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19922 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. B.1klmg Adders.: _ - eleT 19922 Lnere, arse: Phone: ��/J-'''J�f'�•1'�']� 5 OSS CITY OF CUPERTINO-BUILDING DIVISION c°"aeon a or'eName: Lm.No: APPLICATION / PERMIT ^ -0- 0 D SG PL 'BUfLDINGELECTRICALPLUMBING-MECILANICAL CATTS-ARY - CONTROLS Architect/Engineer. Lie.No: 'QTY t� 'ELECTRIC PERMIT "FEE [BUILDING PERMIT'INFO o ' Addreos: s PERMITISSUANCEi f� ❑ LICENSED CONTRACTOR'S DECLARATION - LJ I hereby affimthat I am licensed under provisions of Chapter9(commenc- APPUANCESRESIDENTIAL - I JOB DESCKB'TION Ingwlth Sectmr7eW1of Divlslon3 olthe Buslnessand Profeas ns Code,andmy ' license l (orceand effect ' PANUS . License Chus Class Lica - - Date Contractor ARCHITECT'S DECLARATION -211-1000AMPS - fx]- I understand my plans shall be used as public rvnnls. OVFRIOOOAMPS\ SQ.FT.FLOOR AREA S/SQ.FT. 00. z�j Licensed Profeasional - SIGNS ELFFCTRICAL 6�" OWNER-BUILDER DECLARATION SPECIALCIRC / Y Ihereby affirm that l am exempt from the Contractor's license Law for the q following mason.(Section 7011.5,Business and Professions Code:An cit or qq \ .atM F I'�y countywhichrequiresaper dommtmd,alter.impmve,dennlbh,orrepair P.M POLE INST. , `'q 7¢ anystructure peter to Be agence,alsomq.i.theappllcant fm,sarh permit to �"'I' rNL U file a signed statement that he b licensed pursuant to the provisions of the WER DEVI CRU Contractors License Law(Chapter9(comci menng with Section 7000)of Dtvl- .. .1110 xn s 30 slon3 of the Business and Professlora Code)crthat he is exempttherefromand MING POOLELECTRIC _ VALUATION the bash for the alleged exemption. Any violation of Section 7031.5 by any " >tis v✓'+ �' h �A^�G• applicant fora permit subjectsthe applicant to a civil penalty of cad more than EIFSWITCHvs IgXIgES tq; (iyel,as owner of pr). RESIDENTIAL ELEC osPBQ.FT, STORIES 7' MCONSTRUCTION R° 6R'c I,act owner of the property,or my employees with wages as their sole mpensation,wWdothew.ak,.cd thestrocture Is not Intended or offered for 5 0ulu(Sec.7014 Business and Profession Cade:The Contractor's License Law V ' $ does not apply to an owner of property who builds or Improves thereon,and I who doessuchworkhlmselforth.gh hisown employees,provided that®ch OCC.GROUP RIS.UNITS, Improvements are not Intended oroffered for sale.If,however thebuilding or TOTAL: provementlesoldwithinoneyearofcompletlon,theowner-builderwlll have Xeden of proving that he did not build or improve for purpose of sale.). Qi`Y. i,. PLUMBINGP &MIT ' t �' rEEt" FIADD ZONE. APN L as owner of the peopeny,am exclusively contracting with licensed o✓•1 ctors to constructct the project(Sec.7044,Business and Professions PERMIT ISSUANCE Code: The Contractors License Law does net apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) - builds or Improve thereon, and who contracts for sucti p(a)ects with a offactor(a)Bernard pursuant to the Contractor's License Law. - `, FEE SUMMARY 1=1 am exempt under Sec. B&P C for this reason BACK FLAW PROTECT.DEVICE Owner Data DRAINSFLOORROOF,AREA,COND. SANITARY Y N RECEIPT M / WORKMAN COMPENSATION DECLARATION FIXTURES.PER TRAP • SCHOOLTAX Y N ❑f hereby alarm that I have'. lmumne of consent to opytnersi ora RECEIPT M mNflab ofWorkers'Compevatlonlnauranceoramrtl(led ropythereof(5ec. / GAS EA SYSTFMI INCA � PARK FEE Y N Pol3800,his C.) I a Com N RECGAS F.A.SYSTEM-OVER 4(FA) DING DI'p a"y BUILDING DIVISION FRES Certified copy b hereby th the city GREASE/INDUSTRL WASTE INTERCEPTOR - PLANC14ECK FEE Certified ropy I,filed with the city Inspection division:, , CERTIFICATE OF EXEMPTION FRO MWORKERS' GRFASETRAP PAID Cos PATIONINSURANCE SEWFR.SANITARY-STORM EA.200FT. - Date RCCCi t# (TMs section need nos be com compiMed If tM permit is(or one hundred tlollem (41 I0)orfm3 WATER HEATER W/VENT/ELECTR ENERGYFEE Y N [certify thatoy an perf on nce inan thewoek for whic,to become permit issublec booed, I shall rV employ any person In any manner at as to bcceme wbject to the WATER SYSTEM/TREATING Workera'Compensation laws of California. Date - PAID - O Z Applicant - _Z O NOTICE TO APPLICANT:[(after king this Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQb7, Date Recei t# ~ should became sub)ect to the Workers'Compensation provisions of the Labor TOTAL:W Code,you must forthwith comply withsuch provisions orthb permit shall be »•� 'W > domed revoked. d C CONSTRUCTION LENDING AGENCY BUILDING FEESEISMIC PEE a -a I hereby afirrnthat there h a romtruction lending agency for the perfornF TOTAL: ELECTRIC FEE O once of the warkforwhich this permitls issued(Sec.3097,CIv.CJ (� Lender's Nafre_ _.A./OCL - 1 , PLUMBING FEE LL ~ Lenders Atldress_ - QTY. , MECHANICAL'PERMIT , 'FEE. MECHANICAL FEE O W ImrtBythmlhav<readthbappliratlonand otatethattheabovelnformitlon d Is correct.l agree to comply with all cityand county ordinances and state laws PERMTTISSUANCE FEES PAID: N relating to building construction,and hereby authorize representatives ofthis rity to entero caths above-mentioned property for inspection purposes. ALTERORADDTOMECH. V — (We)a save,Indemnify an d keep harmless the City of Cup,nle. - Date Receipt# agaimtlla lit. ,NdRr' ate d 1preseswhichmsyinanywayaceme AIR HANDLING UNIT(TO 10,000CFM)- SUBTOTAL: aga Wt.1 yin cons t e t a sting of this permit. Zd� AIRHANDL4NG UNIT(OVER H ffl0CEM) CONSTRUCTION TAX Signature of Ap cant/Contractor ID,ta EKHAIIs'r HOOD(W/DUCT) - CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Willthe applicant°rfutum building occupant store orhandle hazardobs' HEATING UNIT(TO 100,000 BN) Date ReCei t# materUl as defined by the Cupertino M.Mdp.l Code,Chapter 9.18,and the - Heahhand Safety Cod"71e��_SIection 25532(.)1 HEATING UNIT(OVER tail"BTU) OTAL: . 7L ❑ Yes bM No ma —TOTAL: the'applirant mrc building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) CE DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? BOILER-COMP(3IE'OR 100,000 BT[n 4 Yen ��}}��o haveread the alth&k�ta matertabrequirementsundee Chapter 4. I of BOILER-COMP(OV IR 100,000 BTU[ the erataneniallifthebSafetyCode,Satlora 75505,25533 and 25534. 1 understan at ltthebuildin doesnotcuerenllyhave a meanpthatlllsmy NEW RESIDENTIAL MECLL SQ.Fr caporal natlfyth to he qulrcmentswhich must be met - prior to ce of a Ce t • '• „JJ < l(,(L,IJ .n Owner.r..thad4fidagent Dae ISSUEDBY: y�VT�as`a TOTAL:' OFFICE COPY