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20430 (2) x APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY u Building Project Identification PERMITNO. BuRding Addrea,:vs 20430 one: A CITY OF CUPERTINO-BUILDING DIVISION IraNaVIP-me: L . oeAPPLICATION / PERMIT _ "U.J BUILDINGELBCTRICAL-PLUMBINC MECHANICAL CATEGORY CONTROL N rchitect/Engineer: Lic.No ger r'I ' `QTv, tEIECT ",) rcr. ' ' „'_,�? jBUILDINGPERMIT:INFO'- ° i` '1 ' RIC PERMIT ' � � i PEG PFRMITISSUANCE .❑ El CONTRACTOR'S DECIA ATION ]hereby affirmthat l am licensed under provisionaof Ch.pter9(omm.c. APPUANCESRESIDENITAL J BDESCRRTION Ingwlth Se on7000)OfDlvirion3ofthe Businesaand ProfeaslonaCode,andmy - - lioudeb;n knocandeffect PANELS Llcen l sat LIr.N 2 n O Date Lt.t our J '�J ARCHITECT'S DECLARATION 201-I0OOAMPS 00 I understand my plana shall be used sat public records. OVERIOOOAMPS .. SQ.IT.FLOOR AREA $/SQ.FT. U0' Licensed ProfemlanSl •' SIGNS ELECTRICAL 6 - OWNER•BUILDER DECLARATION' SI'ECIALCIRCUIT/MISC a^ G Ihereby affirm that Iamexempt fromthe Contmctor's Licenselwforthe 700.. following reason.(Sealon7R115,Busberoand Professions Code:Any city or p4 countywhich rnqulmo a permit W ounsouct,alter,Impmee,denaelbTEMP.M17Et ORIOLE]NSI'. h,or repair ' OOVanystructure primir,Its lawance,also requireethe appliantforsuch permitlo POWER DEVICES a U file a signed statement that he b Licensed pursuant to the pmvblom of the 3�G Contractor's License Law(Chapter 9(mmmeneing with Section 7000)of Diel- SWIMMING POOL ELECTRIC 5 sloo3 of the Business end Podenlons Cod¢)Orthat he b exempt therefromand VALUATION the basis for the alleged exemption, Any violation of Section 70315 by any GL>_ applicant fora permit subjects the applicant to a civil penalty Of OUTLETS-SWITCHES-FIXTURES not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sok NEW RESIDENTIAL ELFCTR Fr. STORIES TYPE CONSTRUCTION 7a- compensation,will dothe work and thestruturc b not Intended or offend for O We(Sec 7044,goal..and Professime,Code:The Contractors License Law does not apply to an owner of property who Wilds or improve thereon,and _. OCC.GROUP RF5.UNITS 'who doeasuch work hlmrelf orthrough hls own employee,,provided that such Impmvements am mt lntendea oroffered formle.IL however thebulldleg or TOTAL: Improvement lssold wilhinoneyearofcompinuor,the owner-bullderwlll have the burden of proving that he did not build or Improve for purpose of sale.). QTy, ", IPLW13(NG'PERMIT, I 'ti FEE '" FLOODZDNE APN LJ L as owner of the property,am exclusively contracting with licensed PERMR ISSUANCE rontmcton to censtrvt the project(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who gL7IIt DRAIN&VENT-WATER(FA) Wilds or Improves thereon, and who contracts fee such ptokts with a e ator(e)Imemind pursuaec.nt te,the Contraire.License Law. — t ,Li.,•,,' FEE,SUMMARY I_J I am exempt under SB k P C for this reason BACK FLOW PROTECT.DEVICE Owner - DRAINS-FLOOR ROOFS AREA,COND. SANITARY Y .N� - Date RECIEPT N WORKMAN COMPENSATION DECLARATION p0(TURES PER TRAP SCHOOLTAX Y N ereby affirm that I have a certt(late of on to self-ineurc,ora RIiCFJPf M ifiate of WOrken'Compeusationlreuranceora certified ropythemof(Sec. GAS BA SYSI'EMIINC.40UTLEfS PARK FEE Y N 800,fab CJ - Policy N RDC M=N Com any - GAS EA.SYSTBM-OVER4(EA) - BUILDING DIVISION FEES Certified copy is heed withfurnished,tcity GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE nullified copy b filed with the tlty Inspection division. a CERTIFICATE OFIO(EMPTION FROM WORKERS' CRFASETRAP .PAID COMPENSATIONoINSURANCE SEWER-SANTfARY-STORM EA 200Ff Date Recel tH r (fhb section bOromp]tN need not pltithe permit b farovs hundred dollars (f100)offy that work WATER HEATER W/VENT/FLECTR ENERGY FEE Y N ]certify that Uthe performance of tAewmklarwMch this pemNtla bared, — I shall not employ any person In any manner an as to become subject to the WATER SYSTEM/TR1iATING . Wmkue Compensation Lawsof Califomla.Date PAID C• Z Applicant Z U NOTICE TO APPLICANT:If,after making this Certificate of Feemptlon,you NEW RESIDENTIAL PLMB._SQFf. Date Reeei tN Fshould beromesubjet to the Workers'Compensation provblons=LaborCC TOTAL: W Code,you must forthwith comply with such proWlOru orthb permitshallbe BUILDING a. W ] deemed Invoked. - CL G CONSTRUCTION LENDING AGENCY SEISMIC FEE I henbya(flrmthat there lata mnstrurtion lending ag Of for the petomm TOTAL: ELECTRIC FEE Z ante ofthe work forwhichthe,permit b Issued(Sec.3097,CIv,C.) (.) 2 Lentler:Nam PLUMBING FEE LL Lender'.Adder. QTY. , MECHANICAL.PERMIT'',, ', FEE, , MECHANICAL FEE U I retilfythat l have road thisappliationand tlnt¢thattheabove in(ormotem - W. bcormt.I agree to complywlth all city and county ordinances and slate laws PERMIT ISSUANCE FEES PAID: } V) relating to building construction,and hereby authorize rep sentatives ofthis - ?0 city to enter upon thea ex.menti p rtyforl Ion purposes. ALTER OR ADDTOMILH. - - (We)ogre¢to ve ndemni an dl harmi the City ol,Cu pertlno Date ReceipNl _ (.I against llablWl d menti, sande nsea ch may In anyway acrzu¢ AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: against Bald '¢ re it antis this permit. AIR HANDLING UNIT(OVER 10,000 CEN) CONSTRUCTION TAX . ig turn dAppiiant/Contractor Date EHAUSTHOOD(W/DUCT) 'CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous TREATING UMT(TO100,000BTU) Dat RCCCI tN material as defined by the Cupertino Municipal Code,Chapter 9.12,and the - Health and Safety Code�u+.�Setion2S532(a)7 BEATING UNIT 100,000 BTU) -TOTAL; •� Yea fis NO - ' Willi the hamolntor tum building occupant by theequipernotArear davits VBNHIA770N FAN(SINGLE RBsID) ISSUANCE DATE hfch emithaement air contaminants as defined by the Bay Area Air IBJ Illy Management Dist BOILER-COMP p]B'ORIOO,IXp BTIn �Li�Y¢a ❑No }�� Ihyesmadthe hazardous materials requirements underChapter6.95 Of BOILER-COMP(OVER 100,0(0 BN) ciI of rUJJPrtjnry the Cailfornia licalth $a! Code,Section 25537 an 25534.1 - - ..,,v� untlemmnd that i( but ng dose menti asses nL that ltbmy NEW RESIUF1J77AL MGCH. SQ.IR. - .. ropowibllity to Ify eoccupan them hfch must be nuM prior lO sears fa rtlflcate co ,, ' r thorized agent - Date - TOTAL: ISSUED _ OFFICE COPY