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21604 r' NarrLllaAlY I iv rILL IIn1 Flvrvnnl/1N wNv I-1 `-/ ' Building Frowt Identification PITMTNOO. O4 . Building Addrusv ./ A � 1 `I I 13ouI-I rJ 6- z I �c3 oND G 'DWWer. ami: Yr J !�L.t_o Q R 5, Q CITY OF CUPERTIN0.BUILDING DIVISION .antmctm'.Name: �^ Lk.Na: APPLICATION 11. — `' A� �YW cal —� BUILDING-ELECTRICAL-MUMBING-MECHANICAL CATEGORY C M ArchiN ct/Engineer. Lk.No: RE R y r' '"N m ,r' "' BUILD C PERMIT INFO Q'rr ;1... a A ELECT•*PERMt ' +.i" A. FEB.- -•,=. - Addrees: PERMITISSUANCE ❑ ❑ LICENSED CONTRACTORS DECLARATION I hereby.(firmthat lam licensed under provisions of Chapler9(mmmenc- AI'1'WANCESRESIDENML Og D,ES1C�R,E.'�niIIIOON Ingweh in fultlonl force of Divfect. the Buslrua@and ProleuloneCode,and my Ikenn b ecfun loroe.nd dfed. PANELS \\\ Llnnse Class Lk.N Dale Contractor fi11000AMI5 ARCHITECTS DECLARATION SIO l understand my plans@hall be used u public records. OVERI000AMIS SQ.ET.FLOORAREA 3/SQ.IT {ELicensed P,of,.Wul SIGNS ELECTRICAL !! OWNER-BUILDER DECLARATION In @ SPECIALCRRCIIIT/MISC p, 5 ,hereby affirum.(that l am 31.5,Bxempt from s a d I'mfesslo License Law for the Q falWwing mum.(Section 7031 S,Business and Profeubns Cade:Any ally or uI county which requires a permit to construct,alter,improve,demollah,orrepalr TEMP.METLR ORPOLE IN57. �E 7 any alrudun statement WuauIs gabe rc d prumu tat to the provisions of t e POWER DEVICES K Oleaactors icnseLa,hathetlicensed enclegtit the pon 700M f the ��rq Contndor's License Lew(CMpter9(commencing with Section 7000)01 qvl- SWIMNIING POOL ELECTRICn VALUATION 1 alon3olthe BuaneuandPMculonsCode)orlhat henvemptihercfromand �y G the basis for the alleged exemption. Any violation of Section 7001.5 by any OUTLETSSW,TCHmr ESFIXTURES CfO �/ �-// applIcant fora permit subject,the applicant to a civil penalty of no ore than 0 flv61,undred dollars(S500). - NEW RESIDENTIAL ELECTRSQ.FT. STORIES 1YI'ECONSTRICTION �n as owner of the pmperty,or my employees with wages as their solo CC compensallon,will dothe work and thearucture Isnot Intended or offend for psale(Sec.7044,Bushaeasand Profeselom Code:The Contractors License Law $ docs not apply to an owner of property who builds or improve@ theme,and OCG GROUP RFS UNITS whodoea such work himself or through hiSOWA employees,provided that such Improvement.are not Intended oroffered forsale.If,however,Ihebullding or TOTAL: Vr50 Improvement Issold within oneyearofcanplNlon.theownerbullderwlll have ;y^' p l"rden of proving that he did not bundar improve for purpose of sale.). yta. ":^,;:"PLL<MBWCP I( 1T-:r^�+1' E`; FLOOD ZONE APN L-1 L as owner of the pmperly,am exclusively contracting with licensed ppJ(MIT ISSUANCEmnindan to..truct the project(Sec 7044,guinea and Professions Code: The Contractor's License Law dm not apply to an owner of property who ALTER-DRAIN k VENT WATER(FA) builds or Improves thereon,and who contracts for such p,ulecta with a ' ''.FEE SUMMARY cj5ador(@)Oanaed pununt ro the Contndoes Lianw Law. ^3.":`I(":':`e" LL�J I am exempt under Sec. B 4 P C for this reason BACK FLOW PROTECT.DEVICE OUTSI OF FEES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_ Owner Dae RECEITT N WORKMANlh.v..COMPENSATION DECLARATION FIXTURES PER SCHOOL TAX Y_ N_ QI hereby affirm that,have o ceaOMate of conrem to opytnsun,ora RECEIPT N 38W,Iateol Worken'Compensallonlnaunnceora artifled copy ihenmf(Sec. GAS RA.SYSTEM-i INCAOUTLETS PAR Y N Policy a CJ - Ib11ryN —t INGDIN Ca�mp�ray � GAS G.SYSNM-OVER1(RA) BUILDING DIVISION FEES I ICer110ed copy Is hedwith ne city GREASE/INDUSIRL WASTE INTERCEPTORCIIECK PFS Csettled copy Is herebyllhthesty Inspection division. �� �[�'/"��I CERTIFICATE OF EXEMPTION FROM WOR KERS' GREASETRAP 1 �"1COMPENSATION INSURANCESETVFR-SANITARY-STORM EA 200Rf �/—Date Revel 1p(Thlasedion need rad hcomplemd Ifthe permit Isformehundreddollar(f1Im"ifyes.) WATER HEATER W/VENT(ELUCTRGY FEE Y N Iceor has.at Wtheperfomunn cal the work forwhlch this permit is Wooed,IshallnotemploynayperamiInanymannermuto be ome mJ to the WAq�SYSTEM/TREATINGWorker Com ya�Ion ya spl Califq��s Dale Q Z Applicant �(��-Sb w/l r '/a�+U NE'W RESIDENTIAL PLM8. SOFT. Date Revel t#Z 0 NOBCETO APPLICANT:If,after makdngthttCertlfialeof Exempllon,you.hwldbecomesubject to the Worker'Compensation provisions ofthe Labor TOTAL: nCodeyou mustfonhwithcomplywilhwchpro lo"orthispermitihalibe W j domed revokd. INGt1C CONSTRUCTION LENDING AGENCY IC FEEl hereby affimChat there Is e coutrudlon lending agency for the perform TOTAL: RIC FEEO anon of the work for which this rmit Is issued(Sec.3097,CIv.C.) BING FEERlender's Name LLLendersAddress IY.>M� _1NH� fAN[CAL�PER(v�ITg�;?. ANICAL FEE OW lcertltythali hvereadthbappOalionandaatethaltheabovelnforoallonIscumd.l agree to complywlth all cityand county ordinanm and elate laws PERMITISSUANCE r.N reI.tlrgtabuidI,Sooutrur1I. ,.nd herebyanthornerepmaentallvuofthIs C't�city to enter upon the above-menlloned property for lupedbn purpox.. ALTER OR ADD 70 MECH' ate - Revel tp — (We)agree to save,Indemnify an d keep harmien the City of Cupertino against liabilities,Fadgnomt,ccau. d upenanwhich may lnanywayaaroe AIR HANDLING UNIT(170 10,000CFM) SUBTOTAL: - against said City lnconsequence ofthe granting of this permit. AIR HANDUNGUNIT(OVER 10,000GFM) ONSTRUCTIONTAX Slgnatu n of Applicant/Conlrador Dole E(1 IAUST 1100D(WI DUCT) NSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE I- Wllllheappllcantor future building occupant stare or handle haeardous BEATING UNIT CFO 100,000 BTU) Dae Receiletfl material as defined by the Cupertino Municipal Cade,Chapter 9.12,and the - - I fish and S.(My Code Section 25532(.)7 BEATING UNIT(OVER 100,000 BTU,) TOTAL: RYes L_I No ill the applicant or future building occupant use equipment or devices VFNTILATION IAN(SINGLE RESID) ISSlrr MATE which colt harardom air contaminant,as defined by the Bay Area Air t'r'J�'�Y1B • Quality Management District? BOILER-COMP OFR'OR 100,003 BTU) r� ❑Yea Q1�1No ,JA QQ9y� ' ,have read the hazar`fi ossa materials requirements under Chapter 6.95 of BORER-COMP(OVER 100,000 BTU) the California l lulth k Safety Code,Sections 25505,25533 and 25531.1 u oderstd!that if the bu llding don not correnlly have a tenant,that It is my NEW RESIDENTIAL MECH. SQ.rF jN1ar�,�rk responsibility to notify the occupant of the requirements which must be met q `� W prior to Lauance of a Certificate of Occupancy. 1{JRy �"C�^- Owner or authorlredagent Data gSUp01/ TUTAL OFFICE COPY