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20290 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. B.Hding Address: —7585 20290 nen acre: one: A A Y A (,IkCI CITY OF CUPERTINO-BUILDING DIVISION /y.0 ContraRore Name: Lk.N. APPLICATION'I PERMIT Arohlted/Engluer. No: BUILDING ELECnUCAI PLUMBINGMECHAMCAL CATEGORY CONTROL h C Z 3A QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: ' PERMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION - Iherebyafere that l am licenaed under providonsofGhapterl)(comment, APPWANCESRESIDENTIAL JOB DESCRE'TION ingwilh Sedion700Wof Dlvikon3ofthe Buslnessand Professions Code,andery /el �� G license b In lee force and effect. PANELS License Cls® G �1 L A ;_ Date Contntcactor ` -JJ ARCHITECTS DECLARATION 2014000 AMPS ceO Zp ]understand mypiatushaBbe used as public records. OVER1000AMPS SQ.FT.FLOOR AREA $/SQ.Fr. dEku Licensed Profeulonsl SIGNS ELECTRICAL c0 OWNER-BUILDER DECLARATION S[+p-CIALCIRCUIT/#LSC C� L.,�� Iherebyaffirm that lame.empt fromthe Contractor's License Law for the O following reaven.(Section 7MIS,Business and ProfessnsioCode:Any dryer ;rZI- 'I�+ countywhlch requires a permit romutrud,alter,Improve,demolbh,orrepalr TEMP.METEROR POLE INST. .s anystmmmpriorlolwlsuarue,.boreq.tr stheappllcantforsuchper tto y'a file a signed statement that he Is Ilmnsed pursuant to the provisions of the [OWER DEVI t O u't�, Contmcmr.Llcenselaw(Chapter9(co—ochngwlth SectWn7000)of Divi- J don3ofthe Budhessand Profmbu Code)orthath.b.mmptihemfmmand SWIMhBNG POOL C VALUATION �n the basis for the alleged evempUon. Any violation of Section 7031.5 by any 0 O a ovn.t TsswlTcHMFIXTUR a.v five hundred aperts($SXBNthe applicant dull pevltyolnd more than a 0. L /y� five hundred dollars(1.5001. NEW FN'DAL ELECTR Fi. I 6 I,as owner of the property,or my employees with wages as their sole P STORIES TYPECONSTRUCTION Q compensation,will do the work and the stmdure ix her Intended or offered for q sale(Seo 7016,Business and Professions Code:The Contractors License law �$ docs not apply to an owner of property who Wilda or Improves thereon,and 'Ryif ) OCC.GROUT' RFS UNITS whodoes mxUo such work himself Ms own employee,provided that Improvements am not Intended oro(fered for Bale.If,however the building's Impmvement Iswldwithinomyearofcompt mtheowher-bu0derwBlhav trden of proving that he dict no[build orimprove for purpose ofule3, ,QTY. .Y PLUMBING PERMIT FEE FLOOD7ONE APN 1,as owner of the property,am sclu b,,ly contracting with licensed PERMD]SSU CE ,r renarieloss to created the project(See.7014,Business and Professions Code: I 1 U The Contractor's License Law does not apply to an owner of property who ETFR-OSMI &VENT-WATER(EA) Wro builds or Impves thereon,and who contracts for such proteins with a r' re ador(a)Wxnxd pursuant to the Contrador� FEE SUMMARY ec License Law. BACK PROTCCT.DEVICE I am exempt under SB&P C for resent,this reaOUTSIDE SANITARY Y N Owner Date ! D FLOOR,ROOF,ARFA,GOND. 'RECEIPT# WORKMANCO PENSATION DECLARATIONPER TRAP SCHOOL TAX Y N ❑I hereby a(flrm that I have a certificate of consent to set(-inure,ora FDntIRHS, RECEIPT'M certlfiate of Workers'Compensation insurance or a certifled ropy thereof See. GAS EA. •I WC.40UTLETS PARK F'FE Y N 3900,Lab CJ Policy# GAS IA. AVER 4(EA) RECEn TIf Co.CnY v BUILDING DI VISI ON FE ES ertified copy is herebyfurnished.the ay CREASE/I DSTRL WASTE INTERCEPTOR PLANCHECKFEE �CedBled copy V filed with the day Inspection divlalan. �3 L{toar� CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TRNs PAID ^� COMPENSATION INSURANCE Rhlaeectlon need cot be compl TI lithe permit b(arose hundred tlollan SEWER-SANITARY-STORM EA 210FT Date Recei t# ($100)hrless.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N I cedlfythat inthe periormanceof the work forwhlch this permit is issued, I shall not employ any person In any manner w ss to become subject to the WATER SYSTEM/TREATING PAID— * lawn of CzlRornw. Data 0 Z Appllant NE'WRESIDENTIALPLMB. SQFT. Date Recei t# Z O NOTICE TO APPLICANT:If,after making this Certificate of Exemptlan,you F N should become subject to the Workeri Compensation provblona Labor TOTAL: ccCode,yourrwatforthwith comro plywilhsuchpvhlouorthbperretshallbe I IN s©S ILI > deemed revoked. G CONSTRUCTION LENDING AGENCY SEISMIC FEE O. I hereby affirm that there b a construction lendingagency for she perform ELECTRIC FEE �a Z ance of the work!orwhich this permit b hued 0)eo 3097,CIv.C.) TOTAL: o(• 5O ( U O La^der.Name PLUMBING FEE U. F Lendre.Addmu QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Iadlfythatlhavemadthlsappliatbnandmatethattheabovelnfor tion O. bcerenct.I agree tocomply with act city and county ordinances and slate laws PERMIT ISSUANCE FEES PAID: 1 >- relating to building construction,and hereby authorize representatives of this Z dtyto enter upon the above-mentioned property for Inspection pu rposes, ALTFRORADDTOMECH. Date ReCCI t# V (We)agree to save,Indemnify an d keep harmless the City of Cupertino against liabilities,judgment,matsand expenses which may In anywayaccrue AIR HANDLING UNIT ITO 10,000 CFM) SUBTOTAL: t said City In consequence of the granting of this permit. AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TAX Slguture.(Appllant/Contndw Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the appilant or future building occupant store or handle hazardous HEATING UNIT CIO I00,0D0 BTU) Date Receipt# material as defined by the Cupertino Munldpal Cade,Chapter 9.1 2,and the d Safety Cade Section 75532(a)7 HEATING UM Heals h and Safety 100,11(0 BTU) TOTAL: Yes No Will the applicant or lure building occupant use equlpmcnt or d evices VENTILATION FAN IS lNGLE RESID) IS ,DA'T'E which cont hazardous air cents brunts as deRrud by the Bay Area Nr Quality Management District? BOILER-COMP OHPOR 100,0(O Bm x 4Yea pNn JUN 1 a 199J havereadleehazy Safety mode,Sections 25555533 aChapter 6.95 of BOILER-COMP(OVFR 100,000 BTU) the Gltandt Health&Safety Code,Sedlountly have a tenant,that I understand that if the ing donocupart of the orquirments which=at Bbmy NEW RESIDENTIAL MECH. SQ.�. C.I sash Cll Bl gppm responsibilitysnc of ify aCeheocte of reu pa requirements which must be met prior to Issuance of a_Certlfiatc of_Omapahey. ��z Zj Oconee or authorized agent DA. ISSUE TOTAL: OFFICE COPY