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24345 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Buildin Pro'en identification PERMIT NO Budd3ng©ddm�� /� - 24345 `Jrc a2nte: hone. - SUBMITTAL 1 I�`�7, CITY OF CUPERTINO-BUILDING DIVISION G r No Lic.No: APPLICATION / PERMIT LEON A Itect/ neer. BUILDINC-ELECTMCAL.ML BING-MECHAMCAL CATEGORY CONTROL# Lic.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add.B: lERM17155UANCE 1:1 1:1LICENSED CONTRACTOR'S DECLARATION _ [hereby ffinnthatI am licensed under provisions of Chapter9(comment, APPLIANCMIZESIDENTIAL ]OB DESCRR'TION Ingwilh Secg9n 7000)ofDivlalon3 oft el Bunusand['rofeaslonBCode,and my license lel deflect 1/CTS - PANELS Lirens_ cy Lic.# Date --ContractUP TO 200 AMPS ARCHITE ION 201-1000 AMPS q�+re0 2, I understand my plans shall be used as public records. OVER 1000 AMPS I�.5Q.FT.FLOOR AREA .5/SQ.FT. FG Licensed ProfesslouI - SIGNSELECTRICAL 9 G OWNER-BUILDER DECLARATION 1=" oQ � 1herebyaffirtnthat I am exempt frornthe Contractor's License Law for the SPF-CIALCEICMT/MISC ��f� l yr, Z following mum.(Section 7031.5,Business and Professions Code:Any city or �p MEfFRORPOLEINST.' V V._J V R eountywhlch requlresa permlttocoutuct,alter,improve,demolish,orcepair anystm=mprlortolmiswance,aborequimatheappBcentfersuchpermitto ['OWER DEVICESTE file'a signed statement that he is licensed purauent to the provisions of the 3 u,� Contractor'sLicense Law(Chapter 9(oummening with Section 7000)of Divi. SWIMMING TOOL ELECTRIC IB- �O along ofthe Business and I'mfesslou Code)orthat he is exempttherefromand VA UATION S the basis for.the alleged exemption. Any vlolatlon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of net morethan OUTLET'&SWITCHFSFIXTURES five F11,..hundred wner Ithe pr., NEW RESIDENTIAL ELECTR SQ.ET. I,asoweroftheproperty,or cimy employees tureiswith wagesrtheir dole STORIES TYPE CONSfRUCTTON mmpeneatlon,wllldotbework andtheetructure'snot Intended or offered for D ole(Sec.7046,Buelneu eM PrMemleu Code:The Contractor's Lireese Law $ does not apply to an owner of property who Wilds or Improves thereon,and OCC GROUP RFS UNUS who does such work himselforthrough his own employees,provided that such Impmvementa are not Intended oroffered foraale.I(however,thebuildingur TOTAL: Improvementbaoldwithinoneyearofcompletion,theowner-builderwill have Up-ti uden of proving that he did not Wild or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE }T-pOD7DNE. APN LJ 4 as owner of the property,am exclusively mntraRing with licensed ppgMTl ISSUANCE oontractms to ooutmet the project(Sec.^064,Business and Professions Code: - The Contractor's License Law time not apply to an owner of property,who - ALTER-DRAW k VENT-WATER Wilds or Impmvu thereon,and who contracts for such pkajecte with a cq➢_tfactor(B)II...d pursuant to the Contractor's Llcenx Law. BACK ROW PROTECT.DEVICE FEE SUMMARY 7l1 am exempt under Sec. B k P C for this recon Qv r pate -- nPerro DRAINS FLOOR ROOF,AREA,CON). SANITARY Y_ N WORKMAN COMPENSATION DECLARATION RECEIRT# I hereby affirm that I have a certificate o!conssnt to soli-insure,or a FIXTURES PER TRAP SCHOOL TAX Y N flute of Workers'Compeuatien Insurance era certified ropy thereof(Sec. RECEIPT# 3B .Lebo C.) D .�/S `�j_ GAS Iii.sYSFh]N-I INCA C)VILEfS PARK IEE Y_ N_ Poliry# ✓ RECENT# GAS.EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES ert1 dcepybhere fu lahed. c led copy I.filed with the city inspection division. GREASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE' CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE SEWEFLSANITARY-STORM EA 200E1' Date Recei t# (0)ne cectien need not becompleted[(the permit b farone hundred dollars ($]00)mloss) WATER HEATER W/VENT/RLECTR ENERGYFEE Y N [certify emploat ie y an person Is an the woocome an as t 'seems ermit issubjec blued, — I shall net empty any person f any manner w u to become subject to the WATER SYSTEM/TREATTNG Werkera'Compensadon law.of Gufomb.Date PAID ' O Z Applicant Date Recei t# Z G NOTICETO APPLICANT:If,after making this Certl(lote of Exemption,you NEW RESIDENTTALPLMB. SQFT. - Hshould become subject to the Workem Compensation proonions ofthe Labor TOTAL: W Code,you meat forthwith comply with such Previsions orchis permit shall be LU � deemed revoked. BUING ECE a C CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby afflrrnthat there b a"construction lending agency far the perform- TOTAL ELECTRIC FEE 0 anwofthe work forwhlch this permit b issued(Sec.3097,Civ.C.) U Lender's Name PLUMBING FEE LL I— Lendoeo Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W I certifythatl have reacithla appllcatlonand statethatthe above hummatlen 6 bcomed.lagreetocomplywitha11 cltyand county ordinances and state laws PERMHISSUANCE PAID. } N relatl tob IWingmmtruction,andherebyauthod mpmwntatives of thio ' [— Z city to on the above-mentioned property for Inspection purposes. ALTERORADDTDMECH, - Date % Receipt# e a o save,IndemNfy an d keep harmless the City of upertlno a lest a t }adgments,mrts and expenses which In ya a AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL• a Blot i n ne seei ni oftbegrantin s.t. . HANDLING UNIT(OVER 10,"CFM) CO ION TAX S of AppIIamt/Contractor Dnte 1\HAUST HOOD(W/DUCT) CONST CTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future buloilig occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) material as defined by the Cu no Municipal Code,Chapter 9.12,and the Date Recei t# i. Health and Safety Co de Se n25532(a)7 HEATING UNIT(OVER 100,000 BTU) TU ❑Ya o Will the appBu futurebulldl pant use equipment ordeviccs VENIILATTON FAN(SINGLE RESID) ISSUANCE DATE which emlthavrdouaairconta is as defined by the Bay Area AU w ality Management District BOILER-COMP OHPOR 100,000 BTU) Yes o have read the haz oua materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU) 'r _ the California Health Safety Code,Sections 25505,25533 and 25534.1 B that lithe building does not currently have a tenant,than Ismy NIEWRESIDENTTALMECH. 5Q.Ff p V nollfy the occupant of the requirements which must netneofaYetbel cetefOccupancy. QCT 30 1992 uth 4 .4,aA f7 . Igent e ISSUED BY: TOTAL: r T! OFFICE COPY