21695 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
11.11,11ra project ldeml(balon PER.WTNO.
B r ingOAddrcs: n :f . �4 � � N �1,(J 21695
.11 ems. Phone' •op OF CUPERTINO-BUILDING DIVISION , L
con Fame: e... Lic.No APPLICATION / PERMIT
Archh girsr,,of 0 ti t.k No: �E lO ELECIRICALPLUMBINGMECIIAMCAL CATEWRY CONTROL
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address 6 U � '� . I'FRh1]"[ISSUANCE 1:1 ❑ �j_ [:1LKENSED CONTRARORS DECIARN Ai10I—fT
hereby lrm famlkmuduMerprwbloruo(aupter9(comnm APPLANCFSRE9DFNML
IngwlehSaction 7(0U)ofDldnm3 oftheBusnmandPoeadonaCode,and )OB DFSCRIFN5N.
c
Iiocve Is In full forte and effe PANES C5
Llamme bs 'Co.Y aAMPS
. . VT V l�.
at Conde or
ARCHITE D CLARATION AM
p�p�uu OQZQ uMe rdmyplamenelbeusedupublicremads OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
EuEj Limned Pmfosbnal SIGNS ELECTRICAL
�n leu OWNER-BUILDER DECLARATION
Thereby afOrm tlutlaro exempt from the CoMruaors Lkenx law(m the SPECIAL CB2CNT/MI9E
p following reasissue sue 70315,Business, ro
a"Pfmro mCode:Any dty or
O Z TEMP.MEITR OR POLE
�� muntywhRh mequbnapr,rnNtromuwd,al(en lmpnre,demoWh,orrepalr ,
< anygmu mprbrtolbbeuarc,olsorequbestheappBootfau6permitto POWER DimCFS
file a he
Okv Cnntradoore Llceue Law(ChapteWarrant that In,is r9(. cing wkhnsed Patentor to tSeGb 70M)of Dlv4
30r^ sbn3of the Buelnes and Pmo(eeamm Code)orthrt iasis see thrrefromard SWIMMINC,17001, C VALUATION
O5 tho Meb for the eltged exempimi. Any Nolatbn of Seabn 70315 by any O
YY��?iiJJ appBant fore permk wbjniathe applicant too tivll peruLLydnca rtnrethan
fW6lydred dollars MM. NEW 9Q.FT. STORIES TYPECONSIRLCTION
LJ I,u owear c f the Property,or my empbyeetwith wage a theirsole
mmpenaadoo,wBldothe work,and theatro=m is oof W eMed or offered for _
psale pec.70K Busness and Avfeslms,Code:The Contra aura Llaroe Law
does not apply tom owner of property who Wilds or Improve therms,and OCC.GROUP RES UNITS
who doesauchwork himself orthrough Msownemplgen,prwldMtlutsuch
improvemew are not Intended oroffemd fineale.If,however,the building a TOTAL
improvememdbwdwlthinoneyearofcanp Ietton,Ikownerbullderwfllluve
t rtleno(pmoWngthrthedfdmtbuI orlmprovefaprrpose nfvle.). QTY. I PLUMBIOW417 FEE
L,J L u owner of the property,am eaclueivey,contracting with license ^ FLOOD 7ION'E APN
condors to mrutrud the project CSL,. 14,c 70Buaond
lna aProfessions Cade: L%UANCE lsCID ,
The Cootrad.e.Llan.Law does not appy to an owner of property who .D & A]FR(EA)
Wilds or Improves thereon, and who mntram (a suah pto)ecta with a
rg01�1or(e)
licensed pursuant to the Cuntranora Laos.Law. BAIX FLOW ,D FEE SUMMARY
LJ I am exempt under Sec B&P C for this rearm 4
ate DRAINS F,AREA,COND. SANITARY Y_ N_
�• Avner WORKMAN COMPENSATION DECIARATION crrppps
Sa100L TAX
Of M1ereby ifllnn the I have a artificer,of consent to.0-Inure,or 0 FIXTURES RECEIPT s_
ormf1we ofworken•Compermauan lewrsna aa ani(led copy thermf(Sec. GAB-F&SYSTEN BJG40U1IEIS PARKFFR Y_ N_
380,Le,Cd
policy y RECEIPT It
Com ny GAS FA'SYSTEM-00 E 4(EA) BUILDING DIVISION FEES
Cenlled ropy b heed with the dlyed. GREASEANDIISTRL WASTE INTERCEPTOR PLANCHECK FEE
cewlea ropy b rued ween the dry impetbn alvwan.
CERTIFICATE OF EXHOPI'ION FROM WORKERS GREASE TRAP PAID
COMPENSATION INSIIItANCE gEwFR-gANITwaY SroILM EA 7oDFr Date Rccci tM
(TMs setbn sad nae be comrLplded ff the permit b faom hundred dollars
(S100)alesJ ENERGY FEE Y_ N
WATERxFi4TERW/VENT/Emla
I art hese.)t m lee pedomana o(the wale far which W a permtt le beuW,
I shall not employ any person to any manner to as to become subject to the WATTR SYSTW/TREATING
Wovkcri Compouatbn law•of GWomla.Date PAID
Z Z NOTICE
NEWRESIDENTIMLPMB. SQFf. Date RCOei tit
O Applb.E
TO APPLICAM:l,after making this Certllcte of Exempbn,you
should become sub)ect to the Workeri Comperwtlon pmvblou of the Labor TOTAL
N Cade,ym=efathw hmmpywlthwchprovbbrsorthbpemdtshallbe
deemed oked. BUILDING FEE
W > revCONS.RUCTION LENDING AGENCY SEISMIC FEE
a I hereby affirm that then is.mrstrudlon lending agency for the pMorn, ELECTRIC FEE
M Z anmof the work for which this permit b beuN(Se,.3097,Clv.Q TOTAL: s
02 lender's Name PLUMBING FEE l{
IL F Lerder.Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W T certify that l have mad this appllcatbn and seethe theabove Information
boa re .Iagreetoemplywlthandtyamdcountyordinmmands telaws PERMIT ISSUANCE FEES PAID:
Nrelating to building mnstrudlon,ami hereby authonr represmelves of this
F Z dty to enter upon the abaanmentbned property for bmpetbn Pu rpme,. ALTER OR ADD IO MTCIiL
_ Date Recti tp
(Ode agree tosaw,IMemNlae l keep harmimthe cityo1Or bio
V .gains lai W,C*NdgmeNs,mssaM ex messes which mymanyw•.yacwe AIR HANDLING UNIT CI1O 10,000 ami) SUBTOTAL:
.g.but ul Econ eraeof �ngo�JhlspermH.
a?Z AIRHANDUNG UNTT(OVER 1,Ia4)CFM) CONSTRUCTION TAX
Sigw of Applane/Contrut Dat EXHAUST HOOD(W/DLCO CONSTRUCTION TAX PAID:
NATARDO TERALS DISC RE
rill epplb, eu or future Wilding ocmPart store rlusdlc h.rdoua 1fEATING UNIT(10 10),(0()BTU) Date Recei t#material a defined by the Cupertino Munidpal Code,Chapter 9.17,and the
R,ahhaMSeuty Code Soonu,2S537p)7 HEATING UNIT(OVER 100,OOD BTU) TOTAL: k�
Yes M No
Il the applicant or futumbullding occupant use equipment adevim VENTILATION FAN QINGLE RFSID) ISSUANCE DATE
which,mit bvrdous e,ormamina Ma.e deftrae by tho Bay Ane.Mr
Quality Manage..Dlstrkl7BOILER-COMP OlIPOR 100,0W BTU)
r�
F-11Ye NoPAM
-have read the ha ematedab requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
the California Health&Safety Code,Saabnm 25505,25M and 75534.I (�
und,rstandthatlfthebuildmgdmrwtmrrentyhryeat.nanL that It b my NEW RESIDENTIAL hiECH. NFT ,1�[� YR- 4�Or�
resporumitity,to notify the o pet of the mqulrtm,rds which maunt be mat d 1v
prior to buena,N a Certificate of Ocnrpeny. \ T/^�.,.�l5( , �Ty�,,��a•• _ .
Owner or auehorirad agent Date ISSUED BY:W`✓mw r•
TOTAL
OFFICE COPY