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23996APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification - PERMIT NO. Building Address: 23996 a ams: one: CITY OF CUPERTINO BUILDING DIVISION APPLICATION I PERMIT BU[LDINGELECTRICALPLUMBMGMECHAMCAL A AWAIL nnr'nN Lie. No: CATEGORY CONTROL It Architect/Englneei: Lic. No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFOBLDG EL�i PLUMB MUCH+ Address PERMIT ISSUANCE _OD y f, ,tea„ ❑ ILV_I1 ILxL[YI LICENSED CONTRACTOR'S DECLARATION I hereby ron7000atlamlkensedhe under provisions 7000) of Divfect. o(lhe Businnsand Pro(esslonaCode,and my Lngweh in license le in fulove and effect License Class Lic.# APPLIANCESRESIDEMTAL JOB DFSCRR'TION PANELS Date IContractor 201-1000AMPS ARCHITECTS DECLARATION I understand my plans shall be used as public records. IOVFRIODOAMPS SQ. FT. FLOOR AlI Licensed professional SIGNS ELECTRICAL IX D 1�tl` SPECIAL CIRCUIT/M19C OWNER -BUILDER DECLARATION I hereby affirm that l am exempt from the Contractor's License Law for the 0�] r�k g g Q p U 1 : IPMPMERYORPOLST. EIN following reason.(Section 7031.5, Business and Professions Code: Any city or countywhichrequirnaper ttomr d,alter,impmve,demlLLh,orrepair ® anystmd mpr rtolbissuance,aMrequirestheappb¢ntforsuchper tto file a signed statement that he is Bmnsed pursuant to the provbloru of theDATE POWER DEVICES SWIMMING POOL ELECTRIC Contractor's License Law (Chapter 9 (commencing with Section 7000) of Divi- slon 3 ofthe Buslneesand ProfessionsCode) orthat he b exempt therefromand VALUATION Ile basis for the alleged exemption. Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of not room than / OUTLETS -SWITCHES -FIXTURES NEW RESIDENTIAL ELECTR SQ.FT, five I, as nerodollaf the pr. i, as owner of the property, or my employers with wages there sole STORIES TYPE CONSTRUCTION compensation, will It o the r kfessir and structureii,Coot or offered for sale( Sec. 7044, Business Business and Code: The ntractors License Law p TOTAL: zy property donsoessuch torn owner ofp rough who bailds mporemproovided eoMand or improves whodoesa work himself ed orangb his own e . If, however, t eb that such intended e. oweveg g orhave OCC. GROUT RFS. UNITS Improvement issold pletioor Improvement Issmld wbhin one yearo(completion, the owner-bullderw111 have the deer ill thp�urdenof provingthat he did notbuild or improve forpurpose ofsale.). u I, as owner of the property, am exclusively contracting with heensM¢ contractors to construct the project (Sec. 70K Business and Professions Cade: QTy, PLUMBING PERMIT FEE FLOOD ZDNE APN pp ITISSUANCE a7 V n The Contractor's License Law ds not apply to aowner of property who Wilds or Improves thaemn, and who contract for such p(ojects with a co actor(s)II¢nsed pursuant to the Contractor's License Law. LJ I am exempt under Sec B & P C for this reason _ ALTER-DRAW&VENT - WATER (EA) 34 ov _ FEE SUMMARY ' BAIX FLAW PROTECT. DEVICE DRAINS FLOOK ROOF, AREA, CONE. FIX.Il1RFS PER TRAP -OD SANITARY Y_ N_ RECEIPT N Owner Date WORKMAN COMPENSATION DECLARATION -. 1-11 hereby a(flrm that I have a certificateof consent t0 f[If-InA1M, Or r urtif tate m Workers Compemationlresurance or a certified copythersof (Sec. 3800, Lab C.) 1 ollry p I Z Q n SCHOOL TAX Y_ N_ RECEIPT M GAS FA.SYS7EMIINC.40UTLEfS PARK FEE Y_ N_ RECEIPT N GAS FA. SYSTEM -OVER 4 (EA) Co any—.J'-t�ul e BUILDING DIVISION FEES �Ccrtifled ropy is hereby furnished. �Cekifled copy Is filed with the city inspection division. CRPASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE GREASE TRAP CERTIFICATE OF EXEM PTION FROM WOR KERS' PAID COMPENSATION INSURANCE Uhis section need not be completed lithe permit b for one hundred dollars - gEWp-R SANITARY STORM EA 2(1011. Date RCCeI t# HEATER W/VENT/ELECTR ENERGYFEE Y_ N (St Bill or I.)WATER I certify that In the p rforran¢ of the work for which this permit is Issued, WATER SYSTEM /TREAT1 NG 1 shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of CaBfomla. Date PAID NEW RESIDENTIAL PLMB. SQ.FT. Applicant NOTICE TO MPLICa to thIf,e after making pen Certificatero ti Exemption, you should become subjM to the Workers' Labor Date Recei t# TOTAL: BUILDING such pruaHo m or this Nimihe Code, you most forthwith comply with such provision or this pemNt shall be deemed revoked. CONSTRUCTION LENDING AGENCY - SEISMIC FEE Iherebya(Brm that them baconstmnion lending agency for the pekorm race of the work for which this permit is ensued (Sec. 3097, Civ. Q ]enders Name Lenders Address v� I¢kl/ythat l have read this app catlonand state thatthe above information Is correct. I agree to comply with I cdyand county ordinances and state laws TOTAL: ELECTRIC FEE ] 2 PLUMBING FEE O QTY. MECHANICAL PERMIT FEE PERMIT ISSUANCE MECHANICAL FEE FEES PAID: relatiegtobui Ing ro ices and here awhorle[MpresenUtivesofthb cit ytoenter`u cit above- boned perry for inspection purposes. Cupertino City In d to e, Inde (sand pharmless es which against la (tics mens strand xpenses whkh may In anywayacome - ALTERORADOTOMECH. Date Receipt# AIRFIANDLINGUMT(I'010,000CFM) SUBTOTAL: as I s tic in ronsry coft h granting ofthls permit - AIR HANDLING UNIT (OVER 10,Of10 CIM) CONSTRUCTION TAX SL r i¢m mr o Date FX( UST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZA DO TERIALS DISCLOSURE HEATING UNIT (70 100,000 BTU) Date Recei t# Will the applicant or future building occupant store or hacid Is havardous matereal as defined by the Cupertino Murdcipat Code, Chapter 9.1 2, and the Ileahh and Safety Code r� —SS�ection 25532(a)r [:]Yrs. No Will the applicant or future building occupant use equipment ordevices which et hacarefous air cents as defied by the Bay Area Air mimi Qu a lily Ma magement District? 4Yrs No hayeMadthe naZard❑ ousmaterinlsrequirementsunderChapter6.95of the California Health & Safety Code, Sections 75505, 25533 and 25534. I understand that if the building does nM currently have a tenant, that it is my HEATING UNIT (OVER 100,000 BTU) TOTAL, VENTILATION FAN (SINGLE REBID) ISSUANCE DATE P A I L) , JUL 21 1992 BOILERCOMPOFT' OR 100,IX0 BTU) BOILER -COMP (OVER 100,000BN) NEW RESIDENTIAL MECFL. SQ.FT. responsibility to notify the occupant of the requirements which most be met prior to issuance of a Certificate of Occupancy. ': CUt Ur "UtIrril iYU BY:�� •r Owner or authorized agent DateISSUED TOTAL: OFFICE COPY