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23908 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Project IdentificationPERMIT NO. Building0 j, 70 N( 23908 Te 2 —760% A CITY OF CUPERTIN46UILDING DIVISION �_ D Coptpc3pry,N�(, G" No- 9 APPLICATION / PERMIT Architect/Engiireeeer. Lit.No: BUILDINGELECTRICA4I'LIMBINGMECFUMCAL CATFLORY CONTROL X QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address PERMTISSUANCE ❑ 1:1 El CONTRACTOR'S DECLARATION I hereby Sectioaffirm that lamlken3ofthe usineprovisions andP ffesk=sr9de,and c- APPLIANCESRESIDEMTAL JON DESCRB'TION irenseISection force and effeon3ofthe Bualnessand Prolcaslone Code,and my license Is Ins force and cited. PANELS License Cha Lich Date Gantmdar ARCHITECTSDECLARATION 00 AMPS �Z 1 understand my plans shall W used as public records OVEROVER 1000 AMPS SQ.FT.FLOOR AREA SISQ.F[. CO d(� Licensed Prol.lonal SIGNSELECTWCAL Q w OWNER-BUILDER DECLARATION res a Fn SPECIAL CII(CUIT/MLSC Thereby affirm that lam exempt fromthe Contractor's License law for the oo following reason.(Sectlun 7NIS,Business and Professions Code:Any city or �,zl"' cauntywhichrNulresapem trommtmM, te,lmprov demolbh,orrepair T�PME7ER OR TOLE INST. anystmc mpMrtoi SE ancgataorequirestheappBcantforsuchper tto POWER DEVICES K U file a signed statement that he is licensed pursuant to the previsions of the Contractor's License]aw(Chapter9(commencingwith Section 7000)of Did. SWIMMING POOL ELECTRIC VALUq,'LOSJ O slon3ofthe Businessland ProfmlomC.de)ortbathebexem thercfmmand (rQ Qthe bash for the alleged exemption. Any violation of Section 70FIS by any OUTLETSSWITCHES-FIX1URES L an <� applicant fora permit subjects the applicant to a civil penalty of nal morethan a+� 2-0. dreddolla1t$h ). NEW RESIDENTIAL ELECTR SQ.Ff. STORIES TYPE CONSTRUCTION Z Las owner of the property,or my employees with wage as their sok p atlan,wBldothe work and thestmcture b not intended or offered for $ k(Fee 70$X,Bmineas and Profmlons Cade:The Contractors Untrue law �s$ don not apply to an owner of property who Wilds or improves therms,ano. d OCC.GROUIa RFS.UNITSwhodoessuchwarkhimxlforth=ghhisownemploym providedthatsuch Improvements are not intended proffered for sale.If,however,the building or TOTAL: Improvement bsold withinoneyearofcomple im,theowner-builderwill have t"eden of proving that he did me Wild or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLODDTDNE APN LJ L as owner of the property,am exclusively contracting with licensed pRMIT ISSUANCE l• contractors to construct the project(Sec 7M4,Business and Profmbw Code: The Contractor's License law does not apply to an owner of property who Wilds or Improves thereon, and who contracts for such pPinots with a ALTER-DRAIN&VENT- WATER(EA) cgp[+dods)licensed pursuant to the Contractors License Law. FEE SUMMARY 1_j 1 am exempt under Sec. B At P C for this reason BACK FLOW PROTECT.DEVICEOUTSIDE FEES DRAINSFLOOK ,AREA,CONE). SANITARY Y_ N_ Owner Date RECEIPT If WORKMAN COMPENSATION DECLARATIONFIXTURES-PER SCIdOOL TAX Y_ N ❑1 hereby affirm that I have a certificate of consent to self-Insure,or RECEIPT N mKificusofWorkers Compensation Insurance ora.milled copy thereof 6ec. GAS EA.SYSTEM-1 INCX PARK FEE Y_ N_ 3800,lab C.) RECEIPT X Policy# CAS EA.SYSTEM-OVER EA) Com any BUILDING DIVISION FEES Certified copy In hereby furnished. PLANCHECK FEE ❑Certsed copy is Bled with the city Inspection division. GREASE/WDUSIRL WA RC TOR CERTIFICATE:OF EXEMITION FROM WORKERS' CREASE TRAP PAID COMPENSATIONINSURANCE SEWER.SANITARY-STORM EA. Date Recei t# (TMs section need not be completed litho permit b far oK hundred dollen ($100).'1..) WATER HFATERW/VENT/ELFJCTR ENERGY FEE Y_ N_ 1 certify that In the perfornunceof the work forwhich this penult is Weed, 1 shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING Workers Compensation Laws of California.Date PAID O Z Applicant NEW RESIDENTIAL PLMB. SQFT. Date Reeef t# Z O come NOTICETO APPLICANT:If,after making this Certificateof Exemptionyou should besubject to the Workers'Compensation provisions of the Labor TOTAL'lip CC W Code,you moat forthwith comply with such provisions or this permit shall be BUILDING FEE deemed revoked. W CONSTRUCTION LENDING AGENCY SEISMIC FEE 1 C Iherebyaf@.that there is a corotmction lendingagency forthe perform- ELECTRIC FEE M Z ante of the work for which this permit is Wued(Sec.3097,Civ.Q TOTAL: O O Lender.Name PLUMBING FEE f I.ender's Address QTY. MECHANICAL PERMIT FEE LL U Icenifythat l have read thkapplication and statethat the above information MECHANICAL FEE 0 W boomed.I agreeto comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID: } C relating to Wilding oomtmction,and hereby authodo,representatives of this F Z city to enter upon the above-mentioned property for Inspection purposes. ALTERORADDTOMECH. BVe)agee t.save,indemnify a.d ke harmim me City.(Cupertino Date Receipt# Z5 ilia nts,00stsand pe nes whidsmayina.ywayseems AIR HANDLING UNIT(TO Ift"CFM) SUBTOTAL: a of tingofthispemmlt. .a/ AIRHANDUNGUNFT(OVFAIO,000CFM) CONSTRUCTION TAX cpntraddr ate E%FIAUS'T HOOD M/DUCT) CONSTRUCTION TAX PAID: RDOUS 'RIALS DISCLOSURE 'future buildingoaupant store or hand le havardous HEATING UNIT 100,000 B'N) ReCei t material as defined by the Cupertino Municipal Code,Chapter 9.12,and thetit ❑ealth and Safety Code Sedim 25532(a)? HEATING UNIT(OVER 100,000 BTU) TOTA : ❑Yrs r]No WIII the applicant or future occupantVENTILATION EAN(SINCLE RFSID)building opant use equipment or devices ISSUANCE DATE which emit haaa rdoos air contamim rats as defined by the Bay Area Air Qu a lity Management District? BOILER-COMP(311P OR 100,0M BTU) ' 4F� Y's F❑� a havereadthebaza oNmaterials mquirementsunder Cha pier 6.95of BOILE .�R-COMP(OVERIM,000 BTU) 4 �® the Califomla Health&Safety CWe.Sedions 25505,25533 and 2S53X. I understand that if the building don nm mrrently have a tenant,that It is my NEW RESIDENTIAL MECFL SQIT Ex"//� mg(7 pHi omity to notify the occupant of the requirements uirees which must be net V prior to Issuance of a Certificate of Occupancy. co? ` 0 , as/l`'r.'X7/`�/\ _ l r s7C` Owner or authorised agent Date TOTAL: ISSUEDBY: �T/ ..� OFFICE COPY