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22956 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Buildin ha ect Idmtlfkatlm PMWT NO. RulldDAOd?� 22956 rete _ y5 CA b me: . o�o�', 0QJ CITY OF CUPERTINO-BUILDING DMSION • mvad or'eNsme: IJc.No: APPLICATION /PERMIT 6 BUIL.DINGELF.CIIUCA MP BINGMECHANKAL CATEGORY CONTROL Areed/Engirmer. Lk.No: Q ELECTRIC PERMIT FEE rBUILDING PERMIT INFO Address POWTISSUANCE ❑ ❑ �7c1 ❑ LICENSED CONTRACTORS DECLARATION I herebyafflrm that l em Itimeed under provisions&Clupter9(eommeo APPLIANCES-RESIDENTIAL )OBD RIPFION Ing with Section 7000)of Divldm3 ofthe BusireumdPrefeedonsCode,and ory lkeree V In full fora and effeci. PANELS 11 Liana Class Lk I ��/ `- Date Conmad.1 —UP TO 2DOAhff'S ARCHITTCPS DECLARATION 2014000AMPS pQ+{M�yz I undemaM eny plans ebaB be used a public record& OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT. E L LlceuM Profesbnal SIGNSELECTRICAL OWNER-BNLDER DECLARATION SPECIALCIXCLIIT/MISC 7 i'o+� Ihereby afBrnn that l am exempt from the Contractor's Llcerue Law for the F�^❑ following maser.(Sedlm 7(315,Buelness end Pmfssbne Code:My dty or � cwntywhkhrequbesapeodttommtaud,eter, pmve,der h,ormpalr TE.IP.MEIFR OR POLE WST. ed y� anysbumrrt prbrty its fswarce,ebo requlresthmappBant(ee each permitro POWER ER DEVILS KFq K file a signed easement that he is lkrr purwnt to the provlsiom of the Contractor.Lke.Law(Chapmr 9(mmmendng with Section 7000).f Divi- SWD. NG POOL,ELECTRIC of slo,3ofthe Business and ProfmlomCode)orthrt he is exempt therefemaM VALUATION the beale for the alleged exemption. My Wdallon of Sed1On I'MIS by any 7� 81 appllant fore permit sub)octs the applicant toot civil .by dnd mom than OUTIXSSWITCHES FIXTURES c. $ five hundred dollars(SSM. ❑I,as owner of the property,or my employs,with wages as their aob NEW RE9DENIIALELFI IR SQ}7. STORIES TYPECONSIRUCTIM �7 canpewHon,wlll do the week and the strudum b not(tended or offered for Dsale(sec.7014,Buelress est Pmfm ic.Code:The Gerstmann.u..Law $ does net apply to m owner of property who builds or lmpmvn thereon,and FS^ who doessuchworkMmeelforthrough wownemployeee,pmvidcd that such OCC.CROUP RES UNTTS Improvemmw are nd intended oroffered fee sale.If,however,thebullding or TOTAL bnpmwmm lasaidwthinomyearofceeiple Ntheowner-buMerwBlhive t eden of p,wing the he dm out build or improve fee purpoea of sale). QTY. PLUMBING PERMIT FEE � w [u owner of the property,am evcfvely conix rang with licensed FLOOD ZONE APN mnirertmato mmfnud she pmjrd(See 7W4,Buelnm and Prdesbv Cad,. PERMITL'S[JANCE 15— The Contrsciors Lkerme Law don not apply tom owner IX property who ALS-DRAW 4 VENT-WATTR(EM bu Bole c9atEact r Imprwa thereon, and who mMrsde fee loch p(ojede with L.JItnne. mpt under ScttotheCmtrador'aLloenaelrw. BACK FLOW PROTECT..DEVICE FEE OUSUMMARY IDEH LJ I am nempt under Sec B k P C for this maven S DRAINS FLOOR,ROOF,AREA,GOND. SANITARY Y_ N_Owner Date RFLEPTI WORKMAN COMP E395ATZONree of pp(.NRES I'ER TRAP 5a IOOLTAX Y_ N_ ❑1 hereby affirm Co I have• lMR of amdif to self-insWytheurt,T • RECEPTY adlDabC.Worken'Compematlmlwrsnaeeacertified ropytherroff5ec. GAS FA.SYSTEM.1 INCA OUTLETS PARK FEE Y_ N 3800,Lab C.) P on GAS EA.SYSI'FM-0VER 4(EA) DING DIPT Y ny BUILDING DIVISION i510N FEES m afdifled copy b heburnished, GREASE/IN'DUSIRL WASTE INTERCEPTOR PLANCHECK FEE Crafted ropy ts/lieded with with the city impectbn division. CERTIFICATE OF EXFAIPTION FR WORKERS GREASE TRAP PAID COMP ION( E SEW'FR-SAM'EARY-STORM EA.70(BIT. Date Recel t# OTta atoll coon lot d e molt (orore hundred dollve (glm)ee wATRHFATFRW/v /E.FICTR ENERGY FEE Y N I ylhrtdthe ser once (o hlchtwpemttV Wiled. I e o emplo to become subject to the w rk< r n'C of WATER SYSTE7d/DRFAUNG PAID O Z wp or ZO NOTC ,elver .8tw Certifkateof Exemptinkyou NEW RFSDE21MALP B. SQFT. Date Recd tH sharld mesu ' tothe Workn e 'Compermrtion provisions of the labor TOTAL: S N Code,y sur athwith comply witheuch provisions,orthh peret ehal)be BUILDING ] deerned W p CONSTRUCTION LENDING AGENCY SEISMIC F CL EE IheabyafRrmthethereb, comtnuctlmlendingager"fortheperfonn ELECTRIC FEE Z ..of the workfor which twprmit h issued bee 309'/,CN.C) TOTAL: e� V O lander.Name PLUMBING FEE a-�--- IL lender,Addrt., QTY. MECHANICAL PERMIT FEE iMECHANICAL FEE O W ladlfy thatl have rtadtw appllotbnaM eatethrtthc above lnformetm boned.Iagratocomplyw"allcityand muntyoedbunmand elate laws PERMIT NUANCE. FEES PAID. } N rtleing to building consbudion,and hereby authortre representatNn of this F Z dty to enter upon the abovcmentbnrd property for Inspection purpcm ALTERORADDTOMECH. (J _ (We)agree to save,indemrsify an d keep harrdes,the City of Cu xf W Date Recei to agalvt liabilities,judgments,meeaM eapemes whkh may,In any wayamue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL tsaid C N cmmequeye�of tFe gnmi�dtw pemdt 1yj`� AIRHANDLINGUNIT(OVER10,000cPM) CONSTRUCTION TAX Signature of Apphcant/CoJktractor e0ate EXHAUST HOOD(W/DLCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applletnt or futum building oaupent port or handle haraedous HFATWG MIT CEO I Of1,ODO RTL!) Date Recti Ile rtuterbl as deflred by the Cupertino Muddpl Code,Chapter 9.17,and the Health and Safety Code Section 2SM(a)7 HATING UNIT(OVER 100,000 BTI!) TOTAL: E Yes n No.T1'ill the applicant or future building onvpant usecquipment ordevk VPNITLATTON FAN(SINGLE RESID) ISS A •DATE whkh enet hamedou,air centaMnants as defined by the Ray Area Mr • Quality Managemem Derrkt7 BOILFR-COMP DEW OR 100,000 Fl Ut NovR �� Yn No ,r v Qy have read the hanoos Ar mrteriab requirements under chapter 6.95of BOILER-COMP(OVM 100,000 BTU) as the California Health 4 Safety Code,Seetbm 75505,75533 and 75534. I CITY 1 Of underetand that if the buildingdoes rot curremly have a tenant,that it b my NFWRESTDFNITALMECIL SQ.FT 11 CUPERTINO nssponsibllity,to notify the occvprt of the mqukmmew whkh ovsat be met prior to Wuance dfla a Ct,titmof Occupancy. Ownn ee awhorlad agent Date ISSUED B TOTAL OFFICE COPY