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20215APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Prom Identlflcaasn - Building Address: s s -f PERMIT NO. 2021.5 Name; 'Uv,rter.r., l U • W3s, CITY OF CUPERTINO-BUILDING DIVISION APPLICATION/PERMIT BUfLDING—LFJCTRICALPLUMBING-MECHAMCAL C S '— Contmdor's Name: Lic. No:/ CATEGORY CONTROL p - Arcd/ gineer. Lic. Nen q�, PEItMTT'I .. �'i BUILDING PERMIT INFO •. ..� -' Address aO IC 54 •Qrr,�,' [ELECTRIC ,,iE IPFRMITISSUANGE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provbiona of Chapter9(comment, Incense I In full force and dielon3o(lhe BuelneasandProtnaloneCode;and my license le In full form and died. APPLIANCES -RESIDENTIAL JOB DESCRIPTION PANELS Llma.Class LIc.0jP & Date Contractor UP TO 2DOAH!S 201-10MAMN " ARCHITECT'S DECLARATION [understand my planashzl be used as public records. OVER IOOO AMPS SQ. FT. FTOOR &RFA /SQ:Ff. SIGNS ELECTRICAL Licensed Professional SPECALCI6CUIT/MISC OWNER -BUILDER DECLARATION Ihercby a(Orn that l amexempt fmm the Contractors, License Law for the following reason. (Section 70115, Business and protestors Code: Any city or countywhich rcqulms a pemdt to mmtrud, alter, Impmve, demolish, or repair ' ^ f TEMP.METTRORPOLEINr. - anystrudure priertobeasuance,alsorequlresthe applicant for such permit to Its a signed statement that he is licensed pursuant to the pmNalov of the Contractor's License Law (Chapter 9(commencing with Section 70f1f1) of Divl- aion3of the Businss eand Professlona Code)orthal hebexempt therem froand POWER DEVICES ^ -SWIMMING [POOL C VALUATION the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant too civil penalty of not morothan OU LRTSSWI . ' NRWRESIqWLELEC4 SQ.Ff. five hundred dollars($SM. nL as owner of the property, or my employees with wages as their sole STORIES TYPE CONSTRUCTION mmpensaboar,wlll dothe work andthe strudurc isnot Intended or offered for _ .. -In (Se. 7064, Business and Professions Code: The Contractors License Law _ does net apply loan owner of propedywho bulldsorlmproves thereon,and who does such work himself orthrough his own employees, provided that such OCC GROUP - RFS. UNITS improvements are not intended oroffered forests. it, however, the building or Improvementlesoldwithinoneyeaiofecmpldlogtheowner-bullderwillhave tt,,�urden of proving that hedidnwt ildorlmpmveforpurposeofele.). LJ L as owner of the property, am exclusively mntmcting with Iireneed dent adam to comtmd the project (Be. 7064, Business and Profess.. Code: TOTAL: , Qty. I;,1�• PLUMBING''PERMIT',' .'FEE+, PERMIT ISSUANCE , FLOOD ZONE APN The Contrai License Law does me apply to an owner of property who Wilds or Improves thereon, and who contracts for such pLojects with a �gR�{ad.r(a) licensed pursuant to the Contractor's Law. LI I am exempt under Sec. B k.P C for this mama ALTER -DRAIN k VENT -WATER [EA) it ,'�. 'FEE"SUMMARY' BACK FLOW PROTECT. DEVICE DRAINS -FLOOR ROOF, AREA, CONTI. FIXTURES PER TRAP SANITARY Y N - RECEIPT# Owner Date '- WORKMAN COMPENSATION DECLARATION Ofhereby affirm that I have clrtof m SCHOOL TAX Y_ N ao difi pythaure, ore o certificate ofWorkers'Compenaatlonlnaurance ora certified copy thereof (Sec. cane abs .. RECL'I'r M GAS F.A.SYSTEM-1 INC.60UTLETS - PARK FIB: y N ' Policy3800, olkyN RECEIPT Comny GAS EA. SYSTEM -OVER BUILDING DIVISION SION FEES�Clfed copy is hereby te Cb filed with ertified copy W pedlars division.. the city city CREASE/INDUSTRL WASTE INTERCEPTOR PLANC14ECK FEE GREASE TRAP CERTIFICATE OF EXEMPTION FROM WORKERS' Cot bec.ATIONINSURA isfor (fhb sectionneed not be compldI NI permitbCorona hundred dollars PAID Date Rece{ t# SEWER -SANITARY -STORM EA 200Ff. (81(D)or less.) '" I certlfythat In the performance of the work for which this permit is bored, I shall not employ any person In any manner so as to become subject to the Workers'Compensatlon laws of Callfomia. Date WATER HEATER W/VENT/ELECTR O ENERGY PEE Y N ' PAID WATER SYSTEM/TRGTING Applicant NONCE co MPLICAM: a after making this kro is Exemption,ns oftab u co Worken'Compensationies rthiopermht Labor should you mustme subjectforthwith deems r moat forthwith comply with each provlslona orthLs permitahallbe deemed revoked. Date - -Reset t# NEIN RESIDENTIAL PLMB. Ff. —� _ TOTAL: BU LIJING SEISMIC FEE CONSTRUCTION LENDING AGENCY IhercbyafBrmthat there Is a corutrudion lending agency for the perforrm anm of the w.rk for which thio permit b bored (Sce. 3097, CIV. C.) TOTAL: - • • ' ELECTRIC PEE. QTY. ,,„ ',,-MECHANICAL. PERMIT•'' , •''•FEE+,•, PERMITISSUANCE PLUMBING FEE Leader's Name Larder's Add mee •. • I ceditythat I have read thbappliaHonand statethattheabove Infomatlon .bmrred.Introit, complywith all city and county ordinances and statelaws MECHANICAL FEE. FEES PAID: .. relating to building construction, and hemby authorteencomeentatives of thio city to enter upon the above-mentloned property for Inspection purposes. (Na) agree to save, indemnity an d keep harmless the City of Cupertino against liabilities,judgments, mks and expenses which may In anywayacnue agubm said City in coneayuenceof the granting of thio permit. . • ALTER OR ADD TO MECH. Date Receipt# - AIRHANDLNGUMT(TO10,030CFM) " SUBTOTAL; AIR HANDLING UNIT (OVER l0,000CIMD CONSTRUCTION TAX SignaieradApplicant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE - HFATINGUMT(TO100,0DOBTU) - Willtheappllcantorfulure building occupant store or handle hazard..,. material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Plealthand Safety Code Section 25532(a)7 Yee ,tr. No Date Recel t# HEATING UNIT (OVER 100,000 BTU) - TOTAL: 11f/ .`lU VEN77LA770N PAN (gINCLE RLSID) , ISSUANCE DATE PAI r f -'FAl Wiil the applicant or luturebuilding occvpantux equipment ardevicn which emit hararluus air contaminants as defined by the Bay Area Air Quality Marsgement DbVid7 IP, Yee � N. ave readlthe .Itha uammeriabrcquiremems5533aChapter6.95 of Health Code, 1 BOILER-COMPOHIPOR 100,000 BTU) - BOR.ER-COMP(OVIR IHI,OfJO RTU) - - NEW READENTIAL MHCH.-SQ.Ff. understand that notifthe thatI534. understand t building otcurrntlyh have currently a tenant, thatIt is my f•,fCM1d U the occupant of the responsibility to notify the ocmpantofth.acyr. menti which mustbemet which to reofaC< toofOcmpancy. — .-city,Of13unetlBtl,w ISSUED BY1�0 VV _ Owner or au orlud agent„ Date ' TOTAL OFFICE COPY