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22344 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY tlul"Un Pro'ect Identification PEILWTNO. Building dress: 22344 O L.FIr 2, .S 2© � vers ams: one: q A . $11 riz CITY OF CUPERTINO-BUILDING DIVISION �� Cor r'aName � Llc.No: APPLICATION if PERMIT 'f- BUILDINGELEOTRICALPLUMBING-MECHANICAL CATEGORY CONTR LR Archtect/Engineer. Lic.No: 'n ,y QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: 6b7 Z'I'�O PERMITISSUANCE 1:1 1:1 IPLUMB 1:1LICENSED CONTRACTOR'S DE Cr TION T hereby affirm that l am licensed under provisions of Chapter9(commman APPLIANCESRESIDENML // ]OB IDDESCRB''f10N Ingwlthmhon7000)and sixon3o(1he B;�neuand ProleaslonsCode.and my PLV tJ Bance '3m s in fu and Af on PANELS Llanm Ch E Date Conlntor 701-IOW AMPS ARCHITECTB DECLARATION OVER100AMPS SQ.FT.FLOOR AREA $/SQ.FT. 7� 7 understand my pions shag b.used u public records Licensed Professional SIGNS ELECTRICAL p LED ' ¢cm OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC H L., Iher.byafl m that l am exempt from the Contractors License Law for the OOF following reason.(SrsMon7015,Businessand Professions Ccde:Aoycityor TEMP METERORPOLEINST. M P U � 1 countywhich requlresa permittomvtruct,alter,Improve,demolish,oreepair q anystm=mpdortoltslssuame,alsomquirestheappBantforsuchperMttu POWER DEVICES / f•�/// ,S file a signed statement that he is licensed pursuant to the provisions of the ! b,/ O a' 3cG Contractor's License Law(Chapter 9(commenWg with Section 7000)of Divi- SWIMMING POOL ELECTRIC O slon 3ofthe Business and Professiov Code)orthat he is exempt therefromand g <S the Wsis for the alleged exemption. Any violation of Section 7015 by any OUTLETSSWITCHFSFlXTURES applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500) NEW RESIDENTIAL ELECTRFT. F1 1,as owner of the property,or my employed with wages as their sole STOWCS TYPE CONSTRUCTION X compensation,will dothe week the and thtructure is nor Intended or offered for � p sale(Sec.704d,Business and Professions Code:The Contracior's License Law $� docs not apply to an Owner of property who Wilds or improves thereen,and OCGCROUP RES.UNITS whodoessuchwork himself orthocugh his own employees,provided that such improvementsare not intended oroffered for sale.If,however,lhebuilding ee TOTAL: improvement issold within oneyear ofcompletion,the owner-butiderwill have the burden of proving that he did not build or Improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN u L as owner of the property,am exclusively contracting with licensed PEEME.CSSUANCE ID contractors to construct the project(Sec.7644,Business and ProfesinCode: 2, The Cont radm's License Law does na apply to an owner of property who Wild.or improves thereon, and who contracts for such pNfcts With a ALTER-DRAIN&VENT-WATER(EA) q¢lfactoto licensed pursuanttothe Contractor's Llanse Law. FEE SUMMARY c LJ 1 am exempt under Sec B&P C for thin reason BAIX FLOW PROTECT.DEVICEOUTS]UP I'l PS Owner Date 2AI DRNS FLOOR.ROOF,AREA,GOND. 4 SANITARY RECEII'N WORKMAN COMPENSATION DECLARATION FIXTUgES PER TRAP �t_v_ SCHOOLTAX Y_ N_ ❑I hereby 01.that I have.certificate of consent to selbinwre,ora IV RECEB'T M certi(Iate of Workers'Compensation Insurance or a certified copy thersof(Sec. CAS EA.SYSTEM-1 INCA OUTLETS PARKFEE Y 380,labCJ N_ PolicyM DIM Com ray GS EA.SYSTEM-OVER4(EA) BUILDINGDI VISION Fr.US ElIRe"ified On ts hereby fumished. PLANCHECK FEE Cedifiedcopy lsfBed with the city Inspection division. CREASE/INNDUSIRL WASTE INTERCEPTOR CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM PA 700F1. Date Receipt# (Thissectlon need not W completed iftW permit is forov hundred dollars ($100)or less.) ' WATER HEATER W/VENT/ELLCTR ENERGY FEE Y_ N_ I anlfythat In the performance of the week for which this pennir b(awed, 1 shall not employ any person in any manner so as to become subject to the WATER SYSTEM/TREATING Workere Compensation Laws of California. Data PAID- 0 AID0 Applicant NEW RESIDENTIAL PCMB. JQFI'. Date Remi til Z z NOTICE TO APPLICANT:ILafier making this CertRlate of Exemption,you H N should become subjet to the Workers'Compensation provisions of the Labor TOTAL: Code,you must forthwith comply with such provisions Or this permit shall be _BUILDING FEE deemed revoked. W � CONSTRUCTION LENDING AGENCY { SEISMIC FEE 11 IhercbyalRrmthal there ba nslmctlon lceding agency for the perform TOTAL erg ELECTRIC FEE a. Z ante erebyf the worontl which ryi� rDdrtetl landl.S.Se.ey forv. t 9 (� O Lender.Name /V (.1, PLUMBING FEE . O LL F Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE U I artllyrhatl have read lhisappliationand state thattheabove Information PEES PAID: 0 W Iscomea.Iagreetocomplywahallcityand muntyordinanmand statelaws PERMIT ISSUANCE >• G relating to building construction,and herebyauthorlurepresentatwca Ofthti F (0 city toe ter upon the above-mentioned property for Inspection purposes. ALTERORADDTOMECH. Date RCCCIpt11 _ e) gree le ss�e, demnify an d keep harmless the City of Cu pen ino AIR HANDLING[IMT(TO 10,00 CFM) .8. stl bilLLp,p rats,roc and expenxe whkh may In anywayattwc SUBTOTAL: -(J aid l4,iequenc f the graming of this permit. AIRHANDLING UNIT(OVER I0,000CFM) CONSTRUCTION TAX �Z''a CONSTRUCTION TAX PAID: gruture of AppBant/Contractor Dare EXHAUST HOOD HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle ha,cadom HEATING UNIT(TO 10,000 BTU) Date Recei tN material as defined by the Cupertino Municipal Code,Chapter 933 and the .n I lvRh and Safety Code Stolon 25537(a), HEATING UNIT(OVER 100,000 BTU) TOTAL: ❑Yes n No Will the applicant orfuwm building Occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit havrdous air contaminants as defined bythe Bay Area Air PAID Quality Management District? BOILER-COMP(3TIPGR 10,00 BTU) [�1�� 1 Yea No 1 have,[. thebav materialst[on2menbundeand 2S53r8.95 of BOILER-COMP BTU) � 0j, 6199 the Ca lf.rn la Ilealih&Safty Code,notions 25505,ve a t nan,that.Iu�dersl. that if thbuildidocs not arrendy have atenanL that ltkmy NEW RESIDENTIAL MECH, SQ.FT. rep. I lily t.na occupant of the requirements which must be met Frt sof ifkate of panty. �yp$�IYrr" Wer or authorl dagent Data TOTALISSUED BY: _Lj y— / : 111 OFFICE COPY