B 0124 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _
CITY OF CUPERTINO BUILDING-ELECPRICAL PERMITNO
IT X012 4
BUILDING DIVISION APPLICATION/PERM PLUMBING-MECHANICAL S0001 +1/V^/
. •• ItUII,DING(•ROJECTIDFU'LFICATION.y, ?: J
BUIV)iNG ADDRESS SANfI'A RYNO, APPLICATION SUBMITTAL DAI'I
�yII 2Z7, 4. JOZZ9 Al-.)12j ANA`'+� /�1y ay c��y)/py,r�n (ry(�//.G �j�I(� 1111 �e/i71� �
�IL / I .-11D1 L�JJa/USV/Yr CCW/l�/W ❑
—/I'il N/C LON'I'Ronp
RCI II'TECT/1?NGINHI.R: LIC NO A 55 /1
oSOACT PHONE 1 ,IaY�AM/ (/ BUl1,DING PERMIT INFO
a s_n,P ❑ ConsnitanlGFecs Paid by Applicant(Initial) I BLIND ?LC❑C'1 PLUMB hfh❑CII
LICHNSEDCONTRACIOR:S DECLARATION
QTY •I IiI:ECTRIC PL^'RMIT.` � •• ','FEB.
I hereby ihlRrin ma l am licensed ands,pmvh+harhx of Chapter 9 aammennihe •, h.. ,r I •+. I JOB DESCRIPTION
apO wnM1 Secnon]nlxllof Oivmm�Jaf,M1e liusmosanJ hofenums Gale,and my hcenwu PERMIT ISSUANCE I ❑SsfpENTIAI: ❑KITCHIiN REAIODF,1.
W F is lull torcosmd enter.
a V V h¢enu Clds+ Lic p APPLIANCES-RESIDENTIAL.
FZ W Due -- Contrane OADDITION ❑PLUMBING BE PIPE
ha0. 1 ❑h1UI:f1.UNIT ❑STRUCTURAL
stn ."halTEC'PS DECLARATION PANELS
�' z I understand my plan+shull Mused as aubhcrecords I NIODIhICA'I'ION '
OZ„N,� UP TO 200 AMPS ❑INTERIOR ❑CHIMNHYREPMR
1-13 F'W Lncn,ed Pmt e+e.onal 201-1010AMPti IhIPR VENIIiNT (]SWIA1hIING POOLS
gs4 -i OWNER-BU ILDERDECLARATION OVER(BOB AMPS ❑I3 REh10UliIJREP71R ❑DEh1D1.ITIDN
iY W G I hereby aRnn Ndt 1 am ewmpt from the Contractors License I.aw for the /
'!6y�(d, 4 V Mlnwmg radon.Notion 70115.Ba+lnm+and 1'ndcssmns Law:Any city or cnunlY SIGNS IiLF.CI'RICAL OTHE qcy
W'3 4 rF which renames m promo m consaun,also.tmprove,demahsh,m ream,any arucmm
qFq y� prior In In issuance,also mgmres the aaplicam for such perntto file a signed slalemem SPECIAL CIRCUIT/MISC
WN1y}tei than hall lleenwd ratio lo0warnvwions olla Carl ydcmr's Linen+a Law(Chain,s)
�4'p0 (commencing wall Section7000lof Dn,num 3 mille Nuvne+t and Prolesemns Cndel:.r TENII'METER OR POLL IN S'I' COMMERCIAL;
64 a IX that he is exempt therefrom and the basis for the allege)c.emptinn Any violerhon n. ❑NEW BL)G/ADDITION ❑DEMOLITION
XMW See6on70315 by any applicant our a permit subject,the apphcennn acivil penalty of POWER DEVICES ❑TENANT ❑FOOD SDRVICI'.
W m nor more Nan live hundred dollars 1S51xb.
F Z N OTHEPVEMIiN'I'
=pQ ❑Les awn<r of the pmpeny.or my employees with wages as their sole nnnprnsation, SWIMMING POOL ELECTRIC
wJl An the work,and theamnnrc hs nonneendeJ nrnRernl fur solo lSCC]fNJ,HUSine+. ❑DTHIiP
3 m and Professi nis Care:'I'he Colonel license Law does not apply m in,owner nl OU'I hf:15,_SW ITCIIIiS-PIX'I URfiS
property who hadds of improves Hereon,and who does such o' P himself nr Nrough
his own employees, m
yees,provided thin such ar sar n en art not inienJed or aOereJ tar NEW RESIDENTIAL 17LECI'R SQ FT.
,all.]I.howevea Ne hnlJmgarlaprovemmiluswld within nneycur nl cnmplcuon,Ill. { SQ,IT FLOOR AREA S/SQ.IT
wnerrvbuilder will have the burden of proving that he did not hind)anmprove for pose at at Wile.),
❑ hits owner of the pahaeny,am c"Ita vely cal lraamng with rcenwai wnlawans a TOTAL:
<on+aucl flue protect(Sec]UW.Business and Profession,Carlo The Conlrec'.rs Lh- ., .
< srl.awa:m+itot applymaih owner of pmpeny who nrtild,or imprawe+meream,:hw IQTY.' PLUMBING PERMIT (\�\ �. FEE hf
won lunatics kn mei probed+with a tamnar WnH Breamp r,munt to Ne Cmmmetars � •�' •' , • ` �] �� ••
IJttn+e law PERMIT ISSUANCE, �D•\r
❑ l rim exempt under See .H&P C far thareman e
AIIIiR-DRAIN&VENT-WATER II?A) - VALUATION
Own WORKER'S COMPENSATION DECLARaIION BACK FLOW PROTECT.DEVICE
Iherehy alfnn under arnalty at pepury one of the Bdlnwing Jcclunnina, �f !i} ✓V.
mnaas pit mdeld fmnhY Section P(N)of he LaborCaJenpar'he perfomanceo h. DRAINS-FLOOR.kq)P.AI21?A.COND. _ $TORUS 'TYPE CONSTRUCTIUD
Walk tar which tins permit a rimed FIXTURES-PER TRAP
FI I have and wJl moment Worker's Compensation Insurance,as required by Senn,
3700nf,he LbarCNC,hans,performance of the work for whnh this perms is issued I GAS-EA.SYSTENI-I INC 4 OUTLET S OCC GROUP APN
My Workers Compemauon lnwtraw�cericranI Policy mmaherure: GAS-EA SYSTEM-OVER
Caner Policy N^
CERI'IITCATE OF EXEMPTION FROM WORKERS'
COMPENSAI ION INSURANCE GRTASFl1NDUSl'RI.WASTE INTERCEPTOR BUILDING DIVISIOy FEES
(Dart Witter need a.,RCOmpleted if the .it a far one hundred dallars(S 11x) GREASETRAP Y
or Ica) PIANCHF.CK PIJ?
Icenily lhenn the perlmmanccoflhe work forty huh this lherina urcweJ.leh,dl SRWI3R-SAN(fARY-STORM F.A.2n0 FT.
rim employ any person m any mmnnenn as m became object to the Worker,'Compen- I?NERGI'FEE
Zz moon Lawenf Caharria.Dal- WATER HEATER WNENT/ELECIR
O APphcent GRADING FEE /
.N. NOTICE In APPLICANT II.am,muAng Nn Cen icnc of Exemption.you should WATER SYSTENVI REATING
a become rob W I to the Worker's Compensation f the Labor Cale,you must 1 SOILS Plili
1 ps or previsions ri
W fimhwnh conialy Will)such provisions nr this aennit shall he deemed rcvakeJ WATER SERVICE
;D z CONSTRUCTION LENDING AGENCY NEW RESNENTIALPLN1H SQ.FF. LAID Date R<cehtax
V O l herchy elfirm tlist here is a contraction lending agency for the performame of.
L4 F-' the work far which this perms is issued(Sec 1097.Ov C I ]
p U Lenders Nam- / Al..
,r W Lender's Addict, TO"fAL /� ' r 1 ,
y 1 remly that I have red)this aaphcalion and slat That the abuse inlnrmelum i, 1 BUILDING T HE yyy\\\ J 7
�(A career.l agree mcamply with all city end county ordinances and uem laws relahmgm QTY.'. MECHANICALPERMI'p ' FEE\' \ '
U baulking enndmchnn,and herebyamhar opeavrnmuvesafthis city'.enmrupan he .. . '^IM:ISNfICFEE \\\
abnveirraminned p...Play fonm,mr,na purpose, I PERMIT ISSUANCE A`
(Wet agree m save,indemnify and keep harmless the City if Cmarmo against v it �ELFQjyIC FEE
h: ill tadgmems,cn rise+ ahmayi anyway accrue against said City I AMTR OR ADD TO NIECH. ` ..x 1 B`INGFIT
eaftim mar of, +pc it
API ,If 1 T UNI RSTA DS NI WILL CO /PLY WITH ALL NON-POINT AIR DANDLING UNI'I'(TO IB.OIIII CPM) w\ NIECHAN&L FEE
f/O, Alt HANDLING UNIf10V1?It 10.(NIUCPhp a� �,QbNS'I ItUC'I'ION'I'AX
Signduhr of Appl-an cur / Da¢ EXHAUST HOOD(W/DUCU V vS HOUSING MITIGATION 17EE
Z )OUSNIATERIALSDISCLOSURE
M the applicant future Wilding occupant stare orhandle hmnrdom,mmenal HEATING UNIT 0 O I(k,M)BTU)
as de red by the Cuperno Mumcipal Cash.Chaim,9.12,and the Health and Safety e
Cud ,Sell 25532(a0 LIE nshn UNIT(OVER 100,000 BTU)
❑Ym 0 N VENTILATION PAN(SINGLE RESID) ('AID
Due Recerp p
N9l)the apdnaara nr lulam I Ling occupant use ,rip lmr,or devices which 1
it hawNoos air commensals at defined by the Bay Area An Quality Manage v BOILER-COME QHPOR 100,000 III U) 'IOTA].
_
.Inch? BOILER-COOP(OVER IIhIWHT
OU) /`
L1 Yes ON. .I Iles /J_I
I have read the hazardous mamriale restaurateurs under Chaprer6.95 airline Car- AIR CONDITIONER ISSUANCE DATE
71:1�.an Heller&Safety Colic,Scenam 25505,2,55]3 and 25534 1 nidenlund Thee Blhe NEW RESIDENTIAL MECU SQ IT
nding Jres not conically have atena)0.,Nadi n my retpmubday to notify the occupant / 7� `r
the requimmems whnh muv M met poor nth iwuance of a Cemhrnte of Occupancy.
neror uuN onzW agent Date TOTAL (ISSUED BY
OFFICE
C(ty of Cupertino
Department of Community Deveiopment
10700 Torre' Avenue, Cupertino, CA. 95014 (4oft) 252.4642
September 17,. 1997
(DATE)
I am an adjoining property owner of R & Z DEVELOPMENT CO. , INC.
(NAME)
whose property is located at 10227 Adriana Avenue, Cupertino
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a 8 foot high fence facing my
(8 MAXIMUM)
property.
SIGNED: NAME: LAPS & ELAINE KOLNES
ADDRESS: 10231 Adriana Avenue, Cupertino
Cupertino, CA
1 1
i �
SEP 19 1997
i !
L-JkoLnu U L J
------------------------