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24658 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO, APPLICATION/PERMIT PLUMBING-MECHANICAL 24658 BUILDING DIVISION BUILDING PROJECT IDEN'PIF'ICATION BUILDING ADDRESS: ` SANITARY NO. APPLICAT10NSUBMI'ITALDAIE i 19 ND ( . UNITN OTp 1 �� OW ERS NAM PHONE:lONE: CONTRACTOR'S NAME: LIC�NO: l((l j SGC to - '3311 e *3051 Co W i N/C CONTROLN RCHIT[CTp 'INFER: LIC NO: ADDRESS: W j ns d5 CONTACT: PHONE: BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE LOU E LIf MEC PERMIT ISSUANCE: ' 666��p LICENSED CONTRALTOR'SDECLARATION APPLIANCES-NESIDENTIAL sn+ ) FS R q00 Ihereby 0004re rmthatlam licensed andsrProvisiortof Chepmr9(commen<inB with �I /19 �' vioi_ 1100 Section 7000)of Divisi Sof the Businwaend Professions Code.end mylicenseixin PANELS SAI JIB-1, � FMdE full force and off 0 1a„ZW me Claus - Lic.N +I 103G5 ! UP TO 200 AMPS io Q Dam Contractor 201-1 WO AMPS F y ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.FT. ZOvs�' OVER IOW AMPS qq 1 undentnd my plana shell be used as public records. Fy It SIGNS ELECTRICAL rl E © S N gqq''��dd [4j Licensed lkofcsxinnal e V gm< OWNER-BUILDER DECLARATION SPECIAL IR UI SC �yLx(00.1U- 1 hereby affirm thin 1 am exempt from the Contractors License Law for the W 3 R-v¢� following reason.(Section 7031.5.Business and Professions Code:Any city or county TEMP.M R E _ .t C 0.o, 1 which requires a Permit to Corcoran,alter.improve,dmud,h,or repair:ny sweture a� Sa;!I Q� prior to it issuance,also reyuims mea,licartt forauch permitm file.signed mumem PO - 6?1�e N �7 W�a� O that he is licensed rursmnuo the provisions of the Commcters License Lew(Chapter ��7 0. 0� 9(commencing with Section 701afDivision 3 ofthe Bminess and Professions Code) SWIMMINGP OL ELGLTRI yA ATI ^y or thin he isexempttherefrom and the basis for the alleged exemption.Anyviolatiunof Y Section 70313bY an cant for. tsub'cts the Icununacivil malt f UTLETS-SWITCHIS-FIX �ZQ, YuDP(i pmIDl Ic PPI' a Yo O not am'. him five hundred dollars($SWI. KK ❑ I,asmwnerofthepropcny,ormyemployeeswithwageutheirsolecompenmdon, NEW RESIDENTIAL f:L _SQ.FT. S IES TYPO CONSTRUCTION y3-. will Professions and the he Contractor ois License awoneno,apply 7o 44,Business end Professions Code:The ves tnmmrr License Law does not hams to an owner of property who builds orimproveathercnn.unJ whodues such work himselforthrough his employees provided thin such improvements m<not intndrdoroffertdforsale.IL OCC.GROUP RES.UNITS however the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1,m orwncr ofthe property,am exclusively convecting with licensed commctorsm QTY. PLUMBING PERMIT FEE FLOOD ZONE APN construct the projem(Sec.7044,Business and Professions Code:)The Connector's License Law does not apply to an owner mfpropcny who buildsmimpmvea thereottenJ PERMIT ISSUANCE whocmnvactsforsuchpmjatswithac inctor(s)limnu ,u..uennmbe... a rs ALTER-DNAIN&VENT-WATER(CA) FEESUMMARY License Lew. ❑ 1 am esempt under Sec. ,B&PC for this reason OUT BACK]LOW PROTECT.DEVICE SIDE IS SANITARY Y N Owner Data DRAINS-FLOORRGOFAREA. RECF.I"It , , , . WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y ❑ Ihertby.IEnn thatlhaveecenificeu of conumto ulGinsure,ser.cenificem of FIXTURES PER TRAP RLCF.IPTN WorkerCompenxaton lnsumnco or accrdfied copy thereof(Sec.38M.Lab C.)which PARK FEE Y N covers all employer's under this permitGAS-EA.SYSTEM-1 INC.40UTLE1'S �..� RECEI N Polcyp BUILDING DIV] ON FEES Cm y GAS-EA.SYSTI?M-OVER4(EA) PLANCHECK PER r Cn Yified copy is hereby fumisheJ. .mined copy is filed with the city inspection division. GRPASEONDUSIRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (This section need notbe completed ifthe permit is for one hundred dollars($100) SEWER-SANITARY-STORM EA,2001"f. ENERGY Flif or ress.) to I certify that in the performance ofthe work for which this permit is issued,l shell WATER HEATER W/VENT/ELECfR s01— mu employ any perom in any manner so he to become subject to the Workers' PAID Z Compensatmilnwsof C.lifomia. Date WATER SYSTEM/IREATING Dote Receiu Applicant C NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: CI) become subject to the Workers Compensation provisions ofthe Labor Code,you must . forthwith comply with such provisions or this Permit hall he dxmed revoked. BUILDING FEE pkL4 4 w [(] CONSTRUCTION LENDING AGENCY - SEISMIC FEE D Z 1 hereby affirm Nat there is a construction lending agency for the performance of T [MFIKHANICAJ CTRIC FE V O Ne work for which this permit is issued(See3007,Civ.C.) t L7. Lender's Name UMBING P L' lenders Address QTY. MECHANICAL PERMIT FEE V I cenify thin 1 have read this application end state that the above information is FEE correct.l agree to comply with ell city and county ordinances and stte laws rlating to PERMIT ISSUANCE building construction,and hereby authodserepreuntatives ofthis city to enter upon the STRUCT] NTAX U Z ahnve-mentioned property for inspection purposes. ALTLRORADDTOMECH. (We)agree to save,indemnify and keep harmless the City of Captain.aguivt 1]abiliries,judgment,costs and expenses which may in any way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM) in consequence of the granting of this peon' 1 - AIR HANDLING UNIT(OVER UL"CFM) Signature of Applicen4Commcmr Date EXHAUST HOOD(W/DUCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT 100,000 BTU) One cipp Will the applicant or future bulmlmg rccnpam nme or handle heaardom mmerinl as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100.001 BTU) �TOTAL: Code,Section 25532(a)? VENTILATION FAN(SINGLE RESID) ❑Yca ❑No ISS NCE DATE Will theupplicantmfumrc building occupant m<m useequipordeviceawM1ichemit BOILER-COMP(3HP OR IW,fpO BTU) hcammus air contaminants a defined by the Bay Area Air Quality Managension BOILER-COMP(OVER 100,000 BTU) District? ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.Fr.. I have reed the hemandous materials requirements under Chapter 6.93 of the PCalifornia Health&Safety Code,Sections 25505,25533 and 25534. 1 underetand thin -4 p if the building does not currently have a tenant,that it is my res sensibility tonality the - recupem of the requirement which nun be met prior m issuvtce info Cenifcou of J"p, Occupancy. nlll Q Ownermauthorixedagem Dam ISSUE / `� OFFICE rtKurvu