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21889 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Address: a� (�n n son21889 eone: p A p IT CITY OF CUPERTINO-BUILDING DIVISION ^�rt 'q Name: APPLICATION I PERMIT 3 S� / ` -x BUfLDING-ELECMCALPLUMBING-MECH LAICAL CATEGORY CONTROL p rcMtect/Engl eer. QTY ELECTRICPERMIT FEE BUILDING PERMITINFO Address: - PERMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S pr DECLARATION Ihthb to0mnehatlaiv Rcrosedhe Bug errand mChapter9(commmc APPLIANCES-RESIDENTIAL JOB DFSCRErTION Ingwith5edlon7(100)of Divlslon3 ofthe Buslnessand Pm(eaalonaCode,and my ��2 license is In full((pp�E d onus or PANELS r d. Limnse ClaZj' , Lk.p 1 Date-zr_Q_t_ContnRor ( �ARCHITECT•SDE IA ATION 201.1000 AMPS rc0 Z I understand my plans shall he used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FI. CO 2 (0 Limned Professional SIGNS ELECTRICAL 6c. OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MLSC owing ream. that I CSctien xempt(roess. dm the Profctsion.0 ne:Law fort he followingreason.iresa e70115,Buelness and Profealona Cade:Any city or I"'t,9- auunrywhich rcqubesa pemdt toconstroct,alter,improve,demelbh,orrepair TFMP.METERORPOLEINSf. gg� .a anystructurc prforto its issuance also requirothe applicant for such permit to 1-" V file a signed statement that he is licensed pursuant to the provisions of the POWER DEVICES 3u, Contractor'.License Law(Chapter9(comumncingwith Section7000)of. Divi- SWIMMING POOL ELECTRIC sion3ofthe Bualneaand Pmf.ss .CWe)arthathebe.a ptthemfromand VALUATION the basis for the alleged exemption. Any violation of Section 7MLS by any « applicant fora permit subjects the applicant to a civil penalty niece more than OUTLEISSWIICHESFIXfURIS - e.py O five hundred dollars($SM. 0 ❑I,as owner of the property,or my employees with wages as their sole NEW RESIDENTIAL ELECTR SQFT. ES TYPE CONSTRUCTION N�< compensation,willelothe work andthe structure'.not intended or offered for Nor/ O sale(Sec.7046,Business and Professions Code:The Contractor's License Law �$.9 does not apply to an owner of property who builds or improves t hereon,and OCC.GROUP RFS.UNEfS who does such work himself or through his own employees,provided that such improvements are^cat Intended or offered for sale.If,however,the building or TOTAL: Improvement issold within oneyearofcompletlon,the owner-builder will have t rdcn of proving that he did not build or improve for purpose of sale.). QTY, PLUMBING PERMIT FEE IgAO mZ - ATN {as owner of the property,am exclusively contracting with licensed PERMITISSUANCE contactors to construct the project(Sec.7014,Business and Protealom Code: Mco The Contactor'.L1mnw Law dm nes apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) Wilds or Improves thereon,and who contracts for such pWiecta with a <gDt(actor(s)licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. B &P C for this reason Owner DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y_ N_ Date RECEIPT# WORKMAN COMPENSATION DECLARATION ❑1 hereby affirm that I have a certificate of consent to se -Inane,rn a FIXTURES PER TRA l 8xt� SC iOOL TAX Y N_ r' certl0mate o(Worken'Compensatton Insuranm aramrtifled apy(hereof(Sec. RECEIPT# 3800,Lab C.) GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N Policy# RECEIPT# Cam any GAS EA.SYSTEM-OVFR 4(EA) BUILDING DIVISIONFEEB Certified copy is M1ed with t ecity GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECK FEE Certified ropy b filed with the city inspection division. atted CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE la frn one hundred dollars SEWER-SANITARY-STORM EA 200FT Date Recei t# Rhlsaction need nu be crnnpinted lithe perMl ($100)orina.) WATER HEATER W/VENT/ELECTR ENERCYFEE Y N Performancerti(ythat in the Performance of the work fee whkhthis permit is Lsaed, N— I shall nes employ any person in any manner a m as to become subject to the WATER SYSTEM/TREATING Worker'Compensation laws of CaliforaW.Date PAID O Z Applicant Z O NOTICE TO APPLICANT:If,afor making l his Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQ,Fr. Date Recel t# should become subject to the Workers'Compessation provisions of the Labor TOTAL: N Code,you most forthwith comply with such provisions mthis permit shall he W > dee^,ed rev^kad. BUIL12ING FE d f] CONSTRUCTION LENDING AGENCY SEISMIC FEE I herebyalflrm that there is a contraction lending agency for the perform, 7 Z anceof the workfor which this permit is issued(Sec 3097,Civ.C.) TOTAL. ELECTRIC FEE V O Leader'.Nan¢ QTY. MECHANICAL PERMIT PEE PLUMBING FEE O\W LL h I.enae:apaarea MECHANICAL FEE O W Icertifythat l have read thsapplkattonand nate thattheabove information 1 Iscerenct.I agree to comply with all city and countyordinancesand gate taws PERMIT ISSUANCE FEES PAID: >. N relating to building construction,and hereby authorise representatives of this Z city to enter upon the abovo-nientioned property for Inspection purposes. ALMORADDTOMECH. (We)agree to ave,Ind courtly an d keep harmless the City of Cu pertlno Date Receipt# 4agalngl�bdfflea,judgments,costa and expenses which may In any way accrue ATR HANDLING UNIT(TO I QOOO CFM) SUBTOTAL:in conseque oflhe grant Ing of this permit.- AIR HANDLING UNIT(OVER 10,000 CIM) CONSTRUCJ'IONTAX B Contract^ pate EXHAUST HOOD M/DUCT) CONSTRUCTION TAX PAID: H DO ERIALS DISCLOSURE ese r future building occupant store or handle havardous HEATING UNIT(TO 10))000 BTT) material as defined by the Cupertino Municipal Code,Chapter 9.12,and the _ Date ReceI t# Ilea lth and Safety Code Section 25532(x)7HEATING UMT(OVER I W,000 BTU) 0 r] Y. �J Na TOTAL: Will theSppllcant or fRture building part use equipment ordevims VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE which emit havrdous air contaminants as defined by the Bay Area Air Quality Management District? BOILER-COMP OtIP OR 100,0())BTU) L''rl.sE✓ 71 Yes n No havereadthAh r�oua materials requirements under Chapter&95 of IKIILER-COMP(OVER 100,000 BTI) 10 the California fiealth&Safety Code,Sections 75505,25533 and 25534.1 I Irl T\ a lY � understand that lithe building does not currently have a tenant,that It is my NEW RESIDENTIAL MECH. SQ,FT, Y responsibility to sunce faeheicte of of the uparcyulrcmenh which must be nal dor to issuance of really the- to of Occupancy. Owner or authorized agent Date ISSUED BY: L TOTAL: OFFICE COPY