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20515 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY building Project ldentlflcation 1101 11T NO. Building Add..: 1")O C C — 1, G J J vm�r%Name: I I—— p RCRAWS jp nqq—j7()6 CITY OF CUPERTINO-BUILDING DIVISION c° ndnr' a'm�e1 Lt..No: APPLICATION I PERMIT ( (/ W /v. © BUTLDINC ELECTRICALPLUMBINC MUCHANICAL CATEGORY • Archlt gineer. L11o: S QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addreaa'11,349RA";kaL Ulf. :ik�10q PERNI TISSUANCE LICENSED CONTRACTOR'S DECLARATION IMrebyafftrm thatlam llc=dunderprovWwaof Chapterg(mmmenc- APPIJANCES-RESIDENnAL PAD— JOB DESCRIPTION IngwithSedion 7000)of Dlvlelon3oftheguamm[/and ProfesslonsCode,and my U.Icenx I`�(u to ConetIt ractoP "[3A/_G�6r: PANELS a�oO Date (v ARCHITECPS DECLARATION 201-1ODOA.MPS I q�q�vv IXO O I undemtand my plans shall be used as public records OVER 10110 AMPS SQ.FT.FLOOR AREA S/SQ.FT. Fi Licensed Professional SIGNSELECTRICAL r,< OWNER-BUILDER DECLARATION SPECIALCWCUIT/MISC t., a IherebyafOrmthat lamexempt fromthe Contmdm'e License Lawforthe n Z q following reason.(Section 70315,Business and PmfeaWns Code:Any city or rountywhich requmeta pemdttocovtvd,alter,improve,demnlbh,orrepatr .METDUQR MLU INST: Hq� anystmetum prlorto its issuance,also requiresthesppllcant(o %chprn lha I WER DEVIC, O file a signed statement that he b Bcensed pursuant to the pto tons°( the G67 ((.� Conlndofe Llceve Low(Chapter9(mmnrncing with5edl°n7000)of Xvl- NG IY)OL ECTRI� VALUATIOLY 30J si..3.ftha Bug....and ProfeabvCode)orthat helsexempt therefromand the tools for the alleged exemption. Any violation of Section 70115 by any .Eg, ES ^ ^ O appIlcant for a permit subjects the applicant to a civil penalty of not conn than S IJ five hundred dollars($5M. V ❑I,as owner of the property,or my employees with wages an their sole NB RESIDENTULEL TR FT. SPORIES TYPE CONSTRUCTION compensation,wlll dothe work and thestvcture is not Intended or offered for Osale&c%7064,Business and Profealov Code:The Contrad.e.Lim.Law rag does not apply Was ownerotproperty who builds orimproveathereon,and OCC.CROUP RFS UNITS ,who doessuchworkblmxlforthrough his own employees,provided that such . Improvements are not Intended cr°lfered forsale.If,however,thebullding or TOTAL: Improvement b sold within ovyearo(compinlon,the owner-bullderwill have t1tyLden of proving that he did not build or Improve for purpose of nb.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN LJ L as ors to construct owner of the property,am exclusively contracting with licensed pp(Myp 1Sy.UANCE contractthe project(Sec 7064,Business and Profession Code: �.C. The Contractor's License law does nn apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) builds or Improves theeon,and who contracts for such p(eiecta with a FEE SUMMARY �q➢((ad°r(s)licensed pursuant to the Contractor's License Law. BACK PLOW PROTECT.DEVICE LJ I am exempt under See. B&P C for this mown OUTSIDE FFC—S DRAINS FLOOR ROOF,AREA,COND. tSANffARY Y N Owner Date RECEIPf p WOR1OstAN I have a COMPENSATION DECLARATION FTXTURFS PER TRAP L TAX Y N ❑I hereby affirorkcrrt that I have o certificate o consent to copy m a RECEIPT N m00,Lab of Worken'Compevaflonlvunnre oracertifled copythereof(Sec. CAS EA.SYSrEM.1 WC4 OUTLET 2,� EE Y N 380J,lab C.)Pollry It GAS FA.SYSTEM-OVER 4(EA) RECEIPT N Com any BUILDING DIVISION PEES �CertNed copy b herelryth(he city CRFASE/INDUSIRL WASTE INTERCEPTOR CHECK FEE ❑Certified mpybfiled with the city inspection division. T CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE (fhissectionneed not becomplded Rlheperrdt bforov hundred dollars SEWER.SANITARY-STORM EA.200Rr. Date Remi t# W100)orlca0 WATER HEATER W/VENT/ELEOTR ENERGY FEE Y N I certify that In the pert.in an the work forwhich this permit subj c booed, — 1 hall not employ any person N any manner at as to become subject to the WATER SYSTEM/TREATING Workers Compenaatbn Laws a(Callfornb. Date PAID 0 Z Applicant Z 0 NOTICE TO APPLICANT.I,after nuking this Certificate ofons.ft a you NEW RESIDENTIAL PLMB. SQFT. Date Remi t# should become subject to the Workers'Compensation provlslons o(the Labor TOTAL: CC (A Code,you most forthwith comply with such provisions or this permit shall he > deemed revoked. U I u V LU G mCONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirm that them i a ermtroctlon Iendingagenq for the perform=) erform ELECTRIC FEE =) Z ante of the work/or which this permit lshued(Sec.3097,Civ.C.) TOTAL: V O Larder's Name PLUMBING FEE t LL Leader.Addma QTY. MECHANICAL PERMIT FEE MECHANICAL FEE f� O W Imrtlfythat l lave mad this applicatlonand natethattheabove Information ^�T ,r..fi�ttf b correct.I agomw comply with all city and county ordinances and gate lawn PERMITISSUANCE `LLS!/ FEES PAID: } IL relating tobuilding construction,and hereby authorize representatives ofthi. F N city toenterupon the above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. V a the City of Cupertino Date Recei t# agaWtllabiWF Qgments, rt ndexpsp�ya111chmuylnanywayaccrue AIRHANDLINC UNR(f010,000CFM) SUBTOTAL: against. n meq a the his Pe It. �i AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIONTAX S n mof Applont/R nor Na Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HA Ug MATERIALS DI SCLOSURE Will theappllcant or tumbullding.p.m.lore orhardIah.rdov HEATING UNIT(TO 103,0DO BM Dale RCeei t# material as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the IIealth and Safety Code Sect[on 25532(a)7 HEATING UNIT(OVER 100,000 BTLI TOTAL: 45 ❑Yes �No L Will the applicant or future building occupant use equipment or devices VENTILATION PAN(SINGLE MID) _FJ{�[CE DATE which emit harardous air contaminants as dented by the Bay Area Air Quality Management Dbt6d2 BOILER-COMP OHP OR 100,01111 BTU) Cw 4 Yea No have read the bazar curt materials requkamcntsunderChapter 6.95 of BOILER-COMP(OVTR 1001000 BTU) JU11� 2 u the Callfomia I Iealth&Safety Code,Sect tom 25505,75573 and 25534.1 19511 understand that l(the bulidin do root mrrently haveatenant,that itbmy NEW RESIDENTIAL MECH. SQ.Ff /. napovibllit fy theo i o(lhefggeR9mentewhich must be met City CLL Ifo 1 prior Certl Oc. 14 pe n® nerorauthorlu ge S Date TOTAL: ISSUED BY-- OFFICE COPY