22224 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
Iiullding Address.
2z-74o O 22224
s wnewam/: i none:
/ iP" `/34I ,t LZ CITY OF CUPERTINO-BUILDING DIVISION Al'1'LI(.A 11UN SUbAfl11AL UAlt
y ��iG 37 t
• �a1r°tt�°/i•� / LIc.No: 'APPLICATION /PERMIT '�� R'
/f 2/rte I Aa°s✓K k t)r 6e a`C.� .6 3SZG YZ BUILDINGMDCTRICALPLUMBING-MECHANICAL CATEGORY CONTROL It .
ArcMtect/Raglneer, 1 LIC No. '., J
N I'Q1v �ELECTRIC,PERMIT•'.;',, FEE BUILDING PERMIT INFO',. .I
\nL�}, u(Gl.l �1.UMtl j
Address: I PERMIT ISSUANCE mt.,_n r, /�•� ❑
LICENSED CONTRACTOR'S OECLA RATION
I hereby affirm that lam licensed under provisions o(Cs.I.r.9(ros.don AI'PLIANGESRESTDENTLAL JOB DESCRIPTION
IngwRh l.full7000)ofd effeon3o(the Buelneseand Pm(esaloneCodeand my -•t•CJ
Lcense leln full(o Pad effect. -� PANELS
Lianaae cla Llea 35 z(o Y R � (j
Date Contractor y /N L t CC--
201-1 W0 AMPS
ARCHITECTS RATION r I
aO Zp I underetand my plans shaBbe used m public record.. + -- OVER 1000 AMPS I•�' It`S(D.I �W.@OR' AD
�z�j°1 Licensed Profneional SIGNS CLECiRICAL lVI//'�` �� N
!ten `al OWNER-BUILDER DECLARATION (SPECIAL CIRCUIT/MLSC C O M P U T '
�1p.,�g Ihereby.ffirm that lam exempt from the Contractors License Law for th•
O rs following mear m6 ection7MI-S,guaineroandPmfcnlon.Cod Any city or E �3�rj' j
7.t-
county whichr Imo permit to rorutruct,alter,improve, TEMP.MLTTItORI'OLE INST. '� /I
P my equ pe provgdfr such repair
any s[mred priement that he issuance,also licensed Pursuant to the Horsuchpeof permit to POWER DEVICES
E`C c floe a signed statement that he la Ilrenam pursuant to the pmWloro of wl. ,th-On, Comnctore Luins Law rofession(commencing with xemptthe00)°marl- I
F•�O the siom3 bsHhe thealle and exemption. Any violation f exempt therefrom an I SWIMMING POOL'ELECTRIC ygLUA710N
the basis for the alleged exemption. Any violation of Section 7031.5 by any ,.x.1
<$ applicant fora permit subjensthe applicant to a avll penalty of not more than I I U OOTLE'ISSWITCHESFIXTURES Ja V-7� �Q t
ofive hundred dollars(S500).
❑I,as owner of the property,or my employees with wages as their Bale NEW RESIDENTIALELECTR SO SE
I 1 SH)RIIS I TYPE CONSTRUCTION:
5 tmmpensatloo,wel dothework,andthestrucame is not intended or offered for
9S sale(Ste.7074,Business and Professions Code:The Contractors Ueeme Law I
fE5 does not apply to an owner of property who builds or Improves t hereon,and I OCC.GROIII' RfS.IMITS
who doessuchworkhomself orthrough hisownempioyees,provided that such
Improvements are not Intended oro(fered(or sale.I(howeveq nhebuilding or Tppp
Improvement iss ld within oneycariecompletion,theowner-bellderwiuse 1CJJY
t1l9,kurdenofprovingthathedld not build orimprove for purpose ofnle.). QTY. , �" PLUMBINGPERMIT FEE FLOOD ZONE APN
Lj I,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to construct the project(Sec.7074,Business and Professions Code: '
The Contractor's License Law does not apply to an owner of property
builds or Improve ther co
eon,sad who mract. for so& ptojeg ALTER-DRAW&VENT-WATER(EA)
s with a�. I I - ' �' FEE SUMMARY
cgp[iactor(s)licensed pursuant te,the Contractors License Law. BACK FLOW PROTECT.DEVICE I "
Ll]am exempt under Sec. B &P C for this moron I - I qurvlPF per Y,
Owner Date DRAINS FLOOR ROOF,AREA,COND. I (SANITARY RECEWii
WOR KMAN COMPENSATION DECLARATION FDCT(1RES.PER TRAP I �SCHOOLTAX YR RECEIPT I
AI hereby affirm that I have a certificate of consent to self-mace,or a
cerbflceteof Work m'Compev tlonlruurenmoramrtifk mpythemof(Sec. GAS G.SYSTEM-1 WC.60U1LETS
3800,Lab C.) /p I I PARK FEE Y N
P.IiryN ] RECEIPI'M
Co any 'AD �. CAS EA.SYSTQdAVERd(EA)
' any—ed copy is he . I I BUILDING DIVISIONI'CES
Certified copy Is filed with the city Inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR I I PLANCHECK FEE
CERTIFICATE OF EXEM PTION FR ERS' GREASETRM _ I
PAID
COMPENSATION
SEWER-SANITARY-STORM EA.200FT. I I Date RCCCIDt#
(This Beeson need not be completed tithe permit hforone hundred dollars ,
(s10(Berefyt.) I ENERGY FEE Y N i
(certify that In any person mannrkts,ast becomemdtis isseve,
the WATER HEATER W/VENT/ELECTR, —
I shall not employ any person In any manner m u to become subject m the +
Wwkcrs Compensation Laws of Calilomla.Date WATIIi SYSTEM/TREATING I PAID -
O Z Applicant
Z U NOTICETOAPPLICANT:If,after making this Cereflczle of Exemption,youl NEWRESIDENTIALPLMB. SQFf I Date. Receipt#
should became subject to the Workers Comperuatlon provisions ofthe Labor I TOTAL:' / yy /1(�I
W~ W Code,you most foe hwith comply with such proWlgre or this permitshallbel IBUIT DING pEE �&r0-
> deemed revoked.
CL CONSTRUCTION LENDING AGENCY SEISMIC PEE a l O
a there that there is a construction lendingageacy forthe perform-( TOTAL:( ELECTRIC FEE
0 ,ramie!the work(orwhichty out Mewed($ec.3t797,C1v.C.)
U Lender.Nam• 4/ � ;PLUMBING FEE'
Il U Lender's Add... in 7 IQrY. ", 'MECHAN[CAGPERAIIT;', I, FEE PLUMBING
_
U orrect,I read application and emmthatthe above information
r0 C Iscti.gt building comply h antltyabysuthyordinancesa.tiveselaws PERMIT ISSUANCE I (FEES PAID:
(A city embuponge albov ion,andhembyauthorinrcctionp rpos°(this I
Z cityW)aree to the,hove-men,a.d keepelwrmI stheCt purposes. ALTERORADD TO MEGH. I ]
— (We)agree to save,indemnity an d keep harmless the City y Cupertino 1 Date Receipt# ,)
against mid In dgmeme,cos,eaf expenses which permit anyway accrue AIR HANDLING UNLIT(TO 10,000 CITE)
against said City in cgnearyenceo� granting of this pennlL I 1 SUBTOTAL:
6V-'e, A R HANDLING UNIT(OVER 10,0 O CFM I I CONSTRUCTION TAX
SignanNiof Applicant/Contractor Dae x IXFLIUSTHOOD(W/DUCT) I CONSTRUCTION TAX PAID: j
HAZARDOUS MATF,RIALS DISCLOSURE - 1
Willtheapplicantor futurebuildingoccupantstgre orhandlehazardous HEATING UNITHO 100,000 BTU) I ' .Date
materielmde0ned by the Cupertino Municipal Code,Chapter912,and the Receipt#
He❑.It Yaend SafetyCod�ee Sre�cil.n2S532(a)7 HEATING UMT(OVER 100,00)BTU) I I 7� TOTAL:
Will the applicant or fu" turcbullding occupant timequipmentordevicea VF1J"I LA770NGAN(SINGLE RFSID) .I NSrU,4ZJCE DATE
which emR hamelous air contaminants as defined by the Bay Area Air
Qu lityhtam man Dime Dish 7 BOILER-COMP(3IIPOR100,000BTU)
Ye G 1
®. IAave read the hav or7i ue materials requirements underChapter 6.95 a( BOILER-COMP(OVQ2100,000 BTU)
the California Health&SafetyCode,Sections 25505,75533 and 75537.1
understand that lithe budding does not currently have.tenant,thatit I,my NEWRESIDEN77ALMECH. �.FT.I /ism �{
responsibility to notify the occupant of the requirements which must be met I "T'T.'o
prior no t of a Certifli °ICE P.nry.
' Owner or au&riud agent in TOTAL: (I (ISSUED ON
�
OFFICE COPY
i
(408)996-3722
' ' FAX (408)253-8068
• Terry Brown
Construction
LM 6 26 2
21721 Granada Ave.
Cupertino, CA 95014
PERMIT No . 22224 Description of Work-Existing Garage
22740 Alcalde Ave .
1- Remove and replace roofing materials , including replacement
of damaged wood .
2- Remove and replace dry-rot and termite damaged wood framing .
3- Remove and replace exterior siding.
4- Upgrade electrical to meet current code .
• Total Value $3500
DATE
EPT,
Dq�
BLDG. DZPT O lb Vs>
.iUiV n
BLDG. INSPECTION DEPARTIIW
Cllr of 6lP-EB -g "
OFFICE Copy