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21035 (2) > APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY /f ' Building I'm'ect Identification PERMITNO. Building Add OL•-rh fv^ 21035- /mere —res: one: CITY OF CUPERTINO-BUILDING DIVISION Conntyt rux"aNa u<. a: APPLICATION / PERMIT q- `ppLCIctn 5 ` BUfLD1NGELECTRICALPLUMBING-MECHAMCAL CATEGORY CONTROL N �AmchitM/Engineer. Lk.No: ' BUILDING PERMIT INFO" QTYELECTRICPERMIT FEE - Addrne:l - CONTRACTOR'Sp LICENSED ICENSEDpBCLARATION PERMITISSUANCE Ihercr70 dull lkemsedunderprwlaof Chapter 9(romec APPLANCESRES[DENTUL ]OB DESCRIPTION11STI0TO N IngwllhSection7000)aDIvWon3 ofthe Buslnee.and PefesslonaCode,and —' rtry limns¢In In loin and effect ppp���^^^ PANELS Lim Clan LIc.N'-�' Dale Il� p_Contra CT —Y N ARCHITE kC15 AT10N 201 OVERiudt PS Am LLQpw�00 zpC lundereland my plans shall be used as public records. OVER 1000 AMPS SQ,FT.FLOOR AREA $/sQ.FT. Licensed Professional SIGNSELEC7Rl ptkL�R�u OWNER-BUILDER DECLARATION SPECIAI4CE(CUfT/ z p.,q� Ihcmby.fflmthat lam exemptfromthe Contractor's License Law for the po to following reason.(Section 7031.5,Business and Professions Code:M cityor rzi"' county which requires a permit tocomutmct,alter,Improve,demolbh,orreair TEMP.M QF LE IN anystruaure prior to its Wuance,aLso requlreslheappliant for.uch permit to Ik7WERD 0 file a signed statement That he b Licensed pursuant to the provisions of the �a Contractors License Law(Chapter 9(commencing with Section 7000)of Divi- .too 3 of the BusNessarad ProfemioruCade)or that he is exempt therefrom and swam NG LEI VALUATION{••� )s-.�� �5�p+ O the barb for the allepermit su exemption. Any violation of Session net by any OUTLETSSWHC FIXTURES `Ldzu appllcantfor a perMlsubjMetheapplicant loa civil penalty of nal=to than IV x+v ai 2 five hundred dollars($500), NEW RLSIDLN7IAL ELECTR SQ.FT. �n ❑1,as owner of the property,or my employees with wages as theirsok {/ STORIES TYPE CONSTRUCTION compensation,will do the work and the structure is not Intended or offered for , Osale(Sec 7044,Business and Pectmiam Code:The Contractor.License Law does not apply to an owner of property who holds or Improves Ihercon,and G OLH. RrS who doessuchwork himself orthreugh hlsownempleyees,provided thatsuch Improvements are not intended reoffered for sale.if,however,thebulldleg orTOTAL: Improvement Jai sold within oneyearofcomplelion,the owner-builderwlll have Rtheeburden of proving that he did not build or improve for purpose of age.). QTY, PLUMBING PERMIT LJ I,as owner of the property,am exclusively contracting with licensed PERMITISSUANCE r Iaa rentractostomec nstruettheproject(S .7044,BudnessandProfessionsCode: TE 3� The Ca tractor's License Law does one apply to an owner of property who ALTER-DRAIN&VENT. [EA) Wild.or Improve thereon, and who contracts for.uch p(ojects with a coyy{{(Iactor(s)licensed pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE FEES Y• LJ l am exempt under Sec. B k P C for this reason OUTS I OF FEES DRAINS FLOOR ROOF,AREA,COND. SANITARY . Y N Owner Date - RECEIPT M WOR KMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCITOOL TAX Y N ❑1 hereby M.that 1 have•certu a c of consent m opythwrc,or RECEIPT p certificate of Workers Camperuallonlrinurance oracertllled copy thereof 'GAS FA.SYSTEM-1 INC4 OUTLETS PARKFEF, Y N 3BIJ0,Lab C.) Policy p . . DECEIT M Com n GAS E.A. YSTEM-OVER4(EA) �Cy BUILDING DIVISION FGiiS ertlBed copy b herebyth thehed. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE ❑Certified ropybfiled with the dty,Inspection division. ' CERTIFICATE OFEXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SAMTARY-STORM G.X10Ff. D2fC - RCCC1 IN (Thle section need not be completed If the permit b(arose hundred dollare ($100)aty that WATERIIEATERW/VENT/E.1CTR , ENERGYFEE Y N (certify shat In the performance of the work for whkM1lhli permit ie issued, ]shall n rp o) ¢non In any manner n/////!!!!!.....tc be%me gubled In the WATER SYSTEM/TREATING PAID Workers tlo we of GlBomia.Dald]� C) Z AppllNOTICmt E 11 NEW RESIDENTIAL PLMB. SQ.FI'. Date Recei lit Z O NOTICETOS C ,ager making this Certificate of Exemption,you should berome suis' ih Workers'Compenution provisions of the Labor - TOTAL: tll Code,you mu at forthwith ply with such provisions orlhis Permit shall be W > deemed revoked. BUILDING FEE w n fl C CONSTRUCTION LENDING AGENCY SEISMIC FEE Lim Iherebyeffimmthat thercbaconstroctland(Secgagency 7,Civ. .) perform, ELECTRIC FEE __$st Z once ofthe work for whhem J, contra Weed(Sec.3097, t TOTAL 1 V O Lender.Name - - ` PLUMBING FEE LL H Lenders Addreas QTY. MECHANICALPERMIT FEE' MECHANICAL FEE OW Icerti(ythallhave read thbappllationaM rtetc thattheabrve Information IL is correct.I agree to comply with all city and county ordlnanm..cd nate laws . PERMITISSUANCE �, FEES PAID: } W relating to building construction,and hereby authorize reprcsentativesi of this - Z city to enter upon the abovecmenlioned property for Inspection purpose. ALTER ORADDTD MECH. Date ROeel ted _ (We)We Ind madly an d keep baroness the City of Cupertino - agal me,cusb.nd expenses which ray In anywayaccem AIR HANDLING UNIT(TO 10,0W CFM) SUBTOTAL' agnst uquence of the granting o(ehl emit AIR HANDLING UNIT(OVER 10,000CIM) CONSTRUCTION TAX Signal of Ap o%actor to EXHAUST HOOD(W/DI1CT) CONSTRUCTION TAX PAID: AZA OUB MATERIALS DISCLOSURE !_ ITT Will the a pplian r turc building oavpantmone or handle li.rdou. HEATINGUNIT(TO100,01HITU) Date ROcei IN V ` material as defined by the Cupertino Municipal Code,Chapter 9.17,and the - ,I1ralth and Safety Code Sedlon 2S537(a)7- HEATING UNIT(OVER 100,000 BTU) TOTAL" ❑ Ye No Wlllthc.pplicant m 1utumbuildingoccup.m.seequlprem ordevices VENTILATION FAN(SINGLE READ) ISSUA which emit haeardous air contaminants as defined by the Bay Area Air .� Qua Illy Ma wgemene Di9M07 BOILER-COMP(311P OR 100,IX0 BTU) (�r(� t •IOQ0 ❑ Yes n No S r lx 049 � (" lhuve reatl the hazardous materials requirements under Chapter 6,95 of BOILER.COMP(OVE2100,000 BTU) the CallfomIs I lealth k Safety Code,Sections 255D5,25533 and 75534.I p u extents no that if the building does not currently have a lenanh that it b my NEW RESIDENTIAL MF.CH. SQ.FI'. !!l fTf Qf(Ona{:naa n,po iblit y to notify the occupant of the requirements which must be met Lx�`na c"LR7li!r-1 prior to seance o(a Cu tlfiateofOavpanry. Owner oraulhorl ed.gen Date I TOTAL: ISSUED '7' -x OFFICE COPY