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20059 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BuIldfoR Project Idemlf tion / PERMIT NO. Building Addrtv: $ �fvldoO — B-3 d0 UuZTc,, 3 3s rP 20059 TRZMFVM_m: me: APPLICAT[ON SUBMITTAL DATE �) CITYOFCUPERTINO-BUILDING DIVISION APPLICATION / PERMITcd jZ BUILDINGkLACALPLUMIGMMCAL CATECARY g �SCONTROL 0 a ' Z C� BUILDING PERMITINFO Q ELECTRIC PERMIT FEE Addrmc ,�OrS PERMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I..licensed urder provldon.&Chapter9(mmmenc APPLIANCES-RESIDENTIAL JOB isc {LTI0 Ingwith Sectbn7000)of Dlddm3 efthe Businesand Rofesslon.Cedq and /�f"J� /,•�-JJ license b In to d e fed. s///cy q r� PANELS L rI` E U FL 01)e Date etas Lie e ` �L 7 74 Date CorRTE(7 ARCHITECTS DECLARATION q�v aO ZpC ]undentaM rtry plaro shall be used s public records OV OVER 1000 AMPS - sQ.Fr.FLOOR ARTA 5/�.FT. k t(ttuaa/ Licensed Professional SIGNS ELECTRICAL• - A L E D . S OWNER-BUILDER DECLARATION SpTCIALCRiCUI7 A45C Z �G Ihembyaflmthatlame.empt fmmthe Cordndorsltceraelawfmthe MPjjU foVowing maane.SeNm 7m15,Busines and Prefesbro Ce:Any city or 'V'C�jTTj�!'/ v O TFMP.MbTQt OR POLE AST. KER � osunrywhkhre to lapcmdttoar md,altm theapUv tie olbh,orrepto (��El �[ any atrudare pdmtolte leRrarae,abo requkmtheapp0cant/meuch pemdt to POWER DEVICES '� 'I • , K` file a dgned daternent that he b licensed pursuant to the provbbv of the E. Ou Contractor'sLlceuse Law(Chapter9(conunnctng with Section 7000)of Divi. VALUATION F,30�n don 3 of the Business and=ra Code)or tW ha L eampt therefrom and SWMIMING POOL ELECTRIC the Well for the dleged eaemptlon. My dolaticn of Section 70315 by any G� applicant fora peredt eubjede the applicant to a ddl perolly of no enonthan OUTLEISSWTTCHFSFD(TURES flue hundred dollars he Pro NEW RESIDENTIAL ELEM SQFr. -STORIES TYPENNSIRUCTION esaowrerof theproperty,d the structure ankhwags rtheresok offered for sampewdon,B.inesill do hawork•andlhe,Code: brut MaldeIntended or.Lw sale Sec 7041,Buekas.cerci PNsbro Ce:The Conindor.Warne Law (,}5$ don not apply to an owner,of property who builds or lmprwes thereoq and OCC.GROUP RFS.UNITS - LL whodooachworkhdmaU mthmugh hiaown enrylaym,provided thatsuh Improverre ds are not Intended oroffered!sale.If,however,thebullding or TOTAL - Imp w,re,rt bsold within oneymrofccenpletbd,the owner-0udderwW have t)q_kurden of proving that he did not build or Improve for purpae ailk.). QTY. PLUMBING PERMIT FEE FLOOD ppNp ApNr LI L as owner of the Property,am eecLuivety contracting with Ilreed contradon to corolnud the project(See.7344,Buslnemard Prdeslom Ce: PERMIT ISSUANCE The Co terador's Lka Law docs no apply to an owner d property who ALTER-DRAIN A VFM-WATER TA) or Improves thereon and who contracts for wed plvjeN WIN a Banned pursuant to the Cmtadds Ltoerae Law. AAO(FLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec B k P C for this rt awn DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y N_ Owner Date RECEIPT R � WORKMAN COMPENSATION DECLARATION FIXTURES.PER TRAP SCHOOL TAA Y N }�}fhereby af(Irm that 1 have a artlfconsentwrc te of consent to sere-I ,ora — anl rneof WorFen'Comperodlm lrounnaaaanlfkd copythertof Sec. ATCFTITI Yb 3 oft0 Q GAS FA.SYSrEM-1 WG40UTLLTS PARK FIE RECEIITN GAS FA.SYSTEM-0VER g(EA). y '1 a(f , BUILDING DIVISION FEES Cenlfled copy L hereby furnished. / GREASE/INOUSIRL WASTE wTERCErmR PLANCHECK FEE ert13ed copy L filed with the cityIropedbn dlv on. CERTIFICATE OF EXEMPTION FROM WORKERS GRFASE98AP- PAID COMPENSATIONINSURANCE SEWEt-SANTTARYSNRM EA.20lFr Date Recei t# (ITL eedbnneed sat beconpleted tithe pemdl b(mamhundrtd doBan Il alm)nify that WATER COATER w/VENT/ElFmt ENERGYFEE Y N Ianor thatbthe peron,anany he rrawale for tohco pemrkc Wiled, laha0notemploy rrany perwa of manneratuto bttome subject to the WATER SYSTIM/TRFA"ING hackers'Comperwtbn haws of UllfomL.Date PAID PP NEW RESIDENTIAL"B. SQFr. n leant Z 2 NOTICE TOn,subp ANT:I/, .rk..'fter k.vnpeong this Ction proof Ens f the ,you Date TA 1# aholdbecomeforth to thenply wiComprwtlons or thbpeofthe Mbar TOTAL: LU N Cnedi mndtathwilh comply with wch provisions or thL pemdt shdl be `> dnmed rooked. BUILDING FEE W O CONSTRIK.TION LeMiNG AGENCY SEISMICFEE CLIherebyafllrtnthattherchacornierdimlcedingageeryfOTt pedor TOTAL ELECTRIC FEE Z anceoflheworkforwhlchthbpermkbie dSec3 ,CW.CJ U O leodcra Nam PLUMBING FEE LL Iender.Add. QTY. MECHANICAL PERMIT FEE MECHANICAL FEE Q O W Iartltythatl Wvr rtdthbappliotbnaM aatethrtthe above Lfornratlm bconeer.lagree Wo plywkhakckyaMd ntyordinanmanddate Lws PERMIT ISSUANCE FEES PAID: } N relating to building construction,and hereby authodv mprexntadvn ofthk - 1— Z ctty,to enter upon the abov .ttcned property for Inspection purpose. ALTERORADDTOMECFL Date Recei (# _ (We)agree to emd(y barrel.the fty of Cupertino P agdrot WblBtln d nxa,cots roe which Lany way accrue AIR FANDONC[UNIT(IY313,000 CFM) SUBTOTAL: agalrot aid b e ting h melt. `^ 'n eAIR HANDLING UNIT(OVER IR"CFW CONSTRUCTION TAX SIg1U App��dor Date EXHIAus'rmm(W/DUC'D CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the appBant or future bullding aavpant atone or handle haTardaw HFATING UNIT GO 100,000 BTU) Date Rccci t# rratedd as defined by the Cupertino Municipal Code,Chapter 9.12,and the Hakhand Safety C cr$mim 25532G)I HEATING UNIT(OVER 100,000 BTU) TOTAL: 870;;?) Yee 3l the applicant allCfdl obuilding occupant uae equiprrcnt or devlss VENTILATION FAN SINGLE RESID) ISSUANCE DATE which emit hamrdou•dr curuun mni..a dcfirad by the Bay Ara Nr Qualky Mawge"en' t 7 BOILER-NMP OFR'OR ID0,0W BTU) 4 Yn No have read the haw oil.rnutedala reyuU<menLunder Chapter A95 of BOILER-NMP(OVIR IW,D00 BTU) SIL 31 199 the California ff.hhh sty Cade,Sectloru 25505,25S33 and 25534.1 O uode nd that If th I Ingdon ntly ha atenant,thatltLmy NEW RESIDENTIAL MECHL SQFI' 1, resporolbllhyton copa oft recJ Na which�at W met Cly,/ n[ n, prior to taus rt13at pa ' r^nPFirr.I Owner thodudagen Date ISSUED BYJ I.Q/ rornL OFFICE COPY