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S 0521 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.-F.LECI'RICAL 1'ERMII'NO. BUILDING DIVISION APPLICATIONOTERMIT TING PROJECT DUANIFIC Q 0521 BUILDING PROJECT IDI?NI'IhICATI(1\' O �J SANITARY N(m. AP11IC TION SUBMI'1'IEN) - ' BUILDING ADDRESS: 0 OWNER'.' R PHONE: CONTRXCTOR'S NA i / ` 1NIC 17DNTROL# Milo; NW4 CHII'liC/IiNGINEER: LIC NO: A DRIitiS, N Ji �- ❑ (5701 10 147&2 ONTACF. PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECU ❑ ❑ ❑ LICHNSBDCONTRACIOR'S DECLARATION QTY. ELECTRIC PERMIT FEE Jek DESCRIPPION I hereby affirm that I out Iiceowd mule,provisions of Chaptm 9lcammemcing TIAL MOZZ with Scnam7001IInf Division J oflhe Business and Professions Code.and my license is DSIT)�— ❑KITCHEN RIiM0UE1. FSO. s,full force and effect. PERMIT ISSUANCE aUU License Class Lic.N APPLIANCES-RES IDCNTIAL ❑ F1 ADDITION C PLUMBING REwPIP rnQL Dam Conlmena ❑MULTI-UNIT DS'I RUCfURAL ARCHOECTS DI;CLARA'FION PANELS MOOIFICAIION Z O y Z ll, 1 understand no,plans shall be user as public fecorls Oil FO 200 AMPS OZ-0� DINTIiRIOR [I CHIMNEY REPAIR F-14 Licensed Professional 201-1000AMPS IMPROVEMENT 0SWIMNI1NG PWIS OWNER-RU1LDER DECLARATION OVER IWAMPS D BATH REMODEUREPAIR ❑DEMOLITION ?'C Q I hereby affirm that I am exempt front the Commctor's License Law for the CUTLER 7�x(' d U following rloxton.(Section]031.9,13s,on 1 and Pollissiom Code:Any city or county SIGNS IiLECIRICA], W 3 LL h which requires a permit m construct,alte,improve,that llsh,nr repair any nmchre F 0 Inammitsiwanam.alwrequinelthe applicam for such perminnfilca signed na¢mcnf SPE!CIALCIRCUIT/MISC. Ebythat he is licensed pursuant the pmvisilnsof Ne Condemnor,l.ittnsc Low(CM1apmr4 COMMFRCIAI, W�GCC m (comencing with Section 7000)of Diio visn 3aDIw Business and Professions Code)a, TEMP.METER OR POLE INST. a q o y that he is exempt Nerefmm and the basis for the alleged cxnnptian.Any violation of D NEW BLDGIAUDITION C DEMOLITION W y Section 91131.5 by any applicant for a permit soh,"',the applicant la a civil Penwlty of POWER DEVICE: ❑TENANT FOOD SERVICE not mom than five hundred dollars(8500). IMPROV CMEN'1S5 Sp ❑Loswoorw,oftbe propeny,or my employees with wages a,their sole compensation. SWIMMIN 01.ELECTRIC BOTHER iii F- will dome work.and lhestructumis not intended of offered for sale(Sm.9(IW.Business Wand Professors Code:The Conmzctors License Law does not opply to as owner of OUTLET - {ES-FIXTURILS property who huildx or improves thereon,and who dons such work himself or through NEW RESIDENTI . FCTR SQ PC. his own employees.provided that such improvements are not intended or offered far SQ.ITC.FLOOR AREA $ItiQ.IT. we.If,however,the buil,) improve cat in sold witl.inon.yea of"compinion.the owacrhuilder will have the burden of proving that he did not hold or improve for par- grow,o(xale.). TOTAL: 1,as owner of the property,am exclusively contracting with licensed contraction to construct the project(Sec.7044.Business and Professions Code:)The Contractors I.i- P A 9 cause Law does not apply to anuwne of property who huild-n impmvcs that and QTY, PL IWSI P M FEE who contracts Iorsuch projects with a comnunnr(sl licensed pursvunl to the Cenuvaor's AVGf License Law, I VRMI'F ISSUANCE D 1 am exempt under Sec. ,B k P ason C for this re ALTER-DRAIN h VENT- hit MA)Da1C �TVALUATION ner Owy WORKERS COMPENSATION DECLARATION BACK FLOW PRCrDF7..DEVICE ' r�UYGH qN I hereby affinn under penally of perjury one of the(allowing JeelmuJane I lower and will muimaina Cenifeale nl Con®nnaself-toxon hot Wader's Conmpen- DRAINS-FLOOR,ROOF AREA.COND. STORIES 'I'YI'1!CONST BLOC'I'ION tion as provided for by Section 3900 of the Ichor Code.for the perfonm mon,of the work for which this permit is issued. PI%'I'URFS-PER TRAY liolwrfnvc and will maintain Worker's Compensation Insurance,as required by Section 3900 of the Labor CWe,lie the panto,corm of the work for which this Penni)i.s{swat GAS-CA.SYSTEM.I INC.4011'f1.ITS OCC.GROUP APN My Warl.txnCo�rYnti' rPnIJy NAY nn byr:1¢ Currier:'SSYYMM TTEE++ //aortic 1 GAS-EA.SYS'I'IiM-OVER4(IiA) CERTIFICATE OF EXEMI'UON FROM WORKERS' GREASt%INDUSIRI.WASTE IN'1'IiRCEPI"OR COMPENSATION INSURANCI! BUILDING DIVISION EELS (TaiwOmaneedmnbec rairch lifthe permit isforrnchunNeddnllers($10(B GREASETRAP PLANCHECK FEE or less.) Imai fy that inthe ise,ourenccutda, look for which this psoitis{swot,I'hall SEW ER-SAN]I'ARY-STORM EA.21X1 FT. I!NFRGY FEE not anpinY any penin in any mm,nm oa r,,a hr-one cubist,to the Worker,Cnnq,en. Z soften Laws of California,Dam WAI ER HEATER WIVENI'IELECI'R GRADING FEE O Applicant NOITCETO APPLICANT:If,after making Ibis Cenificam of Exemption,you hoald WATER SYSTEMTREATING SOILS FEE I"' ^ become subject to the Workers Compensation provisions Of the Labor Cade,you must ai ti fonhwith comply with such provisions or this permit shall M deemed rooked. WADER SERVICE z CONS'RUC-HON LUNDIN ,AGENCY NEW RF.SIUENTIAl.PI.MB. SQ.P], PAID Unto Receipt Of I hereby affirm that there is a construction lending agency for the psrboun hof U Othe work far which this permit is issued(Sec.1099.Cr,CiC.) TOTAL: U.Q U Lenders Name TOTAL: C) U Leader's Address BUILDING FEE 0.t I eerily that I have mull this appliaainn and shoe that the above informal a is .H-: tin c ncc(.I ogre ns nmmply wrM1 all city anti roomy oNinuncex and sm¢laws ml:ningm QTV MECHANICAL PERMIT FEE SEISMIC ITH J building construction,and hereby authorie,representatives of this city to enter upon the al ove-mmabonad pmpeny for inspection ptmpwx% PERMIT ISSUANCE ELECTRIC FEE. (Wc)agree to save,indemnify and keep hafmlesx the City of Cupertino against liabilities,judgments.costs and expenses which may in any way,accme against said City ALTERORADDTOMECH, PLUMBING FEE in conw,finac of the ginning of this permit. APPLICANT IINDFRS'1'ANDS AND WILL COMPLY WI'UI ALL NON.POINT AIR HANDLING IINI'I('TO IQ(NX)CPM) MECHANICAL.I:EC SOUR /?FNS. " -�— AIR HANDLING UNIT(OVER IB,(NX)CFM) CONSTRUCTION TA% Si namrerf Appl' nU ontrnof Dares EXHAUST HOOD DYMUCI) HOUSING MITIGATION FEE 1 ZARDOUS MATERIALS DISCLOSURE - W:Iltheepp ant or future building oceuLanlsmre er hi dlr h:,andanxnmhri^I III?ATING UNIT(TO 100.000 li'I'U) as definedCu by the lmrtino Municipal Cede,Chapter 9.12,mad the lfealm and Safely BEA.1.ING UNIT(OVER 100.0001 BTU) Code,Section 25532(u)9 ./ E3 YO, [1 N° VENTILATION FAN(SINGLE RESID) PAID Dam Receipt a Will the applicant or lama building occupant use equipmcm or devices which BOILER-COMP(31{11 OR 100,(0X1 BI LJ) m t lomanlom air conuuninar,h ms defined by the Bay Arm Air Quail',Munwgcmrert TOTAL: �i'tnay ""/ HOILF.R-COMP(OVER 100,000111 U) Yes �No I have read the haode,S s lams Z55 5.2553 an under Chapnd 695 of the Cali- AIR CONDITIONER ISSUANCE DATE famiu Eleuhb&Safety Ctdc.Sectirns 25505,25513 and 255}1.I understand Nal if the NEW RESIDHNTIAI.M1fECH, SQ.FT. haldingdumnccum iti,crm m,lhm it lx my msponsiMlimym n�tifyth omio,am ol'tIs ra u' as,lwh mmlxtb ,.Pnia to issuanecot a Ccnificam of Occupancy. Owoaorma m;aed gee Dam TOTAL: ISSUEDBY: OFFICE / / � � 5 XAJI § \ § \ ) _ \ % ` \ ( k ( � - 47 _ ) m 71\ i § ! / 9 : m _ m - _ - - $ ; 2 ) » ! , \ \ \ 3i - j (7 ! ) ) ) ® 7 ! § 2 , © ® ¥ ( § 2\ / ) # _ m { j ?I ® § @ jib \ \ 2 \ | § % § j cp \/ � rz �_ � C) \ § � 2 \ z {/ ITIT § wt a > ƒ ■^Vo �)� o/ ® ( + *\/� \\ k% , t t � I 4 � l • �� 'lYpl j°���,p��rrr y' � . » 4 . } / / \ \ ( § / � { ¥ } \ ; § \ ;�\ ) _ ) ) / y to § \ \ ' 9 / � ( } \ � � \ ) [ ) ; : ; z to 713 � @ ; 22 . ) K ® . \ i \ \ — \ — ( ( m m � \ K % ` \ ) \ \ \ _ \ � \ m ) \ ( m \ $ ) ) [ \ ) } { » — ® ! $ � } ) ) � • . j ; \ ' / w`�A ■% k&& N � /\ k2 .F • I i� • ' A 4 .L=. u s • - r fir; "...<: ' ' � � 7:.k.�..!U :•„�tl^:i, 1b��,c ?},rvp'M.,!L,;>6\. Lf:a,y.a l .�i,N,• m:.u ,t..r., 1. ,r .+.,i_'for ,.