19525 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification POWIT NO.
Building Address 19525
ja50-0 R(96EVIEW C
/ante: Phone: A A
DIy!(_FA G
L FI/'�KL(1(2, COg1p CITY OF CUPERTINO-BUILDING DIVISION
Contractors Name: Lie.No: APPLICATION /PERMIT
BUILDING-ELECTRICALPLUMBING-MMIANCAL CATEGORY CONTROL N a�Q
! Arch /� n«r. L No: �l CJ
el 2 QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: 745 PERNUTISSUANCE El ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
I herebyafflrmthat lamlicensed under provitionsof Chapter9(commec APPWANCESRFSIDENIIAL JOB DESCRIPTION
Ingwith Setion7000)of Dlvislon3 ofthe Businessand ProfessionsCode,and my �`t
license is In full(oQ�and effect. PANELS
License Class 0 tic N 4ef O$�4 �'P+- 'r I w.
P D�,
Date—]ri—Spr
ANCHITECPS DECLARATION - 201-IODO AMPS
of 7 I understand my plans shall W used as public recoNs. OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT.
CR .ftO
Licensed Professional SIGNS ELECTRICAL
Q Eli OWNER-BUILDER DECLARATION SPECIALCIRCUIT
Fg7' thereby affirm that am exempt from the Contractors License Law for the
O Z following reason.(Seenon 70115,Bu.henta nd Profession.Code:Any city or TEMP.METER E
e' countywhich requiresa permit reconstruct,alter,Improve,damelleh,orrepair
mystrutlure prior to its ismance,alsomquireslhedpp0ant for uch permit to
Oc. file a signed statement that he U licensed pursuant to the provisions of the POWER D a I
Contractor's License Law(Chapter 9(commencingwith Section 7000)ofDlvl- y� L VALUATION
QO sion 3 of the Business and Professions Code)or that he is exempt therefromandyl S the basis for the alleged exemption. Any violation of Section 70715 by any OUTLE - �D '10
applicant fora permit subjectsthe applicant to a civil pemltyafna cromthan
$& five hundred dolhrs(SM. 1
�n ❑I,as owner of the property,or employee with wage as]heir sole
NEW D SI'ORI TYPE CONSTRUCTION
C7Q
compensation will dothe work,and the hestructure Vnot intended or offered for
5�❑ sale(Sec.70Ed,Buslr�ess and Professions Cade:The Contractors Wcense law
�s$ does not apply to an owner of property who Wilds or improve lhereoq and OCC.GROUP RFS.UNITS
whodoe.suchworkhlmaelf orthraugh hisownemployces,provided that such
Improvements am not intended oroffere!forsale.IS however,lhebuilding or
Improvement issold withinoneyearofcompletim,theowner-buRderwill have
t1�o arden of proving that he did not build or improve for purpose of sale.). QTY. PODINME IkII&AFM FEE FLOODTDNE APN
LJ 4 as owner of the property,am exclusively contracting with licensed PERMIT A
contractors to construct the project(Sec.70K Business and Professions Code: /
The Contractor'.License Law does not apply to an owner of property who ALTER-DRAIN ..
Wilds or Improve M thereoand who contracts for such pkejecis with a FEE SUMMARY
�,ptllaater(s)licensed pumuanl to the Contractor.Ll an.Law. BALI(FLOW PROTFC sE
U 1 am exempt under Sec. B&P C for this reason
i SANITARY cY_ N_
t Owner Date DRAINS FLOOR ROOF, CO RECEPT II
WORKMAN COMPENSATION onnifi DECLARATION FIXTURES,PER TRAP SCI TOOL TAX Y_ N_
❑I hereby affirm that I have a l...e of ao dif to pytheurc,ora RECEIPT N
artltlate o(Workers'Compensatlonlnsurana ora artifkd copy thereof(Sec. GAB-FA.BY -1INC.4O PARKFEE Y_ N_
3800,Lab C3
PolicyM — 'IN
y GAS EA.BY -0VER 6 BUILDINGDINGDIVISION FEES
an
e filled copy U hereby Winched. GREASE/IND LwA 1 T PLANCFIECK FEE 1
'
Allied copy U filed with the city inspection division. ?Z7.4—/�r.� `'
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID / I� !U `r3 7 7
COMPENSATION INSURANCE SEWER-SANAR RM EA Dale Remi t#
(fhlssectlon need not M completed If the permit h for one hundred dollars `�
(5100).1 leas.) WATER HFAT[R v /nra.FCTR ENERGYFEE Y_ N
I amity that be the performance of the week forwhich this permit is Issued,
I shall not employ any person in any manner so as to become subject to the WATER SY /TRrA
r Warkcrs'Compensation laws.!California. Date igh
PAID
.0 Z Applicant NEW RES DENTIALP B. BQ Date Remi t#
Z O NOTICE TO APPLICANT:14aher making this Certificate of Exemption,you i
should become subject to the Workers'Compeneation provisions of the Labor TOTAL:
fd
Code,you=at forthwith comply with such provisions orthb permit shall be
BUILDING
LU j deemed revoked.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
11 Iherebyaflmnihat there is a construction lendingagency forthe perform TOTAL: ELECTRIC FEE
M Z ante of the work for which this permit is Issued(Sec.3097,Civ.QPLUMBING PEE
V O Lender's Name
LL F- Iender.Address - QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW Icenifythat l have read thisappliatlonand sunthattheabove information
S Iscorret.Iagreetocomplywlthallcityandcounty ordinance and slate laws PERMIT ISSUANCE FEES PAID:
>. (L to Wilding construction,and hereby authorize representatives of this
(— U) city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. Date ReCCIPt#
(We)agree to save,Indemnify an d keep harmless the City of Cu Perrino
V against lUbll ,' dgeornts,cossmd expense which may in any wayacaue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
agains City mnsequenaafthegrmtl le permit.
c J AIR HANDLING UNIT(OVER 10,!X10 CIM) CONSTRUCTION TAX
Signal of App ontractor Date EXI-IAUST1I0013(W/DIX:T) CONSTRUCTION TAX PAID:
DOUR MATERIALS DISCLOSURE
WiIIIa the defined or ytheC rebuilding occupant store or handle havrdous HEATING UNIT(TO 1fD,0000TU) Date Recel t#
anterial as defined by the CuyPyPPPeeeeee++++++111111Ino Municipal Code,Chapter 9.12,and the
llealthmd Bafety Ced =U)? HEATING UNIT(OVER100,000BTU) TOTAL: so
❑Yes Irj No r�B'A
Will the applicant or futurebuildingoccupantu.equipment ordevices VPN"IIIATIONFAN t51NCLERESID) I tDATE
which emit haNaMous air costar rsms as defined by the Bay Area At,
Quality Management Distrl BOILER-COMP PHPOR 1(10,000 BTU)
4Yes ;� X990
havc read the bazar ousmaterials requirements a nder Chapter 6.95 of BOILER-COMP 100,00081U) APR
the California Health k Safety Code,Sections 25505,2_5.W and 25534. 1
understand that if the building does not arrcnt ea tenant,that It is my NEW RESIDENTIAL MECId. SQ.FL ft (TIMI f10
responsibl t notifythc occopant of th uimmmis which must be met 1'a
prior to uan cats Ccrtif¢ate of panty.
n nor authors cog nt $ �UDate ISSIZ6B
TOTAL:
OFFICE COPY