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20107 (2) APPLICANT TO FILL IN INFORMATION WITHIN REDLINES = USE BALL POINT PEN ONLY Building Project Identification - I' PERMIT NO. BaBdl.o3_=►-, 20.107 APPLICATION SUHMrrr7,r= rvLAY` n �' �217F'q 1\L'1tT arse C CITY OF CUPERTINO-BUILDING DIVISION C°"" ° aN u..N°: APPLICATION / PERMIT .' O n Ino Co - > p Architect/Ent,ser. -. LIc.N% BUILDINGELECTRICA4PLUMBING-MEC}iAMCAl CATEGORY CONTROL p/'!JL© 01 p 'L 1 $ QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO O Addreaa: O S - U3)� v- PERht1i ISSUANCE LI ENSED CONTRACTOR'S DECLARATION - ❑ ' ]hereby affirm that l assn licensed under pronsdonsof Chapter9(oommenc APPLIANCESRESIDENTIAL j BDESCRI'TION Inlicense I Seatfon 70(p)of d effect on3.(the BulmmmdProfemloneCade,and my R Li ms la In fact In d effect. /1¢¢ �e PANELS SU}a11C11]\,'\J Data, Clam Llc.p or Data, O Contractor UPT02DUANTS - ARCHITECTS DECLARATIO 201-1"AMPS - p❑� I understand my plans shall be used is public records, OVER I ODO AMPSFr. R AREA $/SQ.FT. u Licensed Professional SIGNS ELECTRICAL, T W ' «<6FSi7 'OWNER-BUILDER DECLARATION 5PECIALCIRCUIT/MLSC' og � I hereby affirm that lam exempt from the Contractors License Law for the0 TER 2 1011-wing mason.(Section 70315,Business and Professions Code:Any city or Tgfp,METFR DIPOLE IN ra' county which requires a pemdt to construct,alter,Improve,demoilsh,or repair !a nystructure prior to Its Issuance,also requires the applicant for such Permit to DATE Q 41 file a signed statement that he Is licensed pursuant to the provisions of the POWER DEVICES vie I G 3µis CmI adm'e License Law(Chapter 9(commencing with Section 70110)of Dist- SWIMMING POOL ELECTRIC cion 3 ofthe Business and Profmalons Code)orthIs at he exempt therefrom and VA U TION , Ey�� the basis for the alleged exemption. Any violation of Section 7MLS by any ON applicant for a permit sublets the applicant to a civil penalty of not room than OUTLETSSWIICH64RIXTURES five hundred dollars(BM. s �n 1711, NEW RESIDENTIAL ELECIR I,as owner of the property,or my employees with wages as their sole SQ,FT. STORIES' TYPE CONSTRUCTION compensation,will do the work,and the dmonme Is not intended or offered for n mle(Sec 7044 Business and Professions Code:The Contractor's License law �R does not apply to an owner of property who builds or improves thereon,and - who doessuchwork himself or through his own employees,provided that soh OCG GROI/P RES.UNITS improvementsaren.HntendWorofferedfwmle.If,howevepthebulldingor TOTAL: ` Improvement l°sold Within.neyearofcompldlogtheo a>bulderwlll have tl veers of proving that he did not baud orimprove for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD NE APN LJ L as owner of the property,am exclusively contracting with licensed PE_R IT ISSUANCE motnRors to construct the projed(Sec.73d4 Business and Profembru Code: The Contrsctoes License law does not apply to an owner of property who ALTER-DRAIN kVENT-WATER(EN 1 builds.or Improves thereon,and who contracts for such pW*U with a agR(Iatote)licensed pursuant to the Contractors License Law. FEE SUMMARY L�I am exempt under See. B Ar P C for this reason BACK FLOW PROTECT.DEVICE OUTSIDE FEES R AREA,COND. SANITARY Y - N Owner Date DRAINS. ROOF, RECEPTM WORKMAN COMPENSATION DECLARATION QI hereby affirm that I have a certlOcate of consent to self-Insure,m° FATURE__"PER TRAP SCHOOL TAX Y N c difloteofW.rke Compensatlonlnsummwacertl(hdmpythereof(Sec. I RECEIPT 3800,Lab CJ GAS EA.SYSTEM-1 INC.40UTLET5 PARK FEE Y N RECEIPT Cn�mpanv- �7n�)eH. —1l anlo.�t GAS EA.SYSIFMAVERd(EA) - BUILDING DIVISION FEES ANDUS7RL WASTE INTERCEPTOR I ICertlfied ropybhereby fumished. GREASEEPLANCHECK FEE etlied copybfiled with the city Inspection division. _ � }x /`' CERTIFICATEOFE)CMPTION FROM WORKERS' GREASETRAP_ - ' - PAID(�` S,'ly . "Lo COMPENSATION INSURANCE (rhissectlonnend not becompletedifthe permlt Isforom hundreddollars SEWER-SANITARY-STORM EA.2001T: Date Re I t# '2Qi1lB ($1I affifess.) WATER HEATER W/VENTIELECTR ENERGY FEE Y N IcetH(ythat In the pedormanceo(the work for which this permit is Issued, I shall not employ any person In any manner so as to co su ct to the - Wmkere'Com. Rensaiton las a fCall rola.Dat I WATER SYSTEM/TREATING PAID Z ApplicsNOTICnt "MA a7;L; NEW RESIDENTIAL PLMB. SQ,FI. Dale Rei t# Z NOTICE TO APPLI ANT:If,aReri ng tide-CedBlcate o(Exemptl.n,you r should become subject to the Workers'Compensation provisions ofthe Labor - TOTAL: W Code,you most forthwith comply with such provisions or this permit shall be BUILDING -E t W > deemed revoked. aCONSTRUCTION LENDING AGENCY SEISMIC FEE Z a I hereby affirmthat them Is co a mtmctlon lendingagenry forthe perform- TOTAL: ELECTRICFEE e ance.fthe work forwhichthis permit is imued(Sec.3097,Civ.C.) PLUMBING FEE 0+0 Lenders Name LL F- Lender's Address QTY,j' MECHANICAL PERMIT FEE MECHANICAL FEE O WIcertlfythatlhavereadthisapplicatlonandslabthattheaboveinformatl°n Isco,red.IagreetocomplywithaBcilyandcountyordina.sand datelawsPERMIT ISSUANCE FEES PAID: 1 relating to building ronstmdlon,and hvmbyauthorlure1.._.. tivesof this F 2 city to enter upon the above:mentioned property for Inspection purposes. ALTER OR ADD TO MECH. — (We)agree to save,Indemnify an d keep harmless the City of Cupertino Date Receipt# agaimtllabWties,iudgroens,c sandexpenae ichmaylnanywyaccrue AIR HANDLING UNIT(TOIO,ODOCFM) .SUBTOTAL: against mid City in consequence of the granting of this pemni4 - AIRHANDLINGUNIT(OVER tO,ODOCIM) CONSTRUCTION TAX Signature of Applicant/Contractor . Data ExHAUB'r HOOD(W/DUCT) - CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant atom or handle hazardous HEATING UNIT(TO 100,000 BTU) Dafe. ReCei t# material as deflned by the Cupertino MunldpaI Code,Chapter 9.1 2,and the Health and Safety CaleryS.ed1on 25532G)7 HEATING UNrT(OVER 100,"BTM PAW%AL: ❑]Yes Will thezppllcant or fuNrc building occupant use equipment or devices VENTILATION PAN(SINGLE REBID) ISSUANCE DATE ' which emit hamrdous air contaminants as deft nod by the Bay Area Air YIISS ( T ,DAT, Qu ality Management District? BOILER-COMP(3FPDR 1110,000 BTU), tY Ji V 1 Yea 7 No ¢averead Health a let mater,Se requirements 5533underand 25534. of BOILER-COMP(OVER 10f1,000 B'r(n y,�{,� the understand that Health building does, occur oily haven Sand,that ] Wa) & �:IIIIP.y undentanathatlthe the o.cgdcesnotaurreuiren sta hich,thatitIsmy' NEW RE9DENT[ALMECH. �.Fr. ffIBU responsibuatonollfytheoatchf oftherequlrementewhich must 6e met prior ssuance ofaCedilcate fOmpanry. q p� Owner or auflumacd agent Date - 155 DSY TOTAL: OFFICE COPY