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22719 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project IdentificationPERMITNO, Build Ng Address: el! r d G 22719 w �l4 �. U l one: A I (�� CITY OF CUPERTINO-BUILDING DIVISION cJ• © ^ Ci l c°"tr8° '' •^� Lk.Nn• APPLICATION I PERMIT ( C XAFAukI BUILDING-ELECTRICA MP BINGMECtiAMCAL CATEGORY CONTROLS Architect/Engineer. k No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: POWTISS(IANCE ❑ 1:1 E:1LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions of Chapter 9(comment, APPLIANCGSRESIDENTIAL )OB DESCRIPTION Ingwith Section 7000)of Dlvielon3 ofthe Business and ProfessionsCode,and my licenr Ia in fuB orae and effect ,� 0 S(n PANELS LlanrC r — LIaS 1_� {i DateContractor e��klHN,GA 1 e L ARCH ITE CPS DECLARATION 201-1000 AMPS SCO I understand my plans shall be used as public records OVERIODDAMPS SQ.Ff.FLOORARIA $/SQ.FT. d(/ Licensed Professional SIGNS ELECTRICAL LED I N OWNER-BUILDER DECLARATION SPECIALCB2CUIT/MIST R z Thereby at ..(Sallamexempt(romlhe COnractorssCodc Lwfor y he PUT • r QQ county hichre uirectlon70i15,Businoc andr,Im rove, Code:My city or O 2 i,� TEMP.METER OR POLE[NST. F� county which requlmapertNt tocorutruct,alter,Improve,dennlbh,orrepair a anystruct re prlorto its issuame,alsorequlres the appliantforsuch permit to POWER DEVICES /^ µU file a signed statement that he is licensed pursuant to the provisions of the v Oµ Contractor's Lice.law(Chapter 9(commenting with Section 7D00)of Dlvi- 1.,30 slon3ofthe Businesnand Profeaderu Code)orthat he b exempulmonfromand SWIMMING POOL ELECTRIC ON O the basis for the alleged exemption. Any violation of Section 70315 by any OUTLETSSWITCHESFLYTURFS applicant fora permlt subjects the applicant to a civil penaltyof not more than five hundred dollars(g5DI). NEW RESIDENTIAL ELECTR n _SQ.FC, 7 6 n I,as owner of the property,or my employees with wages as their wk STORIES TYPE CONOTRUC'1'ION - compmsation,wBldothe work and the arodure la rot intended or offend for O rte(Sec.7094,Business and Proferiors Code:The Contractors Licere Law $ does not apply to an owner of property who builds or improves therroq and OCCCROIIIe RFS.UNITS does such work himself or through hisown employees,provided that such Improvements are rot Intended oroffered for sale.If,hom,o,r,thebullding or TOTAL: Improvement la sold within oneyear ofcompletion,the owner-bullderwill have the burden of proving that he did not build or improve for purpose of sale.). Q7y, PLUMBING PERMIT FEE FLOOD ZONE APN LJ 4 as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE motram rs to mrutruct the project(Sec.7044,Business end Professions Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN kVENT-WATER(EA) builds or Improves re theon,and who contracts for such pv0 a with a cqp(Tactor(s)Iluensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY L ec.j I am exempt under SB k P C for this reason QUTSIDFFEES DRAINS FLOOR ROOF,AREA,CONTI. SANITARY Y N • Owner Dale RECEIPT S WORKMANCOMPENSATIONDECLARATION HXTl)RES PER TRAP SCITOOLTAX Y N hereby affirm thtl 1 hove a cert l is of consent is rlLlneure,or RECEIPT S omIflateofWmkaWComperu.lion lrtoomerora certified ropythereof(Sec. GAS EA.SYSTEM-1 INC.40UTLEl'S PARK FEE Y N 3800,Lab C3 C.4nv % In �r]�g� I DING DIS szc GAS EA.SYSTEM-0VER d(EA) BUILDING DIVISION FEES Cert,Re�mpy V hereby famished. s CREASEANDUSIRL WASTE INTERCQe7OR PLANCHECK FEE ❑Certilled copy lallhd with the city inspection dlvlal°n. CERTIFICATE OF E)(EMPTION FROM WORKERS' CREASETRAP PAID COMPENSATION INSURANCE DR Rhia section need not bo completed if the perrtdt V forone hundred dollars SEWER-SANITARY.STORM P.A.2DOFrate eeeiPtp (S10)orless.) WATER HEATER W/VENT/Fl.ECTR ENERGYFEE Y N I certify that In the performance ofthe work forwhich this permit is blued, — I shall not employ any person in any manner sor to become aubJetl to the WA.IL2 SYSTEM/TREATING Workers Compensation Laws of California. Date PAID O Z Applicant NEW RESIDENTIAL PLMB._SQET. Date Repel tg Z O NOTICE co APPLICANT:e,aher makinrs'Co this ersationCertificate of pswisi emptl°n,you F should become subject to the Workers'Compowtlon provision piths you TOTAL: CC W Code,you=at forthwith comply with such pmvklor orthla permitshall be `J deemed revoked. UG FEE W CONSTRUCTION LENDING AGENCY SEISMIC FE tl I hereby affirm that there is a construction lending agency(orthe perform ELECTRIC FEE M Z ance of the work(or which thlspemdt la issued(Sec.3097,Civ.C.) TOTAL: O O )ander.Name PLUMBING FEE LL I— Utultee Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW ImrHfythati have read thkapplicatron and statelhat the above infomutick 1 Is comed.I agree to comply whh.0 tltyand county ordinances and state laws PERMIT ISSUANCE �-(� FEE$PAID: ). relating to building construction,and hereby authorize repreeentalives of this cit to entero the ffiove-mentlooed a for inspection u see. ALTERORADDTOMECH. Date ReCCI tN H Z Y upon property pact P rW D _ (We)agree to judgments, Indemnify and keep harrtdm the City of Cupertino against said City,,sdgmequerm.and which peyinanywayammo AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL, 0 agalwt said City In consequence of granting e(thle permit AIR HANDLING UNIT(OVER ID,000CFM) CONSTRUCTION TAX �J'pii>ti I 1 nQ�a 9/T�l9L CONSTRUCTION TAX PAID: Slgoa ureof AppOAZAR�trnta �Ta� Dao IXI-IAUg"C HOOD(W/DIK'O HA2ARDOUSMATERIALSIISCLOS URE Willtheapplia .fined tothe ure Cupertino gooropan ode, hhandle havrdous HEATING UMT(TO 100,000 BT1A Date RCCCI NI material.a defined by the Cupertino Municipal Code Chapter 9.73,and the I iealth and Safety Cadefietton 25'a32(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: QU Yea Im No Willthe applicant or future buildingoceupant use equipment ordevlces VFNIILATION FAN(SINGLE RESID) ISSPA(fdATE which emit havardous air contaminants as defined by the Bay Area Air [sM�t� Quality Mawgement Dist d7 BOILER-COMP OHPOR 100,000 BTU) 4 Yes No have read the haze ous materlats requirements under Chapter 6.95 of BOILER-COMP(OVER I0D,000 BTU) IC`�� 8Q p 1 the CaliforniaCaliforniaHealth A Safety Code,Sectloro 25505,2up and 25534.1 u oderstand that if the build Ing does not mrrently have a tenant,that It is my NEW RESIDENTIAL MECH. SQ.I7 resporslblllty,to cad By the occupant the requirements which must be met prior to lssu race of`a CertlBcale of parry. WW Ow er�dud agent ' Dat TOTAL: 2--Q--0b ISSUED BY: OFFICE COPY