S 1696 APPdCANTIT6 FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAI, PE8ITNO. 1696
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECI1ANICAL \V
BUILDING PROJECT IDENTIFICA'T'ION:
BUILDING SANITARY IS APPLICATION SUBMIII'AL UA'1'F.
ADDRESS:4ii` vio-e r-+t 11G
OWERX AM PHO CONTRACTOR'S NAME: LIC NO:
NIC CONTROLM
Ad AW
Im RCHITFC'"IFSGINEFIt LIC NO: ADDRHSS: ❑
INTACT: PHONE' _ BUIEDINC P8RM1'C INFO
❑ Consultant Pees Paid by Applicant(initial) B- I.DO ELECT PLUMB MECH
It
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby air...I dhel 1 Fah heen,ed moor mwisi is.1 Chapmr9(uhmoaercing JOB DESCRIPTION
WOO O with Section 70F of Division 3 of the Busaw,sandProfese.rs Code,and my license is RESIDENTIAL'
in fun ad force moi PERMIT ISSUANCE
6VU License Class Lic.K ❑SFDWL CIBIN RE-PPE EI.
NQL Dole—Channel., APPLIANCES-RESIDENTIAL []ADDITION PLUMBING RG-PIPE
ARCHITECT'S DECLARATION PANELS ❑MUI:17-UNIT STRUCTURAL
zo.z I undersand myplan,shall be used mpublic records MODIFICATION
p,$.4,Q UP TO 200 AMPS El INTERIOR El CHIMNEY REPAIR
F W Licaard Professional 201-I000AMPS 1PROVEMEN'I'- OSWIMMING 1'001.5
,E
OWNER BUILDER DF.CLARALION OVER IIlg1AMP5
yy I heathy affirm that I am exempt form We Contractor's License Low fur the H REMODEL./REPAIR 0 DEM OLITION
h(O p U following reason.(Section 7031.5,Basins,and Pact ..tons Cale:Any city rnoumy SIGNS ELECTRICAL OTHER �L�• M
which rhquiras a pe,ndt to chnswd,eller,Improve,demolish,or repair any.vtmcmre ���G�—S
its 1
�.1�6 poor t.,aissuance,nls.regmm,the'Ph"Fin far nue permit In B to a signed selcment SPEC]A I.C I RCU I UM ISC.
$;"
L1F tort he is licensed pursuant to the provisions of Contractor's Lleense Law(Chapter 9 ��
W q0 (con g ih Seer JIIW) ID' imh 3 flh R : ens FruitI gee Code)or TEMP.METER OR POLE INS] COMMERCIAL,
W ry,m C
that he is asturps tbemf d he back f the ll g 1 axe pt A y aloti.n of ❑NEW BLDG/ADDLHON ❑DEMOLITION
i4C1 4�•
Section 90315 by any p,li.n,f a...it hataida,mr,...licarrus a rl,fi,aarall,of POWER DEVICES
p
auto...c Wo five hundred dollar,($500). ❑TENANT ❑FOOD SERVICE
2 2 0 I,as Twiner of the IMPROVEMENT
2 ❑ property,Fir my with wages as their coleannpenxminn. SWIMMING POOL ELECTRIC
by
Tel Il do the work and he Fracture isnot intended To.ramal for Fale(See 9044,Hurt nes, ❑OTHER
a^st and Profes,inns Cade.''I he Conaoor..'.Llennse Law does not apply In an owner of oUTLSTS-SW I'fCI IRS-FIXTURES
3
property who builds or improves final and who one,such work himsrlf or through -
hl,,own employees,provided that such improvemata arc her intended or atered far NEW RESIDEN9IAI,HLECTR - rr
File.If,however the talking Fir improvement lssrld within hneycarofev aturde,the SQ.FT. ,O BA $/SQ.FI.
r-builder will have the burden of proving Ihaf he did not build or ro
impve fur put-
p meofadr ]f
❑ 1 a. f the pru,aaa,am esel.,i,,Iy contracting with licensed ortme,finan. TCAL.
mn,t tfibe project S 0044 B o d P t C d )Th C f Li
aerie L i t pplyt m et I'P Pty h b 'Id: p W and QTY PLUMBING PERMITh FEE YI:* � 0
who tauvforsaehp 1 kwfhaeonr t (s)I're tred pursuant(I)the Crntmuors (�
License Law. PERMIT ISSUANCE
�O�f1fyV
❑Iamesemplu orsee. ,B&PC"1 11rens.
ALI HR-DRAIN&VENT-WATER RA) VALUATION
Llale
WOR , 'SCOM PENS 'ION DECLARATION BACK RAW PROTECT.DEVICE
net 1 haehy nlrrm under family of pcUury ane of the fallowing deductions '
FFIhaveand will ma,ntalnoCenifoheof Consenuoself-insurofor Worker's Ghmpett- DRAINS-FLOOR,ROOF,AREA,GOND.
as Provided for by Smion 3700 of the Lahnr Cada for the performance oflhe STORIES TYPE CONS'fkUC'[ION
Irk for which this prank le issued. FIXTURES-PER I O,P -
I have and will maintain Waders Compatsaton Insurance,as required by Senior
3700hf the[.shot Code,for thnperfonnmme of the work for which this permit is Fumed. GAS-EA.SYSTEM-I INCA OUTLETS OCC GROUP qPN
My Worker's Compensation Insurance carrier and Policy number rrc:
Carrico Policy No.: GAS-EA.SYS9'EM-OVER 4(EA)
CERTIFICATE Op EXEMPTION FROM WORKERS'
COMPHNSAI'ION INSURANCE GREASE/INDUSTRI.WAS IF INTERCEPTOR
(Tlik,retinnread no(M completed if he penni(k far cru hundred dol lea($100) , pgILDINa;DIVIMONTEES "
or less.) OItP.ASE'I'ItAP
PLANCIIBCK PEE
I certify that in the perlonnnnaeofthework forwhich thisperntitiviesued,LvhW1
— SEWER-SANITARY-STORM EA.2001a1'.
not nnplhy very penin in my manner so o,m heeonm whject no the Worker,.'Cotnpen- - ENERGY FEE
,Z %anon Lawsof California.Dam
z Q Applicant ) WATER HEATER W/VBN'I'IELECTR
GRADING FEE
tip]
NOTICE 10 APPLICANT:If,after making this Certificate of Exemption,you should WATER SYS I EM/TREATINO
bce.n a subject In the War was Compensation movis]om of the labor Code,you must SOILS FEE
W G forthwith camply with such pmvioo-or this permit sial l he deemed revrked.
WATER Sf?KVICE
Q
� zCONS'1'kUC1'ION LENDING AGENCY NEW RESIDENTIAL PI-MB. SQ.IT PAID
U O l herehyafrrm that them isa construction lendingageney for We perfonnarceof - Data f
W. rthe work for which this lwnnit is issued(Sec.3097.Cie CJ -
O Lender's Name TOTAL:
a Lendef,Addrea, TOTAL:
1 certify Wet 1 have mad this application and state that the above Information is BUILDING FEE
ret correct.Tripled m comply with all city and charity onlinancesand sate laws Nadi ing nh QTY. MECHANICAL PERMIT FEE
buildingcumstmetihn,and hamby authodeerePme,native,of Wiseity to enterup.n theSP,ISMIC PEE
above-mentioned property for inTri,ti.r TREAT, PERMIT ISSUANCE
(We)agree to save,indemnify Find keep harmlcas the City of Cuperinn against ELF,CTRIC PEE
liabilities,)udgment,,cnsteandexpahses which may in any way acerae against sold CityALTER OR ADD TO MECII.
in mse,narce rf the pterin,of thus penniL PLUMBING FEEL
APPLICANT U ?RSTANUS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IQ000CPM)
SOURCER
BONS.
MECHANICALTEE
AIR HANDLING UNIT(OVER I0,(100CFM) CONSTRUCfIONTAX
111
fC�ad,
n I' pPleanl/Commcmr Dat EXHAUST HOOD(W/DUCT)
LOUSING MITIGATION FEB
HAZARDOUS MATERIALSculart tnuo or RE
Will the uPPliwnt or Tatars building occupant vtorcnrhnndle hamrdous Inotedal IIBA'1'INC UNIT(TO 100,(100 PTU)
nal by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Section 25532(x)^ HEATING UNIT(OVER 100,000 BTU)
El Yes 0N PAID
VENTILATION FAN SINGLEk[SID)
Will thep a.heFint in boom builmu Dao Receipt#
I g ocvhprvnt ase equipmun or devices which BOILER-COMP 3HP OR 100,000 BTU
it hazard...air contaminants as defined by the Boy Am.Air Quality Manegemenr ( )
TOTAL:
-❑Yes ❑No BOILER-COME(OVEk Ig1,I11X1 BTU)
I have mad the hvanlors materials re requirements under Chapter of We Coli- AIRCONDITIONER
0 P ISSUANCE DATE
frnniu HCFIOt&Safely Cnde,SmOons 25585,25533 and I I I 1 undenland tont i(Ihe NEW RESIDENTIAL MFCH. SQ.Fq
building dies ri marrently haveatenant.Wad ithmyresponsibilihy to Fully Thu ocerpant
Of the realmmmems which list be met prior to issuance of a CoatBe Beale of Oceupancy.
Owner or autherized agent Date TOTAL: ISSUED BY:
OFFICE
MAY 22 1998
aLOCy,CN�ECTION OEPARiWtwl
OFCUPERTINO
MASTER BATH
- - - - -- -� Cabinet
r New vanity with sq. raised
_ -H-t- panel Foiled fronts (white)
ELECTRICAL NOTES �-3 ®7-1
:xisting ceiling fan to remain Med/canet
Frame ibid window and
_xsiting Florescent fixture to remain \ j
lust change existing outlet to GFIC v ( J
PLUMBING
Replace the following in same locations
New lav 8 faucet
New drain&valve at shower
TILE New toilet
New Tx 3' 2 wall shower and Pan
New file counter top
New tie floor and base
OFFICE COPY
C�
tL--Jl Cabinets
G�i New sq. raised foiled fronts
(white)
i New laminate tops with 4 In.
°° splash
W�
3
i
HEATER j Existing
Pantry closet
to remain
HALL CLOSET
X
9
y
1 73"
i
31,
0
vn i
` PLUMBING ELECTRICAL
Replace in same location as follows Replace ceiling fan with light/fan
unit ( with Florescent light).
New tub , Valve, lav, faucet, toilet Replace (E) outlet with GFIC
TILE MIRROR
New tile surround, counter, floor & base Replace mirror on back wil of vani
CABINET Carpentry
New vanity with sq. raised foiled fronts. ( White ). Replace pocket door
x