20061 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Ideml(ka im
Buil (ev-dov PFkwTNO.
ding Address 20061
�3 bo VN
nen spa , A
a to CITY OF CUPERTINO-BUILDING DIVISION
® cm N.ne' �. / ZAPPLICATION / PERMIT
BN
LOINGaECTRICAI InUMBINGMH NK;AL CATEGORY CONTROL
"'=7c
7c
Z' Q ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: S
_ p[7(MITI:S(IANCE L-1 ❑ ElIC
LE. BED CONTRACTORS DECLARATION - 19
-
Ila,mby aHbm that l en licensed under provisions of Chapter 9(commenc, APPLANC SSRFSIDENIIAL
ing wit h Soction 700D)of Division ofthe Buss reqs ProlessionsCoae,and nd my S DESCRIPTION
L�nwbin(uRJONLI�f� L / P„NEIS 1.- 2ojF DVPLF—�C
Date` C. ctor [.p 1�1.
�G
ARCHITECT'S DECLARATION 201.1"ANIPS • `
a 7. I urderstsM my pbv ahal be used as public records OVER 1000 AMI5 - 9Q.FT.FLOOR $/�.FT.
�j Licensed Professional SIGNSELECIRICAL E D
OWNER-BUILDER DECLARATION SPECIALCIRCUTE/MISC UTE R
]I' S Ihereby afHrro that Iam exempt from the Contractor's License law fa the
following reason.(Section 7mt5,Business and Professions Code:Any dty or
C$ TElop METER OR POLE INSI'.
F� muntywhmpn tol pe mt am rua[,dttheaprwe,demwch,orrt w
any awwrttatemeltshe he is abensed pursuant to the fm suchpematm ]OWER DEVICES ✓� �/ /
5 Ole•signamor's statement that he t licensed endr pursuant ft the tur,71 na of the
- Oja Cnntneorb LkenseTaw(Cfptu9(mmmenctng eb S mpl7000)o! Dain SWINMNG1OOL ELECTRIC
SOS the heft he Busieessand ProfmloNCoda)iolation fSocti pt 70313 by and VALUATION
y.' the baab for the alleged eaemptlon. Any violation o(Soabn 70315 ne any OUTLEISSNITCHESFDCFURFS
appbondred for.pears,%3 ede the appBcant to•dvll penalty ofnat more than
flue hundred dollars Rer001. NEW RESIDENTIAL ELECT'R SQFI. SNRlFS TYPE CONSTRLC110N
]�n ❑I,as owner of the property,or my employees wdh wages as their sole
mmPomedon,will do thew 1,and the structure b rot founded or offered for
sa ie Cec.7064,Bu Mess and Professions Code:The Cortisone.Lave Law
does not a pply to an owner of property who dillds or Improves thereo4 and OCC.GROUT' RES UNITS
who don such work himself or through his own employees,provided!that Buds
improvemew art rot lntrnded orot(ertd le axle.IL however,the W llding or TOTAL
improvementba w oneyearofcompletion,theowner-Wllderwillhave
tIkml.oofpmWng that k did not Wild or improve for purpose of sate.). QTY. PLUMBING PERMIT FEE
I,u owner of the property,am exclusively contracting with III FLOODTDNE APN
contractors to coNtroct the project(Sec.70G,Business and Professions Cade: PERMIT ISSUANCE
The CoMnctors License law does not apply to rn owner of property who ALTER-DRAIN 4 VENT-WATER TIM
or Improve thereon,and who mMracts for such pAojeea wish a
c(T+ctor(s)hces pursuant to the Cmtraeaen Limns Law. FEE SUMMARY
LJ I•m esernpt order Sec. B 4 P C for this recon RACK FLAW RIOniT.DEVICE QIITIIQ�FEES
Owner Date DRAINS FLOOR,BOOP,AREA, SANITARY Y_ N_
,jam WORKMAN COMPENSATION DECLARATION RFAEIR'g
j.�I bench aHlrm thrt I have a artl0nte of c..t to seB-iwrt m a �NRES PEFt TRAP SCHOOLTAXY N_
cateo( orken'Compereation lrwrrancaara nrtH4d ropythenof(Sec. RECFFP'IIs
38M Tab CJ O O�O QQ GAS EA.9YSFFM-1 INCETPARK
40UTLS FFP Y_ N_
m an L GASEA.SYSIT BUILDING OVER4(EM - INGDII
y L n DI VISION FEES
Ccrtiftd copy b heed with the dy GREASE/INDUSIRI"WASTE INTPRCEP'DR PLANCHECKFEE
CertWed ropy b(Tied with the Illy Inspection division.
CERTIFICATE OF O(WIF'ION FROM WORKERS GREASE TRAP PAID .
NCE
COMPFNSATIONINSURASEWERSANITARYSTORM EA 70067 Date RANI tit
(IWasectbn need not b•completed Ht he SURA bfm aN hundred talion
(slao)arl..) wATFR HEATER w/vPsrr/ELEcrR ENERGYFEE Y N
Inrtifyth•tlntheperforrtunmofthewmktorwWch t•Permit is blued. —
I shaft rash empby•ray pence N any manner ro u to beaorne object to the
WATER SYSTEM/TREAnNG
WmFen'Campenaatbn lawn ofGWornh. Date PAID -
O Z Applicant NEW RESIDENTIAL PIMB. SQFI'. Date Reeei tit
Z O NOTCE TO APPLICANT:If,after nakingthb CertHlnteof Eaemptbn,you
"should hmmesubject to the WorlersCompensation provisions of the Labor TOTAL: '
F N Cade,younuatfwthw hcomp)ywthuchpro morthhperm llbe
Wj deemed revoked. - BUILDING FEE
CONSERUCTION LENDING AGENCY S ISMIC FE
CL I herebyafirm that there In a construction lording agency for the perform,
7 Z anmofthe workforwhlch thio perndt b buod(Sec.309],CW. L:
C.) TOTAL.
ELECTRIC FEE
(� O IaMera carne PLUMBING FEE .
LL I— L<odveanddrtaa QTY. MECHANICAL PERMIT FEE MECHANICALFEE
O W Iartlfythrtlluvx rtodtMsappBcalbnard state[hHihe above lnlorml(Ion rs Comingtoagreetoconplywthaucheut embyethortnelnanmaathmsolaws I'QLAfp]'155UANCE 1,sa4J FEES PAID;
} 1 cityreLat tees upong mvwMontinned eoperty orUertpQnpurposof thio
F to tll(Wo)ASmeto ta"clhe e-mentioned Propebwrml Wpecclt pu ALTER ORADD TO MIC]i.
e)ague to f rt cg y, n harm] a city o�raw Date Recei tM
V egaWtllabWHes a rats,mal ode re. nuyln any way accrue AIR HANDLING[JNn CIU 10,000 CFM) SUBTOTAL:
agalNtsald b oft vtigs la pemdt.
AIRHANDLNOUNTNOVER10,000CM CONSTRUCIIONTAX
Sig Applicant/ ntrartcr Date EXHnIaTHOOD(w/DUcq - CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant refuture Wilding occupant Blom or hsndle hevrdous I IFATINGUMT07010D,"BTU) Date RCCCI fit
d
moterbl as defined by the CupertiCupertino,Munidpa]Code,Chapter 9.1;and the
HeAtheSeety Code Ion7553](a)i HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑ Ya
Wlllthe.pplicamm tore Wlldbgo pantumequiprrent«devices VENTILATION FAN(5INGLE RESID) ISSUANCE DATE
which emit hsvardous air centambame as defied by the Bay Area Air
® Malty hbooflcmuntD (nett BOBPR-NMP QHPOR 100,000 BTU) I.
4No
h,eamad the ouameerlab requirements under Chapter 6.95 of BOILER-NMP(OVFR100,00oBM JUL `�®
the Calilomin Health Safety Code,SM1ons75.505.25533and75534.1 U1 1990
urdmnndthatlf bulldingd aurrentlyha atenantlhattismy NEW RESIDENTIALMECH. SQ.FT L -
rnpom(bBityt o fythc nt lhercqulr fntawhthnsustber
P rI.W a aCcolf sof pan .
_ 3/—i9e>e F�
TOTAL: Cii'hyt�raR^�I�t�L rtin�n y
r authodent Date O ISSIIEDBY:y`�✓ F tW WA\EM/I
OFFICE COPY