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22242 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMITNO. 8u11cmg Address: 22242 Z2Z`fI c Le S11 K� �ls 1"Ou c ("1TrW_�res an,a:o� G �`--- n� on, CITY OF CUPERTINO-BUILDING DIVISION / Contrader Name: Lt,No: APPLICATION /PERMIT -6 LL eUfLDINC ELECTRICAL PLUMBINC.MECHAMCAL CATEGORY CONTROL# Archltect/Englnm Lin.No: CITY OF CUPERTINO BUILDING PERMIT INFO 10300 TORRE AVE. QTY ELECTRIC PERMIT FEE Address 10300 LICENSED CONTRACTOR'S DECLARATION I hereby e(firm that lam llcmeed under prov6lone of Chapter9(rommenc APPLIANCESRESIDENTIAL t/Y JOB 0 R•'7QN Ingwith Section7W0)of Dlvlelon3ofthe Buslnessand Pro(nselonsCode,and my Ilmose e.in full forceand effect PANELS n lea' / License Class Lte.a ��1 e,y.1s„D Date Contractor UP TO 2DOAKM ARCHITECTS DECLARATION 201-i"AMPS M 0 2 I understand my plans AM1eB be used as public records. OVER 10DO AMPS SQ.F7.FLOOR AREA S/SQ.FT. Z° ALED Licensed professional SIGNS ELECTRICAL 6 OWNER-BUILDER D[CLARATION SPECIAL CIILCUIT/MLSC 1'yrj.�i owing raformthatlamexempt fromthed Professions Code: Law fort he E pp county which requir(Sectionspermit to Business and Proprove, Code:Anycttyor TEMP METER OR POLE INST. �� � � countywhich requlroapermitto ronstmd,Alter,improve,demolish,orrcpalr ' C' any structure prior to its beuanc,also requires the appBant for such permit to OWER DEVICES �(• E ©S file a signed statement that he is Bressed pursuant to the provisions of the �--- �3n,� Contractor's License Law(Chapter 9(mmmencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC$ VALUATION O oon3 ofthe Busmassand Profeslom Cod6 e)orthat he exempttherefromand the basis for the alleged exemption. Any violation of Sectio7mtS by any OIIILETSSWITCHFSFIXTURES app8cantforapert taobjedstheapp8canuoadvllpevltydnannntlun O D e. five hundred dolt..($500). NEW RESIDENTIAL ELGCTR �n ❑1,as owner of the property,or my employees with wages as their sole SQ.FL STORIES( TYPE CONSTRUCTION compensation,wllldothe work,and thestrodure Is not intended or offered for Osale(Sec.7044,Business and Professions Code:The Contractors License Law $$ does not apply to an owner of property who builds or Improves thereon,and OCG GAOIR' RFS.UNITS who doessuch work himself orthrough his own employees,provided that such Improvements are not intended ororfered forsale.If,however,thebulldingor TOTAL: Improvement 6sold withlnonayearefcompletimn,theowner-Wilderwill have thAturden of proving that nadidectwudmirnproverorpurpnseofsale.L QTY. PLUMBING PERMIT FEE FLOOD ZONE AI'N lJ L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to coeutrod the project(Sec.7044,Business and Prodoulons Cod A. The Contractor's License Law does no apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) Wilds or Improves themes,and who contracts for such peojeds with a FEE SUMMARY gqyL!�Tactor(s)licensed pursuant to the Centractm'a License Law. cl_I I am exempt under Sec. 8&P C for this mason BAIX FLOW PROTLCT.DEVICE . v DRAINS.FLOOR ROOF.AREA.GOND. SANITARY Y N= Owner Date RECEIPT N WORKMAN COMPENSATION DECLARATION FIXTITRES PER TRAP SCHOOL TAX Y N ❑1 hereby affirm that 1 have a cer ffiWe of consent to self-hame,ora RECEIPT 3800,Lab Cf Wockeptomperuatlonlrnrmuran�orjl f�roPYthenrof(Sec. GAS EA.SYSTEM-1 INCA PARK FEE Y_ N_ 1.1I T RECEIPT# Pdicyp 10300 TpCaF CVT- GAS.EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES Cum any Certlfiedc GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑Certified copy 6 filed with the city Inspection division. CERTIFICATE OF DIEM PHON FROM WOR KERS' GREASE TRAP PAID COMPENSATION INSURANCE SE}yF-R-SAMTARY.STORM EA.200ET. Dat CGl`I t# (fhb section need eta Wcompleted B the permit Is for end hundred dollen ($1W)ce I..) ENERGY FEE N I certify that In the performance of the work for which the.promt is Issued, WATER HEATER W/VENT/ELECTR 1 shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING Werke.Compensation Laws of Califomla. Date PAID 0 Z Applicant NEWRESIDENTIALPLM3. 5Q.F7. ate LR... t# Z O NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker'Compensation provisions of the Labor TOTAL: CC N Cod,you at fan hwith comply with such provisions or this permit shall be BUILDING FEE W ] deemed revoked. CONSTRUCTION LENDING AGENCY SEISM 11 I herebyafirmthat there 6aronstmctton lendingagency forthe perform- EL' G E TOTAL: M Z Lender.Name PL MBI FE LL which this permit is Issued(Sec.309'/,CIv.C.) V 2 lenders Nare LL r- Lenders Addreas QTY.I MECHANICAL PERMIT ::FE:Ej MECHANICAL FE O w I certify that I have read this application and date that the above Information �— FEE a Sia� a Is correct.l agreeto comply with all city and countyordlnancesand statelaws f PERMIT ISSUANCE relating to building construction,and hereby authorlan representatives of / I— U) city to enter upon the above-mamioned property for inspection purposes. ALTER OR ADD TO MECH. Date r CCet [# (We)agree to save,Indemnify an d keep harmless the City of Cupertino P V aga�lSlta(bdl(I�pdggU,lq FopymyMseswhlcheraylnanywayacauc AIR HANDLING UNIT(170 10,000 CFM) BT T63310-0 CC11�-RRE V�_e o1Yllhe granting of this permit.. T6AIR HANDLING UNIT(OVER I0,000CFM) CONSTRUCTION TA ,. signatureerwpploot ont.norjA Datd ExxAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID HAZARDOUS MATERIALS DISCLOSURE occupantv00t Will the applicant or future building occupant store or handle hardous HEATING UNIT 1 ,000 BTU) Date RQCCI t# material as defined by the Cupertino Municipal Code,Chapter 933 and the - 1 halth and Safety Code Section 2S532(a)7 HEATING UNIT(OVER IDQ000 BTU) TOTAL: Fly. LJ No WEI the applicant orTf wm building occupant use equipment or devices VENTILATION PAN(SINGLE RFSID) ISSUANCE DATE which emit harardousalr contamivneas defined by the Bay Area Air k-Pj L# Quality Management District? BOILER-COMP PELT DR IW.IXD BTl!) J `JP 4Yn nine 01pQ� have read the hanr sus mateda6 mqulmmanta under CM1apter 6.95 of BOILER-COMP(OVLR00 1 ,000 BTU) juI the California Health&Safety Code,Sections 25505,25533 and 25534.I 1� understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. FQ.FI'. responsibility to nes lfy the occupant of the requirements which must be met �`, sy pswss�l� prior to Lsuance of a Certificate of Ocnupa my. q W WDM Owmror authorlud agent Data TOTAISSUED BY: L: �� OFFICE COPY