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19895 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Address: G✓ /J, 4/ 19895 7f 1�rcds, .ere time. Phone: APPL1CAr5KT09.qrrrATA CITY OF CUPERTINO-BUILDING DIVISION Contr or'.Name: L+c.Nn/ APPLICATION /PERMIT 5 3536 BU LDINGELECTRICALPLUMBING-MECFIAMCAL CATEGORY CONTROL N -Architect/Engine f Lic.No: QTY ELECTRIC PERMIT FE,E,x� BUILDING PERMIT INFO Address: PERMITISSUANCE 1/�W ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm thatlam Bcenud underprovlalons of Chaper9(comme APPWANCESRESIDENML JOB DFSCRIHON Ingwlth5 ion7000)of MAsimn3oftheBuMnessand Pmfaims Code,and my license lam mu force ti iee // PANELS License Clan G,kV lD LLCMll ;57�9 35340 { Dale ��zN ' _Cantnctor /L-IICa� ARCHITECTS DEC"R TION pl-1� PS 04 Z 1 understand my pian shag be used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT. x�iOSIGNSELECTRICAL �j Licensed Professional Q Q Oyu OWNER-BUILDER DECLARATION p J IherebfB yarm that am exempt from the Contractor's License Law for the SPECIAL CR2CUli/MIST ZOZ � following reason.(Section 7031.5,Business and Professions Code:Any city or TEMP.METER OR POLE INST. countywhich requires a permittoconstmcl,alter,Improve,demolish,orrepair 1m a any stroctum prlorto its issuance,also requlresthe applicant forsuch permit° POWER DEVICES file a signed statement that he is licensed pursuant to the provisions of the O a Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIP(MING POOL ELECTRIC 30� Mon 3ofthe Buslnestand ProfessionsCode)orthat hela cunt therefromand - VALUATION < the basis for the alleged exemption. Any violation of Section 70115 by any OUTLETSSW1MHESFTXTLJRES Q applicant fora permit subjectathe applicant toa civil penalty dna morethan cg C"i five hundred dollars%5M. NEW RESIDENTIAL ELECTR ?�n F1 1,as owner of the property,or my employs with wages as their sole �'�' SI'ORIGae TYPE CONSTRUCTION 76 compensation,waldoehe work t and thestruure is not intended or offered for p sale(See 7064,Business and Proressioru Code:The Contractors License law sn $ does not apply to an owner d property who Wilda or improves thereon,and a$^ whodoessuchworkhimselforthrough hisownemployes,provided thalsuch �^ OCC.GROU[' RFS.UNITS Improvements are not intended muttered for sale.ILhwvevegthebulldlegw TOTAL: rt� improvement lased withinoneyearofeompletlon,the owner-bullderwlll have t119�*,rden of proving that he did not bund or improve for purpose ofealeJ. QTY. PLUMBING P MIT FEE FLOOD ZONE APN IJ L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractorsto..trvct the project(Sec.7014 Business and Professions Code: The Contractors License law don not apply to an owner of property who ALTER-DRAIN&VENT r7:A) Wilds or Improve theeeon, and who contracts for.& ptojects with a c9alr ctor(s)licensed pursuant to the Contractor'•License Law. FEE SUMMARY LJ I am exempt under Sec B&P C for this rcawn BACK FLOW PROTECT.D E OUTSIDE IFFES DRAINSROOF,A . CO SANITARY Y_ N_ . Owner Date RECEIPT N WORK MAN COMPINSATION DECLARATION MnIt SCHOOLTA% Y_ N_ ❑I hereby af(Inn that I have a cemlfinte of consent to self-insure,or a RECEIPT N certificate of W.rke.'C.mpetI.insurance ora metifkd copythereof(Sce. GAS EA.Sy OUTL PARK FEE Y_ N_ IN00c# CJ RECEIPTN Co any _r GAS EA.SY51T2aR4(EA) BUILDING DIVISION FEES ffComified copy is hereby furnished. GREASE/INDUSILA . L WINT TOR PLANCI'IECKFEE T4Cemified copy 6 filed with the city inspection division. �"l CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 2DOFT Date Remi t# (fhlssection need not ed completed If the permit is forms hundred dollars (S100)orless.) WATER HEATER W/VENT/ELGCTR ENERGY FEE Y_ N_ I mmify,that la m the perfoumceof the werk for which this pemdt is astound, I shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING PAID Workers'Compensation Laws of California. Date O Z Applicant NEWRES[DENLALPLMB. SQ.FT. Date Recei t# Z O NOTICE TO APPLICANT:1L after ma king this Ccmiflcam of Exemption,you should became subject to the Workers'Compensation provisions of the Labor TOTAL: H res Code,you at forthwith comply withsuch provlalons orthis permitahail be BUILDING � > deemed revoked.CONSTRUCTION LENDING AGENCY SEISMIC FEE d Ihereby affirm that there is a construction lending agency for the perform- TOTAL: ELECTRIC FEE Q� 7 Z aura of the work for which this permit b Issued(Sec.3097,Civ.C.) PLUMBING PEE 02 Lender's Name LL I— I<naer:��NNddarcaa QTY. MECHANICAL PERMIT FEE MECHANICALFEE U Iwggfihatl have read thbappBcationand Matethattheabove lnrormatlan O W lacomor.l agree to comply with all cityand county ordinances and state laws PERMIT ISSUANCE FEES PAID: } M 'Wing"tmbuilding constructlon,and herebyauhomu representatives ofehis Zcity to enter upon the aWve-medloned property for bupetion purposes. JALTERORADDTOMTDCH. Date Re,ceipt# (We)agree to save,indemdfy an d lamp harmless the City of Cu pemino U AIR HANDLING UNIT(TO 10,000 CFM)against liabilities,judgments,costs and expenses which may In any way accrue SUBTOTAL: ago Wt said City In consequence of the granting d this pemrdt. AIR]iANDIdNG IJh7T(OVER 10,000 CFM) CONSTRUCTION TAX Signature of Applicant/Contractor Date EXHAusr HOOD M/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfutumbulldingompant store or handle hazardous HEATING UNIT(TO IDg000 BTU) Date Recei t# material as defined by the Cupertino Municipal Code,Chapter 9.1 1,and the Health and Safety Code Section 2S531(a)7 HEATING UNIT(OVER 100,DOO BTM TOTAL: M Will r]No VENTILATION FAN(SINGLE RESID) ISSUANCE DATE WIII me applicant or future building occupant use equipment w devices which emit havrdous air contaminants as defined by the Bay Area Air Quality Marugcment District? BOILER-COMP OHPOR 100,000 BTU) Ye No have read the h.Qu materials requirements under Chapter 6.95 of BOILER-COMP(OVER100,000 BTU) the Califemla Health&Safety Code,Sections]550.5,25533 and 25536. I undersea lid that if the build Ing does not co mently have a tenant,that it is my NEWBESIDENHALMECH. SQ.FT. responsibility to notify the occupant of the mqulrcmsnts which at be met prior to issuance of a Certificate of Occupancy. 1. Owncr or authorised agent Date TOTAL: ISSUED BY: OFFICE COPY