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23899 (2)• F y cc > WG CL O OF LL OW N F Z U - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification - Building Address: l �5 '. - G. PERMIT NO. 23899 nere ams: one; 4(,liCIE 40L Ptkf)] -07 _, SCITYOF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDING-ELECTRICAI PLUMBING-MFCHANICAL Al'I'LICA11UNSUKMILIALUAlb Cenlractor's Name: Lie. Nn: 6T KO CATEGORY CONTROLX Architect/Engineer. Lic. N. QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: /0,59Z' C1q-S7-'1 PERh4TISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I herebyaffirm that l am licensed under provisions of Chapter9(commenc- ingwith Sectbn70M)ofDivlslon3ofthe Buslnusand Professions Code, and my license I. In full force and effect. _ License ClassLIc.X Date Contractor APPLIANCESRESTDENTIAL JOB DESC ON t - PANELS UP TO 200 AMPS 201-1000 AMPS ARCHITECTS DECLARATION I understand my plans shall be used as public recmda. ,-, OVERIOOOAMPS - SQ. FT. FLOOR AREA 5/SQ.FT. SIGNSELECTRICAL 1' If Licensed Professional OWNER -BUILDER DECLARATION Iherebyafflrmthat l am exempt from the Contractor's Licenae Law for the following reuon. (Section 70115, Business and Professions Code: Any city or countywhich requlresa pemdttomnctruct, alter, improv, dertnlish,orrepalr any structure prior wits Issuance, also requires the applicant for such permit to file a signed statement that he h licensed pursuant to the provisions of the Contractor'.License Law (Chapter 9(commencIng with Section 7000) of Divi- sbn3 ofthe Buslnessand Pmf.kmxCcde) orthet he I. exempt Nerefromand the basis for the alleged exemption. Any violation of Section 7071.5 by any_sj applicant fora permit subjects the applicant to a civilpenalty of not more than five hundreddollarsof hepr. ❑ I, as owner of the property, or my employees with wage a. their sole compensation, work,and the stmcturehnmbract.? or /n� d� L E© IN' (1 �� JJ U T - - SPFGIALCII4CU[T/MISC -1 T�p'METQt OR POLE )NST. �' + POWERDEVICES SWIMSU POOL ELECTRIC OUTLETS-SWITCI&4FIXTURFS ON NEW RESIDENTIAL ELECTR SQJ,7. STORIES TYPECONSTRUCTION - Buldothe Business, and Code: The C License Law doe (Sec. License Law apply to f property improves whodossuch torn owner otp rough who buinempor improves rou,that and whodoeeauch work MmssBorlhrough his ownemployeea, providedthatsuch GROUP -' RES. UMTS Improvemenis are not Intended oroffered forsale. If, however, thebullding or improvementiswldwithinoneyearofcomple io,theowner-bugderwill have tl gkurden of proving that he did not build orimprove for purpose o(sa1e.). LJ L as owner of the property, am exclusively contracting with licensed contractors to cora uct the project (Sec. 7044, Business and Professions Code: The Contrsctoes License Law does not apply to an owner of property who builds Or Improves thereon, and who contracts for such ptojects w!th a cgB77actoKs) licensed pursuant to the Contractors License Law. LJ I am exempt under &c. R & P C for this reawn TOTAL: Qty, PLUMBING PERMIT FEE PERMITISSUANCE ... ALTER -DRAIN &VENTWATER --A(EA) FLOOD ZONE - APN RACK FLOW PROTECT. DEVICE FEE SUMMARY Owner Date - DRAINS FLOOR D. ROOF. AREA, GON TURES PER TRAP r� SANITARY Y N RECEIPT X WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that I have o certificate of consent d spythwre, ora cartitl1.b C.) orkers'ComperwHonlnsurance oracedifbd mpythereo((Sec. 3800, Lab C.) P.Iky�q SCHOOL TAX Y— N_ RECEIPT X GAS EA. SYSTEM -1 INCAOUTLERS - - PARK FEE _ Y N RECEIPT X Cum Com ny copy is herebyfurnished.the city ❑Certified copy h Ned with the city Wpectbn division. GAS EA. SYSTEM -OVER 4 (EA) GREASE/INDUgML WASTE INTERCEPTOR BUILDING DIVISION FEES PLANCHECK FEE GREASE TRAP CERTIFICATE OFU MPTION FROM WORKERS' COMPENSATION INSURANCE (Th is session need not be completedl(the permith(orone hundreddollan' ($100)or rtifyta clawM, Icert0y thatbthe permunceofemannerhe work an as t become subject I shall not employ any person In any manner w u to beaire subject to the 'Compensation Lawn of California,aliDate Applicant NOTICE TO APPLICANT: If, after making Card firateofons PAID" Date Recei t# SEWER -SANITARY -STORM EA 2XFT WATER HEATER W/VENT/ELECTR - ENERGY FEE Y— N — .PAID Date Recei t# WATER SYSTEM/TREATING - NEW RESIDENTIAL PLMB. SQFT. ft eLyou should become forth t to the Workers' Compensation provhions of the Labor pe drumed you meet forthwith comply with such provisions orthh permit shall be deemed revoked.BUILDING - TOTAL: O CONSTRUCTION LENDING AGENCY Iherebyafftrm that there is a construction lending agency cribs perform- once of the work forwhlch thi. permit is issued (Sec. 3097, Civ. C.)' Gender'. N. Lender's Address I artily Bull have read this application and state thatthe above information hconect.I agreeto comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for Inspection purposes. (We) agree to save, Indemnify an it keep harmless the City of Cupertino against liabilities,judgments, costsand expenses which may in anywayaccrue against said City In consequence off tlj granting of this permit. 7/A///J�(g�a` SEISMIC FEE ELECTRIC FEE QTY. MECHANICAL PERMIT FEE PLUMBING FEE - PERMIT ISSUANCE ALTER OR ADD TO MECH. MECHANICAL FEE FEES PAID: , - Date Receipt# - AIR HANDLING UNIT (TO 10,000 CFM) - SUBTOTAL: Ala 11ANDUNG UNIT (OVER lo,Boo CFM) - CONSTRUCTION TAX Signature- ppllcant ContractorDate HAZARDOUS MA RIALSDISCIASURE Will the applicant or future building oavpant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code�+. -S�ection 25532(x)? ❑ Y. u NO EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HEATING UNIT (TO 100,000 BTU) Date Recei t# HEATING UNIT (OVER 100,000 BTU) TO AL VENTILATION FAN (SINGLE RESID) ISSUANCE DATE pp yp'�� P A 9 y JU1Vp� 25 1992 1s7JG CII�GCn Ur4 Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 4 Yes n No have read the h., us materials requfrements under Chapter 6.95 of the California Healt h & Safety Code, Sections 25505,25533 and 25534. 1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be rrRt prior to issuance of a Certificate of nry. BOILER -COMP OHP OR100,0(DBTU) BOILER-COMP(OVER 100,000 BTU) - NEW RESIDENTIAL MECH. SQ.FT 6 26 Owner or3y toHred agent' Date 11. - TOTAL: ISSUEDBY: OFFICE COPY