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20236 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Proem Identification PERMITNO. Building Address: 20236 ! D�uTL GT mere am: one; LNf/ -3 CITY OF CUPERTINO-BUILDING DIVISION 2�a Q a to or'eName: Q/ Lk.No: APPLICATION / PERMIT J -11 BUILDINGELECTRICALPLUMBINGMrCHAMCAL CATEGORY CONTROL# Architect/ gl Kar. Lie.No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Addrerc PERMITISSUANCE LICENSED CONTRACTOR'S DECLARATION Thereby offirm that l am licensed under provisions of Chapter 9(commen AFPLIANCES-RESIDENTIAL JO DESC ON Ingwlth5ed1on700D)Of AMon3ofthe RuMlm dProfeWoocode,and my Ilcense Is In full( and effect. PANELS License ss /.S LIC. r Date sllL. as�rLIC. _or ARCHITE R Ol-1000AMPS I: rsOp IuMentand my plans elan ed as puhlk recede. OVER 1000 AMPS a t prf. RAREA E/ .FT. (/ LicensedPMessioal SIGNSELECTRI AL q l I I i �� 5-i I-6 OWNER-BUILD ro DECLARATION SI'FOULCIRC T/MISC � � Zp, 5 )wing reason. that In 7031.5, tfromthed Profdofs License Law city or Q followingreason.(Bentonrratt,Businesommusand Proferove, Code:h, n or ��1-Pty countywhkh rcqulrcsa permktocorutruct,alter,impmve,demolbh,ornpalr ThMP'MEfER LET. 7 aeystracNre pdorto its Issuance,also nquimatheappllcantfonuch permit to POWER DEVICES (� file a signed statement that he is licensed pursuant to the provlalom of the Oµrr Contractor's License Law(Chapter9(commencing with Section 7000)ofDivi. 1..,� 1 ai.n3.fth.Budneuand Prf..Io.Cade)arthathebemmptthomfmmand SWIMMING POOL ELECTRIC VALUV.QN ....]]]] the basisfor the alleged evemptian. Any violation of Section 7031 S by any �7f e� applicant for a permit subjects the applicant to a civil penalty of not morethan OIJ71'E7SSN7TCI IFSFlXIIIRFS �t(-g/ y�QU CJ five hundred dollars(x500), 9.1 ❑I,as owner of the property,or my employees with wages as their sole NEW RESIDENTIAL ELECTR SQ.Ff. STORIES TYPE CONSTRUCTION s.7Q compensation,will dothe,work.andthertruclurs is not Intended or offered for gg O dale(Sec.apply to a now and f property Code TM c improves Licewe(qw �$ does not apply torn owner ofpropghhis. .empbuilds orimproovidedrece,that and OCC.GROUP RES.UNITS who dceesuch work hlmxlorthrwgF hlaownemplgees,provlded/hatsuch improvements are not Intended oroffercd forsa)e.If,however,thehullding or TOTAL: Improvement hwld wlthlnowyearoftompldioNtheowner-bu8derwBl have t rden of proving that he did nM build or improve for purpose ofeals). QTY, PLUMBING PERMIT FEE FLOOD TONE APN 11 L as owner of the Property,am exclusively contracting with licensed PERMIT ISSUANCE contradan to construct the project(Sec.7044,Business and Professions Code: 1 LYRI The Contem or's Lkenw Law does not apply to an owner of property who ALTER-DRAIN kVENT-WATER(EA) Wilde or Improves thereon,and who contracts far such p(ojecta with cgn1jenow licensed pursuant to the ContraaOrs License Law. FEE SUMMARY (_I I am exempt under Sec B k P C for this mason BACK FLOW PROTECT.DEVICE DRAINS.FLOOR,ROOF, SANITARY Y N Owner Date AREA,CONI. RECEIPT N sf , WORKMAN COMPENSATION DECLARATION ram. FIXTURES PER TRA p'jy SCHOOL TAX Y N pgf hereby affirm that I have a mdlBcam of cc nwnt to sel6lneure,or a �+wy,^ RECEIPT M IflUbcfWOrkere Compensation Insurance or a certified copy lhereOffSco. GAS EA.SYSTEM.1 INC OUTLETS 1LW PARK FEE Y_ N_ 3o0,Lab CJ On M GAS EA.SYSPFAI-OVER4(EA) RECEIPCN Cam any '� BUILDING DIVISION FEES �ceruffid copy ereby tushed. CREASE/IN�USIRL WASTE INTERCEPTOR PLANCHECK FEE OCeri ied copy Is filed-Mth the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' CREAM TRAP PAID COMPENSATION INSURANCE SIs'WER.SANITARY-STORM EA.200FT. Date Recel t# (Thor I .on need mat ba completed)(the permit h re forone hundd dollen (5103)orlessJ WATER HEATER W/VENT/ELECTR ENERGY FEE Y N I certify that o the penamunce ofthework harmer fa as to b this permit h issued, — I orR nmemptyany person f any manneratesto become abject to the WATER SYSTEM/TREATING Worker Compensation Laws of California.Date PAID O Z ApplicaNOTICE - NEW RESIDENTIAL FILMS, SQ}T. Date Remf t# Z O NOTICEco become notes,after Workers' Compensation atel3of Pxamphe Lyou shouldou at awbtedtothe ply wit uchprovisions provhis permits Labor TOTAL: W y Code,you comply with each provlslonr or this permit shall be BUILDING j deemed rooked. FEE W C CONSTRUCTION LENDING AGENCY SEISMIC FEE Z IherebyafOrmlhat lhemhamrohuctlon lending agency for the per(Omn TOTAL; ELECTRIC FEB co 7 ante of the work for which this permit h Issued(Sec.3097,Civ.C.) Taff V O Iender'r Name PLUMBING FEE ..L LL ~ LeadereAddreas QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W IceAifythatl have read thidapplimtion and statethetlhe above Information ark[ hcorred.I agree to comply with allcityand rountyordlianwand state laws PERMIT ISSUANCE �eyp FEES PAID: } 0. relating to building construction,and hereby authodae representatives of this ^ I Z city to enter upon the abovcmentloned property for bxR spedlon purpoa. AUFORADDTOMECH. rr�t Lc�1 Date Recei t# V — (We)agree to save,Indemnify an d keep harmless the City of Cupertino against liabilities, main and expenses which may In anywayacnue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: ago hist said City In coneaquenm of the granting of this permit. AIR HANDLING UNIT(OVER 10,000 CIM) CONSTRUCTION TAX Signature Of Applicant/Contractor Data EXHAUST I IOOD(W/DICT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Wililheappli nt or future Wlldlegocopant store or handle hazardous HEATINGUNIT(TO100,0DOBT'll) Date ReCCf t# material as defined by the Cupertino Municipal Code,Chapler9.IZ and the Health and Safety Code Section 25532(a)? HEATING UNIT(OVER 100,010 BTUs TOTAL: F-1YesM No Will the applicant orfuWm building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) 9AWE DATE which sort hazardous air centaminanb se defined by the Bay Area Air y Q,J Quality Management District? BOILER-COMP OtN OR 100,0(10 BTU) M11.1�a U� I�Jv Yes ❑No tAx, V JV Ihave haza�ous matedala requirements under Chapter 6.95 of BOILER-COMP(OVER 100,D00 BT U) un i rnth I tis C ,McaSedt.rs25505 nt that I y �LIf9�Mlrgl Ihpq un land shat t ng mol arrcn aveat ant tbalithm NEW RESIDENTIAL MECH. e.QFf. e aP r roibility a ant of the Tremens och muss be root _ J nor to ix n rt eofO ry. nerorauthoriec agent ' Date TOTAL: ISSUED BY.� � .1� OFFICE COPY !ADDITIONAL PERMIT FEES BUILDING PROJECT I DENTI FICATION VALUATION BMIIDING AooREss OWNEPS 1 ��+ NAME `—�" FEE SUMMARY orvE croR NAME s _ BUILDING NAME PLAN CHECK rarvTRacroRs FEE AooREss PHONE SEISMIC FEE OTY. ELECTRIC PERMIT FEE —OUTLETS SWITCHES-RECEP ELECTRIC LIGHTING FIXTURES PPLIANCES-RESIDENTIAL - PLUMBING PANELS MECHANICAL 1�� SIGNS y� SIGNS TRANS. _ TOTAL ��• �s'3) SPECIAL CIRCUIT EMP.METER OR POLE INS. PERMIT VALIDATION MOTORS SEE FEE SCH. O SERVICE CHANGE z F ° TOTAL lnt �lQ itUF�T.I E W LU QTY. PLUMBING PERMIT FEE IUUANCE DATE BLLD�D SG1. ELECT. PLG, MECH. 2 ALTER-DRAIN&VENT-WATER(EA.) L�1' ❑ ❑ ©' C.J O BACK FLOW PROTECT.DEVICE O m DRAWS-FLOOR,ROOF,AREA,COND. } N FIXTURES-PER TRAP f- z GAS-EA.SYSTEM-I INC.4 OUTLETS r� O GAS-EA.SYSTEM-OVER 4(EA.) INDUSTRIAL WASTE INTER. - LAWN SPRINKLERS-1 INC 5 V.B. , rig Q LAWN SPRINKLERS-OVER 5 MA.1 ` !V SEWER-SANITARY-STORM EA.200t[/ WATER HEATER W/VENT WATER SYSTEM WATER TREATING EQUIP. TOTAL QTY. MECHANICAL PERMIT FEE ALTER OR ADD TO MECH. 11• APPLIANCE AIR HANDLING UNIT(TO 10p00CF.M) AIR HANDLING UNIT(OVER 10.13MC.FM.) EXHAUST HOOD(WITH DUCT) HEATING UNIT(TO 100,000 B.T.U.) HEATING UNIT(OVER 100,0008.T.U.) VENTILATION FAN(SINGLE) BOILER-COMP(3 H.P.Or 100,000 BOILER COMP(0-1 IM.000 BTU)SEE FEE scH. aI. TOTAL ? ��