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21592APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY - Building Project Identification Budding Addrea{r.S p- Rslae� L\—" C.A-� PERMIT NO. 21592 ems: ,{ one: ?MA T5AD ¢/3=�62—D� CITY OF CUPERTINO-BUILDINGDIVISION Contraeto;sName: Lia.Na: APPLICATION / PERMIT 1 BUILDINGA ELECIRICALPLUMBING-MILHMCAL CA7E(-ARV CONTROL Y Arehitet/Engineer. LIc. No: • QTY ELECTRIC PERMIT : FEE; %, BUILDING PERMIT INFO . Address:& LICENSED CONTII OR'S DECLARATION I herebyafflrm that l am licensed under provisions of Chapter 9(comment ingwkth Secdon7000)of DNisme3ofthellusincssand ProfeaslonsCde,and my license le In full force and effect. f�71 - ❑. u PERMITISSUANCE (� APPLIANCES -RESIDENTIAL )OB DESCRIPTION PANELS License Class LILY Date Contractor �LV— 2014000 AMPS ARCHITECTS DECLARATION I understand my plans shall be used as public records. OVER1000AMPS SQ.FT.FLOORARFA $/SQ.FT. SIGNS ELECTRICAL Licensed Professional OWNER -BUILDER DECLARATION I herebyafflrmthat I am exempt from the Contractor's License law for the SPECIALCIICUIT/MLSC TEMP. METIER OR ['OLE INST. following reason,Eiedion 70715, Business and Professions Code: Anycity or counlywhlch requlresa permit tocorutmd, alter impmve, de=llsh,orrepair anystmcture priorto its hsaanee, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisime, of the Contractors License Law (Chapter9(commencing with Section 7000) of DWI. Nona of the Business and ProfemleenCode) orthat he h exempt therefromand the basis for the alleged exemption. Any, violation of Seton 70315 by any athe applicant to a civil penalty of nor than applicant for a permit subjetnor m POWER DI:VICES SWIMMING IDOL ELECTRIC 6 OUTLE7SSWITCIiFSHXT[RES I'co VALUATION Soo_ NEW ftLSIDFNTIAL ELECTR _AFI. hundred dollars ($500. n1, as owner of the property, or my'employees with wages as their sale STORMS TYPECONSTRUCI'ION compensation, Will dothe work, andthe structure isnot intended or offered for sale (sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who Wilds at improves thereon, and whodoessuchwork himse0orthrough hksownemployeca, provided that such OCC.GROUP RFS. UNITS Improvements am not intended oroffered forsake. If, however thebuikding or Improvement b sold within oneyearofcompldion, the owner-builderwfll have tt- rrden of proving that he did not build or improve for purpose ofsake.). `�L as owner of the property, am exclusively =trading with licensed ,➢6 traatmstomnswt the project (Sec. 7044, Businesaand Professions Code: TOTAL: QTY: PLUMBING PERMIT-,. 'FEE, PERMIT ISSUANCE I�-a ISSUANCE 4 ILOODZONE - APN , The Contractor's License !aw does cad apply to an owner of property who Wilda or improves thereon, and who contracts for such p(ojets with a �gRt[attor(s)Bcenxd pursuanttothe Contractors LicenseLaw. LJ I am exempt under Sec. B & P C for this reason ALTER- & VENT -WATER (EA) BACK FLOW PROTECT. DEVICE FEE SUMMARY OUTSIDE DRAINS- FLOOR ROOF, AREA, COND. SANITARY Y N Y Owner Date - WORKMAN COMPENSATION DECLARATIONRECEIPT pl hereby affirm that I have a certificate of consent to selfdnaure, FD(IUFM_PER TRAP Cg SC 100L TA% Y N— or a certificate of Wo'ken' Compensation Insurance or a certified copy thereof (Sec. 38OO,Iab C.) � Y ' GAS EA. SYSTEM -1 INCA OUTLETS PARK FII. Y_ N_ PolicyY RECEIPT Y GAS FA. SYSTEM-OVER4(EA) Com an Y BUILDING DIVISION FEES Ceriflcd copy b heed With the cityed. Certified ropy b filed with the city Irepectlon division. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECICFEE GREASETRAP CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (0it Ion need mat be complted Bite permit h(Drone hundred dollars (s100)nres+.) (certify that Nthe person In any for Which this permit Is to the I shag not employ any person in any manner ro u to become svbjett to the Workers Compensation Iowa of California. Date PAID Date RCCeI i# SEWER-SANUARY-STORM FA 7001•-• WATER i IHATERW/VENT,/ELFCTR ENERCYFEE Y N — PAID WATER SYSTEM/TREATING Applicant NOTICE ca APPLICANT: aorkmaking this Certificate of Exemption, you Wcem should e motet to thea Workers'rson provhioof the Labor ne Code, you reset forthwith comply with such rovLsloro orthb permit shall be such provisions deemed revoked. Date Recei t# NEW RESIDENTIAL PLMB.SQ.FT. TOTAL: BUILDING 11E t si_- q TOTAL' tw SEISMIC FEE ELECTRIC FEE um CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a cenotmtlon lending agency for the perform. Ince of the work for which this permit h Issued (Sec. 3097, Civ. C.) Lender's Nana Lenders Adduces - I certilythat I have read thisappllotionand statethat theabovelnformatlon - QTY. MECHANICAL PERMIT('``'' FEE' i PLUMBING FEE�' MECHANICAL FEE FEES PAID: Is coned. I dgreeto comply with all cityand county ordinances and mate lase PERMIT ISSUANCE relating to building construction, and hereby authatu representatives of this citytoenterupontheabove,mentioned property for inspection purposes, (We) agree to save, indemnify an If keep harmless the City of Cu pertlno - ALTERORADDTOMECH. Date Receipt# against liabilities, judgments, caste and expenses which may In any way amme against said City In consequence of the granting of this permit. _IDapt_e `V AIR HANDLING UNIT(To 10,000 CFM) .SUBTOTAL: AIR HA NDLING UNIT (OVER I O,Wa CFM) CONSTRUCTION TAX ,zigrxidureof Appll cat/Contra J `e EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATING UMT(TOlOQ000BTU) Willtheappllcant or future building ocmpantancre or handle harardous material as defined by the Cupertino Municipal Code, Chapter 9.IZ and the floalth and Safety Code Set1on75532(a)7 Yes ,1+�—, No Date Recel t# HEATING UMT(OVER 100,1100 BTU) ' TOTAL: as [Llh VENTILATION FAN (SINGLE RESID) jS5 tx10E DATE Will the applicant or fvturebullding occupant use equipment or devices Which emlt hazardous air contaminants as defined by the Bay Area At, BOILFR-COMP DFP OR 100,000 BTI Quality Management District? 4 Yea No have read the haze onus materials requirements under Chapter 6.95 o1 TOILER-COMP(OVLR 100,000 BTU) the Glifornla health & Safety Code, Sections 25505, 5533 and 2SS34. I NEW RESIDENTIAL MECH. SQ.IT.�w•ry• understand shat iflhc building does not curtently have atenanL that ithmy responsibility to notify the occupant of the requirements which must be met prior to Issuance of a Certificate of Ocm pa ncy. t' '�Y`ti✓4�Iry_dig_ILEA{)�,lf$�`I'I'T�aNtl�`��y'�,,Q ,,� ISSUED BY: �/✓`+'Yv'� �`-- —" Owner or aut horimil agent Date TOTAL: OFFICE COPY 15 q l A sTf-k ANF: GjINFRTI Q0 MBR 1 PATIO BAT H'A- ►�11 N, RDDM �R .3 AM Ra©M 10 WRI< To BE POHE WED . m V A7owl. U�l„v� 0kc 48 t p V&,i &, fez -for &A 1, 9LDG. INSPECTION DEP BIZ, 21 B R 3, N' B R, L IZ,T - C1 Pr®Re-setToi It It .3 F baz�,2�-rv.s :04 jl�j,-i StrJfG 4aY BATIf ! i &ATII 2 , Jr ap-"J mvE �VY �&J',C TAMILY FAf @ UF,oIQwl„ 4vf fATID ROOM t Pi -w T-1{Ur Olt 14d -dc -Or. APPROV D E vvV rr"ri% + IN ACCORDANCE WITH FHE CITY OF rca-ftp-c d WIRERTINO CODES AND RDINANCES I t jD tqfw Dock 4cr i�R2 AAT L — a SIGNED � tdo.rro {�AtuT ,611 Indoor q 6UTmp be t* on the job at all ti hes and it is un- lavdw to flake any change or alterations rmissicn from the building Dept., City of Cupetino. 1 Rtt -%qamping of this n!an end spsaftatlons tMILiNOT be held to permit or to be an I Pt approval of tke vic!atiao of any provision= of any City Ordinance or State Law. -TO€ i F D ✓fj o 1