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20593 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BWWI P'.Jed Iden lot S t--- t f'1��' � PEILWT NO. Bulldog Addmv: Q Q1 �I— �3�oa �N;-rs 60 20593 vier ��' �- u �- Vp pnr. CITY OF CUPERTINO-BUILDING DIVISION A AP •Z`�C�6 G �•"° • 'an.: Vy��� APPLICATION / PERMIT t A ""�'�•' BUIL.DINGELECTRICALPLUMBiNGMEC}IAMCAL CATEGORY CONTROL,/ t /� neerh �31/,�y,. arc Na Q ELECTRICPERMIT FEE BUILDING PERMIT INFO Add— G SY1'ON + , TF PFRI4TISSUANCE ❑ ❑ MM EN LICSED CONTRACTOR'S ❑DECLARATION yam, Ihertby.f(Irm slut lam lkenaMuMer prwltlmsof Chaptcr9(�mnen APPUANCESRESIDENIIAL ingwlth Sedlon7W0)ofl)MM=3ofthe BudrceaandPmfeW C eg dnyy JOB N hoense Cin fu o =d fed. Z 1 PANELS J V Date�?s6�4a9 Camndor pu�L.g.�c ARCHITECT ECU AT &%4PS NOZp0C IuMert MmyplansehaUbeu upublicrtmnL OVERIODOAMPS SQ.FT.FLOOR AREA S/9Q.FT. k to Llassadd Professional SKINS ELEC3RICAL G�63 j+A OWNER-B UILDER DECLARATION SI'FLIALCUiCUIT/knsC z G Iherebyaffirm Uutlamesemptfmmthe Comradorb Llan Lel for e ' O 9.. following reason.(Seelmt 70315,Besiner and Pmfe�bm Code:My city or F Q TEM .MECIX OR POLjq emvcaemm = a qanywu mprtwto RSWrameattomrylmstheappRontfwauch pemdtto L5 O file a signed statement that k Is Ikensed porauant to the proKtloro of the ]ON'FR DEVICES �3 Contndor'•Lkerue Lw(Chupter9(comorcndngwRh Section 7000)of DIW- SRAN(INGPOOL7]R m n3ofthe Bu mond Pmf mCode)orthathe6.a ptthemfmmaM VALUATION <_ the basin for the alleged exemption. My AoLdlon of Sedbn 7Q315 by any /� {� O app0rant for a permfl subull subjects the applicant to a dpenalty of not more than OUTLETSSWITCHES- 2. -l' ' five hundred dollars(5500). {n F1 1,as owner of the property,or me NEW RF9DEMIAy employewith wages as their sole � ' STO TYPE C'ONSIRUCHON mmpevauon,wW dothe wwk.nd themm=m In rot WeMedor offered for �a rz a sale(Sm 7066,Busbd and ProfessionsCode:The Comndol•Llaroe law p fJ� doenot.pplytoaownardpropertywho WlldsorimprovnthemoR d whodounch work hlmneBwthrough hinawnemployees,provided that suds OCC.GROUP RES UNITS Imprvvem=are rot IntendedoroHered twine.If,however,thebulbing a TOTAL:- Qr . OTAL:Qr . PLUMBING PERMIT FEE FLOOD WNE APN u I,as owner of the property,am excbslvehy mntnctleg with Licensed mntnctore to eonstmd the pm}t(Sm 7064,Business and Pmfessbv Code: PERMIT ISSUANCE The Comrtdor's Lloerae Lw doe not apply to as owner of property who ALTER-DRAIN kVENT-WATER(EN bu0ds or Improve the ns, and who..finch fa such p lojeds with a ryut�a�toe(s)Barsmd nned puuant to the Ctraox's Ltnae eLaw. BACK FLOW eRorecr.DEVICE FEE SUMMARY LI I am exemp under Sec B k P C for this reaan OUTSIDE FEES DRAINS-FLOOR ROOF,AREA,ODND. SANITARY Y N • Owrcr Date I RECEIPT If WORKMAN COMPENSATION DECLARATION hemby affirm flat I have•cab0ote of mveot to•elf-burrs a a FOCfUf2F PER TRAP SCHOOL TAX Y N tl8ate o(Workm'ComperoaHon lruu awaarti(4d ropy themo(f$ec. RECEPT# 3Po8010� GAS FA.SYSTEM-1 ING40I7ILEfB PARK FEE RECE]PT s Com GAS-FA.SYSTEM-OVER4(EA) BUIL DING DI VISION FF.ES CertiOe copyle ereby furwhed. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE gCcrtUled ropy is filed with the dty lnapedbn dWisim. CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAP PAID COMPENSATION INSURANCE CidaDate Rcccl IN (f100)wfy tha that WATER HEATER W/VENT/ELECTR ENERGY FEE Y N a I rtily le the pedma ouno(the work forwhN r ithis pemit la r•^,ed, I shall net employ any person to any manner an as to become subject to the WATER SYSTEM/TREATING wwkeri cnmpea,tion Lam of California. Date � PAID ' Z NOliaint TICETO APPLICANT:IL.fter nuking this Certiflota of Exemption,you NEW RmDPNTLQ.PLMB. SQFT. Date Revel ted N should hmone eubFat to the Workers Compematter proWabna of the Labor TOTAL Cade,you nuk forthwith mmply with itch provlporo ar this permit ab al he j deemed rooked. BUILDING ME CL III CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby.Birm flat thereb a mnatmdlm lending agency for the perfor D Z aaof the woikf.tr which this=isLwed 6ec 309'4,Civ.C.) TOTAL, ELECTRIC FEE U O Lender.Nam PLUMBING FEE IL I— Tender.Add. QTY. MECHANICAL PERMIT FEE MECHANICAL FEE 2 O W Icertify thatl have mad this appllatbnand pate that thesberc lnfomution a bmrmd.Iagmeto comply with all ety and county ordbam and late laws PERMIT ISSUANCE ,Z,tl� FEES PAID: iL rclatingtobulidingcorotmdim,and hereby authorbe repmnentatNes ofthb fA citytaenterupontheabove-mentbrud ropenyfw Wpenbnpurposes. AL7FRORADDTOMFcH. Z (We)agrm to ,find fy a p hamdese the City of Cupertbm Date Recei tX V agabuti,dolt ju nems, M penaev 6,mryln.nywayamuU AIR HANDLING UNIT ITO 10,000 CFK SUBTOTAL: g ul tyl mnaequ of grants g hV pennR. ' AIRHANDLING UNIT(OVER 10,"CFM) CONSTRUCTION TAX Signa fAppRont ontradw Date EXEIAUST HOOD(W/DIICT) CONSTRUCTION TAX PAID: HA]A R DOUS MATERIALS DISCLOSURE Will the a ppllo m a future lou Uding omupant store or handle h—ardous HEATING UNIT(TO t 00,000 BTU) Date Recei to materlaI a defined by the Cu penins MuNdpal Code,Chapter 9.12 and the He.lth and Safety C�m 75531(a)7 HEATING UNIT(OVER I00,0DO BTU) TOTAL: ❑ Yn Will the applicant tort building ocev pant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE whkhemithanrdmea mntamlnamaeedefincdbythe Bay Area Alr _ Q.1fit Management tE., BOILER-OOMP OHP OR 100,000 BTU) PAID a e o love mad theh sue matcria6 mqulmmenb under Chapter i95 of BOILER-CV NP(OVF16100,0D0 BTU) the GRfomia Heahh SafetyC lona 75505,Ta533 and 7SLM. I J U_� 31 199© uMmtaMthat a Ildln oe mmently a ve.Wriet,thatitlnmy NEW RESIDFNHAL MECI-L SQFT rnponaibllit n ythe pa mthe coq Rents which ovist bU met /^ prbrto ar t Oav pa b� e� auth agent Date '^3 TOTAL ISSUED BY:"�'�s '�`—`_'��� C OFFICE COPY