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23603APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALLPOINT PEN.ONLY Building Project Identification Building Address: — n PFRMITNO. - 23603 am : TY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT q .Name: N Anahtl Llc No BUILDINGEL9CIRICAI IPLUMBIN MTCHAMCAL CATEGORY COMROL e Q ELECTRICPERMIT FEE BUILDIN G PE\R.�MQIT INFO Address: PERh9TISSUANCE - T� J/� ❑ LS LICENSED CONTRACTORS DRRATION I)erehy a(Orm that l am lkerued under prwblona of Chapter9(uomme Ingwlth Section 70000of Dtv m3ofthe Butlrcnaandl'mfeatlau Code, and I.. b In fu0 d effem APPLIANCESRESIDENTIAL JOB DG9CRIPf10N PANELS Chi /)�/ Lk.I� Ltc.# Date Dam o 201-10DOA.MPS ARCHITECTS DECLARATION Inndcata,d eryplau.hallbe used a publicrecords. OVER1000AMP5 OOR AREA SIGNS Fd})CIRI Llcen.ed Pmfe.Lmid I , OWNER-BUILUER DECLARATION I herebyfR thatIsmexempt(mentheC ant ori Llmrue L.wfmthe following re. 5,di.n 70015, Buzomss.nd P,ofmbru Cade: Any city or county which requires a permit to mawct, alter, Improve,m deoB.h,or repair R SPECIALCIRCUIT IT TEMP. METER OR E WST. - any ameure prior to to bauance,, on requires thea ppllant for ouch permit to fih • dgned statement that he is limned puraunt to the pmvbloru of the ]OWER DEVICES DATE ' SW1PMNG P&L ELEcncc Contactors License law (Chapter 9 (comme.cog with Sectlon 7D00) of Dlvl- elon3 of the Businessand Profeulom Code) orthat he b eumpt therefmmand VALUATIO the Halo for the alleged eumpim.. My vloladxm cfSoclion 7001,5by any appUuntforapemJ bjeLi.the,pp0anttoadvllpevhydndmomthan W7LETSSWITCI-@SFU('fIJRES Anil �� NEW RESIDIRJIIALEL�'IR SQF. I fiv nundned ddhn (f500). ae owner of the property, or my employes with wages u their axle mmpeneatlon,will do the work, andthe,truccom Is ren Wended or offered for SIDWFS E "C"ON1, �' F �'� © .aleecc 70K liu,Inemrd aProfessions Code: The ConIA..ct.e. IA.. law ,f /r\„ _ does not apply to an owner of property who builds or Improves themaq and who dwa.uchworkhlmeelforthwgh wownemploym, provided that uch \ 1 Impmvementa are ret Intendedoroffered for.ak. IL however, thebullding a Improvement bald whhinorcyard<omplellontkawnerbulMerwW have TO Il tF�n ben ofpmWng thakdld notbuudorlmprovermparpo.ed.ale.). LI L a, owner of the property, am e.hudwly contacting with lksneed coMinectaa to construct the project (Sec 70K Busom and Prootslom Code: QTY. PLUMBING PERMIT PERMIT ISSUANCE The C.Mamr/. Llarue law does nes apply to an owner of property who build. or Improves thereon, and who mdracta for inch pfp*o with a ryNjactoro) lkeroed pursuant to the Contactor'• Llanue Law. LJ I am exempt order Sec. B 6 P C for this reason ALTER -DRAW 4 VENT -WATER ff.0 - FEE SUMMARY BACK FLOW PROTECT. DEVICE DRAINS FLOOR. ROOF, AREA, COND. SANITARY Y N RECEIPT If Owner Date WORIOMAN COMPENSATION DECLARATION ❑I hereby affirm that I have a ertiaate of conaent to self -Inure, or a mrtlDateC.Work<riC atl Imur ed Copy thereof LSec. 3800, Lab CJ Fl1(]URFS PER TRAP C,SCIiOOLTAX Y_ N_ RECFR r T . GAS F.A. SYSTEM -1 INCL OUTLETS PARK FEE Y N Policy / Y GAS E.A.FA. SYSTEM-0VER /EA) CpCEIPT m BUILDING DIVISION FEES nNcd Copy is hereby furnished. Certified copy b fB with the city Inspection divWon. CREASE/WDUSIRL WASTE BJIT7rLQ']OR PLANGIIECIC FEE , _ GREASE IRM CERTIFICATE OF FXEMPTLON FROM WORKERS' pplp EA. x10F1' COMPENSATION INSURANCEgpVypR'SANITARYSTORM Unix salon need hat be completed B the permit is for one hundred dollars Date Recei t# (s100)mly that In the penfoa M 1¢Mfyttu mvnof the /arwchthis Permitbu Permit is issued, WATER HEATER W/VENT/OFCTR - ENERGY FEE Y N — I shall not employ any person In any manner so as to become subject to the Workers v Compeetlon laws of California. Date WATER SYS'RM/TRE1nNG PAID AppilcanNOTICE NOTICE co AITLIGIM: a slier madding tw Certificate o is Exempt a Lyons Cod, you forth to tine Workea' Comperuatianprovbbroofthe Labor Cade, you moa forthwith comply with such pmvlsloru .,thio permit shall be dmmed rewted. Date Recei t# NEW RESIDENTIAL PLMB, SQ.FT. TOTAL: BUILDING - EISMIC FEE CONSTRUCTION LENDING AGENCY I here aflm"hat there b amutructlan leMin a en fartk rf.m, R R pe nee of the work for which tw Dermic b hared (sec 307/, Iv. G) ELGCTRIC FEE �—•• Lender. Name Icnder',Add. 1 mntlfythat I have read twappliatumand otatethat the,bove Information Qryl MECHANICAL PERMIT FEE PLUMBING FEE MECHANICAL FEE PERMIT ISSUANCE FEES PAID: bcormo. lag, tocmplywkhaUctyaMcounty.rdlnanmandaatelaws Mating to building mrutmctor, and hereby.whorim representativa of thio caytoenter nthe v nnentloned property for Inspection purpose.. (We) t enWty an d keep hamdess the City of Cupertino ALTERORADDTOMECH. - Date Recei t# agalna Ise . a lama.and „:, which may ln.nyw,y,�e agai I emedt w ingdt1dspermit. 7 Z J - A[R EUNounc uNlr fro to,00BfflM) SUBTOTAL: AIRHANDUNG UNIT (OVER I0,0DDCF,() CONSTRUCTION TAX m.f ppllant/Contnctm Date E UST HOOD(W/DUCD CONSTRUCTION TAX PAID: HAZARDOUSM —IALS DISCLOSURE HEATING UNIT (TO 103,00) BM Will thcappliad or future b5ofirgoccuprt More., kMk ha rdm, mdl dale. defined by tk Cu d re Mucipal Code, Chapter 9.17, and the liahh and Safely CoSection 25533o)t F-1 Y. No Datc Rttel t TOT HEATING UNIT (OVER 100,00) BTU)' '• VENTILATION FAN (SINGLE RESID) ISSUANCE DATE Wllltheappllam or tumbuBding.Lvnpantuseequlpmeru ordeviv which eMt by lit Bay Area Air BOILER-WMP OHP OR 100,000 BTU) Quality Management DLMrict7 Ya No Y> tL ' D BOILER-COMP(OVER 1m,000FM havem.dtbe havnruteriab requimmenb under Chapter 6.93 of i M the California Health k Safety Code, Sectlon, 25505, 25533 and 7553/. I NEW RESIDENTIAL MECH. c''Q'FT undmtand that lithe building does not currently have. tenant, that it is my resporod mo lbility to notify the occupant the requirement, which st be met MAY ' 1 1992 prior to bauanee of. Certificate cfOmrpan y. �•1/ Owneraauthorlved agent Date TOTAL ISSUED BY: OFFICE COPY IaPP,-30-'92 THU 11:41 ID:W(IT - SAN FRfNC1500 TEL N0:415 541-0479 #563 P01 pMr kh� at am plrarce p�IQ I C1�R�►J0 t V► CWrrW HYO PROVE rewmtln+ ac 'avis t01.aos ar h s ac'rfip1I9F ' S7 ,j�ejob;at,alltla� � 11 ib � e: eny , t Mt t ;rr'�Is r_�xx. to ' w7lio�, • tzuo�tl o tiliflt r _ tna tt �PProval of tntdl a='L pot any Z� t Z r 1IJN1-r F1 160 S �LflD EGE VE,D MAY ' X92 Y LDG:INSPECTI DEPARTMEKE CITY OF. C 43MNO M `\ 1�• Et- post-Itm A� 1 brand fax tranamlttal memo 7871 RPR -30-192 THLJ 11:41 ID:HKIT - SAN FRAAICISCO TEL NO:415 541-0479 IN ACCORDANCE "WwrtO CODE and �ryrw� Iaee eny r a.ntrna+.n �JIOIC�MIJ!'tNO, r �1r GMx f'e.•.� I b fti t}IE CfTp OF ND 01 NANOa' 2-101 from e t0 pil it or to be art f ` tion anY Provisions te Low. 71.1 Ica p b-gI f K M. 3� -tit - to N GAR. Does P #563 P01 ARCy� G HE IEOVED MA 1992 BLDG. CITYP CUPERTINOON � post -It- brand fax transmittal memo 76n 100198"1 ' I