19870 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pre'ed Idemlfkatlon pkRhUT NO.
Building Address,/ F / . 19870
aces: one. (�7A�iL A
j6 n sera CITY OF CUPERTINO-BUILDWG DIVISION
ix.N« APPLICATION I PERMIT LAC
Yob BUILD:NGELECTRICAL-MUMBINGMIfFIANICAL CATEGORY CON RO
Ited/Engineer. IJc N«
e� QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Add. PLUMB 9J IIERMTISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATIONf
Iherebyaffirrn that I.licensed underpmwJahmofChapter9(rummers APPWANCESRESIDENf7AL JOB RIPIION
Irigwlrh Section 7000)of gdsion3dthe Busireu.nd Pro/mslovCode,andcry
I..is In full form and effect. pmN
License-�Lk.I
Dale Condrador Up TO 200 ANIPS
ARCHITECT DECLARATION i-1000AM
�xIyZ l understand my plans.hill he usd+s public records. OVER 1000 AMPS X SQ.Fr.FLOOR AREA S/SQ.FT.
y LicenYd Pmfmabnal SIGNS L
< OWNER-BUILDER DECLARATION SPECIALMLSL
Iherebyafflrmthat l am ewes(.,front the Conewor's License law for the
KOO following reason.$adian 7031-5,Business and Professions Coda:My city or
yep' cvnntywhkh regulons.permRtommtrud,dter,Impvse,demoWh,orrtpalr TFMP.M OR EWSf.
<Y < any structure prlwto Its issuance,also requlearhe applicant faaucb permit to IOWFAD
6 CO F U Ne a signed mlensc t that he 611cnvM pumunt to the provisions of the
Contractors License law(Chspter 9(commencing with Section 7000)of qct- SVBdhb NG
.dC
+SOS un3o/the Busbemand Prdmsbru Code)orthathebexemptthercfmmard VALUATION
K' the bast for the allegecd exemption. Any violation of Section MIS by any
applicant fora permdeubjoruthe.pplkanttoa civil penalty deet morcthan OUTLETS FI)TIUR dm
fins hundreddol"(S50I). WR)�D EI.ECTR SQ.FT. RIES TYPECONSTRUICTION
R ri I,a.owner of the property,or my employees with wagesas theirsole
compansatlon,wW doth.wmk+nd thewmcwrc V eat Welled or offered for
In[Sec.700 Business and Profensbv Code Thi Contraeore Llceme Law
♦Vj5@ does not apply to an owner of property who builds or impmvm thereon,andOCC.GROUP
UNITS
F who domsuch work hMselfor thmtsh his ownemplyees,provided that such
Impawemew art not blended oral/erect!orale.If,however,thebuilding or TOTAL
Improvement Vvoid wllhln ovyearofcompletion,the avner-builderwW have
t)sprrdenalpmdngthathadf build orimpmvnforpurpo.eofealn.). QTY. UMBIN ERMIT FEE FIaDDzONE ApN
"I,as owner d the property,+m'.hnWely m"'.." g wNh Ilan.ed PERMIT E
contractors to mnedruct the project(Sec 7014 Bukruea and Pmfesalov Code
The Commences License IA W doe not apply to an owner d property who ALTFRDRAW -WATER(EA)
builds or Improves thereon,and who mmrarts for such p,octs whh
ogp((xtor(s) OUTSIDE FEES
Beenued Wnuset to the Contadds License Law. BAIX FLOW PR .DEVICE FEE SUMMARY
I_I I am.seem(. under Sec S k P C for this reason
DRAWS.FLOOR,RDO REA,GOND. SANITARY Y N_
• Owner Dee RMFIn
WORKMAN COMPENSATION DECLARATION
❑1 hereby.rk that I have• I.e.e c coven[to seythe,r a (Ss F���'r'I'FR TRAP "ATOq.TN( REEMT
MWcertiLstedWarYen'C«npegn+a/tl'm ivurapna or+certlBed mpyrhertof(Sec. GAS FA.SY5TIM-11NGl OUTLL"IS PARK FEE Y N
3800,lab C.)�C a Q / b. I .3 RECEIPT I
Pdkya /.
Com nv�"0T� GAS FA.SYSTEAL-0VER4(FA) BUILDING DIVISION TEES
I ICedlled copy b h`mwith thahM' G GRFA /WWSIRL WASTE INTERCEPTOR PLANCHECKFEE ,
IIAA�-nLLCertNM espy la pled with the city Ivpertbn division.
CERTIFICATE OF FXEIVIMON FROM WORKERS GREASE TRAP PAID
COMPENSATION WSURANCE ShW'FR-SAMT'ARYSIORM EA 700FI Date Remi t#
Rho,section need n«he cnnpletad B the(.eruct[V(e arc hundred dollen
(5100)orfyth) WATER HFATFR W/VENT/R.ECTR ENERGY FEE Y N
Icewlfy that to the pnrforrtunce of the work forwNch this penNtlslwed, —
Ishall of ploy any pe Jr, mann ernutobecomexubjecttothe WATER SYSTEM/TRFA'IING
war'.' ,wtbn Ly . Wanda.Date PAID
O Z nppuam d �/�t�1—a_in�y�, N�RFgDFALpMe. F. Date Reoei t#
Z NO"RCEr ICANT:If,ager nnukl gtNskn teno�fExemptbn,you
ehmld .object to the Workers'Comperuetlon provisions of the labor TOTAL:
~ N Code,you mnt/athwdh comply with such pmvbbns or this pemdt shall he
W ] deemed cooked. — BUILDING FEE
CL c CONSTRUCTION LENDING AGENCY SE IC FE
Iberebyafl7rm that there Is a covnuction lending agency for the perforen.
Z .rses.(theworkforwhlchth.pertnft6Ls (Sm.3097,CW.C.) TOT,w ELECTRIC FEE
00 TLMer:Name PLUMBING FEE
LL F L.wers Addre.. QTY, MECHANICAL PERMIT FEE MECHANICAL FEE
O IU Imrti/ythw l have mad this apInformationnand statethat theabove Information
b mrtm.lagrteto complywlth ail cttyaM amnryordlnanmane state law. PERMIT ISSUANCE FEES PAID:
CL relating to building construction,and hereby auth«i: reprt.enteuvm of this
Z dry to enter upon thn abovernartbvd property for inspection purposes. ALTER OR ADDTO MECH. Date ReCel t#
(We)agree to save,bd emNk
fy an d eep ss o
harmlethe City of Cu pen
V n aivtllabUities,pdgments,cows a�dexpenseswhicbmyln+nywayacvrre ATR HANDLI G UNIT(TO 1o,000CFM) SUBTOTAL:
rut old Clty In egos ofthegniuingdlhlspemW.
� AIRruNDLJbX3STHO01 (WIDUCT)NIT 10,000CFM) CONSTRUCTION TAX
SI IApp loot/Can4t/rector K-L pate E%}IAl15T HODD(W/DIJC17 CONSTRUCTION TAX PAID:
reo HAZARDOUS MATERLALSD SCLOSURF
Weltheapplicant orfuture building occupant Mom or handle havnlous HEATING UNIT(T0100,00 BTU) Dale Recd t#
material as dcOned by the Cupertino Municipal Code,Chapter 9.17,and the
Elealth and Safety Code Section W
25537/(.)1 HFATG UNIT(OVER 100,000 BTU) TOTAL:
Y. PNo
III thcappllamor ture building occupant use equipment or devices VUMLATION FAN(SINGLE RESIU) ISSUANCE DATE
which endt hamrdou,air contamlunts as defined by the Ray Arca AL
Quality Mavgemant DfstMt BO[LFA-COMP OFEOR 100,000 BTI)
Yn ❑No
I have read the hn..Qzreatarial,requirements under Chapter 6.93S of IOILER-COMP(OVER 100.00o BTI) p��
the California Health&Safety Code,Seniom 25505,75533 and 7S5M.1 I�
understand that lithe Wilding does not currently have a tenant,that It la my NEW RESIDENTIAL MECFL SQFf.
res mbUUyton«lfytheoccupaotdtherequWmntswMchmewhe .s�
P oLeuavcd H tc of Ocapanry. W �J
m authorind.gent Date ISSUED
TOTAL:
OFFICE COPY