30529 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY `
CITY OF CUPERTINO I BUII.UINGO-ELECTRICAH PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PLUM! NG'MECHANICAL 9
BUILDING PROJECT IDENTIFICATION
PULLODI DDRBSANITARY NO. APPLICATION SUBMITTAL DATL
97q_ONE:ge Z� CO RACaO E. LjN NIC CONTROLN
ARCHITECTNNGINEER: LIC NO:
A IJIt F:$S:_ r �I�sr �� - ❑ .
CONTACT. PHONE: CJ BUILDING PERMIT INFO
t � ��� q-�4-00" .❑ Crnsulten[Fees Paid 6yAppliant(Initiap BLDG ELECT PLUMB ECH
LICENSED CONTRACTOR'S DECLARATION ELECTRIC PERMIT FEE -
1 hereby aRm that 1 am licensed under provisions of Chapter 9(commenQTY cing JOB DPSCRIPTION
OaZ with Section 900B)of Division 3ofthe Business and Professions Co ,und my license is
00 in full force and cffc �(� PERMIT ISSUANCE RESIDENTIAL:
V kr,]] License Clbss Lic.p—I1L1 ` ❑SFDWL ❑KITCHEN REMODEL.
tiQL Daly-�j--a-/{A- -f—Convector i APPLIANCES-Rf•SIDENTIAL []ADDITION 0PLUMBINO RE-PIPE
'' � •gV gVARCHITECTS DRCLAR�A IOF — ❑MULTI-UNIT [:1 STRUCTURAL
Z O HJ - 1 underamnd my plans shall be used m public me Is PANELS
OZ"r'0 _ UPT0200AMPS CHIMNEY
IZt3 F"I,a Licensed Professional ❑INTERIOR ❑CHIMNEY REPAIR
bd2a-4 OWNER-BUILDER DECLARATION OVEO 1003A$ IMPROVEMENT
'�0.'W 6 1 haehy affirm that 1 ,in
exempt from the Comment's License Law div the OVER 1pN1AMP$ ❑BATH REMOOEL/REPAIR D8M01.19'ION
�p5,O y U following reason.(Section 7131.5,Business and Professions Cole:Any city or Inc.,, SIGNS ELECTRICAL El OTHER
u+a W ya which minutes.permit to construct.alms,improve,demolish,m repair any structure
O.J pdorto its issuance,also rOnires the applicant for such pcwiuo file a signed statement SPECIAL CIRCUGHMISC.
yf5'�yyp11�} thatheislicensedpunuant to Ne provisiore of the Commences License Law(Chupmr9
W IJQO inommencing with Spdion 701x11 of Division 3 ofine Business and Prdeaelone Code)... TEMP.METER OR POLE INST. COMMERCIAL:
6 e' that he is exempt therefrom and the basis far the alleged exemption.Any violation of - ❑NEW BLDG/ADDITION ❑DEMOLITION
ta•
m NANT ❑FOODSERVICE
Station 703 L5 by any applicant for a permit subjects the appinannn a civil penalty of POWER DEVICES
�
FZQnot more than five hundred dollars(8500).
❑l,as owner nflhepropeny,nrmyempinyecswith wngesox heir,inlerompcnsntion. SWIMMING POOL ELECTRIC -IMPROVEMENT
Qa will Jothe work tied the sanctumis not intendedoroffend for sale(Sm.7044,Business OTHER
aand Professions Code:The Contractors License Law does not apply to an owner of OUTLETS-SWITCHES-FI%TURFS
property who builds or improves denten ,and who does such work himself or through
his own employees,provided that such improvements arc not intended or offered for NEW RESIDEN IAL ELEC IL
sole.IL however the building tor improvement is x.o within one ycarofcompleamn,the - SQ.FP.FLOOR AREA $/SQ.FT.
owner-builder will have the burden of proving that he did not build or improve for pur-
pose of sale.).
❑I,as owner of the pmpeny,am exclusively contracting with licensed ctntmeon w, TOTAL: - {.
construct the project(Sec.70441 Business and Professions Code:)The Contractor's LI.
cense Low does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FE gFp 10 1..99
who contracts for such projects with a coronations)licensed pursuant to the Contractors la1('96
License w. PERMIT ISSUANCE
F:31 tan exempt under Sec. B&P C for this mason
ALTER-DRAIN&VIiNT-WATER(EA) who . vt lVt VALUATIO
Owner Date '
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE W
I hereby affirm under penalty of perjuryM^one of the following declarations: w
(hove and will mninwine Ccnifema of Consent meal Ginsum for Worker's Cnmpen- DRAINS-FLOOR,ROOF,AREA,GOND.
atom,as Provided list b Section 3700 of the Labor Code,for the STORIES ' TYPE CONSTRUCTION
#taus y performance of the
we frawh Ni a pend tis istar . FIXTURES-PER TRAP
Ihave and will maintain Workers Compensation Insurance,as required by Section
3000 of the Labor Code,for the performance Of[lie work for which this permit is issned. GAS-EA.SYSTEM-I INC.4OUTLETS - OCC.GROUP _ APN
My Wo.rke'sFGa,-lA`Orticrroiicy
#j:r 'No.:nnper c. GAS-EA.SYSTEM-OVER4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFJINDUSTRL WASTE INTERCEPTOR
(This section need not he completed if the Permit is for one hundred dollars($100) - - - - _ I 1 1 'DIVISION FP.ES,
or less.) GREASE TRAP' PLANCHECK
Icenifythatinnhe performance ofthe work farwhich this permit isissush I shall SEWER-SANITARY-STORM EA.200 PT.
not employ any pennon in any manner so as to become subjnt to the Workers Compen- ENIIRGY l E
,Z satin.Lawsof C.Iilam..Date
Q WATER HEATER WNEN DELEC'TR
r� O Applicant GRADING
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEMTREATING
I•" become subject to the Workers Compensation provisions of the labor Code,you must SOI
forth vith comply with such previsions or this panni)shall M deemed revoked WATER SERVICE .. ,
Q
a
CONSTRUCTION LENDING AGENCY NEWRPSIDENTIALPLMB. SQ.FT PAID
UO Thereby affirm that them isvconswetion leoding agency for tue performance of )ate Receipt# '
!-t
are work for which this permit Is issued(Sec.3(N7,Civ.C.)
O U Lender's Name _ TOTAL:
Lender's Address TOTAL:
y - I certify that 1 have mad this application and state that are above information is BUILDI G FEE I
Vl correct,I agme tocomply with all city and cotnty ordinances and slate laws relating toQTY. MECHANICAL PERMIT FE
U building construction,avdherchy inthorim representatives of Nis city Inciter upon the SEISM FEE
above-mentioned property far inspection purposes. PERMIT ISSUANCE
(We)agree to save,indemnify and keep hawlew the City of Cupertino against ELE IC FEE
•liabilities,judgments.costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH. PLU BING FEF,.
in onsequence of the granting of this permit. - -
APPLICANT R�T ANDS AND WILL COMPLY WITH ALL NON-POINT AIRHANDLING UNIT(TO 10,000 CFM) MEC ANICAL
SOURCE UI/{}��'��S. . -x
/n1 A1� Y� NR HANDLING UNIT(OVER i0,000CFM) CONSTRUCTION Ax
. . Sign mof Aepl nt/Convector �' Dates Ii%I3AUST HOOD(WIUUCp HOUSING MI'TIGATI PEE.
HAZARDOUS MATERIALS DISCLOSURE
Will One applicant or future building occupantstohe or handle Littoral mncrial HEATING UNIT(M 100.01E BTU) -
as defined by are Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Sceian 25532(a)^ i HEATING UNIT(OVER 100,000 BTU)
❑Yes ON.. - - - - - •
VENTILATION FAN(SINGLE RESID) 'PAID
Date eceipt#
Wblostol me air cicantorfumrc building Occupby
nt By Area
Air
ut or ality Mices nagemint BOILER-COMP(3HP OR 100,010 BTU)
-mit hazardous air contaminants as definW by the Bey Ama Air Quality Management _
TOTAL
tstnn' O
BILER-COMP(OVER 2X,000 BTU)
❑Yes' ;(]No
I have read the hamNous mmerials rtquirtmen¢under Chapter 6.95 of the Celi- AIR CONDITIONER ISSUA E
Tania Health&Safety Code,Sections 25505,25533 and 25534.1 understand that it the NEW RESIDIN GAL MECH. SQ.PT,
building does not currently hove.tenant.Nal it o my respmsibilry to notify the cecupoo,
of the acquirements which must be met prior to issuance of a Cerniicme of Occupancy.
Owner or authonred agent Dane TOTAL: ISSUEDBY:
OFFICE
M j�
G�t1 T iter ,
SANTA CLARA COUNTY CONTROL NUMBER
' CENTRAL FIRE PROTECTION DISTRICT
• Acs �a' 14700 WINCHESTER BOULEVARD PERMIT NUMBER-3
rtoN a Z 9
'A p+ LOS GATOS. CA 95030-1818 (408)378-4010
°Ter.
SERVICE SINCE_ 1947 FAX(408)378-9342
PLAN CHECK No.
PLAN REVIEW COMMENTS
CODE/SEC. SHEET NO. c�
1 x /I JrGJ D F ilL/9-AJ5 ",'-a Ho vc /NTE5-(L t,1rgGL
W I-rgJA) EX 157-IA) 6- & o2k 5f�,4 e- C
4-X/3i/NG F/lZe 5P21,L/XL41Z- 54esT,6:-H .5s19ze lac
/,lord c55,4 /2 > T'k-� ,¢cee "- >j,¢7't
A)45-Lj GoAIST/c C'AJStb f//24 /VWO TC, T/eW
C0AJ TR.4-C TD 2 B//,¢/C $H.C�/-1/ T 7"ra ^Tir/C r'✓/2 C'
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l�i/'/?O✓�}� r�/X� r,' STD /55CJ6 �"u/z Di LG $4-d'-/CC7-
.�-p C o r`f /�L 'A-Al G k: H//9's/ �/J,�D✓E c�o/v JY C'd.l Y,y'
JURIS PLANS SPECS NEW REMODEL AS/CONST.DESCRIP. BY ' / DATE PAGE
e- L4P V 1-1 Li � [Ilv6L&-Y l/,9 ASDpi-. ej �o _ey� 1 OF/
SECJFLOOR OCC OCC.LOAD AREA ARCH/ENG/CONTRACTOR/OWNER
• /S -r- / 2mz� JbL/e'OA) C'oN57
NAME OF FACILITY LOCATION
v� ND L &-el # /o y7s A). B,�AJ.e L ci -y
Serving West Valley Cities of:
Campbell, Cupertino, Monte Serena, aratoga,,,Town of Los Gatos, and Adjacent County Areas
Room addition
' 33'-6"
1;� Construct new wall
VtIPt;NT NO PpR/oH �D
BATES IDES AND oR N ES
SIGNED ff���
This set of Plans — _ �� ����I
e kept en theJob
I'd spec,fl 1. 16'-0"
awful to maria ar.• at ah';irnes and �suS; new $EP 1 0 )99
1 same v✓ithou t chap d it is un a�4]CC
alba,c:h 1,, t svnttan or altetaGon� �SJV sq
' ""^ ✓` t C;Y of�4rmission from BLDG. INSPECTION DEPA
�t°•,'B:no;a TENT'
IfIC
tt f'h s p a7 n r Peifno. CITY OF CUPERTIN
mr spe"no'a6ons
-v1 fa,i-n Or tO Je
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jaW
Existing Power Remove existing wall
Room
op� _ Chris Robb
page 6
,• - • � _ 7/9/96
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