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20828 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Pro'ed Identification 7 PERMITNO. Building�61) ?.FAe;g ' Cassom Cr.��✓znnio. CaL.i �iS7iiy � 2 0828 w"nems anteT: ,, one: A MDAIL 4kr> DgfLC'n�ELL �S�- 31/6 CITY OF CUPERTINO-BUILDING DIVISION -� Contractor's Name: Lic.N. APPLICATION / PERMIT - 3 BUILDING-ELECTRICAL�PLUMBINGMECHANICAL CATEGORY CONTROL Architect/Engineer: Lk.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: POWTISSUANCE 12,0l1 V ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION Ihercbyefflrmthat l am licensed under provisions of Chapter 9(commenc, APPLIANCESRESI)ENITAL JOB DESCRIPTION Ing with Section 7000)of Division 3 of the Businessand ProfesslonsCode,and my license Is in full force and effect. PANELS /�� License Clad Lk.p (\ Data Contractor UP TO 200 AM 201-1000 AMPS AR shall CTSDECLARATION OVERIODOAMPS SQ.FC.FLOOR AREA E/SQ.FT. �O I understand my Flom shall be used u public rccordn. Fe 2 Licensed Professional SIGNSELECTRICAL <Gy OWNER-BUILDER DECLARATION �. SI'ECLILCIICIIT/MISC owing asormthat iam 31.5,8xempt Bostonrom. Contractor's.0License da:Lawforthe O 2 t-^ following reason.(Semon 7031.5,Bualness and Professions Code:Any city or TEMP.METER OR POLE INST. K P county which repass a permit internment,alter,improve,demolish,compair q��.n anystmvdurepriorm Ba Lswance,abo requlmutheapp8centfineu<h permitto POWER DEVICES E i1 file a signed stateroom ethat he hiIlomsed pursuant to the provblens of the V �0 U Contractor's License Law(Chapter 9(commencing with Section 70W)ofDiet- SWI 1,1INGPOOLELECTRIC VALUATIO O sion3ofthe Businevand Profms mCode)orthathebeaempHhemfmmand 6 100 the busts for the alleged exemption. Any violation of Section 70315 by any UTLETSSWI FTXTURps D O applicant for a permitaubjets the applicant to a civil Family of not morethan v v fldreddoilars($500). NEW RM- DENTIA ECTR SQYT. STO TW GS ECONSTItUC'1'ION as owner of the property,or my employees with wages as their sole co cution,wtildothe work and thestacture Is net intended or offered for ❑ vie(Sec.7044,Business and Profession Code:The Contradoes License Law docs not apply to an cwnerof property who builds or lmpowasthereon,and OCC.GROUP RES.UNTIS p.S^ who does such work himselforthrough htsownemployees,provided that such "ss� Improvements are not Intended oroffered forsals.If,however thebulldingorTOTAL: y� Improvement Issold with in one yea rofcompletion,the owner-bullderwill have the burden of proving that he did not build or Improve for purpose ofsakJ. QTy, PLUMB G E IT FEE FLOOD ZONE APN u 1,as owner of the property,am exclusively contracting with licensed PISSUAN CIN \N contractors to construct the project(Sec.7014,Busmen and Professions Code: The Contractors Licarae Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a a' RAIN -WA ex ac or(.)licensed Pursuant to the Contractor's License Law. FEE SUMMARY btt[[am exempt under c. B& P C for this reason BACK T.DEV EOUTSI DE FEES DRAINS KROOF,A SANITARY Y_ N_ Ow er Date / REC=N 251."MAN COMPENSATIONDECLARATIDN SCHOOL TAX Y_ N_ I hereby affirm that I have a certificate of consent to self-insure,or a FIXTURES 'TRAP R— NN cordficate o(Workers Compensation lnsu race or a certified copy thereof l5ec. GAS -ZINC.! E75 PARKFEE Y N 3800,Lab C.) RECEIT N Policy N CAS TAI EA.SYSTEM-OVER 4( Cam any BUILDING DI VISION FEliS ffCz1fled copy ts hereby famished. CREASE/WDUSTRL WASTE INTERCEPTOR PLANCHECK FEE Certified copy Is filed with the city Inspection division. CERTIFICATE OF EXEM PTION FROM WORKERS' CRFASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 200FT Date ReCel t# (Ihisaectbn need not be complded if the permit ts furore hundred dollen ($I0B rleas.) WATER HEATER W,/VENT/©.F�rR ENERGY FEE Y_ N_ I certify that in the performance of the work forwhich this permit is issued, I shall not employ any person In any manner so as to become subject to the WATERSYSTEM/TREATING Works Compensation Lawsof Califomla.Date PAID O Z Applicant NEW RESIDENTIAL PLMB. SQFT. Date ReCCI t# Z O NOTICETO APPLICANT:If,after making this Certificate of Exemption,you � should become subject r'to the Workers Compensation provisions of the Labor TOTAL:— Code,you roust forthwith comply with such provisions orthb permit shall be BUILDING FEE .0 W Fnmdeccd revoke d .CONSTRUCTION LENDING AGENCY SEISMIC PEE S tl IherebyaffirenQat there Is a coatrudlon lendingagency forthe perform- TOTAL: ELECTRICFEE 00 7 Z ance of the work for which this permit is Issued(See 3097,Civ.C.) PLUMBING PEE (� O 1<nder's Name IL r Lenders Address QTY. MECHANICAL PERMIT FEE IMECHANICALFEE OW Icertlfythatl have read thisapplimtionand statethat theabove Information C tsmned.Iagree to comply with all cityand montyamdlnanres and state laws PERMIT ISSUANCE FEES PAID: >- (l. to building constmction,and hereby authorlu representatives ofthts I'— Z city to enterupon the above-mentioned property for inspection purposes. ALTFRORADDTOMECH. Date ReCCIPt# (We)agree to save,indemnify an d keep harmlm the City of Cupertino V ag.Wt lWb itk;judgments,mA..nd expenses which may in anywayaccme AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: ago' City tnconsequen of the granting of this permit. CONSTRUCTION TAX O AIR HANDLING UNIT(OVER 10,000 CFM) Xg mrc of Applicant/Contractor I Date IXIIAD$'I HOOD(W/DI1CT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfum re building occupant store or hand In haramdom HEATING UNIT(TO 100,000 BTU) Date RCCeI t# material as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the I lealth and Safety Cada Section 25532(a)? HEATING UNIT(OVPR 100,000 BTU) TOTAL: ❑ Yes M No Will the applicant or future building occupant ase equipment or devices VFNfIATION FAN(SINGLE RFSID) ISSUANCE DATE which emit havardoos air contaminants as defined by the Bay Area Air Qua lity Ma nagement District? BOILER-COMP QJI'OR 100,000 BTU) ❑Ves ❑No I have readthebanmdous materials requirements under Chapter 6.93 of BOILER-COMP(OV 100,000 BN) JUL 311990 the California Health&SafetyCode,Sections 75505,25533 and 25534. I understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT. responsibility to notify the occupant of the requlrerrcnts which most be met loortoomancoofa CertiBatcof Occupancy. CIfiI P4 e�}7Rq Owner or authodud agent Dale ISSUED BY' TOTAL; OFFICE COPY IV