24299 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Pro'en Identification PERMIT NO
Building Address: 24299
06 ,YDE Au
wnersams one: A A
(,ee• WAN6 —'� Q y CITY OF CUPERTINO-BUILDING DIVISION d ^
G°"tr am,e ue.No: APPLICATION / PERMIT L
BUfLDING-ELECTRICA4PLUMBING-MECH NICAL CATEGORY CONTROL a
` Arcbftect/Engineer. 9 q0ttCi
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: I'FRARTISSUANCE �]�J� ❑
LICENSED CONTRACTOR'S DECLARATION IV_T
[hereby affirm that l am Bcend under provisions of Chapter9(comment. APPLIANCES-RESIDENTIAL JOB DESCRIPTION
inense11.full force afPWfect. thegusinesaand ProfeastonsCode,and my
limens fntu.7")and tlM. PANELS
Limax _Lk"Date Contractor
ARCHITECTS DECLARATION 201-t000AMPS
rsO ZpC Iunderstand plans shall W used as public records. OVFRIOWAMPS �, pR y/SQ.FT.
U IF
Licensed Professional SIGNSELECTRICAL
6P T
OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC
s., P (hereby affirm that exempt from the Contractor's License Law fm the / O
Z O— following reason. j S
(Section 7Q315,Business and Pro(esbru Code:An d or
O y city TEMP.MEITRt ORPOLEINST. -GhTC O
K0 fountywhkh rcqulrcsa permit tomwtruct,iltlq improve,demolbh,or repair tt�
anysl =mpdortoitaissuance,alwrcquirestheappBrantfmsuchperMtto TOWER DEVICES t
3 a file a signed statement that he is licensed pursuant to the pmerislem of the L—
Ou. Contractors License Law(Chapter 9(nxn ndng with Section 7000)of Divi- SWIMMING POOL ELECTRIC
F�O< stun 3 of the Buslnev and Profetaloro Code)mthat he laeu
the basis for the alleged exemption. Any violation of Section 70315 by any VALUATIO.
S"•!!
�0 applicant fora permit subjects theappllcant toa civil penalty of not more than OUTLETSSWITCHGSFIXTURES �30a
p,$ cl as o nerdolof the pr. NEW RESIDENTIAL ELECTR
1,as owner property, e�Qf T. STORIES TYPE CONSTRUCTION
p pentyl or my employees with wage as their sole
nsaHon,w0ldo the work and the etrotvre V not Intended or offend for
�p vie(Sec.704q Bualmv and l'Avfmbre Code:7he ContractoJs Littrae Law
s$ does not apply to an owner of property who Wilds or improve thereon,and OCC.GROUP RES.UNUS
whodoss suchwork himself mm
thugh his°wn employees,provided that such
rt
improveents anent intended oroffered forsale.IL however,thebullding or 7
Improvement issold withinoneyearofcompleiogtheowner-W Bderwill have
t"Aden of proving that M did nmbuildorimproveforpurpiseofsals.). QTY, PLUMBING PERMITFEE FLOOD ZONE
APN
LI L as Owner of the property,am exclusively contracting with licensedPERMIT ISSUANCE �s
contractors to contra the project(Sec.7044,Business and Pro(essloru Code:
11he C°ntretor's Licerue Law does cad apply to an owner of pmperty who ALTER-DRAW&OEM-WATER(EA)Wilds or Improves thereon, and who contrafor such Elojecta with a
OW]Eactor(s)licensed pursuant to the Contracture License Law, BACK FLOW PROTECT.DEVICE FEE SUMMARY
LJ I am exempt under Sec B&P C for this reason
OUTSIDFITrS
OvmOr pt DRAINS-FLOOR ROOF,AREA,GOND. SANITARY Y_ N_
WORKMANCOMPENSATIONDECLAR ON RECEIPT
[:,I hereby affirm that I have a certificate of consent to aelf-Insure,ora FIXTURP_4 PER TRAP I SCHOOLTAX Y N
mrti(kate of Worken'Compewllonlrourantt m a cettifled copy tbemof(Sec. RECEIPT a
3800,Lab C.) GAS EA.SYSTEM4 WCAOUTLETS PARK FEE Y N
Policy a
N
Cam any CAS FA.SYSTEM-OVER d(FA)
RECEIEPT
� BUILDING DIVISION FEES Certiied copy V herebyfurnished. GRFASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
�Certified mpybftled with the city Inspection division. '
CERTIFICATE OF INCA PTION FROM WORK ERS' GREASE TRAP INSURANCE PAID
COMPENSATION
Ohisxtlonneed ace be aompl Tpermit V(canons hundred dollars SEWER-SANTTARy STORM EA 200FT Date Remi t#
(St
Ic,difess.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y N
certify thatIo
the peAormanceo(the work for whkhthis permit is issued, —
I shall not employ any person In any manner so as to been.subject to the WATpR S1,gT.p /TREATING PAID
Workers'Compensation laws of California.Date
O Z Applicant
Z 0 NOTICETO APPLICANT-.11,after makingthb Ceni(Icateof Exemption,you NEW RESIDENTIAL PIMB. SQE7. Date Remi t#
shmuld Wco subject tot he Workers'Compensationprovbtors ofthe Labor TOTAL'
W~ N Code,you rtwat fA,C1M1comply with such provision or this permit shall be ^�
> deemed revoked. PGE
a O CONSTRUCTION LENDING AGENCY 4
I hereby aBbm that there b a ooretr Ilion lending agency for the perform EEO dace ofthe workfor which this permit is issued(Sec.3097,Civ.C.) ��u Lender's Name EELL F Leaders Aaartss QTY. MECHANICAL PERMIT FEE AL FE!R�elpt#OW lOnAllythatlhave readthis.pplicationandnatethatthe abovelnformatlond berried.iagreeto comply with all city and county ordinances and state laws PERMIT ISSUANCE rW relating to building construction,acad hereby authorize representatives of thish Z city to enter upon the above-mentioned propertyforimpecdon purposes. ALTER OR ADD TO MECH.Z (We)agree to save,Indemnify an d keep harmless the City of Cupertino
against llabNtle;Pcignenb,cons and expenses which may In any way accrue AIR HANDLING UNIT(To 10,000 CFM) SUBTOTAL•
aga first said City to..got.of the granting of this permit.
AIR HA NDLING UNIT(OVER I Q000 CFM) CONSTRUCTION TAX
Signature of Applicant/Contractor Date. EXHAUST HOOD(W/DIKp CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will theappllcant orfuume Wilding ucrupantstoreor handle hazardous HEATING UNIT(TO IOO,ODO BTU) -
matedalasdefined by the Cupertino Municipal Code,Chapter 9.12and the Date RCC
1❑yend Safety Code,Setioon 25532(a)t PHFA UNIT(OVER l OQ000 BTU) TO
Will the a pphrca At or❑future building occupant use equipment or devicesAN(SINGLE RESID) ISSUANCE DATE
which emit harzrdousair mntaminantsas defined by the Bay Area AirQuality Management DbMctt HP OR 100,000 BTU)Yea nn No
shavereadtheM1arar�ommaterialsrequirementsunderChapter6.95ofV)R1W,0(p BTO) � 'the California Health&Safety Code,Sectiore 5505,255.33and 25534.Iunderstand that i(thebuilding does not currently have a tenant,that it 9 myIAL MECH. SQ,FT
prior tomponsbiity,to encecat ltytbe cadeof ccupa of the mqulremenb which nun be mei SEP 30 1yyQ LL
prior to Issuance Of a Certlfkate of Occupancy.
Owner or aomorlred agent ttaV
TOTAL: ISSUED BY: ,
OFFICE COPY