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24165 24367 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —.USE BALL POINT PEN ONLY B.0ding Address: Building Project Identification 1. 1 - p;elrr_ PERMIT NO s 24165 hone: p W�v gPi\)h C� CITY OF CUPERTINO-BUILDING DIVISION APPLICATION /PERMIT Co "Z Z Y �J BUILDINGELECTRICALPLUMBING.MECHAMCAL CATEGORY ��VV CONTROL Arc tl/En Ina r. ,LIc.No: S QTY ' ELTRIt4'ZpE9 MIT FEE 7 BUILDING PERMITINFO BLDG ELELI FLUME NIECH PERM717MLIANCEAndreas: VP� •�"e }'� LICENSED CONTRACTOR'S DECLAR TION LFS ]hereby affirm that l am licensed under provisions of Chapter 9(comment, APPLIANCFSRESIDENTIAL JOB DFSC ON Ingwlth Section7000)of Division 3ofthe Businessand Profeasions Code,and my lionx la In fuD farce and effect PANES TT License Class Llc.If �l—•a�a Date Contractor UP TO 200 A S ARCHITECTS DECLARATION 201-1000 AMTS q�q�nu mO Zp ' l understand my plans shall be used u public records. OVER1000AMPS SQ.FT.FLOOR AREA, §�/SQ.Fr. FiZ Licensed Professional SIGNSELECTRICAL GGGG 6 LES OWNER-BUILDER DECLARATION ���OOO sial iLs�' `N,ry Fd SPECIAL CIRCUIT/MLSC - a I„ a 1herebyafflrm that l am exempt from the Contractor's License law for the O -"� following reason.(Solon 70713,Business and Protestations Code:My city orcounty T E - TEMP.METER OR POLE INST. anystmhmph artotto seancemit omquiaathemplimntfn ch,orrepalr - G any atacturetatemeltshat he aeresed rersuant to (ormions of to POWER DEVICES I IS O c. 0k a signed statement that he la Dunxd pursuant to the provisions of the ( /IMi Cootnume.License Law(Chapter9(commencing with Section 7000)of Divi- gWRd,VRNGIWLELECTRIC ��1 the heads Business and Pemption. Any)viothat lation In exempt therefrom andapp - ��'�urx �� OGs Q.•�77 the bean for the alleged exemption. Any t toktlon of Section nor room by any OUTLE7SSWITCFiFSFIKI'URES five hundfor apermitS500). the applkanttoatlWl penalty of nor more than five hundred dollarshepr. NEW RE DENTIAL ELECTR SQ.IT. STORIES TT`ECONSTRUCT10N ❑Y,as owner of the property,or he employees with wagm as their sole .Czr� compensation,w0ldothe workand thestructure ode:Th notIntended adoe o imme d for Law F q sac(Sec.apply to a nwasow owner of property u Code: Contractors Llmnan Law nom notapply torn owner ofproughhisa nemorlmprovnted thatand such OCC.GROUP RES.UMTS who does mentsawork himself or through hlsowne.If,ho employees,provided build Ing or improvements sold intended neyear fcomered orsalo If,however, ve ,m impmverrcnt lasold wdhinoncyearo(complMion,the owner-bullderwlll terve - ' t4c.tiorden of proving that le did am build or Improve for purpose ofsale.). QTY.; '.' 'i'PLUMBING PERMIT' ' •FEEit u PI-OOD'IDNE APN 1,as owner of the Property,am exclusively contracting with licensed PERMIT ISSUANCE - contractors to coalnct the project(Sec.7Mqei Bunesdand Professions Code: The Contractor's Liunse Law does not apply to an owner of property who ALTER-DRAIN k VENT-WATER(FA) Wilds or Improvers thereon,and who contract. for such Ink jects with a FEE SUMMARY) cc,6t{{actor(s)Ilcenv:d pursuant to the Contractor's License Law. „r l' LJ I am exempt under Sec. B A P C for this reason BACK FLOW PROTECT.DEVICE OUTSIDEFFES _ DRAINFLOOR ROOF,AREA,COND. Gess­ SANITARY Y N Owner Date S RECEWT I WORKMAN COMPENSATION DECLARATION FIX.TURES PER TRAP SCHOOL TAX Y� N ' ❑1 hereby affirm that I have a certificate of consent to self-Insure,ora RECEIPT R certificate of Workem'Comperuatimlosurarm or a cenl0ed copy thereof(Sec. GAS EA.5YSCEM-1 INC.40I1TLET5 PARK REE Y N Policy 3800,Lab CJ - _ RrcEE'T p CffCGAS EA.SYSTEM-OVER 4(EA) - Com any BUILDING DI VISIO EEES [)Cceitled copy is heed with the cit. GREASE/INDUSTRLWASMINTERCEPTOR PLANCFIECKFEE �Cenlfied mpyb(iled with the city inspection division. r aQ ., CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRA PAID COMPENSATION INSURANCE SEWER-SAMTARY-STORM FA.ZOOFI'. Date R 1 1 §�+ (This section need am be completed If the permit Is forom hundred deltas h (§1(0)or Isco.) WATER HEATER W/VENT/F].ECTR V ENERGY FEE W/R.�ipt#I certifythat lathe performmnceof the work for which thls permit b hsued, — I shall not employ any person In any manner A,as to be oma subject to the WATER SYSTEM/TRFA.DNG Workers Compensation Laws of California Date - PAID z.2 Applicant - - NEW RESIDENTIAL PLMB. SQ.Irr. D Z O NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should becomesubject to the Workem''Compematlon provisions of the Labor - TOTAL: . H.N Code,you at forthwith comply wlthsuch provisions or this permit shall be W j deemed revoked. BUTADIMQAF8 CONSTRUCTION LENDING AGENCY SEI _ C E. a I hereby affirm that them is a construction lending agency for the perform- EL• IC FEE 7 Z aera.ftha workforwhlchthis permit is Issued(Sm.3097,Clv.C.) — O O Landers Name PLUMBING FE V LL F Lenders Address - - QTY. MECHANICAL PERMIT,' r E. MECHANICAL FEE O O l unity that have read this application and statethattheabove Information laormct.Iagreeto plywlthaDtltyand countyordlnancro andatate laws PERMITISSUANCE /s FEES PAID: } C miatingtobulidln onatactlon,and hereby authorize representatives of this F W city to enter up tM above-racnlloend pmpeny for Inspection purposes. ALTERORADDTOMECH. - , Z (W c age to save,Indemnify and p rodess the City of Cupertino DatC ' Receipt# V agalnat Ila t ,o oresacluenc of of Eno Ian_ a AIR HANDLING 1INIT CTOlO.OW CFM) r UBTOTAL: agalnat d nsonuquenc of of Ie pemnit. - / AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTIOJ TAX p an/Contractor D IXHAUS"T HOOD(W/DUCT) CONSTRUCTIO TAX PAID: HAZARDOUS MATERIAL SCLOSURE — Will the applicant orfuture building ant store or band to hazardous HEATING UNIT(TO IOO,WO BTU) Date materialARC material as defined by the Cupertino Municipal Code,Chapter 9.1 Z,and the - - Q( Y.(�j. Healthand Safety 00 Code Section2553Z(a)? HEATING UNIT 1 ,000 BTUI ' Yes N No Will the applicant orfuture building occupant use equipment ordevices VENTILATION FAN(SINGLE RESID) ISSUAN •DATE which emit haeardous air contaminants as defined by the Bay Ares Air _% - . Quality Management District? BOILER.COMp 0HPOR 100,000 BTU) 4 Yes he 11 No haveria Health outmode, etions2W5,255derChapter. 1 of BOILER-COMP 100,800 RTU) PAI the erstan t of the building Safety Code, otcuruntlyh ve a tarnd2553d. I understand that n tifyteoccupant of t erequire encs which that It is my NEW RESIDENTIAL MECH. �.FT responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. - SSEE�PP 1. Owner or authorized agent Data TOTAL: ISSUEDBY: 11T/urtri-f.r OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building AddreBssuilding Project Identification - PERMIT NO. z�Z� sLc, 2.4367 . where me. - hone: A A . CITY OF CUPERTINO-BUILDING,DIVISION c.no-a ops ams _ LIc.No: APPLICATION / PERMIT 4 `2 W L BMLDINGELFCnUCALPLUMBINGMECHAMCAL CAiFLORY CONTROL a' Arch ect/ gi r. Lic.No: ,�,.,,°'I'1• .,'• 1 "'9 1�" - )• ',`,!j�'BUILDING PERMIT INFO. ? QTY I . ',ELECTRIC PERMIT Address: '. ' < r I'f7iMIT ISSUANCE '�s� El a " ❑ ❑ LICENSED CONTRACTOR'S DECUBATION I hereby affirm that lam licensed under provisions of Chapter9(<ommmc- MPLIANCESRF.SIDENfIAl ����pppOB�PSC ON IngwlthSelon7000)of Dlvision3oftheBusinrmand PmfesslonaCede,andmy - f.;M OW- Iicense la in f cit force and effrct. PANELS ' t��,,aa��j„ I HT1 License Clam Lica Dale Contractor - ARCHITECTS DECLARATION 201-1000 AMPS Ob I understand my plans shall be used as public mounds. OVER IOW AMPS SQ.Fr.FLOOR AREA $/SQ.FT. k Licensed Professional '• SIGNS ELECTRICALi << © s OWNER-BUILDER DECLARATION SPFCIALClRCUFT/MISC �m, ' "� following reason. tMtlam31.5,B(ro Business Professions Code:Any for he } , V ppp county hick reuiresa ermittoccalnemand Pmprove, Code:Any dtyor F +" anystm=mreortoiapea=t aomquialter, aplientfrsuchper ttlr TEMP.METER ORI'OI.E INST. '� any ahuRure statement Cut he is;Lica sed pursuant t the rovial nst of the 4 R, g POWER DEVICES L5 O a -Rica signed statement that he h Licensed pursuant the pon 7000) of the Q6 II-� Contractor's Licenseuenft ..d Pr-apter.(mmmencing thathe withS mFrtthem(ot and SWIMMING POOL ELECTRIC, BOJ slon3o(the Bualnnsand Pro(emlamCode)orthat hehexempttherefromand TION Sn•77 the bash for the alleged exemption. Any violation of Semon 7031.5 by any <� OUTLETSSWITCHISFIXTURES appLunt for a permit subjecd the applicant to a civil penalty of not morethan five hundred dollars($500), - NEWRESIDENTIALELECTR - " o �n ❑I,as owner of the property,or my employees with wages as their sale SQ.Irf. STORIESTYPR CONSTRUCTION cempenmthm willdo the work,and thestructure b not Intended or offered for O sale(Sec.7044,Business and Professions Code:The CmdraRors License Law $ does not apply to an owner of property who builds or improves thereon,and EEE who doessuchworkhlmseQorthrough hisownemployees,provided that such OCC.GROUT' RES.UNITS Improvements arc not Intended or offered for sale.If,however,the buildings Improvement is sold within one yea ro(completion,the owner-builder will have t4Rkurd on ofproving that he did not baud or Improve for purpose of sale.). QTY, �'a �r t'PLUMBINGARMIT ,'') I ''t,' FEEij• FLOOD TANS APN "L as owner of the property,am exclusively contracting with licensed contract..to roretrun the project(See.7044,Beeduessand Profesame;Code: PERMIT ISSUANCE ' TM Contractor's License law does nat apply to an owner of property who ALTER-DRAIN kVENT-WATER(G) Wilds ordmpre ss thereon,and who contracts for such ptojeab with a do 6)Located pursuant to the Commerce's License Law. `t '''t„FEE'SUMMARY' LI I am exempt under Sec. B k P C for this reason BACK FLOW PROTECT.DEVICE DRAINS FLOG ROOF, SANITARY Y NE I LES ' Owner Date R AREA,GOND. OUTRECESITN WORKMAN COMPENSATION DECLARATION MTURF_S PER TRAP SCI100L 7'AX Y_ N ❑I hereby affirm that I have a certlRota of consent to self-Insure,or a - RECEIPT a certlfluteo(Workers'Compewationlmuranmoracenifiedmpythereof(Sea. GAS EA.SYSTEM-11NC.40ITTLECS 3800,Fab C.) PARK FEE Y_ N Pollry a RECEIPT p CAS EA.SYSCFM-0VER 4(EA)Co any B UIL DING DI VI SION FE ES ertlfled copy is herebyfumished. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE Cenifled copy b filed with the city Inspection division. CERTIFICATE OF PXEMITION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Dale Recel t# (this section need not be completed If the permit h!.cone hundred dolls. ($100)orlrm.) WATER HEATER W/VENT/p-FLTR ENERGY FEE Y N I certify that in the performance of the work for which this permit is Issued, ].halt not employ any person In any manner so as to become subject to the WATER SYSTG7/TREATING, Workers'Compenmtionlawsof Cthf.mia.Date PAID O Z Applicant NEWRESIDENTIALPLMB. SQ.FT. Date Recel t# Z O NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become sub}ars t to the Worke 'Comperuat Ion provblom of the Labor TOTAL: LU CC �) Cade,you most forthwith comply with such provisions;provisions;or this permit shall be j deemed reval ed. BUILDING FEE LU G CONSTRUCTION LENDING AGENCY SEISMIC FEE Ihembyaffirmthat them is a mnalmctlon lendry ingagency forthe perforrELECTRIC FEE Z anceofthr work ferwhichthb permit b tssued(Sce.3097,Clv,C.) TOTAL: V O I.cndcr'sNana - - PLUMBING FEE U., Lender'sAddrom QTY. ' 'MECHANICAL PERMIT F +.t 'FiEE, MECHANICAL FEE O-W 1certlfythatl have read this.pplicalionanl etatethattheabovelnformatim 1 iscomet,I agree to complywith all eltyand county ordinanceaand state lawn PERMIT ISSUANCE FEES PAID: } relmingtobulldingcoratauctlon,and herebyauthorix representativesoflhls - H city wenterupon the above.mentioned property for inspectioninspectionTO ion purposes. ALTERORADDMFCH. Z (We)agree to save,Indemnify an d keep Aar the City of Cupertino Date Receipt# V 'against llablLties,judgments,Wks and expensea maylnanywayacctus AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: against said Citfln co encti oltM ntln Is permit. �Y•�S AIR HANDLING UNIT(OVER IO,OWCFM) CONSTRUCTION TAX 51 tureot App not ontract.r Date EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCL SURE Will the applicant orfutumbuilding occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) material as deRimd by the Cupertino Municipal Code,Chapter 9.12,and the Date Reeel t# Flealthand Safely Code Secilon25532(a)P HEATING UNIT(OVER 100,OM BTU) TO 0a7—� 0 Yes No Will the applicant. tum building occupant use equipment or devices VENTILATION FAN(SINGLE RESEy ISSUANCE DATE which rout haurdous air mnlamlwnts as defined by the Bay Area Air Quality Management District? BOILER"COMP Oi POR 10J,(N%)BTU) 4Yes ❑❑ uvcreadthehazallousNomaterialsrequirementsunderChapter6.95of BOILER-COMP(OVIM100,000 BTA pp the California Health&Safety Code,Sections 25505,25533 and 255M.I A I-D understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.Ff. responsibility to notify the occupant of the requirements which most be met ob� prior to Issuance of o Certificate of Occupancy.' 19 199 Owner or authorized agent Date %E vi: ' TOTAL: ISSUE�IIY:`��aTj[(_I_(Iuyu— . OFFICE COPY