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29518�i U U 0 F't V APPLICANTTO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING -ELECTRICALP13RMIT NO. /�/1 BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL 2 518 BUILDING ADDRESS: BUILDING PROJECT IDN. IN I1F'ICATION � �� SANITARY NO, APPLICATION SUBMITTAL DAPI 1-13 ❑ Consultant Fees Paid by Applicant (Initial)' HAZARDOUS MATERIALS DISCLOSURE Will The applicam or future building occupant store no handle hi amous mutation as defined by the Cupertino Municipal Cale, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? Fl Y. ON. Will the a,hemit or human huddim, occnpont use <c,on,a mor devices which mit himardous air contamitwnta as defined by the Bay Arca Air Quality Management Disme,? ❑Yes ❑No 1 have read the haczrdo e, materials requirements under Chapter fi 95 of the Cali. Road Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if the building does not currently have a froom, that it is my r<xlson,hi lity to norily tb<onvrynn of the requirements which must he use Prior 10 issuance ela Certificate of Ocaphne, ELECTRIC PERMIT FEE PERMIT ISSUANCE APPLIANCES - RESIDENTIAL PANELS UPT02WAMPS OVER 1000AMPS SIGNS ELECTRICAL TEMP. METER OR POLE INET'. POWER DEVICES . SWIMMING POOL ELECTRIC OUTLET'S - SWITCHES - FIST NEW RESIDENT'I AL ELECfR PLUMBING PERMIT PHRMI'PISSUANCE ALTER -DRAIN & VENT- WATER (EA) RACK FLAW PROTECT. DEVICE. DRAINS -FLOOR. ROOF, AREA, CONI). FIXTURES - PER TRAP U GAS -EA. SYSTEM-] INC.4 OUTLETS GAS- EA. SYSTEM -OVER 4(EA) GRBASFANDUSTRL WASTE INTERCEPTOR CREASETRAP SEWER -SANITARY-STORM EA. 200 FT. WATER BEAT 17R WNIENTMLECTR WATER SYSTEMG RIEATING WATER SERVICE NEW RESIDENTIAL. PLMR. SQ, ET MECHANICAL PERMIT PERMIT ISSUANCE ALTER OR ADD TO MCCH. AIR HANDLING UNIT (TO 10.000 CIM) AIR HANDLING UNIT (OVER 10.000 CPM) By: IMUST HOOD (W/DUCT) HIEA'I'ING UNIT (TO IMal BTU) I[RATING UNIT (OVER 100,00(1 BTU) VENTILATION FAN (SINGLE REMD) BOILER -COMP (7111' OR )00,000 BTI!) BOILER - COMP (OVER 100,000 BTU) AIR CONDITIONER NEW RESIDENTIAL MECH. sc OFFICE (,t -Ab 6 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (enmmenem, ZO with Ssaion70,00) fDlvidon3orde, Business and Profesxinns Cede,^ndmyliceascis in full Ibmc and Lie...e�CC.�less 64(1 Lic.M '�'j-a1 QTY. CONTROL# ED Wd Date `j —171'{ DE1or� y ARCHITECTS DEL blit re ON 111 -ARCHITECTS Z 1 undcrsmnJ my plans shell he used as public rensrds BLDG ELECT PLUMB MICH ❑ ❑ I ❑ u�] Lie consul Pmlbxsional RESIDENTIAL' CSFDWL ••1 OWNER -BUILDER DECI.ARATTON' Q1 hereby affirm that I am exempt from the Contractor's License Law lot the !U following reason. ISectian 7031.5. Business and Prafcedurs Code: Any city or county which "Worst v permit to samormt, aloe, impreer,demons b, or repair any swewre Ja prior to its issuance, also requires the applicant for such Permit to File a signed statement OADDITION PLUMBING REPIPE that he is licensed parsuantit) the provisions of the Contractor's License Law (Chapter 9 C (commencing with Sectom7000)of Division 3 of the Business and Pr..fcssiona Cole) or tv flat( he is exempt therefrom and the hast' for that exemption. Any suctalon of I+• Section 7031.5 by any applicam for a .it subjects the applicant to a civil Penalty of }not more than five hundred dollars G$500). ❑STRUCTURAL MODIFICATION G01,m owner (if the Property, or my employees with wages as their sole compensation. will do the work, and the suucm¢ is no( intended unaffected forsale (Sec. 7044, Business .. and Professions Cale: The Contractors License Law does net apply it an owner of properly who builds or improves thereon, and who does such work himself or through IMPROVEMENT his own employees; provided that .such improvements are not intended or offered for C BATH REMODEURF-PAIR sale. If. howevea the building or improvement is sold within one year of completion, the C OTHER owner -builder will have the burden of proving that he did not build or improve for pur- ,a of sale.)., I, as owner of the property, ran exclusively contacting with licensed contractors to construe( the project (Sec. 704,L Business and Pimmoiens Code) The Contractor's Li - Q'Tg move Law drew not apply to an owner of property whit no Ids or improves them)., and , who embal s for such projects with a connowtotfs) licensed punoant In flie Conbne(ods License Law. ❑ I am exempt under see. . B & P C fm (his fewer, Owner Dale WORKER'S COMPENSATION DECLARATION I herehy affirm under perahy of perjury one of the fnllnwing declarations: ave and will nmintaia a Cecil 'Icant, of Consenno self -Insure for Worked' Congen- as provided for by Section 3700 of the Labor Code, fur the peK mpnce of the work for which this permit is issued. I have and will maintain Workers Compensation Insurance, ss required by Section of the laborCede. for the pedomtarece of the work for which this Permit is issued. My WorkeCr's--Crompc tion In rvni'gyim r and Policy wbepTq,`a Cartier: ,may-/jT q� f/ 1llJs Policy Nn.: r CERTIFICATE OF FN EMPTION FROM WORKERS' COmpbNSA'f10N INSURANCE (This section need not be completed if the permit is forms, hundred dollars IS [ad) or less.) 1certify That in the this permit isers'Co shall oastwork any mewhich not employ any Person ininy mann<r m as m become subject the Workers' ComPen- scion of California.aDate anws i Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Warkery Compensation pmvisinns of the Labor Cede. you must foMwith comply with such pmvisinns or this permit shall he directed revoked. CONSTRUCTION LENDING ACENCY is a ed (Secti0n lenJi ng agency fonhe perfonnwce of ho h ed This permit ry which work the work fur which this permit is lxsacA (Sec. 7097, Civ. CJ Lender's Name Lended1 aertimif S 1 cfyyt then I have read this application and spm that the above information mlatinn to 7 correct. I agree ct comply with all city and county ordiwneof and store lows r upon the above-meding niound construction, and hereby amtioriwrposes. representatives of this city to enter upon the above-mentioned pmp<ny for inspection purposes. QTY. (We) ^gram save, indemnify and keep hamJus the City of C against and expenses which may in any way accrue against said Cify gents[ s in coitiquejudgments. hecosts Aconsequence of the Ranting this pe S APPLICAN'INUNUERSTANDS AND WILL COMPLY WITH ALLNON-POINT WILL HAZARDOUS MATERIALS DISCLOSURE Will The applicam or future building occupant store no handle hi amous mutation as defined by the Cupertino Municipal Cale, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? Fl Y. ON. Will the a,hemit or human huddim, occnpont use <c,on,a mor devices which mit himardous air contamitwnta as defined by the Bay Arca Air Quality Management Disme,? ❑Yes ❑No 1 have read the haczrdo e, materials requirements under Chapter fi 95 of the Cali. Road Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if the building does not currently have a froom, that it is my r<xlson,hi lity to norily tb<onvrynn of the requirements which must he use Prior 10 issuance ela Certificate of Ocaphne, ELECTRIC PERMIT FEE PERMIT ISSUANCE APPLIANCES - RESIDENTIAL PANELS UPT02WAMPS OVER 1000AMPS SIGNS ELECTRICAL TEMP. METER OR POLE INET'. POWER DEVICES . SWIMMING POOL ELECTRIC OUTLET'S - SWITCHES - FIST NEW RESIDENT'I AL ELECfR PLUMBING PERMIT PHRMI'PISSUANCE ALTER -DRAIN & VENT- WATER (EA) RACK FLAW PROTECT. DEVICE. DRAINS -FLOOR. ROOF, AREA, CONI). FIXTURES - PER TRAP U GAS -EA. SYSTEM-] INC.4 OUTLETS GAS- EA. SYSTEM -OVER 4(EA) GRBASFANDUSTRL WASTE INTERCEPTOR CREASETRAP SEWER -SANITARY-STORM EA. 200 FT. WATER BEAT 17R WNIENTMLECTR WATER SYSTEMG RIEATING WATER SERVICE NEW RESIDENTIAL. PLMR. SQ, ET MECHANICAL PERMIT PERMIT ISSUANCE ALTER OR ADD TO MCCH. AIR HANDLING UNIT (TO 10.000 CIM) AIR HANDLING UNIT (OVER 10.000 CPM) By: IMUST HOOD (W/DUCT) HIEA'I'ING UNIT (TO IMal BTU) I[RATING UNIT (OVER 100,00(1 BTU) VENTILATION FAN (SINGLE REMD) BOILER -COMP (7111' OR )00,000 BTI!) BOILER - COMP (OVER 100,000 BTU) AIR CONDITIONER NEW RESIDENTIAL MECH. sc OFFICE COMMERCIAL - C NEW BLDG/ADDITION CTENANT IMPROVEMENT COTHER C DEMOLITION C FOOD SERVICE SQ. FE FLOOR AREA ?.AID FEE APR - 9 1996 CITY ur k urrmiIDU BUILDING PLANCHECKF ENERGY FEE GRADING FEE SOILS FEE PAID Date Raelpt# BUILDING FEE FEE SEISMIC FEE ELECTRIC FEE PLUMBINGFEE ' MECHANICAL FEE CONSTRUCTIONTAX HOUSING MITIGATION FEE PAID Date I R<ceipt# DATE qc v • < (,t -Ab 6 NA] CONTROL# ED BUILDING PERMIT INFO BLDG ELECT PLUMB MICH ❑ ❑ I ❑ JOB DESCRIPTION - ' RESIDENTIAL' CSFDWL - C KITCHEN REMODEL. OADDITION PLUMBING REPIPE ❑MULTI-UNIT ❑STRUCTURAL MODIFICATION C INTERIOR C CHIMNEY REPAIR IMPROVEMENT C BATH REMODEURF-PAIR ODEMOLITION C OTHER COMMERCIAL - C NEW BLDG/ADDITION CTENANT IMPROVEMENT COTHER C DEMOLITION C FOOD SERVICE SQ. FE FLOOR AREA ?.AID FEE APR - 9 1996 CITY ur k urrmiIDU BUILDING PLANCHECKF ENERGY FEE GRADING FEE SOILS FEE PAID Date Raelpt# BUILDING FEE FEE SEISMIC FEE ELECTRIC FEE PLUMBINGFEE ' MECHANICAL FEE CONSTRUCTIONTAX HOUSING MITIGATION FEE PAID Date I R<ceipt# DATE qc v • <