20786 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification I
q -7 _ / PERMIT NO.
Building Address: A O ,KILTO_I PArZK 101 y NOQ(N �IVQ � 20786
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010 __ '� 7�146 IJLTSV CITY OF CUPERTINO-BUILDING DIVISION
I. Contractors Name: Lie.Na: APPLICATION /PERMIT
BUILDING-ELECTRICALPLUMBING-MECIIAMCAL CATWORY CONTROL 4
Archited/Engineer. Lie.No:
'^IIDD (^� r QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Addrem:iL.�..Gj t)aR�INO , �U �J PERMITISSUANCE �00 1:1 ❑ 1:1LICENSED CONTRAC(OR'S DECLARATION
Lherebyaffirntfutlamlkenaedunderpr Wmaof Chapter9(mmmen< APPLIANCES-RESIDENTIAL JOB DESCRIPTION
Ingwith Section 7000)of DiWsion3ofthe Budnemand PmfpsionsCodeand my
license Is In full f d dfect. L PANELS
Limn Chas O Llc pt4b .S S
Date",- Contractor e-( sL UP 201 TO20OMh V]�
ARCHITECTS DECLARATION
�2 I understand my plans shall be used u public records. OVERIODOAMPS SQ.FL.FLOOR AREA $/SQ.FT.
w OSIGNS ELECTRICAL
rr�4 V ou Licensed Professional
<QwOWNER-BUILDER DECLARATION
G, $ SPECIAL CIRCUIT/MISC
Ibercbyaffirm
that lam exempt from the Contractorb License Lawlor the
ZOOFQ following...(SMIon 70715a
,Busineanmfem
d Pions Code:Any city or 72fp MITITRORPOLEINST.
U td cmntywhi&mqui aper tiomnstmd,alter,impmve,demol6h,orrepair
q anystructure prlortolts Issuance,alsorequires theappllcant for suchpermit to POWER DEVICES Q7
Z4td
^EQoS 0 file a signed statement that he b licensed pursuant to the provisions of the
3w� Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC VALUATION
O d er3oftbe Buslorm.nd Profemlom Code)orthat heat exempt therefromand
S the basis for the alleged exemption. Any violation of Section 7W 1.5 by anyOUTLETSSWITCI IF_SFIXIURES I�a Q7
O
applicant fees permit subjectsthe applicant to a civil penaltyof nut more than
$ five hundred dollars($500). NEW RESIDENTIAL ELECTR .FT.
❑I,as owner of the property,or my employees with wages as their sok STORIES TYPE CONSIRLCTION
I— compensation,wBldoUc work and thesmiclure 6 not intended or offered for �jU itV� (�pY{pQK[Q, (�CD
5 ❑ sale(See.7044,Business and Pro(eniora Code:The Contractors License law
$ does not apply to an owner of property who builds or improves thermn,and
n. who does suchwork himself or through his own employees,provided that suchOCCGROUP RIS.UNITS
Improvements arena intended oroffered fermle.If,however,thebullding or TOTAL: ss-7
improvement6soldwithinoneyearofcompldiogtheowner-b Ederwillhave
the burden of proving that he did not build or improve for purpose ofsale.). QTY. PLUMBING PERMIT FEE FLOOD TONE APN
F1 1,as owner of the property,am exclusively contracting with licensed PERMITISSUANCE
contractors to construct the project(Sec.7014,Business and Professions Cade:
The Contractor's License Law does not apply to an owner of property who
ALTER-DRAIN& -WA (EA)
Wilds or Improves thereon,and who contracts for se pkojem with a FEE SUMMARY
TT'c`'.xr'.mnaedper Sce.m the Contactors License Law. BACK FLOW PROTECT.DEV
LJ I am exemp under Sec 0 k P C for This reason
DRAINS-FLOOR, F,A SANITARY Y N_
. Owner DateRECEBxI's
WORKMAN COMP EIVSATION DECLARATION FIXTURES.PER SCI{OOLTA% Y_ N
0
1 hereby affirm that I have• Immane of consent to opytneurc,ora RECEIPT I
38M,abofWorken'Compensatlon Wurance ora<ek1(ied copythemo((Sec. GAS EA SY -i O0,3117 PARK FEE Y N
Pollry M — REGEErI'N
Ca ray - GAS EA.SYS 4 BUILDING DIVISION FEES
rCertlficdcopy 6 hereby fumished. GREASE/INDU WASMNARCEPTOR PLANCHECRFEE
❑Certified copy 6 filed with the city inspection division.
CERTIFICATE OF EX::MPFION FROM WORKERS' GREAS TRnr PAID
COMPENSATION INSURANCE SEWER- EA Date Receipt#
(fhissection need nu ke completed lithe permit 6 forom hundred dollar
($100)anea.) 1YA. W,/vEhTVEL ENERGY FEE Y_ N_
I mdtfy that N the performance of the work forwhlch this permit la issued,
I shall not employ any person In any manner so as to become subject to the WATER SYS TREATING
Work es'Compensation Laws of Csi fornia.Date PAID
0Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Recel t#
Z O NOTICE TO APPLICANT:If,after rtaking this Certificate of Exemption,you
should become subject to the Workeri Comns
peation provisions of the Labor TOTAL-
CC y Code,you at forthwith comply with such provisions or this permit shall be BUILDING FEE
tL ] deemed revoked.
cONSTR=ION LENDING AGENCY SEISMIC FEE
a I hereby affirm that them is a construction lending agency for the perform TOTAL: ELECTRIC FEE L
7 O arm ofthe work for whichth6 permit 6Wood(Sec.3097,CIv.CJ
lender.N.me PLUMBING FEE
O I- Lenders Address QTY. MECHANICAL PERMIT FEE
LL U I mrtifythat l have read thitappliationand date that theabove Information MECHANICAL FEE
0 W .correct.l agree to comply with all city and countyorduances and date laws PERMITISSUANCE FEES PAID.
>. IL relating to building mretrudion,and herebyauthorlacrepresentativesa!that
W city to enter upon the above-mnNioned properly for Inspection purposes. ALTERORADDTOMECIL
? (We)agree to save,indemnify an d keep harmless the City of Cu pertlna Date Receipt#
V against liabilities,judgments,.9...d expenses which may In any way accrue AIR HA NDLING UNIT(f010,000 CFM) SUBTOTAL:
against mid City in consequence of the granting of this permit.
AIRIIA NDLiNG UNIT(OVER IO,000CIM) CONSTRUCTION TAX
gesture of Applicant/Contactor Date EXIIAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hirardms HEATING UNIT OC)IDOp00 BTU) Date Recel t#
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
I ealth and Safely Code Section 25532(.)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: k -+
❑Yes M No
Will the applicant orfutum building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hamrdous air contaminants as defined by the Bay Area Air
. Quality Mansgcment District? BOfLER.COMP PHP OR 1W,OlD BTU) PAM
4 Yea Q No AAf�
have read the haat ons materla6 rcqulrements under Chapter 6.95 of BOILER-COMP(OVER 1W,000 BTU)
the Ca lifomh Health 6 Safety Code,Sect lora 25505,75573 and 25534.1
understand that lithe building does net currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQFI'.
responsibility to notify the occupant of the requirements which most be met
prrto esus cola icateo Occu an . -
7_ City d CRnertt�inao4��� 64
Owner or authorred agent Date ISSUI>DBY: Utns-'yar""'S''c"l
70TH L:
OFFICE COPY