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24367 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building AddreBssuilding Project Identification - PERMIT NO. z�Z� sLc, 2.4367 . where me. - hone: A A . CITY OF CUPERTINO-BUILDING,DIVISION c.no-a ops ams _ LIc.No: APPLICATION / PERMIT 4 `2 W L BMLDINGELFCnUCALPLUMBINGMECHAMCAL CAiFLORY CONTROL a' Arch ect/ gi r. Lic.No: ,�,.,,°'I'1• .,'• 1 "'9 1�" - )• ',`,!j�'BUILDING PERMIT INFO. ? QTY I . ',ELECTRIC PERMIT Address: '. ' < r I'f7iMIT ISSUANCE '�s� El a " ❑ ❑ LICENSED CONTRACTOR'S DECUBATION I hereby affirm that lam licensed under provisions of Chapter9(<ommmc- MPLIANCESRF.SIDENfIAl ����pppOB�PSC ON IngwlthSelon7000)of Dlvision3oftheBusinrmand PmfesslonaCede,andmy - f.;M OW- Iicense la in f cit force and effrct. PANELS ' t��,,aa��j„ I HT1 License Clam Lica Dale Contractor - ARCHITECTS DECLARATION 201-1000 AMPS Ob I understand my plans shall be used as public mounds. OVER IOW AMPS SQ.Fr.FLOOR AREA $/SQ.FT. k Licensed Professional '• SIGNS ELECTRICALi << © s OWNER-BUILDER DECLARATION SPFCIALClRCUFT/MISC �m, ' "� following reason. tMtlam31.5,B(ro Business Professions Code:Any for he } , V ppp county hick reuiresa ermittoccalnemand Pmprove, Code:Any dtyor F +" anystm=mreortoiapea=t aomquialter, aplientfrsuchper ttlr TEMP.METER ORI'OI.E INST. '� any ahuRure statement Cut he is;Lica sed pursuant t the rovial nst of the 4 R, g POWER DEVICES L5 O a -Rica signed statement that he h Licensed pursuant the pon 7000) of the Q6 II-� Contractor's Licenseuenft ..d Pr-apter.(mmmencing thathe withS mFrtthem(ot and SWIMMING POOL ELECTRIC, BOJ slon3o(the Bualnnsand Pro(emlamCode)orthat hehexempttherefromand TION Sn•77 the bash for the alleged exemption. Any violation of Semon 7031.5 by any <� OUTLETSSWITCHISFIXTURES appLunt for a permit subjecd the applicant to a civil penalty of not morethan five hundred dollars($500), - NEWRESIDENTIALELECTR - " o �n ❑I,as owner of the property,or my employees with wages as their sale SQ.Irf. STORIESTYPR CONSTRUCTION cempenmthm willdo the work,and thestructure b not Intended or offered for O sale(Sec.7044,Business and Professions Code:The CmdraRors License Law $ does not apply to an owner of property who builds or improves thereon,and EEE who doessuchworkhlmseQorthrough hisownemployees,provided that such OCC.GROUT' RES.UNITS Improvements arc not Intended or offered for sale.If,however,the buildings Improvement is sold within one yea ro(completion,the owner-builder will have t4Rkurd on ofproving that he did not baud or Improve for purpose of sale.). QTY, �'a �r t'PLUMBINGARMIT ,'') I ''t,' FEEij• FLOOD TANS APN "L as owner of the property,am exclusively contracting with licensed contract..to roretrun the project(See.7044,Beeduessand Profesame;Code: PERMIT ISSUANCE ' TM Contractor's License law does nat apply to an owner of property who ALTER-DRAIN kVENT-WATER(G) Wilds ordmpre ss thereon,and who contracts for such ptojeab with a do 6)Located pursuant to the Commerce's License Law. `t '''t„FEE'SUMMARY' LI I am exempt under Sec. B k P C for this reason BACK FLOW PROTECT.DEVICE DRAINS FLOG ROOF, SANITARY Y NE I LES ' Owner Date R AREA,GOND. OUTRECESITN WORKMAN COMPENSATION DECLARATION MTURF_S PER TRAP SCI100L 7'AX Y_ N ❑I hereby affirm that I have a certlRota of consent to self-Insure,or a - RECEIPT a certlfluteo(Workers'Compewationlmuranmoracenifiedmpythereof(Sea. GAS EA.SYSTEM-11NC.40ITTLECS 3800,Fab C.) PARK FEE Y_ N Pollry a RECEIPT p CAS EA.SYSCFM-0VER 4(EA)Co any B UIL DING DI VI SION FE ES ertlfled copy is herebyfumished. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE Cenifled copy b filed with the city Inspection division. CERTIFICATE OF PXEMITION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Dale Recel t# (this section need not be completed If the permit h!.cone hundred dolls. ($100)orlrm.) WATER HEATER W/VENT/p-FLTR ENERGY FEE Y N I certify that in the performance of the work for which this permit is Issued, ].halt not employ any person In any manner so as to become subject to the WATER SYSTG7/TREATING, Workers'Compenmtionlawsof Cthf.mia.Date PAID O Z Applicant NEWRESIDENTIALPLMB. SQ.FT. Date Recel t# Z O NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become sub}ars t to the Worke 'Comperuat Ion provblom of the Labor TOTAL: LU CC �) Cade,you most forthwith comply with such provisions;provisions;or this permit shall be j deemed reval ed. BUILDING FEE LU G CONSTRUCTION LENDING AGENCY SEISMIC FEE Ihembyaffirmthat them is a mnalmctlon lendry ingagency forthe perforrELECTRIC FEE Z anceofthr work ferwhichthb permit b tssued(Sce.3097,Clv,C.) TOTAL: V O I.cndcr'sNana - - PLUMBING FEE U., Lender'sAddrom QTY. ' 'MECHANICAL PERMIT F +.t 'FiEE, MECHANICAL FEE O-W 1certlfythatl have read this.pplicalionanl etatethattheabovelnformatim 1 iscomet,I agree to complywith all eltyand county ordinanceaand state lawn PERMIT ISSUANCE FEES PAID: } relmingtobulldingcoratauctlon,and herebyauthorix representativesoflhls - H city wenterupon the above.mentioned property for inspectioninspectionTO ion purposes. ALTERORADDMFCH. Z (We)agree to save,Indemnify an d keep Aar the City of Cupertino Date Receipt# V 'against llablLties,judgments,Wks and expensea maylnanywayacctus AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: against said Citfln co encti oltM ntln Is permit. �Y•�S AIR HANDLING UNIT(OVER IO,OWCFM) CONSTRUCTION TAX 51 tureot App not ontract.r Date EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCL SURE Will the applicant orfutumbuilding occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) material as deRimd by the Cupertino Municipal Code,Chapter 9.12,and the Date Reeel t# Flealthand Safely Code Secilon25532(a)P HEATING UNIT(OVER 100,OM BTU) TO 0a7—� 0 Yes No Will the applicant. tum building occupant use equipment or devices VENTILATION FAN(SINGLE RESEy ISSUANCE DATE which rout haurdous air mnlamlwnts as defined by the Bay Area Air Quality Management District? BOILER"COMP Oi POR 10J,(N%)BTU) 4Yes ❑❑ uvcreadthehazallousNomaterialsrequirementsunderChapter6.95of BOILER-COMP(OVIM100,000 BTA pp the California Health&Safety Code,Sections 25505,25533 and 255M.I A I-D understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.Ff. responsibility to notify the occupant of the requirements which most be met ob� prior to Issuance of o Certificate of Occupancy.' 19 199 Owner or authorized agent Date %E vi: ' TOTAL: ISSUE�IIY:`��aTj[(_I_(Iuyu— . OFFICE COPY