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24306 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PFRMIT NQ, 4 3 0 6 Building Address: Z nen a / t APPLICAITONSUBMIIIALDATE- CITY OF CUPERTINO-BUILDING DIVISION c.n APPLICATION /PERMIT K BUILDING-ELECTMCAL-PLUMBING-MECHANICAL CATEGORY A QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Ad PERMITISSUANCE EN CONTRACTOR'S DECLARATION Ihembyaffirm t l am lkemed under provisions of Chapte,9(comme APPLIANCES-RESIDENTIM, BDFSCRI''HON OIN ingwith Section )o(III v is ion 3ofthe Businsand no ssimsCed,s liunselslnfill and Wfs27 / PANELS _ Date ac Cla O' Date Contractor - ARCHF=S 12019i"\. reO ZpC I understand my plans shall be u public recoNa. OV 1000 AMPS.. n SQ.FT.FLOOR AREA S/SQ.FT. U Licensed Professi.ml SIG I LECTRICAI. l QF75 OWNER-B UILDER DECLARATION t- IhWebyarmthat l am exempt fromthe Contractor's License law for the SPECIA /M OOZFq fRfollowing reason.(Section 70315,Business and Professions Cade:Any city or Q;QAP.METER OR POLE INST. S;P , countywhlchrtquiresaper ttoromtmd,Oter,tmpmvgdennlbh,orrepalr .a any structs re prior to its issuance,also requires the applicant for such permit to F Fu file a signed statement that he V licensed pursuant to the provisions of the POWER DEVICES 3 4 t, Contramm rs Lice.law(Chapter 9(commencing with Section 7000)of Diet. e,Gy.'S sion3ofthe Bus nand ProfessiomCWe)orthatheisexemptthemlmmand SWIMMING POOL ELECTRIC VALUATIQU the basis for the alleged exemption. Any violation of Section 70315 by any ��0� DITILETSSWIICHFSFIXIURES applicant fora permit subjects the applicant to a civil penalty of not more than w c, five hundred dollars f$SM. NEW RESIDENTIAL ELECTR _51 FEES TYPE CONSTRUCTION 7 I,as owner of the property,or my employees with wages r 'Mir sok �'FT C 6 samp(Sec. 70K Business ess Wed work and ima,Cede: Th n IntenContractors .,offered for ��p rile(Sec.7004,Busimss and Pro(esslom Code:The ConlraRofs License law does not a pply to an owner of property who Wilds or improves thereon,and OCC.GROUP RES.UNITS whodomauchwurkhimself.,through hisownemployees,provided that such improvements arc not Intended oroffered forsals.If,however,thebullding or T improvementasold within oneyearofrompletion,the owner-budderwill have t ,den of proving that he did not bund or improve for purpose of sale.). Qly, PLUMBING PERMIT FEE 17LOUDZONE nPN L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE / contractors to combuct the project(Sec.7004,Busine The Contrare and Ih.lessiom Code: ctor's License Law does not apply to an owner x pmpery who ALTER-DRAIN&VENT-WATER(EA) Wilds or Improves thereon,and who contracts for such pAojecs with a FEE SUMMARY ro,IWBTTactor(s)ifenssd pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE t_J ,am exempt under Sec on B&P C for this reason Owner -rte DRAINS. ROOF,AREGOND. SANITARY Y_ N • WORKMAN COMPENSATION DS FLOOR, A,DECLARATION RECEIPTN ❑I hereby affirm that I have a certificate of consent to self.insurs,or a FITDTRFS PER TRAP SCHOOL TAX Y_ N o ei0cateof Workers CompersatlonImuranoramd[fled ropythereof(Sec. RECEIPT N S 380,Lab C.) GAEA.SYSTEM-1 INCA OUTLETS PARK FEE Y N Policy N RFCDIPI'N Com any GAS EA.SYSfEMOVERd(FA) BUILDING DIVI51 NFEES Certified copy is hereby th the city ❑Certified copy bfiled with the dtyimpection division. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK F�� CC l N 4�to CERTIFICATEMPE SATIO I N FROM WORKERS' GREASE TRAP PATQ7 COMPENSATION INSURANCE E foro (This sectiSEWER-SAN TEARY STORM EA 200FT Date Re on need na W compicted if the permit m hundred dollars ($1 W)or less.) Irortify that In the perfermance.fthe work forwhlch this permit is issued, WATER HEATER W/VENT/ELECTR ENERGY FEE N_ 1 shall not employ any person In any manner so as to become subject to the O Worker Compensation L,wsof California. Date WATERSYSTEM/TREATING PAID Applicant Z 0 NOTICEIOAPPLICANT:If,aker making this Certificate of Exempllon,you NEWRESIDENTIALPLMB. SQFT. Date RC N �. HAmid become subject to the Worked Compensation provisions ofthe Labor TOTAL: W Code,you moat forthwith compiywith such proom vislorthis permit shall be LU > deemed revokad. BUILDING FEE ^N d p CONSTRUCTION LENDING AGENCY SEISMIC FEE _ I hereby affirm that there V m a construction lending agency for the perform,Z anceofthework forwhichthb permit is iawed(Sec.3097,Civ.C.) To ELECTRIC FEE U O Lender's Name PLUMBING FEE / U. U Lender'stAthatI QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Icertlfythatl have read this appBcationandsatethattheabove Nformation IL ucomect lagree to comply with a B city and county ordinances and sate laws PERMIT ISSUANCE FEES PAID: r W relating tobuliding comWctlon,and hereby ulhorize reprcxntaevm otthis Z citytoenterupon theabove-a 'It"dp rty for Wpe<to purposes ALTER ORADDTO MECH. (We)agree to save,Inde f4,and harMem me city.,a no Date Receipt# against) ;iadgme sand n whlchruyina AIR HANDLING UNIT CFO 10,000 CFM) SUBTOTAL: aga' id ny I. ..it ant' gofthispermil. AIR HANDLING UNET(OVER 10,000CFM) CONSTRUCTION TAX 5 re C e EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: A US MAT CLO RE Ill the applicant or future building occupant sto rhan e� o HEATING UNIT(TO 100,00 BTU) terial as defined by the Cupertino Municipal C ,Chapter9 andthe _ Date Reset t# Ith and Safety Cade Section 25532(a)? HEATING UNIT(OVER 100,000BTU) TOTAL: ❑ Yea No Wlllthe appllra nt.,(score buildingoceupantusecqulpmentordevices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit hazardous air rontanne.,us as defined by the Bay Area Air Quality Management District? BOILER-COMP 011POR 100,000 BTUI o Yes 11'�No ^ 'have read the haz,rQiousmaterlak requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU) be California Flealth&Safety Code,Settlors 75505,75533 and 25534.1 understand that if the building does not currently have a tenant,that it iseny NEW RESIDENTIAL MECH. I1 mspomibSQ.F7iiitytonctifythenecvpant ofthe requirsermtswhich must be end PPC 31 priortoissuanofa CcnifinmofOvdpancy /y . Clly - 994? Owner or authonud agent Date I 'Ul, TOTAL ISSUED BY: OFFICE COPY