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23349 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project ldemlHation PERMIT NO. Building Address: 23349 a s eme: FitArnimone: jQ iume L- CITY OF CUPERTINO-BUILDING DIVISION Contractor' Neme: , e ,Noy:/ APPLICATION /PERMIT JTN✓�-S / OJI�040 BUrLDINGELECTRICALPLUMBINC-MECHANICAL CATEGORY CONTROLY Archlted/Engles,•. Lie No: . QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addreu PERMITISSUANCE ❑ ❑ ACI ❑ LICENSED CONTRACTOR'S DECLARATION 1-T Ihereby ecron 7FWdDiv Bemsedunder p essand sofChapter9(commnc APPLIANCES-RESIDENTIAL JOB DESCRB'ITON Ingwsh inhill7000)e(Dl Affect lthe BudweandProleWonaCode,and my Ilwense le In Tali fp d d(ect. � (J PANELS Data Clam G Lok.N_C� DateLtcca7- ntndorIM TO WDANTS ARCH ITEI DECLARATION 101-0DOAMI'S q�++pe Zp Iundentandmyplaru.haBbe used aapubOcrecorda JOVERIODOAMPS - SQ.FT.FtCCR AREW S/SQ.FT. 6i, (a Licensed Profmai SIG NS ELECTRICAL IL�`R� OWNER-BUILDER DECLARATION SPECVLCIRCUIT/MLSC -F1 114-A Z 1.., IherebyafRrmthatlamexemplfromthe Contradoe.Llcenselewfwthe L. © I N pp following rcmon.(SMion 7RIt5,Business and Professions Code:Any or At BOia" TEMP.METERORPOLEWS7. CUTS I OF FEES F wuntywhichcture requlrcsapouarcocoorequies alter,the applicant gdfr such permit repair any structure statement that he I.also requires W the for inionsof e POWER DEVICES D file a signed ice.L[that het Reeved pursuant it the provisions a( the L Oµ� Connector.fth.Bke...nd PmfA.I. C d.)mcing with exempt hereof Divi- SWR.IMING POOL ELECTRIC 0 TE dwn3ofthe Buslnnsand Pro(emlovCode).,that hely exempttherefromand LUATlO the basis for the alleged exemption. Any violation of Section 70X.5 by any OUTLETSSWITCHES&FIXTURES applicant fora permit subject the applicant to a civil penalty d net morethan i five hundred dollars CSM. ❑L as owner of the property,or my employees with wages as their wk NEW RESIDENTIAL ELECTR SQFf. STORIES TYPE CONSTRUCTION compensation,wgldothe wwF.and thestructure is norIntended or offered for Osale(Sec.7064,Bwlnem and Profemlov Code:The Contractor's License Law $ does not apply to an owner of property who builds or Improves thereon,and OCC.GROIIP RFS.AMTS wbodonwch Work himselforthr.ugh Msown ereplgees,provided that such Improvement.are not intended oroffered forsale.If,however lhebulldlng w - TOTAL: Improvement issold withinoneyearofcanpldiogtheowner-bugderwill have t ,den of proving that he dM not build or Improve for purpose create.) QTY. PLUMBING PERMIT FEE FLOOD ZONE APN LJ L as owner of the preperty,am exclusively contracting with licensed PERMIT ISSUANCE contactors to covtmct the project(Sec 7061,Buelnem and Professions Code: The Contractors License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) Wilda or Improves thereon, and who contracts fee such ptu)eds with a - __ FEE SUMMARY .qut[dorN,Hameed pursuant to the Cuntracta's License Law, BAIX FLOW PROTECT.DEVICE LJ I am exempt under Sec B& P C for this mason ' DRAINS.FLOOR ROOF,AREA,CONTI. SANITARY Y N Owner Date RFLEE'TN WORKMAN COMPENSATION DECLARATIONSCHOOLTAX Y_ N_ QI hereby aHkm that I have•adlfiote of consent to self-Inaurc,w a FIX7l1RE4I'ER TRAP certifieate of Workera Cwvv npeatlon iuna naa o:rtlf cd copyth,ecef(Sec. RFLEB?N 3800,Lab C.) - CAS EA.SYSCEM-1 WC.60I1TLET5 PARR FEE Y_ N_ Policy N GS A.SYSTEM-OVER 4( ) URECEIPT N Com any DING DIVISION P[T:S 0CArtified copy Is hereby famished. GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECK FEE GertNed copy,Is filed with the city ivpeetbn division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-BANffAgY-SNRM FA 2(pFf DBIC Recei 6# (Thlssection need not becompleled lithe permit is fee..hundred dollars ($100)or less. WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_ I certify that N the pc A.i a any m work so As to b this permit c blued, I shag not employ Any PA.In any mune,so m to become subject to the WATER SY57F.m/TREATIN'G ' Wwkenm 'Capensatian Jews of Gllfomh.Data PAID Z Z Appllant NEW RESIDENI7AL PIMB. SQFT. Date Reuel t# Z NOTICE TO APPLICANT.If,after nuking this Certificate of Exemption,you should become subject to the Worked Comperadion provisions of the Labor TOTAL: N Code,you maistforthwith comply with such provisbvorthb permit shall be BUILDING •E LU > deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FTE d Z Ihercbyaffi,mrwhichthem isacovtmdion lendingagency 97,Civ.C.) perform, � ELECTRIC FEE' 7 an. And.e Nwork(ar which this permi[isissued(Sec.3097,CIv.CJ LL O Ledees Name PLUMBING FEE LL H L<ndets6ddam QTY. MECHANICAL PERMIT ITE MECHANICAL FEE O W ormet. talimet coriple need with aBatyndcountyardiheaboW ld date lam ion IL bcorreci.Iagreerocomply with all cityend countyardlnanres and datelawe PERMITISSUANCE FEES PAID: >. W relating to build trudlon,and hereby authorize representatives of this cit to enter n abov ntW forW len ALTER OR ADD TO MECH. ~ Z (Wel a e save, coni o d.keep harmlem the ityof mw Date Receipt# V a inst bll d nb, send ex en. whlchma Inan ova ocme AIR HANDLING UNIT 10,000 CFM) ga V p y y y. SUBTOTAL: .gal sa ce of the granting of this permit. ,v Ba`I�/ p AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX reofA rt/Contract., Dae EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the appBant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 am Date Recei t# materbl as defied by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code Section 25532W2 HEATING UNIT(OVER to0,000 BTU) TOTAL- — ' ❑Yes r!No Will the applicant orfuture building occupant use equipment or devices VEMTILATION FAN(SINGLE RESID) ISSUAN DATE which emit hazardous air contambu me as deft ned by the Bay'Area Air P A I� Quality Mavgement District? BOILER-COMP OHP OR 700,000 BTU) Yee Q No have read the hazimious materials requirements under Chapter 6.95 of BOILER-OOMP(OVER lO0,000 BTT) FEB the California Health&Safety Code,Sections 25505,25533 and 25536.I LN[ 1992 understand that if the building don net comently have a tenant,that It is my NEW RESIDENTIAL MECH. SQ.FT nepovib0lty to notify the occupant ofthe requirements which must i e met prior to issuance of a Certificate of Occupancy. CIIY Of L'UYCII I UY Owner or authorized agent Date TOTAL ISSUED BY: OFFICE COPY