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22271 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT-PEN ONLY Building Project Identification - '" - PERMIT NO. Building Address: . - LGG 2 2^7 1 So . -sioKez. ita-12- caner ams: one: . A nJ Cov/ J it)o - CITYOFCUPERTINO-BUILDINGDIVISION / / Contradnr6 9 Name: .).LIe.No: APPLICATION I PERMIT Amhllect/Engineer. BUILDING-ELECTRICAL - COPLUMBINGMECHANICAL CATEGORY NTROL# LkNo �i . . fiQ as trTY ELE(C'TRIC PEBMFTiIhti " �s �,,4t; oaq et,BU1LDING'PERMIT INFO, ' 'n' C�Address: PERMITISSUANCE• .� QD (�I ❑ ❑ . LICENSED CONTRACTOR'S DECLARATION Ihereb e((Irm that lam L'cnsed under 'salons a(Cha erg commenc/" APPLIANCFS.RESIDENLAL TOB DE HLMON Ingwith SeRlon 7000)of Dlvlslon3 o(the Businessand Profasdone Code,and my' - licenx Is In full force and died. PANFdS LlcenseChss Lic.N Date Contractor IM TO 2QQAhIp5 ARCHITECTS DECLARATION 2014000AMI5 02. l understand my phroshallbe used as public records. OVER1000AMPS FLOOR AREA S/SQ.FT. PqqP� CO q E z(0 Licensed ProfessionalI -• SIGNS ELECTRICAL Pee t - rqlL Z <QQQ Q w License DECLARATION a�l SPECIAL CIl2CUIT/MI .7a mn yI' Iherebyaffithat lam exempt fromthe Contractor's LlcenLaw for the : • p following reason.(Section 7031.5,Business and Professions Code:Any city or OZt=. 'TEMP.METER OR POLE IN . O� oaantywhiciftcture montoIspecance,mroreclum t the eaprovent for.lsh,orrepairmito g anystructure pritatcmmtthat a Is also sed portheapp the forsuchpemdt a POWER DEVICES . 65 �' file..signed statement that he la licensed pursuant it the ion 7"1 of the - - 3� Contractor's uaffice Low(CMsslon Cmmmendng e6a as thinefofrarsd ` OCi SWIMMING POOL ELECTRIC ' sion3ofthe Business and Professloru Code)orthat hell ezemptthercfromand VALUATIO D Q 5 the basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLET&SWITCHESHXTURES - (] �. p applinnt(ora permit subjects the applicant to a civil penalty of not more than s S Y;7, five hundred a.owner of the pr. SQ,FT. SIORI: TYPE CONSTRUCTION NEW RESIDENTIAL ELECTR as owner of the properly,or he employes with wage a there sole _ compensation,will do the Business and kand thnlCode:Thure Contraot ndedo License ed for Law O saledoe(See 7044,to Business and f property Code:The Contractors License Law $ don net ssuchtoan ownerofprough who W[Ids mporimpmvnted turner,that such OCC.CROUP RFS.UNITS EE who donsuchworkhlmsen edorough Msowaeered .It,ho evertheb building or improvement Issoldare lmendneyear kempletion theoweveglheerwill have TOTAL: +3 ' improvement bwid whhlnoneyeara(completion,theowner-WOderwW have tF rden of proving that he did not build or Improve for purpose ofsale.). QTY; ;11"i" ',PLUMBING PERMIT_w FEC'{!` FLOOD TANS MIN�1,as owner of the property,am exclusively contracting with-1- i PE4MITISSUANCE ' contractors to constrict the project(Sec.704A Business and Professions,Code: The Contractor's License law don net apply to an owner of property who ALTER-DRAIN&VENC WATER(EA) Wilds or improves thereon,and who com - rade-for such pvjmU with a , ,a"'; ., mpJpaOur(.)Ilnnxd pursuant to the Contractor's License Law, [am exe un Sec B&P C for this reason - BACK FLOW PROTECT.DEVICE' 'II .'t#i ''j-t .FSU OUTSIDE EELS - DRAINS FLOOR ROOF,ARCA,CONU. SANITARY Y . N•_ ® Owner OR KMDate RECEIPT p AN MPENSATION DECLARATION �.�S�.�P SCHCOLTAX Y 711[hereby a(flrm that I ave a cert!l of consent to sneure,ora RECE1N X certificate o(Workere'C mperwtlon lnuumrance oracertlfled copy pytthereof(Sec. 3500,Lab C) GAS EA.SYSTEM-I WCAOUTLETS PARK FEE Y N Po11cyX - GAS EA.SYSTEM-OVER4(EA), RECEBxT# Com any -I BUI LDING DI VI SION FE CS FCertified copy Is hereby thMGREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECKFEE 4[ - F1 Certified copy Is filed with thee city y inspection division. 3 CERTIFICATE OF ILCEMPHON FROM WORKERS" GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.XM)F'C., - Date RCCCI I# (Thlssectlon need not be completed lithe permit isfor one hundred dollars (SI00)or less.) WATEICHEATERW/VENC/ELDCTR ENERGY FEE Y N I.Aifythat in the performance of the.ark(orwhlch this pe.it i,Was,d, I shall not employ any person In any manner n as to become subject m the WATER SYSTEM/TREATING Workens Compensation lawsof California. Date PAID l Z2 NOTICE NEW RESIDENTIAL PLMB.__SQ.WT. Date Recei t# NOTICETOxe..bpt to the orlefter maklompesationng this ProcatevI xempdon,you should you mmcaubjhwith comply Work en'Comprewisinprovbiomrmit s Lab be + TOTAL: s� LU N deemed revoked. must forthwith comply wllh auchprovlalors,arthis permit shall be BUILDING 0 •� j. deemedrevoked. ' aCONSTRUCTION LENDING AGENCY - / SEISMIC FEE s 9 I herebyafflrmthat there is a construction lending agency for the perform ELECTRIC FEE Zance of the work!or which this permit bLsaaed(Sec.3097,CIv.C.) r TOTAL: ��•� '. U O Lenders Name PLUMBING FEE ly -- Lender.Address Qr4. ;� '„MECHAIVICAL',PERMIT; ,t,FEE+,t MECHANICAL FEC OW Icertlfythat l haveread thisappliationand statethatthe above information , 1 lammed.I agreeto comply with all city and county ordinances and state laws- PERMIT ISSUANCE FEES PAID: >_ IL relating to building construction,and herebyauthorlaerepresentativesofthbt 'f. cityto enter upon the above-mentioned property for,impection purposes. ALTER OR ADDTOMECH. a (We)agree to save,Indemnify an d keep harmless the City of Cupertino Date Receipt# 'V against BabiIties jidBrrent{cone and expenses which may In anyway accrue AIR HANDLING UMT.(C010,006 CFM) - SUBTOTAL: against sal By, m enno(thegraningofthi.pemdt. - , CONSTRUCTION TAX . _ AIR HANDLING UNIT(OVER 10,000 CFM) "K� Si reof Applic' /Contractor . Date EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: H RDOUS MATERIALS DISCLOSURE Will thea B turfuture building occupant store or hand le hazardous HEATING UNIT ITO 100,000 BTU) Date RCCei t# material as defined by the Cupertino Municipal Code,Chapter 9.1 7,and the Ilealth and Saldy Cod,Section 75537(.)7HEATING UNIT(OVER 100,000 BTU) TOTAL:' 3a ❑Yes M No Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit hazardous air contaminant ads defined by the Bay Arca Air - t' Al il+41 oftQuality Management Disco? BOILER-COMP OHP OR 100,000 BM ❑ Yes' . . ❑No r cur, Ihave rndthe hazallous matcrialirequlrcmenb under Chapter 6.95 of BOILER-COMP(OVER100,000 BTU) JIjjt' 7 7 (ay{, ,. the California Health&Safety Code,Sections 75505,25533'and 75534.I VlC �a i C undeniand that ifthe building does not currently have a tenant,that it is my NEWRESIDENTIALMEOL SQFT responsibility to notify the occupant of the requlremcnts which most be met - Q11141o4i M1�®• prior to Issuance ofa Certificate of Occupancy. Owner or authorized agentUale 4rCV�', - TOTAL: ISSUEDBY: I ,.OFFICE COPY S ) CZs !rP4 a 10 � Ob \ � ot, o ' Rb rn c lI � t a31 acsgo O Oo O Axa y O � 0 1 w