mare,hun five hondrwl dollary (x500), ❑ 1, as owner of the property, or my emplh,ws with wages as their solo compensation, will do the woe:, and the structure is not intended or offuul for sale (Sea 7044, Business and Prnre d..d, Cede: The Cl)mmmors Live... Law urea not apply to an -ra, of properly who hands or improves dneroon, and who rotes such work himself or through his own enployecs, provided that such improvements are not Intended or offered for sale. If, however the building or Improvement is sold within one year of completion, Ibe pael) -budder will have the movica afpmving that he did no, bund or fmpmve for pa- c rI sale.). ❑ I, as owner of the prepery, am exclusively contracting with licensed contractors to Sumer, the uncia (Sao 91144, Brasiers, and Poefe...oma Calc:) The Connector, U- se Las Anes not apply loan ownet (if property will) Hailes ot improves drawer. and QTY. who carvers lorsueh prrjeen wish n...nimanr(s) licensed pursuant to the Contractor's License La.. ❑ I ant excum, under Sce. ,B& P C for this meson Owner Der WORKER'S COMPtiNSAI'ION DECLARATION I hereby affirm under penalty of lwrjury one of the following dealers inns D I have amd will mutation a Cemfcale of (7 I to self -insure lot Worker's Compcn- salion, as provided for by Section 3900 of Ibe ].shot Code, for the performance of the work for which this ,inal Is issued. ❑ I have and will maintain Workers Compensation Insurance, as acquired by Section 3700 of anc Label' Code, for ane pert artmnse of the work for which this Permit f, issued, My Workers Conmensntjrn Insurance wmrier and Policy u lumme Center: Policy Na CE TIFIC TE OF .REMOTION FROM WOR CI bar., SA'I'ION INSURANCF./fo C-2 It (Thi -c scetion reel urn bar., if Wepemit is far on t allure ($100) al) Ica.) I beary that in the perfonnenhe of the work for which Ibis permit is issued, l shall not employ any person in any manner to as tu h ra men subject to the Workers' Compcn- Z smear Lawsrf California. Dile Q Applicant y NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should a�became subject to the Workers Compensation provisions of Ate Labor Code, you trust forthwith connply with such trust does or this permit shall be deemed revoked. 0 CONSTRUCTION LENDING AGENCY U O herebyaffirmthe, that there isneod(Sao 30 lending agency for the performance of W.0 U the work for widen mix Aman fc issued (Sao 3097, civ. CJ U Lenders Name W Lenders Atldfea V) 1 carrify mil 1 have with this application county and state ces and starve Iws o dation is % correct, l agree to comply with all sty and county orl Lives of and Sete laws r uplin t e QTY Uz buRmngamswdiomand farebyemhorizerepresvmmivcs of this city memer upon the shove -mentioned propury far inspwlion putPnsec. (We) agree to -sour. authority and kcep hamdcss me Cily oI Cu a'Ima agalnsl liabilities.judgments, cove, and expenses which may In any way accrua against auid Ciry nce thegranting permit. APPLICANT UNNDERSTANDSS AND WILL COMPLY WITH ALL NON -POINT HAZARDOUS MATERIALS DISCLOSURE will 117e phcam or future budding«cupanlxmtcor handle Future! ... sunmeant ,as defied by the Cupertino Municipal Code, Chapter 9.12, and he Health and Salary Code, Senior 25532(n)? El Yes E] No W,ll he applicom or fume handing occupant nae "impmenf or device, which emit hazardous air contaminants as defined by the Bay Area Air Quality' Management Divlrict, ]Ye's No I have read the managers matendl, ove re fonts under Chapter 6.95 of the Culi- fornic Health & Safety Code, Swfmn, 25545, 25533 and 21534.'T understand that if be building does not currently hive n tenant, that it is my responsibility to reify the acupant of the oquir mons which nmol be mm put to lecuanee of Coal p,me of Occupancy. - ELECTRIC PERMIT FEE L \ C JOB DESCRIPTION RESIDENTIAL: PERMIT ISSUANCE NEW RESIDF.NTI41, F.LECTR ❑SFDWL ❑ADIIITION D MULTI -UNIT D KITCHEN REMODEL I-] PLUMBING REPIPE D STRUCTURAL. APPLIANCES -RESIDENTIAL FEE PANELS MODIFICATION UP T0200AMP5 ./� Ll INTERIOR El CHIMNEY REPAIR IMPROVEMENT []SWIMMING POOLS ❑ RATE REMODEL/REPAIR El DF:MOI.1'TION 00THER 201-1000AMPS OVER 1000 AMPS SIGNS ELEC'PRICAL M TEMP. METER OR POLE INS'I'. COMMERCIAL: D NEW BI DG/ADDITION [] DEMOLITION %JeFNANT D FOODSERVICE PROVEMENT D OTHER POWER DEVICES SWIMMING POOL ELECTRIC 1TLETS- SWITCHES -FIXTURES NEW RESIDF.NTI41, F.LECTR SQ UL P�RMITPERMIT ISS 'LL AL'I'BI1-DRAIN&VF.N IVATER(F.A) RACK FLOW PROTECT. DEVICE ,DRAINS - FLOOR, ROOF, AREA, COND. FIXTURES -PERT RAP GAS - BA SYS '1'HM-I INC. 4 OUTLETS GAS - EA. SYSTEM OVER 4 NA) GREASEANDUSTR, WAS' IF IN'I ERCEP'IOR CREASE 'MAP SEWER -SANITARY - STORM EA. 200 FI'. WATER HEATER WNENT/ELECTR t WATER SYSTEMn RIiAI'ING WATER SERVICE NEW RESIDENTIAL PLMU SQ. FT. MECHANICAL PERMIT PERMIT' ISSUANCE C (4I.TERORADDTOMF.OH. t AIR HANDLING UNIT(TO 10,000CFM) AIR HANDLING UNIT (OVER 111,1100 CFM) EXHAUST HOOD(W/DUC ) HEATING UNIT (TO 1011,0011 BTU) BEATING UNIT (OVER 100,000 BTU) VENTILATION PAN (SINGLE RESID) BOILER - COMP (3HP OR 100,000 BTU) BOILER -COME (OVER 100,000 BTU) AIR CONDITIONER NEW RESIDENTIAL MECH. SQ. FI'. AIDrFEE r� eeivlTDTAL:BUILDING FEE SEISMIC F�ELECTRIC An. L PLIIMBI f FEE {Q `\, MF.CHA ICAI, ME CONSTR 'ION TAX HOUSING MIT TION FEE PAID Data TydTW I ISSUED BY: OFFICE DATE, COMMERCIAL: D NEW BI DG/ADDITION [] DEMOLITION %JeFNANT D FOODSERVICE PROVEMENT D OTHER �2 SQ. FT. FLOOR AREA 2cq�pQ� MAY 6 ANS'[] $/SQ. FEE 'Ittirl STORIES OCG GROUP TYPE CONSTRU APN A OUILDINO DIVISION PEES. PLANCHECK FEE ENERGY PEE w GRADING FEE 0SOILS CUP A AIDrFEE r� eeivlTDTAL:BUILDING FEE SEISMIC F�ELECTRIC An. L PLIIMBI f FEE {Q `\, MF.CHA ICAI, ME CONSTR 'ION TAX HOUSING MIT TION FEE PAID Data TydTW I ISSUED BY: OFFICE DATE,