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23673APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Ii Project Idebtiflotims Building PEItMITNO. - to Sere 23673., warm one: ,(� ,Qr j / - �I CITY OF, CUPERTINO-BUILDING DIVISION. APPLICATION / PERMIT BUILDING-ELECTWCALPLUMBING-MECHANICAL /k - 7 j��,trors Name: J uc.N/°/: ' C t7. "J— /'� CATEGORY - CONTAOLN _ ted/Engleeer. Lic. No: �Q1Y +•,' 4 „ ELEGTI-jRICPERMIT s+�'"'FEE s ' i BUILDING PERMIT INFO Addreui PEPMTISSUANCE LICENSED CONTRACTOR'S DECLARATION Thereby offlan that l amlicensed under provlsl°nsofChapter9(mmmnc 'ngwlthSenlon9(100)of DiAslon3afthe Buslnessand Pref"wmsCo andm limnselelnfu jjpprcnan effect If Date Contractor (%offUP ARCHITECT'S DECLARATION f(r I understand my pansshallbe used as public records APPLIANCES -RESIDENTIAL JOB DFSCRB'ITON IY1V OcT 04r- &T7P,_ PANELS TO 2i00AMPS 20]-IppO AMPS OVER 1000 AMPS SQ. I. FLOOR AREA $/SQ. FT. SIGNS ELECTRICAL - Licensed Professional SPECIAL CBtCU1T/MLSC OWNER -BUILDER DECLARATION f hereby afRrm that I am exempt from the Contractor's License Law for the ' TEMP. METER OR POLE!NST.'' following reason. (Section 7031.5, Business and Professions Code: Any city or countywhlch requlresa permit Wmnstmd, alter, Improve, demolah, orrepaer ' anystrucrure prior to Its Issuance, also requireathe applicant for such permit to :file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter9(mmnendng with Section 700)) of Dlvl- sloe 3 ofthe Rosiness and Professions Code) orthe he a exempttherefromand POWER DEVICES '' .. SWDAMNIC POOL ELECTRIC VALUATION the basis for the alleged exemption: Any violation of Section 7031.5 by any applicant for a permit subjects thea pplicant to a civil penalty of not even than OU7LETSSWITC1iESFIXTl1RES - ' J ❑On 500) five hundred dollars ($. I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure Is not intended or offered for NEW RESIDENTIAL ELECTRSQ.Fr. STORIES TYPE CONSTRUCTION sale(Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and whodonsuchworkhlmselforthr gh Msownemployees,providedthatach OCC.CROUP - RIS. UNITS impro ,amens are not Intended oroffered for sok. If, howevep thebuilding or improvement bsold within oneyearotcompletion,the owner-builderwill have this L,orden of proving that he did not build or anprove for purpose ofsale.). L I, Ise owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7M44, Business and Professions Code: TOTAL: QTY.' '` ' PLUMBING+PERMITI FEE" ' PERMIT ISSUANCE �,. C ✓ VV �Y)i FLOODIDNE APN TM Contractors Urease Law don not apply to an owner of property who Wilds[EA) Wilds or Improve thereon, and who contracts for such projects with a P° mpJ[actor(el licensed pursuant to Contractor)License law. - iJ I am exempt under See, B k P C for this reason ALTER -DRAIN VENT BACK FLOW PROTECT. DEVICE , , •'''+.ii,t..., FEE SUMMARY "' DRAINS FLOOR ROOF, AREA, COND. FIXTURES PER TRAP SANITARY Y IN 'T'A RECFJPTN Owner Data + WORKMAN COMP I:NSATION DECLARATION I hereby a01rm that 1 have o Insurance nsura c of consent to opytneure, or a certificate ofWorkero Campensationlnsuranreora rertlfled copythereo((Sec.' 380), Lab CJ Pollry a l Z �J� � l� -�2 - SCHOOL TAX Y N - RE03PT a CAS EA.SYSTEM-1 INCA OUTLETS iPARKFEE Y N RECEIPT N Com any �j �r'r—� YazaVJ CAS G.SYBTEM-0VER BUILDING DIVISION FRES WCe tBedcopyi herebyfurnlshed. ertBled copy Is filed with the city Inspection division. / L,wA' 1MfltCgs-IY�RR PLANCHECK FEE RFi3SETRAPV 33 p . CERTIFIGTE OFEXEMPFION FROM WORKERS' PAID "-SAMTAIi •' COMPENSATION INSURANCE (TMssedi°n need not W completed If the permit Is forone hundred dollars Date RCCeI I# ENERGY FEE Y N PAID ' ($1000arleas) ' I certify that in the performance of the work forwhlch this permit is issued, I shall not employ any person In any manner eo u to become subject to the Workcre'CoATER peneation Laws of California.Calllo . Date WA r[EnrFx x SYSTEM / ,TREATING Applicant— ,NOTICE NOTICE co APPLICANT: If,a titer king this Certificate is Exemption,you Code, mbthwithect to Workers' Compensation provisions oftpermit Date Recei t# NEW REBIDEN'UAL PLMB. SQ.FC. TOTAL: you =a co Coda you =at forthwith comply with such provisions °rthG permit shall be shall be deemed revoked. - � BUILDING • •E - - SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there Is aconstmctlon lendingagency for the perform anceof the work for which this permit is Issued (Sec. 3097, Civ. G Tendxea Name Address I certify that[ have read thaapplicatlon and gatethattheabove les(°rmatlm iscormR. I agree to comply with all city and county ordinances and stale laws ` TOTAL: ELECTRIC FEE - QTY. MECHANICAL. PERMIT' FEE i. PLUMBING FEE 6Vlenders MECHANICAL FEE - PERMIT ISSUANCE FEES PAID: relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for Inspection purposes. (We) agree to save, IndemNfy a d keep harmless the City of Cu part Ino aga last liabilities, Ndgments, costs and expenses which may In any way acerae again a Cl Inconsequence of tb graNing of tole perm it. nr�v/94, ALTER OR ADD TO MECH. Date Receipt# AIR HA NDLING UNIT (TO 10,000 CFM) SUBTOTAL: , AIR HANDLING UNIT (OVER 10,000CFM) CONSTRUCTION TAX a roof Applicant/ ntmctor ' Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZAADOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100,ODO Bile - Will the appilrant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the' Fimithand Safety Code Section 25532(a)i qYes No 'Date, RCCeIp[# - HEATING UNIT (OVER 10,000 BTU) TOTAL: a5 VENTILATION FAN(SINGLE RF:SID) - ISSUANCE DATE ill the a ppllce nt orfutu re building occupant use equipment or devices which smithaesrdoueaircontaminsntsasdelined bylhe Bay Area Air QualityManagement District? Yea - No hlvcread the haaaQ us materials requlrcntents underChapter6.95 of - - p BOILER -COMP PFR'OR IOWDM BTU) BOILER-COMP(OVERIfIDp000IU) the California Health k Safety Code, Sections 25505, lEiS33 and 25534. 1 - A D NEW RESIDENTIAL: MECH. SQ.FT u nderstand that it the building does not currently have a tenant, that it is my responsibility eheoc tem ocftherequircments which must be metprior responsibauarce of aCertificate issuance or a y the c occupant mrpa mcI UG q� AUG 1 _ ' r ISSUEDO, Owner or authorized agent Data - TOTAL: OFFICE COPY .