23528 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Project identification PERMIT NO.
BunaiH L06. lick CL 23528
n C.IC5 l.C.�
era mime: { one: A
I�Y4 M^,tn ff6-37,1 CITY OF CUPERTINO-BUILDING DIVISION (J.�r�
Contractor lame: Llc.Noo APPLICATION I PERMIT le l
J CL k 37L9 /7 BUfLDINGELECIMCALPLUMBING- EC MCAL CATEGORY CONTROL
Tql-
Architect/Engineer. Lk.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Add.
, ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
PERMITISSUANCE � ❑
Thereby
affirm
..7000'hat l ividonedunderprovtsbnsof ChionsCo e,andm APPLIANCESRESIDENTIAL JOB DESCI ON
limosch Section 7000)01 Didsion3o(the Buslnessand ProfeulamCode,and my
license le In!calif and dfeci. . - PANELS
LlcenseC ss Lonni �`7-lR�r�
Date Contractor < 'L e UP TO 2DOAMPS
ARCHITECTS DECLARATION 701-10DOAMP9
O 7p7OC I understand my plans shag be used n public records. OVER 1000 AMP$ ' .FLOOR AREA
r4 Z U Licensed Priefevi.eal SIGNS ELECTRICALFIN E R
Lj
�<6, OWNER-BUILDER DECLARATION SPECIALCIRCUfT/
71.., 7 Iherebyalfirm that l am exempt fromthe Contractor a License law for the
Mr, 0 Al
po following reason.(Se tion 7031 S,Business and Professions Code:Any city or
O vi t- TEMP.METER OR POLE INS,.
F- .a any stywhirh requlma Issuance,ronstmct,esth a provgdemolish,ormit to
g.a any structure prior
ement iswance,els also licensed pursuant
to the ,.,ismsor such of to DATE Lxidassa
U file a signed statement that he is licensed pursuant to the provision of the POWER DEVICES
�0 Contoa.rsLka.Iaw(Chapmr9(rommencingwlthSecti.n7000 .dDivi- SWATh9NGTVOLELECRC
sion3ofthe Busincaand Profemi.nsCWd ).,thatheisexemptihemfromand �y VAUJQj}QN
the basis f.,the alleged exemption. Any violation of Section 7031.5 by any ax �j1 applicant for a permit subjects the applicant to a civil penalty d no momilum OU'ILETSSWITCHIESFIXTURES o
five hundred dollars($500). NEW RESIDENTIAL ELECTR
Z¢ ❑I,as owner of the property,or my employees with wages as their sok SQFr. STORIES TYPE CONML)CTION
compensation,wd)dothe work,and thesnucture is not intended or offered for
5 ❑ sale(Sec 7044,Business and Pr.leseionsCode:The Contractors License Taw
ra does not apply to an owner of property who Wilds or improves thereon,andc. UNITSOCC GROUP RES.
who does such work himself or through his own employees,provided that such
Improvements arc not Intended oroffered forsale.If,however thebullding or TOTAL:
improvement issold withinoneyearofcompletsm,lhe owner-W Bderwlll have
th rdc.ofphwingthat he did not bund.,Improve for p.ryoseofsak.). QTY. PLUMBING PERMIT FEE
[,as owner of the property,am exclusively contracting with licensed FEEDZONE APN
contractors to ronslroct the project(Sec.7044,Bush.and Prefeuimu Code: PERMIT ISSUANCE
The Contractor's License law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER ff.NN
Wilds or improves thereon, and who contracts for such ptojects with a
cactor(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY
8cyl(rI am exempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE
Owner Date DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y_ N_
WORKMAN COMPLNSATION DECLARATION EII
REC 'T p
❑I hereby affirm that I have a mn ificam of consent to self4tuture,or a TURES PER TRAP SCHOOL TAX Y N
certlllate of Workers CompensatlonInsurance or a certilledcopy themof(Sec. RECEIPT N
3800,Lab C.) GAS EA.SYSTFM-11NC.40I1TLE75 PARKFEE - Y N
I'oliryp Ju<'J oo l-5y CAS EA.SY577]T4-OVERd(FA) RECEIPT#
Cram a 1R. uuv BUILDING DIVISION FEES
�C�nifled ropy is hereby furnished.
❑Certified copy 6 filed with the city impectlon division. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
CERTIFICATE OF CKEM PTION FROM WO R K ER S' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARYSTORM EA 200FT Date Recel t#
(fila section need no W completed If the pemdt isle,,one hundred dollars
(S100)or ly that
WATER HEATER W/VENT/HECTR ENERGYFEE Y N
I cent that o the person In an the work an as to
this permit is cawed,
I shall not employ any person In any manner n v to berorrc wbject to the WATER SYSTEM/TREATING
Workers'Compensation laws of Califomk. Date PAID
O Z Applicantlicant
Z O NOTICETOAPPLICANT-.If,after making this Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQFr. Date Recei t#
should become subject to the WorkerCompere ac ion provisions of the Labor
N TOTAL:
Code, comply with such provisions or this permit shall be
W > deemed revoked. BUILDING FE
CL f] CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there is a construction lendleg agency for the perform
0 ance of the work for which this permit as Wood(Sec.3097,CIv.C.) TOTAL ELECTRIC PEE
(,) _ Lender's Name PLUMBING FEE
LL I- Lender'sAddreas QTY. MECHANICAL PERMIT ITE MECHANICAL FEE
O W Icedify than havemad nhisappbcatlon.ndstate that theabove information
4 umrrm.I agmete,complywith all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
>. W relating to building construction,and hereby authorize representatives of this
I— Z cityt enter upon the above,mentloned propertyfor WpmER lonpurp.ses. ALTOR ADDTO MECH.
agree to save,indemnify an d Lee arae., Clty of Cupertino Date Receipt#
ag Babllillea,judgmenIs, rade whlccJJ�� inanyw Scotus AIR HANDLING UMT(f010,000 CFM) $UBTOTAL:
I said City 1.con t 10s not,
AIRHANDLINGUNTT(OVEt10,00oCFM) CONSTRUCTION TAX
igna mof p ra /Contract - Da EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
]ARDOUS MATERIALS DISCIAS E
Wi eappbant or future building occupant etre or hand In azandous HEATING UNIT(TO 100,0008
M _ Date Recei t#
materielas by the Cupertino Municipal Coda Chapter 9.1$.and the
❑He.lt Ymd Safety
ty Cede,Se Joon 75532(a)t HEATING UMT(OVER 100,000 BTU) - TOTAL• �/
Winnie appaczntor(u contaminants
as dpandbythe BayAlor devim VENDLATfON4(65INNGSID) ISSUANCE DATE
whicheat hazyrdom air romaanants as dented bythe Bay Arca AirQuality Management District? BOILER-COMPTU)
4Y:sI❑�INoTry p I D
ha,ereadthehazar�i 0.terlalsrequirementsunderChapter6.95of BOILER-COMPU) r P9theGli rola Health&Safety Code,Sections 25505,75533 and 25534.1undersdth.liftebulldingdoes notcurrentlyh a cna.glh.titlamy NEW RESIDENTSQflj1IS5UEDBY
APR 17 1992
M i ility to notify theom t ulrc which must rant
pule, ssuance ofa Certillc o! c
` / CITY Ur77�
�
,.mist .rued g t - ate
TOTA :
OFFICE COPY