23731APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY'
Buildin Pm ed Identification
Building Address:
8 s (9-�Ofa4 0 )'
- PERMTNO.
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CITY OF CUPERTINO- BUILDING DIVISION
APPLICATION I PERMIT
BUILDINGELECTRICA4PLUMBING- MECIIAMCAL
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Contractor's Name: � Lk. No:
So�i17 d Pw �,8! �� la3i1 `f
CATEGORY
CONTROL N
I Architect /Ggineer. Llc. No:
QTY
•' ELECTRICPERMIT '`•
•��FCE�V
1.' BUILDING PERMIT INFO'��'
�+ /�,�
Address: 7 L I LL-z ij- - CA e i r -Q t V.
PERMRTISSUANCII
❑ A�9 ❑
IT7__
LICENSED CONTRACTOR'S DECLARATION
Thereby affirm that l con licensed under provisions of Chapter 9(mmmenc
ingwlth5ection700D)of Divielon3o(the0uslnosand Prefic shmaCade, and my
license la In fuB�pmge�d sited. p -•
Llmnse Clam L— UkeLictl �{�-.
Date�2_r2 Contactor ZA4 ^ffl-�
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Ltmosse i Professional
OWNER- BUILDER DECLARATION
I hereby affirmthat I am exempt from the Contractor'. License law for the
following reason. ( Section 7011.5, Business and Pro /e.slan. Code Anydty or
countywhichrequlrnapertMto mnstmd, alter,Improve, Cade: h,orrep or
anystrucome priorto its issuance,aborequlrestha applicant forsuch permit to
file a signed statement that he is licensed pursuant to the provisions of the
Contractors License Law (Chapter 9(commenting with Section 7000) of Dlvl-
slon3.(the Business and Professions Code) action he is eaempt theenfromand
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant fare permit subjects the a pplicant to a civil pedalty of not more than five hundred dollars (5500).
nI, as ownerof the properly, or my employees with wagn as their sole
compensation, w0ldothe work. and theatcudure b not lnteMed or offered for
sole (Sec. 7044, Business and Professions Code: The Contractors License law does not apply to an owner of property who builds or Improves thereon, and
who dmasu ch work hlmasUmthrough Ma own employ., provided that such
Improvements are not Intended reoffered for sale. If, however, the building or
Improvement k sold within oneyearofcompletion , the owner- buliderwill have
t"ed en of proving that he d ld not build or improve for purpose of ask.)..
LJ f. ate owner of the properly, am ezdusively contraaing with Ilrenxd
mntmemes toconstrud the Project (See7044, Business and Professions Code:
The Contractors License law does not apply to an owner of property who
bu
Wilds or Improves thereon, and who contracts for such p(ojects with a
cgIlL7�dor(a) licensed pursuant to the Contractor's Llanse Law.
IJ I am caempt under Sec. B & P C for this reason
APPLIANCESRESTDENffAL -
JOB DESCRIPTION
1
PANELS
UP TO 200AMPS
201 -1000 AMPS
-
OVER 1000 AMPS
SQ, FT. FLOOR AREA •
IN-
S /SQ. Fr,.
-
SIGNS ELDCTRICAL
SPECIAL CIRCUIT /MISC
TEMP. METER OR POLE INST.
POWER DEVICES '+'
SWIMMING POOL ELECTRIC
IVIP
ATION
OU7LETSSWITC}IFSFIXT[R2ES
NEW RESIDENTIAL ELECTR SQFL
7S40FJES
TYPE CONSTRUCTION
QTY.-
TOTAL:
:d'�(, PLUMBING`PERMIT,' r•1•. ��
PERMITISSUANCE ' '
ALTER -DRAIN & VENT -WATER (EA)
:� IFEE•�APN
r1
RES. UNITS
I
BAIX FLOW PROTECT. DEVICE
•.,FEE SUMMARY
OUTS1 OF IT—Ls
Owner Date
DRAINS -FLOOR ROOF, AREA, CONED.
IV(T11RFS I'Elt TRAP
�a
SANITARY Y N
RECEB'T a
WOR"AN COMPENSATION DECLARATION
❑1 hereby afflmt that I have a certificate of consent to ul(- inmtre, or a
arliflate o(Workrn'Compensatlonlnsurance oracertifled mpy therm /(Sec.
38M Lab c)
Po11ryY ST>71� /--N% Gw JLIZ—
SCHOOL 7A% Y N_
RECEIPT# '
CAS EA. SYSTEM-VINCA OUTLETS
PARK ITS. -Y N
EET M
Cam any
[P Certified copy 6hed with the
�Ccni(Icd copykflled with the city Inspection division.
CERTIFICATE OF EX M. P`HON FROM WORKERS'
COMPENSATION INSURANCE
(Thlssectirnneed not becompided iftheperent bforonehundred dollars
(810( riflyt.) .4
I llnet that In an personal any crooner so as to ons, subject is tuned,
I .hall not employ any Person In any manner m m to become subicd to the
s'Compensauon Laws of California. Date
APpllant
Applicant
NOTICE TO APPLICANT :ILagernmkingth0Cerllfiateof Exemption, you
shouldbecomesubFdtothe Workers' Compensation provisions ofthe Labor
Code, you most forthwith comply with such provisions or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a mnstrudion landing agency for the perform
ance of the work forwhich this permit is Issued (Sec. 3097, Clv. C.)
Lender. Name
LendcreAddel
Icertlfyth.t I have re ad this application and statethatthe above in formation
Iscorrect. l ageeto comply with all city and county ordinances and date laws
relating to building a mtrudion, and hereby author an representatives of this
city to enter upon the above- mcntloned property for Impectlon purposes.
(We) agree to save, indemnify an it keep harmless the City of Cu Pert ono
agalmtliabilltiea' nt.,caeu. dexpo which may In anywayameue
agalnet m\C Incon uenceoflh gr ti ofthl.pemnit.
/ C ^�• ��.
GAS EA. SYSl'EM"OVER 4(EA)
GREASE /LNDUSTRL WASTE INTERCEPTOR
-B UIL DING DI VI SION FE.
PLANCHECK FEE
PAID
` Date Recef t#
ES
,
GREASE TRAP,
SEWER SANITARY STDRM EA. ME.
WATER HEATER W /VENT /ELECTR
ENERGYFEE' Y N
PAID .
Date Recei t#
WATER SYSTEM /TREATING
NEW RESIDENTIAL PLMB,__SEEP7.
TOTAL:
-
ZJILDINC FEE
SEISMIC FEE
ELECTRIC FEE
QTY.
. MECHANICAL PERMIT'
FEE
PLUMBING FEE
PERMIT ISSUANCE
ALTE40RADD'TOMECH.
AIR HANDLING UNIT (TO 10,(IDO CFM)
-
MECHANICAL FEE
FEES PAID:
Date Receipt#
SUBTOTAL:
AIR HANDLING UNIT (OVER I CI"CIM)
CONSTRUCTION TAX
Signature of Appllant/Contrador Date
" HAZARDOUSMATER1ALSDISCLOSURE
Will the applicant or Future building occupant store or handle h.rdous
material as defined by the Cupertino Munldpal Code, Chapter9.12 and the
I lealth ❑Yaand Safety Cade, Setddloon2S532(a)7
Will theappliant or furore building occupant use equipment or devices
which emit haeardoua air ormumdnanta as defined by the Bay Area Air
Quality Management Dishid2
4 Yen E No
have read the hazar ous materials requirementsunder Chapter 6.95 of
the Gll forma Health & Safety Code, Seciions 25505, 25533 and 25534.1
understand that if the building does not currently have a tenant, that it is my
rmponslbililytondifytheoccupa Nofthemqulrerr..tewhkhmuatbemet
prior to Issuance of a Certificate of Ocapancy.
EXHAUSTHOOD(W /DUCT)
CONSTRUCTION TAX PAID:
HEATING UNIT (TO 100,ODO BTU)' -
_
D ate Reeei t
HEATING UNIT (OVER 100,000 BTU)
_ TOTA
VENTILATION PAN (SINGER BESIDE
ISSUANCE DATE
pp
PAID
D
[a
"MAY2V 1a7a7 2
CII c r4V
ISSUEDBY:
BOILER -COMP OHP OR 100,0(0 BTU)
BOILER-COMP(OVM 100,000 BTU)
NEWRESIDENTIALMECH SQ.IT
Owner or authorimd agent , Data
-
TOTAL:
-
OFFICE COPY