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23396 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES'— USE BALL POINT PEN ONLY Building Pm'ect Identification PERMIT NO. ° Bnnod5� ©� ►� 23396 hers ams: on APPLIUA I HJN 1U WMI I I AL UA 11, CITY OF CUPERTINO-BUILDING DIVISION egyp ano Name: sec. APPLICATION /PERMIT. C� ra�� � BUILDINGELECTRICALMIrOBiNGMECHANICAL CATEGORY CO Nas Mtect/ Lic.No: 6 QTY ELECTRIC PE FEE BUILDING PERMIT INFO Add 'D PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION I hercleyaffirm that l am licensed under provisions of Chapter9(commenc PLIANC L ]OB DESCRIPTION ingwith Sectton70D0)of DiAsion3ofthe Businessand ProfesdonsC e,andm license is In full force and effect. �) License Class Llc.p I "' Popp '•' �� Date Contractor ARCHITECTS DECORATION AIVIPS VER1M SQ.FT.FLOOR AREA 5/SQ.FT. a0 7 I understand my phns ahaB he used as public records O - s� ��//aa�� d Licensed Professional SIGNS �(i L (� S{a( �< OWNER-BUILDER DECLARATION SPECIAL ILA T; t �— Sf I hereby affinnthat l am exempt from the Contractor's License Law forthe 7 Q 'pp� following mason.(Section 7031.5,Business and Professions Code:Any city or TEMP.M R POLE]NST. 07i: 1 cauntywhlchmqulreaapermittommtmMalteglmpmvgdennlish,ormpalr - �`a�� an ystmctumpnnrtolOW ance,aborequimtheapphcantlmsuchperMtto ppWERD CFS E O V file a signed statement that he is licensed pursuant to the provlaions of the 0.0. ce Contract./s License Lav,(Chapter 9(mmmencing with Section 7000).(Divi- SWIMMING POOL ELECTRIC � �Oe sion3of the Business and ProVALUATION fessions Code)orthat he is exempt therefrom and the baso for the alleged exemption. Any violation of Semon 70315 by an I Q Cz OITILETSSWITCHFSHXTUI4ES applicant fora permit subjectstheapplicant to a civil penalty of not more Uun five hundred dollars($500). NEW RESIDENTIAL ELECTR SQ,}T. STORIES TYPE ❑ CONSRbIKT10N 1,ac owner o!the property,or my employees with wages as their sole C%a cumpensatlon,wllldo the work and the structure Is not Intended or offered for D sale(see 70K Business and Professions Code:The ConUacto/s License Law �$Q does not apply to an owner of property who Wilds or Improves thereon,and who does such work himself orthrough his own employees,provided that such Improvements are not ntended oroffered for sale.If,however,the building or TC611 n /] Improvement issold within oneyearofcompletion,the owner-budderwill have �J B Ilickurden of proving that hedldm WBdorlmprove(mpurpo ofule.). QTY. PLUMBING PERMIT " FLOpD& LJ I,as owner of the property,am exclusively contracting with licensed PERMITISS LANCE ( p 7E contractors to construct the project(Sec.7044,Business and Professions Code: � The Contractors License Law does not apply to an owner of property who Wads'.,improv.thereon,and who contracts fee such pt,ojens with a ALTER-DRAIN&VENT-WATER(FA). cgpl,actorp)hmnsed pursuant to the Contractor's License Law. FEE SUMMARY (_J 1 am exempt under Sec. B k P C for this reason BACK FLAW PROTECT.DEVICE DRAINS FLOOR,ROOF,AREA,COND. SANITARY ' Y N_ Owner Date RECEIPT p _ WORKMANCOMPINSATIONDECIARATION FWURIES.PER TRAP / �� FiOOLTAK- Y_ N • ❑I hereby affirm that 1 have a mrtilicate of consem to self-Insure,or a t RECEIPT N cedifimteo(Worken Camper tion Lsuranreorarenifie mpythemof(Sec. 3800,Lab C.) GAS EA 3800, INCA OUTLETS PARK FEE Y N . RECEIPT - 1 allay Y GAS EA,SYSTEM-OVER 4(FM BUILDING DIVISION FEES cam any Certified copy Is herebyth the city GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHE.ZCK FEE Certified copy Is filed herebyith the dty inspection division. t CERTIFICATE OF EXEM Pr10N FROM WORK ERS' ' GREASE TRAP PAID COMPENSATION INSURANCE SEWER-SANRARY-STORMU 200FT Date Recd (Thissection need not be completed if the permit is forces hundred dollars fl��x77��g f'��� (5100)otifyth - - WATER HEATER W/VENT/ELLCTR E 4 f Y— — I certify that o the person eof any annex an as t beta e,rmitsubject is t to sexi,the �l/� I able not employ any person in any miner an as ro became wabject to the WATER SYSTEM/TRUTING Woplice Compensation laws of California. Date P Z Z NOICETO APPLICANT:If,after making this CenBlcate of Exemption,you NEW RESIDENTIAL PLMB. SQ.FT. Date Remi Pt# Oshould become subjeet to the Workers'Compensation provisions of the Labor - TOTAL: F N Code,you most forthwith comply with such provialons or this permit shale be LUj dermad remkea. . - . BUILDING FEE 11J F3 CONSTRUCTION LENDING AGENCY SEISMIC FEE (L Ihereby affirm that there hamvtructon lendingagency forthe perform- T ELECTRIC FEE 7 Z ance of the workforwhlch thio perMtb Lashed(Sec.31N/,Civ.C.) U 66 O lenders Name PLUMBING FEE too — LL F- I.enderapddiess - QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OWImnifylhatlhavereadthbapplicationandnatethattheabuve Information I—+�--- 1 bcorrect.lagrestocomplywithalleityand muntyordlnares'and stualaws PERMIT ISSUANCE ` -EES PAID: . T relating to building construction,and hereby authorLm mpresentativeso(thio FW city to enter upon the above-mentioned property for Inspection purposes. ALTNOR ADD TO MECH. �� Z (We)agree to save,indemnify an d keep harmless the City of Cupertino Date Recetrtit V ag n,Judgments, and expenses wed .yi.xryw.y..s AIR HANDLING UNIT(TO I0,0(0CIM) SUBTOTAL: agar is Id Citynsequenceo h<granting of m,it. MR HANDLING UNIT(OVER I0,000CFM) CONSTRUCTION TAX CSgnstumc pp ant/Con ra Data MHAUSTHOOD M/DUCT) CONSTRUCTION TAX PAID: HA] RUDUS MATERIALS DISCLOSURE Wieltheappliont orfuture building omtpant store or handle hazardous HEATINGUN7T(10 100,000BTU) Date Recei t# material as defined by the Cupertino Municipal Code,Chapter 9.12,and the - Iiealth and SafetyCode+—Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:' ❑Y- M No - Willtheapplicantorfummbuildingoccupantuseequipmentordevices I VENTILATION FAN(SINGLE RESID) ISSUANCE DATE. - which endt harardous alt contaminants as defined by the Bay Area Alr _ Quality Management Distde7 BOILER-comp(3HP 611100,000 BTM P A ' D 4y,, E No Y" h bveread the haaausmaterials requiremenlsunder Chapter fn95of BOILER-COMP(OVER 1W,000 BTU) the California Health k Safety Code,Sections 2550.5,25533 and 75534. ] APR 22 1992 understand that if the building does not currently have a tenant,that it V my NEWRESIDFN7IALME(TH SQ.FT. responsibility to notify the man pa at of the requirements which must be cot prior to issuanm ofa Certificate of Occupancy. circ ser cu�tntlj�� Owner or authorised agent Date _ y ' ISSUGDBy _ }� OFFICE COPY