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22572APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Protect Identification Building Address: - z11- PERMIT NO. t 22572 nw aces: one: CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDING-ELECTRICALPLUMBINGMECHAMCAL APPLICA11UNbUbM111ALUAil, cnntndor'. Name: Lie`. No: I L -ID % CATEGORY CONTROLM BUILDING PERMIT INFO Archlied/Engineer. Lie. No: QTY ELECTRIC PERMIT FEE Address:' �I �(� 7y 1:1 I PERMITISSUANCE LICENSED CONTRACTOR'S DECLARATION I herebyafflrm that l ane licensed under provWnns of Chapter 9 (cerrammu, Ing with Sedlon 7000) of Dionvisi3 of the Buslriessand ProfeasioesCode, and my license is In full farce and effect. Lken Class, Llcp .q& Dale#LV&5Contratory►ice- J( ARCHITECTS DECLARATION I understand my platy slug be used rspublic records. Limned Professional OWNER -BUILDER DECLARATION I hereby ason. t I (Section 7 exempt fro mss a Contractors Llrena Law for the county hichreuirsaprmittocuslnessand Professions Code: Any city ir countywhichrcqulresa Issuantomnteuct, alter, quires theaplcGt forsuch,ermit to any structure prior to statement thatle, is lice requires for such permit to Ole a signed aicense La that het licensed pursuant it the tion nun of the Contractor's urine Law(Chapter9(commencing with Sectionheredof Divi- slon3 of the Business and Protesslon Code) orihat he V exempt therc(romand thebasisfortheallegedammptton. Any violation ofSodlon 70315 byany than�-�C/flue hun s ed ownerlarehepr. I, as owner .(the property, or my employers with wages as ihdr sokcompensation, will do the work and thesuuture Is nm Intended or offered for vie (Sec 7014, Business and Pmfession Cade: The Contradora License Lawdome not a pply to an owner of property who builds or lmpreva thereon,andRES.UNRS whodoessuchworkhimselforthmughh[smnemployees,providedthatsuchImprovements are not Intended oroffered for sale. If, however, thebullding or 6nprovement esaid within oneyearofcomplello%theowner-b flderwlll have ttr�¢urden ofpmving that he dW not baud orimprove for purpose orale.). CLI L as owner of the property, am exclusively contracting with licensed - contractors to mntmd the project (Sec. 7044, Business and Profession Code: The Cont meter's License Law does not apply to an owner of property who Wild. or Improvrs thereon, and who contracts for such projects with a cgp(fator(s) limned pursuant to the Contradori License Law. L� I am exempt under Sec. B k P C for this reason APPEANCES-RESIDENTIAL J BDESCRII'TION PANELS TO 2DOAMPS pt t�AMPS OVER 1000 AMPSf/SQ. Ff. `Q� FL \� E V IN /- M P T FER �s SIGNSELECTRICAL SPECIALCI2CUIT/MLSC t TG48METMORPOLEINST. [OWER DEVICES SWIMMING POOL ELECTRIC OUTLETSSWITCHESFIXTURES/^iJappBant(orapermitsubjectstheappik..ttoadvilpeullyofnm.re VALUATION NEW RESIDENTIAL ELECTR SQ.FT. rFL10ODZONE TYPECONSTRUCTION TOTAL: QTY. PLUMBING PERMIT FEEAPN PERMIT ISSUANCE ALTER -DRAIN A VEVI-WATER (EA) BACKFLOW PROTECT. DEVICE FEE SUMMARY DRAINS -FLOOR ROOF, AREA, COND. FIXTURES, PER TRAP SANITARY Y N— RECEIPT Y Owner Date ,�/ WORKMAN COMPENSATION DECLARATION Uv t hereby Oftrm that I have a certificate of consent to self -Insure, or a cenifiateof Workers'Compenationlnunnmoramdtfledmpythemcf(See 3800. Lab CJ �s� �OW�� SCHOOL TAX RFGEB Np GAS EA. SYSTEM -1 WC.40I1TLE1'S PARK FEE Y N RECEIPT N GAS FA.SYSTPM-OVER4(EA) Comas Y �isVh Geb-�• 0r ,✓.� BUILDING DIVISION FEES Certified ropy is heed with ertifled copy V filed wiih We city Inpedlon division. the city CERTIFICATE OF EXEM PTION FROM WORK ERS' COMPENSATION INSURANCE Rhlssectlon need not be completed If the permit b(or oro hundred dollars (f100Iotifyth I snot that In anyhe personIperformance n tmannerhe work an as to becomh this e is lamed, I shag not employ any person In any Trainer an n to become subject to the Workers' Compensation Laws of California. Date ApplicaNOTICE NOTICE co APPLICANT: a .her making this .tion pro is Exemption, you should become subject itthe Workers' Comprovisinprovisionofthe ell be forthwith comply with such provislona orthls permit ehallbe Code, you =at deemed deemed revokes. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction Inedingagmncy for the perform ance of the work for which this permit is Issued (Sec. 3097, Civ. C.) Leaders Nana Landers Aadrcrs t aNfythat l have read thisappllcatlonand datethat the above Information ismrred. lagreeto complywilh all city and county ordinances and tate laws relating to building construction, and hereby authorize representatives of thio citytoenterupontheabove-mentioned property for Inspection purpose. (We) agree to save, IndemN/y.e d kap harmless the City of Cupertino again tlis ditto dgments,mel.and e.pense.which may manywaysecrue .gal sal Clty equence of the granting of thlapennlL CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE PAID Date ReCel tN C�00D GREASE TRAP SEWERSANITARY-STORM EA. 2DBFT. WATER HEATER W/VENT/E.ECTR ENERGYFEE Y N. — PAID Date Remi tic WATER SYSTEM/TREATING NEW RESIDENTIAL PLMB, SQFr. TOTAL: BUILDING' TOTAL: SEISMIC FEE ELECTRIC FEE QTY. MECHANICAL PERMIT FEE PLUMBING FEE MECHANICAL FEE - PERMITISSUANCE FEES PAID: - ALTER OR ADD TO MECH. AIR HANDLING UNIT(TO 10,000CEM) Date Receipt# SUBTOTAL' AIR HA NDWNG UNIT (OVER I0,000 CIM) CONSTRUCTION TAX o(App1i ni/Contradmr Data AZARDOUS MATERIALS DISCLOSURE Wllltheappli ant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the Health and SafetyCode Sect1on25532(a)7 ❑ Yrs M No Will the applicant or future be llding occepxnt use equl pmet or devices which emit havrdoua air contaminants as defined by the Bay Area Air . lity Management Ulundi? Ya o have read the haz9rcl Nmeleriala requirements under Chapter 6.95 of the California Health k Safety Code, Sections 75505, 25533 sad 25534. I understandthatifthebulldingdonnmcurrentlyhaveatenan4th.titismy responsibility to notify the occupant of the requlmments which must be met prior to issuance of a Certificate of Occupancy. EXHAUST HOOD (W/DIICO CONSTRUCTION TAX PAID: HEATING UNIT (TO 100,000 BTU) - Date RCcei t# HEATING UNIT (OVER 100,000 BTU) TOTAL: L VENTILATION FAN(SINGLE RESID) IS ATE �� ,l � 19 t` T'/9, AUG /�11eS wi McMy� �4� W WI,IQI (I s ISSUED BY: BOILER -COMP OITPOR 100,000 BTU) BOILER-COMP(OVER 100,000 RTU) NEW RESIDENTIAL MECIL SQ.FT. Owner or authodud agent Date TOTAL: OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Protect Identification Building Address: - z11- PERMIT NO. t 22572 nw aces: one: CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDING-ELECTRICALPLUMBINGMECHAMCAL APPLICA11UNbUbM111ALUAil, cnntndor'. Name: Lie`. No: I L -ID % CATEGORY CONTROLM BUILDING PERMIT INFO Archlied/Engineer. Lie. No: QTY ELECTRIC PERMIT FEE Address:' �I �(� 7y 1:1 I PERMITISSUANCE LICENSED CONTRACTOR'S DECLARATION I herebyafflrm that l ane licensed under provWnns of Chapter 9 (cerrammu, Ing with Sedlon 7000) of Dionvisi3 of the Buslriessand ProfeasioesCode, and my license is In full farce and effect. Lken Class, Llcp .q& Dale#LV&5Contratory►ice- J( ARCHITECTS DECLARATION I understand my platy slug be used rspublic records. Limned Professional OWNER -BUILDER DECLARATION I hereby ason. t I (Section 7 exempt fro mss a Contractors Llrena Law for the county hichreuirsaprmittocuslnessand Professions Code: Any city ir countywhichrcqulresa Issuantomnteuct, alter, quires theaplcGt forsuch,ermit to any structure prior to statement thatle, is lice requires for such permit to Ole a signed aicense La that het licensed pursuant it the tion nun of the Contractor's urine Law(Chapter9(commencing with Sectionheredof Divi- slon3 of the Business and Protesslon Code) orihat he V exempt therc(romand thebasisfortheallegedammptton. Any violation ofSodlon 70315 byany than�-�C/flue hun s ed ownerlarehepr. I, as owner .(the property, or my employers with wages as ihdr sokcompensation, will do the work and thesuuture Is nm Intended or offered for vie (Sec 7014, Business and Pmfession Cade: The Contradora License Lawdome not a pply to an owner of property who builds or lmpreva thereon,andRES.UNRS whodoessuchworkhimselforthmughh[smnemployees,providedthatsuchImprovements are not Intended oroffered for sale. If, however, thebullding or 6nprovement esaid within oneyearofcomplello%theowner-b flderwlll have ttr�¢urden ofpmving that he dW not baud orimprove for purpose orale.). CLI L as owner of the property, am exclusively contracting with licensed - contractors to mntmd the project (Sec. 7044, Business and Profession Code: The Cont meter's License Law does not apply to an owner of property who Wild. or Improvrs thereon, and who contracts for such projects with a cgp(fator(s) limned pursuant to the Contradori License Law. L� I am exempt under Sec. B k P C for this reason APPEANCES-RESIDENTIAL J BDESCRII'TION PANELS TO 2DOAMPS pt t�AMPS OVER 1000 AMPSf/SQ. Ff. `Q� FL \� E V IN /- M P T FER �s SIGNSELECTRICAL SPECIALCI2CUIT/MLSC t TG48METMORPOLEINST. [OWER DEVICES SWIMMING POOL ELECTRIC OUTLETSSWITCHESFIXTURES/^iJappBant(orapermitsubjectstheappik..ttoadvilpeullyofnm.re VALUATION NEW RESIDENTIAL ELECTR SQ.FT. rFL10ODZONE TYPECONSTRUCTION TOTAL: QTY. PLUMBING PERMIT FEEAPN PERMIT ISSUANCE ALTER -DRAIN A VEVI-WATER (EA) BACKFLOW PROTECT. DEVICE FEE SUMMARY DRAINS -FLOOR ROOF, AREA, COND. FIXTURES, PER TRAP SANITARY Y N— RECEIPT Y Owner Date ,�/ WORKMAN COMPENSATION DECLARATION Uv t hereby Oftrm that I have a certificate of consent to self -Insure, or a cenifiateof Workers'Compenationlnunnmoramdtfledmpythemcf(See 3800. Lab CJ �s� �OW�� SCHOOL TAX RFGEB Np GAS EA. SYSTEM -1 WC.40I1TLE1'S PARK FEE Y N RECEIPT N GAS FA.SYSTPM-OVER4(EA) Comas Y �isVh Geb-�• 0r ,✓.� BUILDING DIVISION FEES Certified ropy is heed with ertifled copy V filed wiih We city Inpedlon division. the city CERTIFICATE OF EXEM PTION FROM WORK ERS' COMPENSATION INSURANCE Rhlssectlon need not be completed If the permit b(or oro hundred dollars (f100Iotifyth I snot that In anyhe personIperformance n tmannerhe work an as to becomh this e is lamed, I shag not employ any person In any Trainer an n to become subject to the Workers' Compensation Laws of California. Date ApplicaNOTICE NOTICE co APPLICANT: a .her making this .tion pro is Exemption, you should become subject itthe Workers' Comprovisinprovisionofthe ell be forthwith comply with such provislona orthls permit ehallbe Code, you =at deemed deemed revokes. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction Inedingagmncy for the perform ance of the work for which this permit is Issued (Sec. 3097, Civ. C.) Leaders Nana Landers Aadrcrs t aNfythat l have read thisappllcatlonand datethat the above Information ismrred. lagreeto complywilh all city and county ordinances and tate laws relating to building construction, and hereby authorize representatives of thio citytoenterupontheabove-mentioned property for Inspection purpose. (We) agree to save, IndemN/y.e d kap harmless the City of Cupertino again tlis ditto dgments,mel.and e.pense.which may manywaysecrue .gal sal Clty equence of the granting of thlapennlL CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE PAID Date ReCel tN C�00D GREASE TRAP SEWERSANITARY-STORM EA. 2DBFT. WATER HEATER W/VENT/E.ECTR ENERGYFEE Y N. — PAID Date Remi tic WATER SYSTEM/TREATING NEW RESIDENTIAL PLMB, SQFr. TOTAL: BUILDING' TOTAL: SEISMIC FEE ELECTRIC FEE QTY. MECHANICAL PERMIT FEE PLUMBING FEE MECHANICAL FEE - PERMITISSUANCE FEES PAID: - ALTER OR ADD TO MECH. AIR HANDLING UNIT(TO 10,000CEM) Date Receipt# SUBTOTAL' AIR HA NDWNG UNIT (OVER I0,000 CIM) CONSTRUCTION TAX o(App1i ni/Contradmr Data AZARDOUS MATERIALS DISCLOSURE Wllltheappli ant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the Health and SafetyCode Sect1on25532(a)7 ❑ Yrs M No Will the applicant or future be llding occepxnt use equl pmet or devices which emit havrdoua air contaminants as defined by the Bay Area Air . lity Management Ulundi? Ya o have read the haz9rcl Nmeleriala requirements under Chapter 6.95 of the California Health k Safety Code, Sections 75505, 25533 sad 25534. I understandthatifthebulldingdonnmcurrentlyhaveatenan4th.titismy responsibility to notify the occupant of the requlmments which must be met prior to issuance of a Certificate of Occupancy. EXHAUST HOOD (W/DIICO CONSTRUCTION TAX PAID: HEATING UNIT (TO 100,000 BTU) - Date RCcei t# HEATING UNIT (OVER 100,000 BTU) TOTAL: L VENTILATION FAN(SINGLE RESID) IS ATE �� ,l � 19 t` T'/9, AUG /�11eS wi McMy� �4� W WI,IQI (I s ISSUED BY: BOILER -COMP OITPOR 100,000 BTU) BOILER-COMP(OVER 100,000 RTU) NEW RESIDENTIAL MECIL SQ.FT. Owner or authodud agent Date TOTAL: OFFICE COPY