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20822APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY - Building Pm'ect Identlflcatl°n Building Address:� g&-_7—X/A PERMIT NO. O n n 2 G ljI(G G 2 sonars arm: roe. ©N/7 CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDINGQ.ECTRICAGPLUMBINGMECFIAMCAL _ GA 7 'L d QY S CATEGORY CONTROL �J3 /p Arcfi1tM/Engineer. Lk. No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INF Add.. fN?i N71 V �y PERMITISSUANCE /de -OD LICENSED CONTRACTOR'S DECLARATION I herebyaffbm that l am lkrnsed under provWons ofChapler 9(ammse Ing Wit ngwltSeaton 70(0)ofon3o(the Butlnessand Pro(euonsCude, and my l 1,1.full�audofe lam,I, laLIc.# 7 _ _ Date 0& elm O& ARCHITECTS DECLARATION DECLARATION 1 understand my plan shag be used a public records. - Licensed Pro(esslarul OWNER -BUILDER DECLARATION I hereby affirm that l am exempt from the Contractor's Licence Lawforthe following reason. (Section 70115, Business and Profeaskns Code: Any city orm countywhich requires a permit tomnstruct, alter, improve, deolish,orrepair any structure prior to Its inuame, also requires the applicant for such permit to file a signed statement that he b licensed pursuant to the porwaium of the Contractors License Law (Chapter 9(commencing with Section 7000) of Divi- sionSWIMMING 3 ofthe Business and Profeal°ns Code) orthat he is exempt therefromand—a the basisfor the alleged exemption. My violation of Se cion 70315 by anyRe— applicant for a permit subjects the applicant to a doll penalty of opo.. than five hundred dollars (5500). ❑ I, as owner of the property, or my employees with wages as their sok compensation, will do the work and the stmcNre is not intended or offered for sale (Sec. 7044, Buttons and Pro(asloro Code: The Contractors License Law does not apply to an owner of property who builds or improves themon, and who does such work himselforthro igh his own employees, provided that such Improvements am not Intended oroffered forsale. I(howevegthebulldingor improvement b sold within °re)earofcomplelkn, the owner-bugderwill have t"mien of proving that he did nM build or improve for purpose ofukJ. LJ [ as owner of the property, am exclusively contracting with licensed contconstruct rutruct the project(Sec. 7044, Buelnea n and Professions Code: The Contractor's License Law does rapt apply to an owner of property who builds or improve thereon, and who co chs fur such ploject, with a cachor(s)gcensed pursuant tothe actor's Llcance Law. 5I am exempt under Sec B h P C !or fhb mason Owner Date APPLIANCES -RESIDENTIAL n ,O� JOAYpewto J PANES UP TO 200AMPS x01-1000 AMPS OVER 1000 AMPS SQ. FT. FLOOR AREA Zp�N�w L7 � $M. FT. 7-( 1 `JD du� SIGNSELECTRICAL SPECIAL CIRCUIT/MLSC TEMP. METER OR TOLE INST. POWER DEVICES ELECTRIC OU'If.ETSSWITCHESFIXTURES 3 p(i VALUATION D / /1 �D ♦ �" V NEW RESIDENTIAL ELECTR SQ ' ' STOW • TYPE CONSTRUCTION 1 , ��TOTAL: QTY, Op UMBING,P RMIT FEE PERMIT ANCE p / I 0r ALTER -DRAIN b VFM- WA (BN,I OCC.GROIIP RES.UM'fS FLOOD?ANE APN FEE SUMMARY --- BACK FL43W� � T: DEVICE 1 ��, OUTSIDEFFES LL DRAINS NODE, AREA, COND,1\ FIXTURES TRAP .'- '� I I' 1 V GAS FA. SYSEM-1 INCA OUTIE15 SANITARY RECEITa WORKMAN COMP' SATION DECLARATION I here affirm that I have a cekificate of consent to self- ❑ by insure, ore certl0cam o(Worken'Comperu�atio�nl)nu�jna ora¢prtyi5fka ropythemof (Sec. 3800, Isis C.�i�C �'D 7r // &x/ P°on p SCHOOLTAX - Y N RECEIPT p PARK FEE Y N RECEIPT0 ,' GAS-G.SYSrlT1.OVER 4' EEA, Comp - BUILDING DIVISION FEES O ertred copy b herebyforthe ed. Certified copy b filed With the city inspection division. CERTIFICATE MPENS TIONINFROM WORKERS' COMPENSATION INSURANCE Uhissesa.) need not hecompleted lithe permit ls(oron hundred dollam (5100)nrlyth (certify that Nthe per(armance°fthe work forwNch tots pemat le lowed, I shall not employ any person In any spanner so as to become subject to the Workera'Compenaattm Lawsof California. Data Applicant NOITCETO APPLICANT: If, after making pe sationipro of &erupt a Labor shouldbecome forthtothe WOrkert Compensation provisions ofthe Lab or Code, 4,°u at forthwith comply With each provlsioru orthb permit shall be armed revoked. CONSTRUCTION LENDING AGENCY I Hereby affirm that there is a construction lending agency for the perform -ELECTRIC ante ofthe work for whi!sued e. 3 p mdtb fse097, Civ. C.) Lemlere Noma,— O Lenders Address Ic Atfythatlhavemadthbappgcatlonandat tethattheaboveinformation isromct l ugmetu comply with all cityand comymdinances and pate lawsPERMITISSUANCE relating to building coutructim, and hereby authomm repmentatives o(thb city to enter upon the above-mentioned property for lwpechlonpurposes. (We) agree to save, indemnity an d keep harmless the City of Cupertino against liabilities, Tdgmeats, emote and evp nsn whlchmaylnanywayaccrue against said City in au quenm°f tich ting of this permit. //V/ CREASE/INDUSTRLWASFEI EmToR , PLANCHECK FEE PAID Date RemJ of j Lp V GREASE TRM ^, It it .y SEWER -SA ARV -STORM P Ff. ,.,�. r WATER HG W/V Fl.eC1R ENERGYFEE Y — — PAID Date Reuel ted J WATERSYSTEM/ •(iV NEW RESIDFN77AL PLMB. SQFF. TOTAL: BUILD G FEE TOTAL: a � SEISMIC FEE FEE ,>' QTY. I MECHANICAL PERMIT FEE PLUMBING FEE0 MECHANICAL FEE �- d ID pJ FEES PAID. ALTER ORADD 70MECH. B Dale ReCei ted AIR HANDLINGUNTF(TO 10,000CFM) SUBTOTAL: AIR HANDLING UNIT (OVER 10,1100 CIM) CONSTRUCTION TAX Sigutumpf Applicant/Contrac4 ° Date =­gMATERIALS DI SCLOSU RE Will the applicant or future building occupant store or hand to hazardous material at defined by the Cupertino Municipal Code, Chapter 9.1$ and the Health and Safety Cade Section 75532(a)? ❑ Yea No Will theapplicant or uNmbulldingo pantueeequlpr ntordevias which emit hassrdous air contaminants as defined by the Ray Area At, Quality Management District? Yes n❑ have read the hazardous materials requirements under Chapter 6.95 of the Califomk Health buil( Code, utcurrently have a tenant, and that ] It is my undcrst Iityto lithe building don nIN a requiyhaves which repo "Iltylo ontity the sof the requirements which must be rraR prl to agnea ofaCertl panty. EXHAUST HOOD(W/DUCD CONSTRUCTION TAX PAID: HEATING UNIT (TO I OO,ODO BTU) Date Recei the r HEATING UNIT (OVER 100,000 BTU) TOTAL: VENTILATION FAN (SINGLE RFSID) ISSUAN(`F, DATE Cp� I'i(YYL`!•1 SEP 12 1990 ,.a, Cif of rUQRI!•AO l�(� y\ DBY: d Lk BOILER -COMP 0HP OR 100,000 BTU) BOILER COMP (OVER 100,000 BTU) NEW RESIDENTIAL MECH. SQ.RI'. th ri neroraufted agent Date TOTAL: OFFICE COPY