S 1669 ^ APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES,USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILDING-ELECTRICAL re rf NO
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 1669
BUILDING;PROJECT IDENTIFICATION t
BUII.DINC ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE
34l
OWN. AMtD� I� I IONE'.��I �I CONT ASC-�T Rp SN/II1!}' ��IC btil N/C CONTROLM
[.ARC]IITECT/ENGINEER: Y LIC NO: /� ADh).�tF S/�,LLLMI`CO AVE a'A ❑
ONTACT: PHONE: �4p l/f .• BUILDING PERMIT INFO
1 Gih`l a KlK1, �1 314 Sn3� — _._._..EC
µCa
Consultant Fees Paid by Applicant(Initial) BLDG ELECT - PLUMB MEC
0-, ❑ F:1 ❑
LICENSED CONTRACTOR S Df CI ARAI'ION QTY. ELECTRIC PERMIT FEE
I by n paid o r i 1 p f Chapter 1 9( cation + - 1 JOB DESCRIPTION
1- ZO withS r ]ad11 fD".ln3 nflhe Rus APmfexs'o Codo,and ny fie n.c is PERMIT ISSUANCE RESIDENTIAL'
W 'n full force cord ellen.
<(WjV Liters,Class Lic# ❑SPDWL El KITCHEN REMODEL
Dam _ Cnmranm APPLIANCES-RESIDENTIAL ❑ADDITION E:1 PLUMBING RE-PIPE
WW ARCHITECTS DECLAR ALI ION El MULTI-UNIT []STRUCTURAL
Z O y,Z„ I undersand my plans chill he used ac puhhe records PANELS MODIFICATION
O Z.. UP 10 AMPS
F',,,,�W Lice ed Prahcsionul []IN'TBRIOR []CHIMNEY REPAIR
C,W 41 OWNER-RULLUHR DECLARATION ❑
201-1000AMPS IMPROVEMENT SWIMMING POOLS
...
W,.;6 I herebyafErm Thal I an,exempt from the Contractors Licence Law for the DYKEIt11X1AMP5 []BATH kF:MODEI./REPAIR []DEMOLITION
[]0. follown"oe...a.(Seelinn9NI.5,Brouessnnd Professions Code:AnyciI,,a county SIGNS ELECTRICAL E:1 OTHER
F O which"door,a permit In cnnsln¢I,ober,Improve,Jmnnlish,nr repair my slmemre F1�9tiG
moz
olio 1 t urs q' Ahoupplacconlyi-Suchpit File a signed.t clues SPECIALCIRCUI'UMISC. _
g her lie licensed pursuant1 theI of fol C t' t Loc (CI Alert,
�yy (col 6 'a Sen' n7OnO),fDvsiat3ofth,l3uine+sard l nfestiotsCcds)or NMP METER OR FOUR INS[( COMMERCIAL:
Ot o Ibat he is exempt therefrom and the basis battle all,gcd exemp0on.Any violation of
[I NEW RIA[]/ADDITION []FOODS RVI
���
Section 90315 by hundred
dollars($500)
subjects theaPPEcnm toadvil penally of POWER DEVICES
pyy Bol more than five hondretl dollar(5500). []TENANT
-1 FOOD SERVICE
FFdQ ElI,ve ownw of the prap,ny.army antplayees with wages ns their colo congwnvalinn. SWIMMING POOL ELP-CTIOC IMPROVEMENT
KZ w ill Eche work and lhusfucutre isnot lntendeJ nr inhered forade(See 9044,Business []OTHER
vad Profession,Code:The Conondnrs License Law does nal apply or an owner of Of ILIT S-SWITCHES-FIXTURES
pmpeny who build,a,fort(heresur and who docs such work himself or through
his own employcec,provided Our such improvommua are not immnded or impel for NEW RESIDENTIAL F.LECTR SQ T.
sale lr,hasivecthe buildid,uh proventem baud withlnone yvn,cl atmplounin he SQ.Fr,FLOOR AREA $ISQ.IrI'.
or-builder will have the Kuri or proving that he did nm build or Improve for par-
prize of sale.). QN
1,m owner of the pmpeny,uu,exclusively contracting,all ha unsed wmreene,m TAI-:
conduct the project(Sea 7044,Business and Pcnfession,Code)'Ifie Comrrida,Li-
coast,Law does not apply manowner ofproperty who build,or improves)hereon,end QTy, '- PLUMBING PERMIT, EE ,
who eontnmts Cor such projects with n cumracmr(s)licensed purwmnt m the Conlmpnrs
License Law. PERMIT ISSUANCE
❑ Ism exempt undar Sec. ,R&PChonbti reason
AClHR-[]RAIN&VENT-WAC HR(EAJ VALUATION
Owner Dam-
WORKER:SCOMPENSATION DECLARATION HACK FLOW PROTECT.DEVICE 2� SCJ
I hereby effimt under penally of perjury one of the following declarations,
I hevcurJwill rani nNina Cvrlificurol'Cnmerthadf-Insure for Worker',Cam)ter- DRAINS-FLOOR,ROOF,AREA,COND' STORIES TYPE CANSTRUC'170N
tion,as provided for by Section 3700 of the Labor Code,for the perfammnce or the
irk for which 0i-s permit is issued. FIXTURES-PER TRAP
❑ 1 have and will nminlnin Workers Compcnsalinn Insurance,as required by Sealion
3900of theLabor Code,for the porfoncraccol'the walk for which Wis hotpot isiapted. GAS-EA.SYSTEM-I INCA OIL LE I -
MyWorkercCmntensao Ins lmnove - dPolicy nu OCC.GROUP APN
Carrier: PolicyNo. n OAS-EA.SYSTEM OVER 4(EA)
CERTIFICATEOFE) tMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUSTRI.WASTE INTERCEPTOR
(Th ,t n need lairb pit fftl pe ir is f no handooddollars($100) "-'- ' BljILEESC DIVISIQN PE-1
t rte ) GREASETRAP PLANCHECK FEE / f
I codify that in the parforrinfaccoffire worklor which this pericit'''Issued,l shall 6 S•yJ`
nor emplo any on' any manner to hcamexuhlecl to the Worker,Cnmpen- SEWER-SAN] ARY-STORM HA200 BE.
ENERGY PEE P�O+4U
Z action Laws of Califomia.One
Z O A lir,nt - WAlER HF.ATF.I<W/VENTILLECTR
pP GRADING FF.F.
F-ty NOTICP.TOAPPLICANTkiEL C..Crmvvatioulx ,ouncpe of Hxentpliode you
WATHI<SYS'I'BMITREATING
�^ humpsl could,
it Workers Campenr this ercauovs of Ih,Label Code,you must SOILS PEE
W G fnnhwith comply with such pmvisinns or this pcmut shall he deemed rcvokeJ. Wq'I'ER SERVICE
Q
CONS reis r cIONLENDINC AGENCY NEW RESIDF:N'I'IAL PL.MB. SQ.FT PAID
1t
UO 11,11 whaffirminetthelIi,neoaelmo 30 len ding agcneyfor the perfnrmnnecof - Date IteceiplN
W Ihewnrk for which this permil is icsual(See 309],Civ.C.)
Q Lenders Name 'TOTAL:
a Lender's Address
Isonify thatIhave read Thisnfourdocuou
counandsplethWNe aboveinformation is BUILDING FEE V
to coma I ansa to comply with an city and county ordinance..nd city t otos moping e QTY- MECHANICAL PERMIT- FEE
V �. building construction,and hereby authorize reprasenmtivus nllhis,ilymenmr upon the - SEISMIC FEB
abovo-mmutioned property for irepeclion puranses. S d
(Wo)vgrec m cave,inJemnlfy and keep h.rndess IheCily of Cupertino agnins PF.I2MI'1'ISSUANCP. BLHC'rRIC FEE
liabilities,judgmuns,casts and expen•swhieh min day way....engsins said City ALTER ORADD TO MUCH.
t moot to,'c
the granting thi mrmih PLUMBING FEE
APP I If UNDERFTAN S WILL Cl, LY WIC'H ALL NO -POINT AIR HANDLING UNIT(TO IQOW CFM)
SOI t( . I U /yTIONS, x MECHANICAL FEE
+/ 7 / 98 AIR HANDLING UNI'r(OVER 10,000 CFM) CONSTRUCTION TAX
Si aluracmr MD
Dula EXHAUST HOOD PW/DUCT)MRDOURE RI ATION FEEe
hpicanl
or future building occupant cmreorhandle hazardous metrial HEATING ON]T(By 100,000 BTU)
o defined by Iho Cupertino Municipal Code,Chapter 9.12 and the Beat and Safety
Code,Strain 25532(a)^ HEATING UNIT(OVER 100,000 BTU) 1 1
Yet; XNo VCN'If LA TION I'AN(SINGLE RESI Of Ay, 4Ume D Receiplq
Will Ih,applicant or furore boildiag occupant ma equipment or devices which
emir hazardous air conmminpnc.,defined by the Boy Area Air Quality Mvnagemcnl BOILER-COMP(31IPOR 100,001 BTU) Ur V111'Lfu ua
)istricto fire, I Ne BOILER-COVE(OVER l0i B U) TOTAL:
1 have read the hoz. 'a' I mriall requlremem,under Chapter 6.95 of lie Cali- AIR CONDITHONER - a
ISSUANCE DATE
I. tis Health&Safe,,C de,S If ns 25505,25- and 25534. anile unJ t i If the NEW RESIDENTIAL.MECIL SQ.FI'.
h d' nm,m'tenl hove t it.buili reaq,nsmility mon fy the uupam
a th r -In 't Ipriorm:t core,fa Ccrlilrld n
-
r autho ed age - m 1 TOTAL: ISSUED BY E AN70A.(�,9cL'
OFFICE
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MAY 14199
B1.DG.INSPEP+S CVPER7 NOlv�c���
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City of Cupertino
_ Deportment of Community Development
ttr,e�
A — —
10300 Torre Avenue, Cupertino, CA. 95014 (408) 252.4642
(DATE)
I am an adjoining property owner ofV&� _z
(NA
whose property is located at 27M , � 2 /Xli
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a �_ foot high fence facing my
(8 MAXIMUM)
property.
lei
SIGNED: NAME: (_1 r� lomk6k�
ADDRESS: 16 4 k ue,
'HE Jpg�q A IT MESS`p RINOtt
CONSTRUCTION,
OFFICE COP
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City of Cupertino
_ Department of Community Development
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—I»4s67 _
4 i I
Y
10700 Torre Avenue, Cupertino, CA. 95014 (408) 252.4602
(DATE)
I am an adjoining property owner of
whose property is located at �3r
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a g foot high fence facing my
(8 MAXIMUM)
property.
SIGNED: NAME:
ADDRESS: l 3 3 ( (a (y
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CITY OF CUPERTINO