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24546 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELLC FRIC,AI. PERMIT NO. PLUMBING MECHANICAL BUILDING APPLICATION/PERMIT BUILDING PR(.Rcr IDEN1'IFICA'1'[ON 24546_ BUILDING A/D/DR�SS. SANITARY NO. APPLICATION SUBMITFAL DATE s Z�( 5-re 03>6pe— LI`+ UNIT# LOT# OWNERS NAME:� O� ^` NF0.15 CONTRACT R'S NAMB: NG 'f ll. C/ N/C CONTROL# ARC[IFFECV,f_ENGINEER: LIC NO ADD R S: "I G ❑ CONTACT: PHONE: BUILDING PERMIT INFO QTY. BLF;CTRIC PERMIT FEC L HLE PLU MHCH PERMIT ISSUANCE � LI SED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL BDfSCR DON ❑mZ Iherehy arumthat lam iiaJ nwunderproviiinniofardw9(eommtncing with +P002 Seeflim70B,d Division 3uf the Business and Professions Code,and my license es in PANELS NtOdM jl2e-to Pet /N 5710-G^ full Rmca5;61== A effect or J aZy`j License Class Lic.# IP70 UP102MAMPsF.4.Co75— oF 4 y Do¢ �,t�Comment, (+ 201-F000 A ZOy�' ARCHITECIPS DECLARATION OVER 1000 MP SQ.M'.FLOOR AREA $/SQ.FI'. OZ—Q IundcrstandmypLms shall heated as public records. �! Ern Fpm SIGNS ELI: TRC I. ,YS g¢YL, Licensed Pmfesxiand is rX y,rt� OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. �xx'0aF 1 hereby affimr that 1 em exempt from the Commetors License Law for the W5t billowing reason l Seuion]031.5,Business and Professions C:xle:Any city or county TF,M'.METER S 41 F-1 0¢ which requires a permit w construct,alcor,improve,demolish,or repair any stmcwrc WNSE to its issuance,Win the applicant for such t to file a send statement POWER DEVICES 1trr�E prior quirts pP tenni g pjK�p that Fencing proton provisionsnfthe Contractor's License Law(Chapter odid 9(commencing with Section OlNq)ofDivisionJofthe Business and Professions Code) SWIMMING POOL ELECTRIC � VAhUA9'ION W—m or that he is exempt therefrom and the basis for the alleged exemption.Any violation of OUT LETS-SWI'I'CI LBS-FIXTURES FZ_a Section 703 IS by any applicant for a permit subjects the applicunnoucivil penapy of aQ"f jU not marc than five hundred dollars($50% NEW RESIUF.NTIAL F.LECfiI S .FF. ✓ ❑ I,nsowncrnOheproptrry,nrmyemployeeawitb wugesas Neiranlccompcnsotion, Q STORIES TYPE CONSTRUCTION will do the work,and the structure isnot intended orofferad fortele(Sex.]044,13woress and Professions Code:The Corrosion's License Law docs not apply w an owner of propeny whobuilds orimproves thereon,and whodoes network himselfor throughhis DEC.GROUP Ell ownemployces,pmvidedthanucbimpmv mentsarcnotintendaAorolemdforsale.If, however,the bulldingor improvement is sold within one yew of completion Na owner- builder will have the burden of proving that he did not build or improve for purpose of TOA , salt.). ❑ I,as owneroftheproperty,cmexclusively Contracting with licensed contractors to QTY. PLUMBING PERMIT FEE FLOOD20NE answer the pmjea(Sec.7044,Business and Professions Code:)The mu Cmnori License hawdoesnm applym an ownerofpmpeny who builds orimprnva Ner<on,andPI7RMIT ISSUANCE who contracts bersuch projects with ecnmraun(s)licensed parsuanuo the Contractor'a ALTER r License Law. FEL,SUMMARY ❑ 1 ata axunpt undor Sec. p&P C for this reason BACK PLOW PRO'I'F.Cf.DEVICE O TSID: BS SANITARY Y N • Owner Data'1'1RECf:11Tp DRAINS.FLOOR,ROOF,AREA,COND. WORKMAN COMPI?NSA0N DECLARATION SCHOOLTAX VN ❑ I hereby affirm that i have a certificate ofconecn to wlf-hour,or a certificate of FIXTURES-PER TRAP RHC1i1P1'N Worken'Compeneatlno Insurance oracetifiedcopy Nenad(Sec.JgIXl,Lab CJ which PARK FEE Y N ers all employee's under this pewit. GAS-EA.SYSTEM-i INC. OUTLETS RECIBPT# Policy# BUILDING DIVISION FEES Company GAS-EA.SYSTI?M-OVIiR 4(I:A) PLANCHLCK ME". Certified copy ishereby fumishW. ❑ CenifieA vopy ie Bled witM1 the city inspeainn division. GRGASMNDUSTIRL WASTE.INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION MOM WORKERS GREASETRAP SOILS PEI? COMPENSATION INSURANCE Obissectian need not be enmplmWifNe permit is foronchundrtd do1lars($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE or Ices.) leedify,that in the perfnwance wife work for which this .it is issued.I shall WATER I WATER W/VENT/ELFCI'R not employ any person in any manner so t me subject to the WorkerPAID Compensation hu do WATER SYSTEM/IREATING Date Reccipt# Q Z Applicant z 0 NOTICE TO APPLIC/pOl.If.afkT1701fig+Ms Cenificare of Exemption,you should NEW REST DwITAL PI-NIB. SQ.PIT. TOTAL: CA become subject to the Workers Compensation provisions of the Labor Code,you must fonhwiN comply with such provisions or this permit shall be deemed revoked. BUILDING FEE I� C Q CONSTRUCTION LENDING AGENCY SEISMIC IEE z I hereby affirm that them is a construction lending agency fnflic performance of T L. ELECTRIC FEE the work for which this Permit is issued(Sec.3N7,Civ.CJ Lenders Name ' PLUMBING HE 0 U Isndcrs Address N/r QTY. MECIIANICALPERMIT FEE I� L) I ceniiy Nit 1 have mad this appiireion and state that the above infwtwtion is coned.lwgreehicaredywithwllcityandcounty oniinwces end sum laws rtlating to PERMITISSUANCE MECHANICAL THE building construction,and hereby authorize representatives ofthis city menta upon the CONSTRUCTION TAX V Z above-mentioned propeny for inspection purposes. ACI'ER OR ADD TO MECH. (We)agree to save,indemnify and keep hemtless the City of Cupertino against liabilities,judgments,etas smalexpenses which may in any way accrue awristsnid City AIR HANDLING UNIT CFO 10,000 CFM) Incnsenueno cef trend of Nis bit. o AIR HANDLING UNIT(OVER 10,000 CFM) J atom of o rat Dam EXHAUST HOOD(W/DUC) PAID HAI /USM IALSDISCLOSURE I IIATINGUNITJO 100,000 BTU) Data Reccipt# Will the app a r forum building occupant store on handle hazardous material as defined by Ne Capetian Municipal Cade,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100,000 BTU) TOT Code,Section 25532(0)? 11 Yes 13 No VENTILATION FAN(SINGLE RESID) 11, ch • Will air eo iwelar 1,as building by the nBay Are.Air aMvicaanagement BOILER-COME'C3HP OR 100,00B BTID ISSUANCE,DATE hazardous air nmrvminums as defined by the Bay Areu Air Quality Management BOILER-COMI'(OVIiR strict? 100,007,BTU) `{f p W p Di ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT. I have read the hazardous mammas requirements undo Chapter 6.95 of he ®EC 3 California Health&Safety Code,Sections 25505,25533 and 25534. 1 undersand that ifthe building fres not currently have a brawn,that it is my responsibility tonotify the ��� is occupant of the rrquirmank,which..at be at prior m issuance of a Cenifcate of Gtcapaaey. ► yr Gu, - v Owner or authuriud agent - Date TOTAL: ISSUED BY: OFFICE