20585 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERIUUT NO.
Building Address: 20585
1010 <9 AAFL.L0 PLAcE
ante: A A A
,J0 /J }Z ROUKl ER 7aS1,-7oy 1e CITY OF CUPERTINO-BUILDING DIVISION o
ontracto .Name: 3,6LL7 APPLICATION if PERMIT
BUILDING-ELFJZMCALPLUMBING-MECHANICAL CATEGORY CO.NIROLN
Arehitttt/Engineer: Lle No:
RIS 1{rrRC .$I`FUG M(NO�A (: 35130 Q.l.y ELECTRIC PERMIT 'FEE
cc�y��� - BUILDING PERMIT INFO,,' . ,'
Address PERMIT ISSUANCE (CID
LICENSED CONTRACTOR'S DECLARATION
I hereby af(Irmthat lam Accrued under pmvidonsof CAapter9(moancre APPLIANCESRESIDE.NfIAL ]OB DESCRIPTION
ingwith Section 7000)of Divlsion3 ofthe Bus!nam(�an�d Pro(essionscmic,and my
license a In(u rat and affect. ,j'._.�Jta PANELS
Limn las LION�`'.� L
Date ContvRor_y N5T1
ARCHITECTS DECLARATION 201-1000AMPS
reZ l understand my plans shall be used v public recordOVERIWOAs1P5 I SQ.FT.FLOOR AREA 5/SQ.FT.
s.
�O SIGNS ELECTRICAL
¢ I
[+,0� Licensed rmfesslarul
F ' OWNER-BUILDER DECLARATION +
SPECIALCIRCNT/MLSC 1 h�Q TDI�(T�ON L'I a
�p ', Ihereby of@mthat I am exempt from the Contractor's License Law for the
following reason.&&I..7MLS,Businm and Professions Code:Any city or TEMRME[Ed ORPOLEIN
ma countywhichrequiresa permit toconstmct,alter,improve,demolish,orrepur
^$a anystrumam prlorto its Issuance,auorequlrestheappl0cant fersuch permit to OWER DEVICES
D< ,k a signed statement that he u licensed pursuant to the provadme,of the
Contractor's License law(Chapter9(commencing with Section 7000)of Divi- SWIs1MLNG POOL ELECTRIC VALUATION
O sion3ofthe Business and Profesloru Code)orthat he at exempt therefromand
a the basis for the alleged exemption. Any violation of Section 7031.5 by any �,E�yryyfTCHESflXfUftES l W 50��
O�
applicant fora permit subjects theappilcamt to a civil penalty of not rrorc than
5 five hundred dollars($500). NEW RESIDENTIAL ELECTR SQ. . STORIES TYPECONSTRUCTION
^ .. �I,as owner of the property,or my employees with wage,as their sole
f.7Q comperuttion,w0ldothe work and thestrocture is not intended or offered for
❑ vie(Sec 7044,Assumes and Profesioru Code:The Comractots LIm.law
G s S does not apply to an owner of propetty who build.or improves thereon,and OCC.GROUP RES.UNT[S
who don such work himself orthoctigh his own employeea,provided that such
Improvementsare not Intended or offered for We.If,howe no,the Wilding or TOTAL:
Improvement usaid within oneycarofcomplaion.the owner-builderwill have
I ofof proving that he did not build or Improve for purposeof Wa.). Qct. - ..' PLUMBING'PERMIT ,.FEE.., FLOODZONE APN
LJ L as owner of the Property,am exclusively mntratting with license PERMIT ISSUANCE
contramors to mnstrud the project(See 70K Business am Professions Code: CD
The Contractor's License Law don net apply to an owner of property who A,qE(-DRAIN&VENT.WATER IFA) CZbu Adm c
a or improves thereon,and who comment,for such ptajes with a ;:FEE;SUMMARY.',••'Nti.e`�Ii'
nor(s)Acensed pursuant to the Contractor's License Law. ' BACK FLOW PROTER.DEVICE
IJyy[[aI am exempt under Sec B &P C for Nu reason
DRAMS FLOOR ROOF,AREA,COAD. SANITARY Y_ N_
Owner Date RFLFTPT N
WORKMAN COMPENSATION DECLARATION FIX.�gES pFR I7LVP 1 (� SCHOOL TAX Y_ N_
hereby affirm that I have a ce0l,cate of consent to x8-uasrc,ora l BE=N
330orker Compenutloninsunncearace0lfkd mpytheieof(Sec. I GAS EA.SYSI4f-I INC.4 OUTLETS 'ze� PARK FEE Y N_
3800,0,ULab bC.)C.) RECEIPT N
Policy N GAS EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES
many
❑pcenin copy hereby fumuhed. GREASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
n CeOUed copy u filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAP PAID
COMPENSATION INSURANCE SEWTIl SANTIARY-STORM F.A.XOFT. Date Remi t# /-JI
([hissec,on need not be,completed It the permit u for ane hundred dollars
(SI00)orlme.) WATER HEATER W/VFNT/ELECTR ENERGY FEE Y_ N_
I earl that 0n the performance of thework for which this permit 0s Issued,
I shall not employ any person in any neater ao as to become subject to the WATER SYSTEM/TREATING PAID
Workeri Compenvtlom Law.of CalBomu. Date—
0
O Z Applicant NEW RESIDENTIAL PLMB. (QF. Date Reoei t# CR)'m
Z O NOTICETO APPLICANT:If,after making this Ce081cate of Exemplko,you
should became subject to the Workers'Compmeatlea pro neiora of the Labor TOTAL:
Fn Cade,you most forthwith comply with such provuiov orthls permit stat be BUILDING
jdeemed revoked.
W CONSTRUCTION LENDING AGENCY SEISMIC FEE a
CL Iherebyatfimthat there u a construction lendingagency forthe perfomm TOTAL: ELECTRIC FEE
M Z arm ofthe work for which this permit is Issued(Sec.3097,Civ.C.) ` PLUMBING FEE
0 O Leader's Name 5^ .
h- Lendce.Addres QTY. 'MECHANICALPERMIT '_FEE ' MECHANICAL FEE SIS
O w IcaNfythatIhavemadthetappllcatlonandstatethatthealeveinformation ( j FEES PAID.
umrrectlagmetocomply with aB et dcounty orelina and nate laws PERMIT ISSUANCE
} 11 relating to building mnsuualon,and harebyauthotlm nutivno(thu
N ALTERORADDTOMFLH. �iCIO
F. Z city to enleru the above-mens prope0y tori p ion purposes. Date Receipt#
V
save,in keepesw aCity of Cupertino AR HANDLING UNIT ITO 10,ODO CFM)
agairat
it, s,Pdg A.a its
dexpensnw c ylnanywayaceue SUBTOTAL:
against Id iry n ro m t granting a pertnd. CONSTRUCTION TAX
AR HANDLING UNIT(OVER IO,000CFM)
—
igv eo(AppAcant/Contnttor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BM Date Reaei t#
material.,delmd by the Cupertino Municipal Code,Chapter 9.17,and the Q
Iieallh and Safely Code Section ))�ion 2553Z(a)I HEATING UNIT(OVER 100,000 BTU) TOTAL: s
nYes L'•IfVO VFNITLATION FAN(SINGLE RESID) ISSUANCE DATE
Will the applicant or future building occupant use equipment or device,
which coal hazardous air contaminants as defined by the Bay Area Air
EPM
Quality Management Districts
ye. BORER-COMP DHPDR 1 W,IXO BTBTL)n /
4h.vare,ithehazaourcl smaterials requirements under Chapter 6.95 of BOREFLCOMP(OVER 100,000 BTT1) *III'''��s}}}
the California Health&Safety Code,Sections 5,25533 and 75534. [
undc. rad that 1 the Ong docs not carr y have a tenant,that It i my NEW RESIDENTIAL MECH. SQ`T
rapppprrr��Iaa+���tttfff����bilityt a t o<mpant of th uircm3ntawhich nwstbe mat1-
praK- 70
aC 01' arc ul Om cy.
Owuerorauthorbedagent Date ISSUED BY-.y
TOTAL:
OFFICE COPY