22461 (3) APPLICANT'-I'U FILL IN IN FUkIVIAI IUN VVIl Plea IiLW LI19L'C3 — UaLUALI i-via+r a a_t. as
Building Project identification l�1-+ PEEMITNO. /�
WildingAdd ,.: 22 A 61
p 0o loo a IpB�1oSt k GL•v D. SHELL a G G 41 I
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A�]_� ane. CITY OF CUPERTINO-BUILDING DIVISION
Con�ty;�tor'eNane; LIc.Nee APPLICATION 1 PERMIT
_11[LI.'L•I"fI ICND`.'�.I�/IL7V, ��f� BUILDINGELECTRICALPLUMBINCMFLHAMCAL CATEGORY COIQR(LtMp^)
--, Archllya/Englneev Lk.No: _ b7 1
4w14Lry[IJY QTi'w:;l -�.ELECFRIC PERMIT I; ,;FEE ',a ° 4,I UIL'DIIN�{G'.P.ER�MMII,TJNF7Ogs,"/
Address: PERMITISSUANCE I r�� IQ ITL. /T, NE
LICENSED that EDCONTR under rDECLA RATION I� JOB
V—t F-'
lhereby affirm that lam licensed under provisions of Cho pter9(comment- APPLIANCLSRFSIDENTUL JOB DESCRRTION
Ing with Section 7000)of Division 3 ofkhe Bus!massed PrefessiomCode,and m 1
time.le In full to.and died. PANELS S
Llmnm Clam Lie.N V
Dale Contractor Q9-Ah1l.5s —
ARCHITECrSDECLARATION Opt-IODO0 Mfg SQ Fr.FLOOR AREA 3/SQ.FT.
ro0 7p I understand my plain shallbe used u public records. _
le U Licensed 1'rofessloml SIGNSELE�TRI
<�6 OWNER-BUILDER DECLARATION SPECUL C[RC I
rt.., 7�Q lhereby alfirm tlwllim exemptfromthe Contractor'•Lkenm law(or the
IO9 following rcsson.(SMlon 7R71S,Bminese and Profemlons Code:Any city or (FMC METIXO L ST.
F�4 county which requircaa permit lororulmd,alley,Improve,dernolish,or repair
any structure pdorto Its Issuance,also requlreslhe applicant(crouch permit to IOWERD CES DATE JV
0. file a signed Natermot that he is licensed pursuant to the pmvbloru of the151
3µr Contractor's License Law(Chapter 9(romrrcncing with Section 7000)of Divi- SSVIMMIN .ECIWC •� VIL"oTJIN
WWF OJ elon3ofthe0uelnem and Pro(emloro Code)orthak hebaaempt therefromand
6•••5777 the basis for the alleged exemption. Any violation of Section 70315 by any OIITLETSSWITCFI6FlJCIURES
d ,
O
applicant fees permit subjeethe applicant to a civil penalty of not momilin
flv^e(�undred doll..($SM. NEW RESIDENTIAL ELECTR_SQ.FT. SNWfS v f7TE fONST,4 TION
�n L,f I,as owner of the property,or my employees with wages as their sole �t'
mmpeneatlan,will clothe work sed theatmckum boot Intended or offered for 4
OmIn(Sec.7N4,Business and Preload..Code:The Contractors License Law
f,13$ does nerapplytoanawnerofpropedywho Wilds or Improves thereon,and
whodoceeuchworkhlmeeVorthrough hisownemplgees,provided lhatsuch OCQ GROUP R15.I3NIT5
Improvements are not intended oroffercd for vale.lLhowever,lhebulldlegor TOT 1
Improvement bsold wilhlnaneyearofcompIdIoNtheowner-bullderwill have ,. �n„ .A.
tFc�arden of proving that hedld notbuildorimproveforpurpooeo(sale.). QTY:',. rPLUMflIN GiPERMITt 7'"t `:'9FEE!'s FLOOD ZONE APN
�dys{.L as owner of the properly,am exclusively contracting with licensed pp�R ISSUANCE
tractors to construct the pro)ed(Sec.7014 Business and Professes,Code
I'he Contmdor's License Law does not apply to an owner of property who ALTER-DRAIN k VFM-WATER(EA)
Wild.or Improve.thereon, and who contracts for such p(ojeda with a �,'•'t •.,y�FEE.SUMMARY«'3: ``'`•' �`"
eget!actor(.)licensed pursuant to the Contractor'.Llcenm Law. BACK FLOW PROTECT.DEVICE
L�I cam exempt under Sec B k P C for this mown
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
Ownsr Date RECEIPT N
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y_ N_
Of
hereby affirm that 1 have a certigate of consent to wU-Insure,ora RFLERT N
certificate of Workers Compemsilon lmeammem.ceKilled ropy thereof(Sec'
3800,lab C) S CAFA.BYSTEM-11NC.1 OUTLETS PARK FEF. Y_ N
Policy a RECEBT N
Com ny GAS EA.SYSTEM-OVER BUILDING DIVISION FEEB
Certified copy 6 hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ss7
❑Certified copy 6filed with the city lrupedion division, rZTII &-Rf
y.L
CERTIFICATE OF p(EMPPION FROM WORKERS' GREASE TRAP PAID b
COMPENSATION INSURANCE SEWER-SANH`ARY-STORM F.I.2DWT. Date Rectipt 292,1
(fhlewdion need net be completed lithe permit 6 for one hundred dollars
(SIM)or less') WATER FIEATQt W/VENT/ELGCTR �E�•Nta•E'7R�GnY FEE Y_ N—
I certify that In the performance of the work for which this permit la timed, C � IOOa
et
I shall not employ any person In any manner m ss to become subject to the WATER SYSITM/IREAHNG Y 1 la-A08Wacker: mlaws of laof California. Date PAID
OZ Applicant NEW RESIDENTIAL PLMB. SQ.FT• Dale Remi tN
Z NOTICEI'OAPPLICANT:It,after makingth6 Certificate of Exemption,youdLi P. r
should become subject to the Workers Compematlon provid ex.fthe Labor PP77�j / u TOTAL.. dye
1— W
Code,you=at forthwith comply with such provisions orthls permitshalibe 1V JO V„�a I-I7� H�e1 �TJ Jia 0-
jdeemed revoked. p Q _Cmss, l / ��'I
Lll CONSTRUCTION LENDING AGENCY IM/TJ CXR/ CarJ(. b pD SEISMIC FEE b0
d I hercbyaffirmthat them ba construction lendingagency lorthe perform TOTAL CtELECTRIC FE' 7J 0
7 Z anceofthe work for which this permit IsIssued(Sec.3097,Civ.CJ O —I-F 5L PLUMBING FEE C7�
V 0 lender's Name A. e -
IL F cndcr'dAddrem QTY: •,r'7}MECHANICAL,PERMIT,.r.,o "JEFF ' MECHANICAL FEE t�
OU Icertifykhatl have read this application and pate that lheabove Information � (� FEES PAID:
W ws lecormet.I agree to comply with all etyand rounlyordlnancesand date laPERMUISSUANCE
>- M relating to building construction,and hembyauthobm representatives ofkh6
~ N cit to entero on the above-mentioned propertyfor Inspection purposes, ALTERORADDTOMECH.
? y(We)agree to save,Indemnify an d eearrenlem the City of Cupedlw Date Reeei to
(.� aI;Arat 11.1,11111m judgmenlgcosisand espameewhkh may I. rymy.caro. AIR HANDLING(IMT UO 10,000 CFM) SUBTOTAL: I
1k mine
CB In pt ate rue ppponto of ml UNITPemnu' CONSTRUCTION TAX-;t_
jjI/�,� s�JGyl •( IINI. / AIR HANDLING UN (OVER IO,000CFM)
Ignaturc 1 (ip cant/ ontrador s:{i/•- a 4 IXFUUST HOOD(P'/DI1CA CONSTgUCTI1,�ON TAX Al
HALARDOUSMATER LSOIS L R 'YyT L� a•a•
Will theapplic.et or future building park. r n Leh boa HEATING UNIT(TO 100,000 BTU) Date R
material as defined by the Cupertino Munlc ode, 9.12 and the
Ilealth and Safety Code Srctlon 25532(a)7 HEATING UNIT(OVER 100,000 RTU) TOTAI l a
❑Ye. No
Will the applicant orutum buildingocapantuw equipment mdeviced VENTILATION FAN(SINGLE RFSID) mcE DATE
which emdk havardous air contaminants as defined by the Bay Area Air
Qua lhy Ma nagcment Dist do? MOILER-COM P Of IP OR I DILOD BTU) C+CE3
4Yee ❑❑No J 4 1991
have ad the hasardom mateslab regniremenU ander Chapter 6.95 of BOILER-COMP(OVF7t 100,(XD BTU)
the CalifemLa Health k Safety Code,Sections 25505,75533 and 25531.I /
understand khal If the building dote not mrrcnBy have a lewnt,That 1k b my NEW RESIDENTIAL MECH. SQ.rT C4.of/,u
responsibility to notify the occupant of the requirements which must be mel ^O 1 /an'iart�nS
prior to Issuance of a Certificate of Occupancy. �sa
Owner or authorized agent Dale TOTAL: ED ISo ISSUBI'!y se-
ll OFFICE COPY