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20435 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification - PER LET NO. Bnlld�g Address: 20435 eQame one: A A ner. CITY OF CUPERTINO-BUILDINGDIVISION n�y //y� manpr'a Name: Lie.No: APPLICATION 1 PERMIT a D`L6 a BUILDINGELECTRICAL-FLUMBING- CAIE(-ARY CON7ROLp rchitect/Ln neer. MFLHAMCAL Lk.No: - M QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO. Address,b1Q Q} r�� PERMITISSUANCE ❑ 1:1 E:1LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions of Cha pter 9(mmmenc APPLIANCES-RESIDENTIAL JOB DESCRIPITON ISection fso�rt).a!�Divi so3 e i nd GPm(eulonaCode,and my lcenexis funforceand ect PANELS f License Class Date Contractor —� FOL i- T—�— ARCHITECT'S DECLARATION 201-1000 AMPS — —V aOz I understand my plans shall be used as public records OVER 1000 SQ.Fr.FLOOR AREA $/SQ.FT. x bCO 6 Licensed Professional SIGNSELECTRIC <�6 to o. OWNER-BUILDER DECLARATION IALCBiCNT/ LSC s., I hereby affirm that l am exempt from the Contractor's License Law for the X0.. followingreason.(Benton 7031.5,Business and Professions Code:An N or OgX4 a ntywiehrequlresapermittomruk MOter,impmve,demolish,orrepair MEIERO LEIN any structure prior to its issuance,also requires the applicant for such permit to 6p�O a S file a signed stateroom that he Is licensed pursuant to the peavbims of the PO DEV! Q3 Contractor's License Law(Chapter 9(commencing with Section 7000)ofDIW- ��0� slon3 ofthe Business and Professions Code)orthat he Is exempt therefemand - C sW VALUATION y-' the basis for the alleged exemption. Any violation of Section 70315 by any applicant fora permit subjectsthe applicant to a civil penalty of not marc than OUTLE TC FIXTUR five hundred delta.(5500). G1�^�n ❑I,ensatlonas owNEW R DENIAL ELECTR owner of the property,or my employees with wages as their sole SQ.FL STORIES IYI'E CONSTRUCTION ��� 'comp ,wUldothe work,and the structure Brsot Intended or offered for a O ro1e(Scc.7004,BusUiessand Professions Code:The Contractoea License law ©S S does not apply to an owner of property who builds or Improv.themes,and OCC.GROUP RFS.UNITS who does such work himself or through hisown employees,provided that such improvements are not intended or offered for sale.If,however,the building or TOTAL: improvement Lssold within omyearofcomplnio,theowner-bunderwlll have ' tryR�nben of proving that he did not build or beprove for purpose ofsale.). QTY, PLUMBING PERMIT FEE pL00DZONE p LJ S as owner of the property,am exclusively contracting with licensed PNPERMIT ISSUANCE rentranors to mrestru t the project(Sm 7034,Business and Profenloru Code: The Contractors License Law does not apply to an owner of properly who ALTER-DRAIN&VENT-WATER(EA) builds or improves thereon, and who centrans for such p ejects with a cgyranor(s)ficenseel pursuant to the Comment's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY - LI I°m exempt under See. B&P C for this reason CES Owner Date DRAINS FLOOR ROOF,AREA,COND. SANTIAKY Y_ N_ WORKMAN COMPENSATION DECLARATION �m'T R I hereby affirm that I have a mnificam of consent to self-insure,or FDTURES­PER TRAF, SCHOOL TAX Y - N-con i.teof Work .'Compevationlmurancemacenlfld wpythereof(Sec. RECEIPT I, 3800,1 bC.) GAS EA.SYSTEM-1 INCA OUTLETS PARK= Y N PofryN Com any amp 1'AA rj �.nl --- GAS EA.SYSIEM.OVER 4(EA) RECEn)TM Certified py r i e BUILDING DIVISION FEES �CertUed mpytafiled with the city impact on division. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE CERTIFICATE OF EX EMPTION FROM WORK ER S' CREASE TRAP PAID COMPENSATION INSURANCE (Thlssection need not becompined Uthepermit isforone hundreddollan SEWER-SAMTARY-STORM EA.200FT. Date Recei [# (S1 I Irfiuless.)oertifythat in the performance ofthe work for which this permit is issued WATER HEATER W/VENT/ELECTR ENERGYFEE Y N , I shall not employ any person In any manner so as to become subject to the Workers'Compensation Laws of California.Date WATER sysrEhl/TREAnNc PAID O Z Applicant — o O NOTICETOAFPLICANT.1f,.ft rm.kingthls CeAiii.teof Exemplon,you NEW RESIDENTIAL PLMB. SQ.FT. Date Reixu t# should become subject to the Workeri Compersat[on provisions of the Labor WW Code,you must fon hwith comply with such provisions or this permit shall be TOTAL: > deemod revoked. BUILDING FEE (L p CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirm that there ta a constmmon lending agency for the perform,Z sereof the work for which this permit is Lssued(See.3097,Civ.G TOTAL: ELECTRIC FEE V O Ieederb Nana PLUMBING FEE LL F- lender's Addmsa QTY. MECHANICAL PERMIT FEE O W Icemify that l have read thbappllcationand nate that the above lnformatlon MECHANICAL FEE (L Is correct.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEE$PAID: } N relating to building romtmetion,and hereby authorise representatives of this F Z city to enter upon the above-mentioned property,for hapection purposes. ALTERORADDTOMECH. — (We)agree to save,Indemnify and keep harrrd m the City of CupeNno Date Receipt# against liabilities,judgments,cons and expenses which may In any wayamme, AIR HANDLING UNTT CTO looDo CFM) $DBTOTAL' against said City I.m.xquence of the granting of this permit. AIR HANDLING UNET(OVM 10,000 CFM) CONSTRUCTION TAX SlgnaNre of HAZAFOCUS MATERIALS DISCLOSURE Appficant/ConDate EXHALECTI ST HOOD CONSTRUCTION TAX PAID: Will the applicant orEatum building occupant store or handle harardousHFATING UNIT CEO 100,M0 BTU) materialas defied the Cupertino Municipal Code,Chapter 932,and the Date Recei t# F❑Eralt Yod Safety Code SeNioon 7SS32(a)t HEATING UMT(OVER 100,000 BTU) TOTAL- Wiiltheappllcantorfams,building occupant use equipment or devices VENTILATION FAN(SINGLE RESIDE d AH9SS.UANCE DATE _ which emitaircontamimntsasde(Ined by the Bay Area Air Quailty Msragentgementnt -1 No BOILER-CAMP OFB'Dft1W,IXp BTU) ` Yrs FM�No t pp 7 V have read the harar�ous materlala rcquimmvntsunder Cha r6.95 of BOIL[R-COMP(OVIR 100,IXp BTU) Ilforn la"ea' &Sa fiery Code,Sen ions 25505,25533 an . I oaf; unden dthat lithe buildingdcea not currently haveatena qt Ittamy NEW RESIDENTIAL MECH. SQ.IT. responcb Ity to notify the occupant of the requirements whic mus beret fs (�tIRgTIIf10 prior to an fa ficate of Occup cy. J ar�r. ya� ll ner or aulhorF agent e ISSUED BY�, TOTAL: OFFICE COPY