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22508 ANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building project Identification PERMIT NO. Add rsu 2oto-o LAS ONAAS CO MT 22508 era Name: hone: A A // Tj4rErno7n IMZS?'V�JYJ9 CITY OF CUPERTINQBUILDINC DIVISION Q / Contractor's Name: Wc.NW: APPLICATION / PERMIT C ? BUILDINGELECTRICAIPLUMBING-MrCIIAMCAL CATEGORY CONTROL N Architect/Engineer. Lic.Na: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addrev: I'FR,ITISSUANCE SII LICENSED CONTRAROR'S DECLARATION 1:1 ' I1:1 El I heremtlicensedunder provisions pr9cAPPLIANCES-RESIDENTIAL ]OB DESCRIPTION inSection 0)ofDiW3oftheBusinandPmfess=sCode,and my license 1s In force addeffect. PANELS Chs e.# Date Contractor UP TO 200 AMPS ARCHITECTS DECLARATION 201-1000 AMPS aZ I understand my plain shall be used as public mounds. OVERl"AMPS SQ.Pr.FLOOR AREA S/SQ.FT. q� O esCCd U Licensed Professional SIGNS ELECTRICAL a, Q'ro OWNER-BUILDER DECLARATION In Er' SPECIAL CIRCUIT/MISC i., = 'I hereby a(firmthatlam exempt Contractor's law for the , C)O.. following reason.(Section 7031.5,Business and Professions Code:My city or O'L F.µ9alter, TEMP.METER OR I'OI.E I ITER �4 county requires permitcontruct,requirestheaprovartfor lshprrcpalr / ) w/ qG' Q anystrutture prior to ltsluvanceaL+o requ pursuant for such permitm POWER DEVICES /7U Yc�V file a signed statement that he b Sensed pursuant to the provisions of the qqQq Contractor's License law rofesser9(commentlng with exempt ttherefof andwl: VAf,gr770N_ 0 Mod 3 CurflaDATE fthe Business and Professions 9 Code)or that he ts with Semp.7000)of and SWIMMING R70L ELECTRIC /j L(f y1 the basis for the alleged exemption. Any violation of Semon 7001.5 by any OUTLETS-SWITCHES-FIXTURES 23 % s-s� <� applicantfora permit subjectathe applicant to a civil penalty a not morethan e five hundred dollars($500). NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPECONSTRUCTION < HI,as owner of the property,or my employees with wages as their sole compensation,wflldothe work,ancithestructum b ect intended or offered for 9 ❑ salc&c.7044,Businessand Professions Code:The Contractor's Licerue law $ does net apply to an owner of property who Wilds or improves thereon,and OCG GROUP RFS.UNITS does such work himself or through his own employees,provided that such improvements are not Intended oroffered for sale.IL however theWilding or TOTAL: - Improvement issold within oneyearofcompletion,the owner-bullderwili have the When of proving that W did not Wild or improve for purpose of vk.). QTY, PLUMBING PERMIT FEE ❑L as owner of the property,am exclusively contracting with licensed FLOOD]ONE APN contractors to constroct the project(Sec.7044,Business and Professions Code: PERMIT ISSUANCE _ The Contactors License Law does net apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) Wilds or Improves thercon,and who contracts for such p�ojec,,with a FEE SUMMARY c 't.[[acto ec 0)licensed pursunt to the Contrattor'e License Law. BACK FLOW PROTECT.DEVICE LJI.am exempt under SB 6 P C far this reason ran aor DRAINS FLOOR MY N_ ROOF,ARRA GOND. SATARY Owner Date RECEIPT N WORKM C MP SA IO DECLAR ON pLXq,PER TRAP SCIi00L TAX Y N_ 1-11 hereby affirm that I have a certificate of consent to self-insure,ora RECEIPT N c AiflcateofWorkem'Comp matlonlnsu acedifkdropythen f(Sec. GAS EA GA INC.4OUTLETS PARK F'� Y N 3800,Lab C.I RECEIPTN Polity N GAS EA.SYSTINI-OVER 4(EA) Com ny BUILDING DIVISION FEES Certified copy is hedwith the cr. GREASE/lIDUSIRL WAS INTERCEPTOR PLANCHECKFEE Certified copy V filed with the dty Inspection division. CERTIRCATE OF EXEM PTION FROM WOR KERS' GREASE TRAP PAID rte/ COMPENSATION INSURANCE SEWERSANITARYS1ORM EA."Fr Date Rtt i t# (rhissection need net becompleted if the Permit lsfurone hundred dollars (5100performanceN I certify thatWATER HFATFR W/VENT/ELECTR ENERGYFEE Y N in the performance o(the work forwch this permit is Is , I shall not employ any person In any manner so ae to become subject to the WATER SYSTEM/TRFATING Workers Compensation laws of California.Date PAID 0 Z Applicant - NEW RESIDENTIAL PLMB. SQ.FT. Date Recei t# Z NOTICE TO APPLICANT.If,after making l his Certificate of Exemption,you should became subject to the Workeri Compereation provislom of the Labor TOTAL: F N Code,you most forthwith comply with such providoro or this permit shall j deemed revoked. BUILDING FEE OD WCONSTRUCTION LENDING AGENCY SEISMIC FEE aS0 CL — Ihereby affirm that there is a construdion lend Ing agency for the perform TOTAL ELECTRIC FEE 7 Z ante of the work for which this permit Ishaded(See.3097,Ci,C.) CIO lender'.Name - PLUMBING FEE LL I— Izndcre Adders QTY. : MECHANICAL PERMIT "E MECHANICAL FEE OW l certlfythd l Mvcm.d this applicattonand state thatthe above information 1 cormet.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES_Pn�R; , �� yr. elating to building construction,and hereby authomm representatives ofthle r<,7-"tr N city ct to enter upon the aWve-mentioned property for impeisn purposes. ALTER ORADDTOMECH. Z - Date Receipt# (We)agree to save,Indemnity and keep ewhich rw the City of CoCupert V against liabilities,pmexpenses whi dgmena,o sand expens chh nuy In any wayacme AIR HANDLING UNIT RO 10,000 CFM) SUBTOTAL: raga lost aid City in conscyuenre fthe,gaming ofthlspermit. -7 es ie, ature of XppBt/Con / / EXFIAUST HOOD(W/DIKT)AIA HANDLING UNIT UN (OVER I0,000CFM) CONSTRUCTION TAX X CONSTRUCTION TAX PAID: / . HAZARDOUS � Da[e MATERIALS DISCLOSURE Will the applicant ned by thefuture Cupertino Municipal ode, hapten le 9.IZahao,andousadd HEATING UNIT(TO 100,000 eTIn - Date RC'cei t# materia las definedbythe Cupertino2(a)? lCode,Chapter 9.12,and the Health and Safety Cade Section 25532(.)7 HEATING UNIT(OVER 1W,000 BTU) TOTAL: 1�1❑'Yes rm No which smut pplicand contaminandingts as defined nt usedby equipment Area devices VENTILATION FAN 6INGLE RESID) ISSUANCE DATE QuicheManaement airrict? ntsasdeBned Wythe Bay Area Air Quality Management District? BORER-COMP(311P OR 100,000 BTU) l'PU Yes No M1avercad the M1eza fcyCdi Sectiulrem05,2553and 255rh.95 of BOILER-COMP(OVpt 100,000 BTU) jtltaaa the understand that lithHealth A building Code,Sec currently have a tenant,that M. p undcrsmndlhat lithe building does not currently have atcnanL that itkmy NEW RESIDENTIAL MECH. SQ.FT. responsibility to notify the occupant of the requirements which most be,met prior to Issuance ofa Certificate of Occupancy. Owner or authodssd agent Date ISSIIEDBY_ TOTAL -�•TTTrrr OFFICE COPY