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24319APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Pro'ed Identification I Building Address: .r�E Z 26M Ch uEZ PERMIT NO. 24319 seesName: hone: 0 C$uJN$.Q,., tAa A CITY OF CUPERTINO-BUILDING DIVISION APPLICATION 1 PERMIT BUILDINGELECTRICAL-PLUMBING-MECHANICAL API1IIrA LION SUBMII IAL a� C•• ona Llc. Nm rchlte /En Engineer. Lk. No: CATEGDRY 11 QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: I� E]LICENSED PERMITISSUANCE CONTRACTOR'S DECLARATION th5ed1on7000)ofDiWslon3ofthe Buslsmand ProlasslonsCodeandmy rebya!APPLIANCESRESIDENTAL�bhx fuPANELS CbContactor ARCHITECT'S DECLARATION I understand my plane shall W used as public records. Licensed Professional OWNER -BUILDER DECLARATIONp I hereby affirm that I am exempt fromthe Contractor's License Law forthe following reason. (Section 7031.5, Business and Profesalons Code: Any dryer countywhichrequiresapen Wmstmd,alter,Impmve,demalbh,orrepalr any structure prior to lb issuance, also requires the applicant for such permit to fib a signed statement that he b licensed punumt to the provbloru of the Contractor'sLlcese Law (Chapter 9(commendog with Section 7000) of Divi- Mon 3 of the Bushes and Professors Code) or that he b exempt therefromand the basis for the alleged exemption. Any violation of Stolon 70115 by any applIcant fora pemdteubjeds the applicant to a civil penalty door more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the stsdure b not Intended or offered for sole (Sec 7044, Business and Profesios Code: The Contredoes Llcese Law does not apply to an owner of property who build, or Improves thereon, andOCC. who doessuchwork himself orthrough N,own employee, provided thatsuch improvements are not Intended proffered forsale. If, however, lhebuilding or improvement bedd wlthlnoneyearofcompletion,the owner-bunderw111 have thaIsorden of proving that he did not bund or improve for purpose of sale.). U L as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec. 70K Businesand Professions Cade: The Contractor's License law does not apply to an owner of property who Wilda or imp. thereon, and who contracts for such pnojeds with a cgpjfador(e)Ilreneed pursuant to the Contractor's License Law. I_J I am exempt under Sec B k P C for this reason nye�,ra �twin QJaP aI 201-1000 AMPS OVER1l100AMI'S SQ. Irk'I� . jZ.CpR AREA tl\VY E: R G 1 E/SQ.FT. .. t SIGNSELECTRICAL -Z $I+ECIpLCE2CIIIT/MISC �e TEMP. METQt OR POLE INST. PO)ypR DEVICES SWIMMING POOL ELECTRIC VALUATION xx�:)s Qer UTLETSSWITCHESFIXTURFS NEW RESIDENTIAL ELECTR SQFf. STORIES TYPECONSIRUCTION T CITY. PLUMBING PERMIT FEE GROUIs RES UNITS EILOID TONE APN PERMIT ISSUANCE 1 ALTER -DRAIN kVENT-WATER FEE SUMMARY BACK FLOW PROTECT. DEVICE' DRAINS FLOOR ROOF, AREA, COND. SANITARY Y N RECEIPT N Owner Dale WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that I have • drificate of consent to self -Insure, m a mniflbateof Workers'Compewtion Imumnmoramnifiedmpylhe;; f(Sec. 3800, Lab C.) Policy p FIXTURES. PER TRAP SCHOOL TAX Y_ N_ RECEIPT N GAS EA.SYSTEM-1 INCA MS PARK FEE Y_ N RECEIPT N Conn. �NFe 10ed copy bhereby famished, III!rtiied ropy b filed with the city inspection division. CERTIFICATE OF MM PTION FROM WORKERS' COMPENSATION INSURANCE (TMssection need net Wcomplded ifthepermt bforarshundred dollen ($100)orlds'7 I certifythat in the performance of the work forwhlch this permit is issued, I sha 11 not employ any person In any manner so as to become subject to the Workers Compenaatxor awaof Canb fom. Date ApplNOTICE NOTICE oo APPLICANT: to a after makingthis ationkro is Exemption, you shouldou =at holo Workers' Compnsatbnprovbiosrmit s Lebon Code,you m.rat(artfiwilh comply with such provisions orchis permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency forthe performTO ance of the work for which this permit b issued (Sec. 3097, Clv. C.) lenders Name Lendels Addres, I certify that I have read thlsappllationand date thalthe above Infmmnlion ismrred.I agree to comply with all cityand county ordinances and nate laws relating tobuilding constructor, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, IndemNfy an d keep harmless the City of Cupertino agaWtliabilities, )rdgments, crosand expenses which may In anyway accrue I said ...soqumelte oat ath% molt. ' 7J- GAS EA. SYSTEM -OVER d (EA) DING DIVISION FEES GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE PAID Date Recei t# GREASE TRAP SEWER -SANITARY -STORM EA. 200FT. WATER HEATER W/VENT/ELECIR ENERGYFEE Y N PAID Date R 1 I# WATER SYSTEM/TREATING NEWRESIDENTIALPLMB. SQbT. TO AL: BUILDING SEISMIC FE '— - ELECTRIC E ISO PLUMBI G)Qk xxx QTY. MECHANICAL PERMIT FEE M CAL FVE PERMIT ISSUANCE FEES P ID: Date ReCei [# P ALTER OR ADD TO MECH. AIR HANDLING UNIT DO 10,000 CFM) UBTOTAL: AIR HANDLING UNIT (OVER 10,1100CFM7 CONSTRUCI7 NTAX Sil m, of Applicant/Contractor Date HATAR DOUS MATERIALS DISCLOSURE Wilthe appllao: ot or building oupant store or handle havardsus Tal as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the Health and Safety Code Scdion 25532(a)7 ❑ Yea No Will the applicant orfuture building occupant use equipment or devices which emit hava rdous air contaminants as defined by the Bay Area Air Ilty Management District? Lr�Yn M�l Ns vemad the havrrousmsterials requsrementsunder Chapter A.95of the California Health A Safety Code, Sed los 75505, 25533 and 75534. 1 undenta ad that if the building does not currently have a tenant, that it b my responsibility to not ify the occupant of the requirements which must be mel prior to issuance of a Cedificate of Occupancy. EXHAUST HOOD(W/DUCT) CONSTRUCTI TAX PAID: Date Cel HEATING UNIT DO 100,000 BM HEATING UNIT (OVER 100,000 BTU) TO L: VENTILATION FAN (SINGLE RFSID) ISSUANCE DATE DEC 17 1999 ap�� ISSUED"•'a..µ�'=—s—T BOILER -COMP OHP OR 100,000 BTU) BOILER-COMP(OVER 100,OOD BTU) NEW RESIDENTIAL MECH. SQ.FI Owner or authorized agent Date TOTAL: I OFFICE COPY