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23226 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Proect Identification PERMIT NO. Build Ing Address: f"� f�f") o� qo GG v �PS gyp/ G weename: one: � CITY OF CUPERTINO-BUILDING DIVISION C d°r•"ani J Lic"o APPLICATION / PERMIT LSO UDDI.ry 1 �.l SL(:TTC(.a I N BUILDINGELECTRICA I LUMBINGMFf_HAMCAL CATEGORY CO O V T ArehltM/Englrmer. Lic.No: �"�V QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add.. PERMITISSUANCE r ED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions of Chapter 9(comment, APPLIANCES-RESIDENTIALJOB DESCRIPTION Ingweh In 7000)ofdeffeDivision 3ofthe Buslnnsand Professions Code,and my I, Ilan is in full fora and k.# PANELS Llan Clem contractor Date ARCHITECTS DECLARATION 701-1000AMM p+re Zp lunde.tand my plans sluebe used sspubacrewds. OVEItl"AMPS ...SQ.FT.FLOOR ARRE,AA $/SQ.FC. Fi b� Llcenmd Professional SIGNS ELECTRICAL L OWNER-BULDER DECLARATION SPECIALCIRCU1T/MISC {•�� 7 � 1herebyaffi.that lam exempt fromthe Contraaor'e Lim..Law for the p following reason.(Section 70315,Business and Professions Code:Any city or O Ip W TEIAs.METER OR POLE INST. 5 coystm khpq wiapera tomrotrud, stheap Uantfm.a p, rept. P .tea any awclure statement that he is also sed pursuant t the revisions ofNt a POWER DEVICES Rle a signed statement that M V licensed pursuant to the provision of the O p, Contractors License Law(Chapter 9(commencing with Stolon 7000)of Dlvl- I.30�' slon3ofthe Business and Profnamu Code)nrthat he b exempt(he.fromand NG POOL F!'ECTR[C ^ VALUATION o the hosts for the alleged exemption. Any violation of Section 70315 by any U ET :TCHE4FIXTURES V appH=tforapev tsub*UtheappllcanttoadWlpemlty ofna..than U C.JL.J�d five hundred delta.($500). NEW RESIDENTIAL ELEGTRSQ.FT. STORIES TYPECONSTRUCTION 7< OI,ac owner o!the property,or my employee with wages as their sole pcnmif -willdo the work,andthe structure Isnot Intended or offered for CI sale(Sec.7094,BusUmss and Professions Code:The Contractors Llama Law �5$ does not apply to an owner of property who builds or improves thereon,and OCC GROUP RES.UNITS who does such work himself orthrough his own employee,provided that such Improvements are not Intended or offered for sale.If,however,the building or T improvement bsold withlnomyearofcompletlomtheowner-bullderwlll have tE�o urden of proving that he dib rust build or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN Lj L as owner of the Property,am exclusively contracting with Ilansed pERMR1SSUANCE contractors to construct the project(Sec.7074,Business and Professions Code: The Contractors Limn Law does net apply to an owner a property who ALTER-DRAIN VEM-WATER(FA) Wilds or Improves;thereon, and who comacte for such projects with a /- FEE SUMMARY coCetor(a)aaneed pursuant to Convanor'a License Gus. A T.D� Cetus am exempt under Sec B k P C for this reason - RAIN5F1-OOR• qqAS SANITARY Y N_ Owner Date ,J RECFET R WORKMAN COMPENSATION DECLARATIONRESP SCHOOLTAX Y N ❑I hereby affirm that I have a certificate of consent to mlf-Insure,ce a RECEIPTNM J 3B00nGb CfWorkers'Compemation lmuranceora certified copy thereof(See. GA��7 P6TEM-I .4 PARK FEE Y_ N_ Policy Y RECEPT a Com ny IM&WSY''TEM.OVER 6(EA) BUILDING D ISION FEES haloed copy b herebyth the city GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE Certified copy is feed with(M city InpMlon division. 'J CERTIFICATE OF E xEMPTION FROM WOR KERS' GREASE7RAP PAID COMPENSATION INSURANCE SEWER-SANTfARY-SCORN EA.d70Ff. Date Recei the Qhisaer ion need not be compleled If the permit is(or oro hundred dollars (St00).H..) WATER HEATER W,/VFNT/©ECTR ENERGY FEE Y N I nrtlfy that In the performance of the work forwhlch this permit Is Issued, I shall not employ any person In any manner w a to become subject to the WATER SYSTEM/TREATING Workers'Compensatlor Caws of California.Date PAID C• Z NOTICAppileaE NEW RESIDENTIAL PLMB. SQFr. Date t11 Z O NOTICETO esubjeAM:IL ager making this Certificate is Exemption,you � should become subject to the Wodsrs'Compewatlon provisions of the Labor TOTAL' f�3 Code,you must forthwith comply with such provisions or this permit shall be 13UILDING FEE LU > deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE a G for Iherebyal0rmtr w therebaermiti construction Issuedndec.3097,Civ. pedorm- TOTAL: ELECTRIC FEE Z Lance ende the work(orwhichthis permitVissued(Sec.3097,C1v.C.) LL O Landers Name - PLUMBING FEE LLQ Lender's Address QIY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Irertitythall MvercadthleappBatbnand tlatethat thesbove tiformation - 1 ctmrrect.Iagreeto comply with elldtyand countyordloancosand orate laws PERMITISSUANCE FEES PAID: N relating to building construction,and hereby authorize representative of this [— Z ctlymenterupontM ve-mentioned property for lmpMlon purpose. ALTERORADDTOMECH. �e Date Recei t# _ (We)ogre my, demmly an d P p herMess the City of Cupertino P agaWtllabil ,N g ens,met nd nen whIchmayinartyw.y... AIRHANDLING UNIT CIO 10,000CFM) SUBTOTAL' agahstsaid i c .aqua. o 1 gr'.ting mthb permit AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX 3 30'92 Signature rat o(Appl /Contractor Date E%HAOST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZA RDOUB MATER ALSDISCLOSURE Will the applicant orbuilding oicipal rode, hhandlehazardous HEATING UM7(TO 10D,000 BTU) 1lealtalaa Safety by Code o2(a)7 al Code,Chapter9.lZand the _ Date RCCeI the FEland Satiety Cade Section 25537(a)7 HEATING UNIT(OVER 700,000 BTU TOTA ❑Ytheen �No WOlmt futum contaminants eavpam use the gay,A or devices VENTILATION FAN(SINGLE RESID) Ry ISSUANCE DATE whichemitairrict? me as defined by the Bay Area Air T 1S� D Quality Management DbWct7 BOILER-COMP pFm OR 100,MD BTU) Vn ❑❑No haveieadthehazartlouematerialsmquimmenOunder Chapter6.95of HOMER-COMP(OVER100,000 BTU) MAR 30 ( (M CaliforniaCaliforniaHealthASafetyCode,Smto75505,25533and25534.1 1992 understand that lithe building does not currently have a tenant,that it b my NEW RESIDENTIAL MECH. SQFT. responsibility to notify the ocsrpant of the requirements which must be met CITY Vf yy''�� v VUrCfII Ili v, to Issuance of a Certlfiate of Occupancy. V Owner or aulhoriced agent Date TOTAL: a�--"SUED Rycx T�•-- OFFICE COPY