05020063 CITY OF CUPERTINO r f •= r `` ' " °
BUILDING DIVISION PERMIT CONTRACTOR 1 FORMAe�IO,N
BUILDING ADDRESS: PERMIT N%5020063 5020063
ER'S NAME: PERMIT ISSUE DATE
EMANUE
O
N
E:
SANITARY N0. q'I CDNIROL N0,
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uo0
LICENSED CONIRACTOR'S DECLARATION JobDescri hon
F❑ I hereby affirm the,1 am licambal under provisions of Chapter 9(commencing p
iW on.I.,..7"')E Division 3o(tha Business and Professions Code.mdmylicartacis
o''n retell force and ereeL ADD 10 ' /REMODEL FRONT ENTRAN. /WINDOWS/
D ? License Claim Lie.g
o Dam corer ter REMOVE FIRE PLACE, INSTALL HEATER
ARCHITECTS DECLARATION
Y < I understand my plans shall he used as public records
�yU
;�� Licensed Professional
p 3 OWNER-BUILDER DECLARATION
d e y I hereby alirm than 1 am exempt from the Contractor's License Law for,he
O O following mason.(Section]031.5,Business and Professions Cole:Any city or county
x m which requires a permit a en tenni,alter,improve,demolish,Or repair any structure
prior to its issuance,also requires the applicant for such Permit to file a signed statement
Fla that he is licensed pursuantmNe moviso.oftheComment's LicenseLaw(Chapter9 Sq. Ft. Floor Area Valuatao�1000
QFCx
(cat he
(commencing Seromon,1ndb Weis For
the
the Business andon.Anymvi Code)of
a 3� that he is exempt Inertfrom and be buts for the ellcgc0 exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicmuo a civil penalty of APN Number Occupancy Type
not more man five hundred dollars(S5W).
37532013 . 00
❑Lssowner Of Ne Pmperty,army emPloyces wire wages as Meir sole compensation. _rl t
will do the work.and Ne ewcmre is not intended.,offered fO...ia Sce 704,1,Business Required a' Inspectlr"' \''i
and Profession"
Code:The Commcmrs License Law does not apply m an owner Of ODS'1
pmy who ilds orimprovas mereag and whodoessuch work himself ormrough his _
Own employees,provided that such improvements are not intended aro@red forsale.If.
however,We building or improvement is sold within one year of completion,the owner-
builder will have me burden of proving mat he did not build or improve for purpose of
sale.). (fJIVI
❑I,as Owner of the propeny,am exclusively commNng will licensed contractors to J?$1Th f
construct the pmjecl(Sec.7W4,Business and Professions Code:)The Contractor's Li- f Ak
ecse law docs not apply to an owner of property who builds or;mprovi s Income,and `'y Ij y�, r� y Yi
who concocts for such projects with a conuzemr(s)licensed pursuant m the C^n ractofs a:I��
Llaw. tI \
�1 am cxcpLpt undo Secy B&P C f/ cob reason
er Date
WORKER'S CO ENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
1..'.yiun,
have and will maintain a Certificate of Consent self-insure for WorkersCompcn-
as provided for by Section 37W of the labor Code,for the perfomance of the
for which this permit is issued.
have and will maintain Workers Compensation Insurance,as reuired by Section
or the Labor Code,for me performance of the work for which this permit is issued.
Workers Compensation Insurance carrier and Policy number art:
Carrier: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' -
COMPENSATIONINSURANCE
(This meticm need not be compleard ir,he Permit is fortune hundred dollars($100)
or less)
I eenifY thin in the performance of me work for which this permit is isvad,l shall not
employ any person in any mantner so Is I subject tions subjeco the Workers'Compensation
Laws of Califs•
Applicant r
NOTICE TOA ICANT:If.inflAnnitking this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mus,
.JZ forthwith comply wit such provisions or this perm it shall M deemed evoked.
z O CONSTRUCTION LENDING AGENCY
Thereby affirm that Vert is a construction lending agency for the perrurmanee of \
a 7 Inc work for which Nis emot is issued(Sec.3(97,Civ.C.)
W Q Lender's Name
0a Lenders Address
C)O 1 certify that 1 have read this city
and coon and state the,and
above information m nion is
U building
lagree,c comply wirdall city and countyordinancesand cutelawsrelatingto
e
V build;ngconsnuctimn,add hereby for impaction
Of this cirymenmr upon the
r 6. above(We)agree
to
o ertysave far emnify a purposes.
(We)agme t,cove,indemnify and kith hay in an the City o Cupertino against
Uh incoitie,ticru mffeeeostsandgrenting ofthisexPermit. may in any wayaccmcagainstsaidCity 7 \
C.7 z APPLICANTeUNDERSTANDS1AND WILL COMPLY WITH ALL NON-POINT Issued by: Dill
SO CE REGULATIONS. yl1 ]
Re-roofs
Sig nature mfA,,lmmm/Cmmr1cIm, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicantor future building occupantst e.,handle hazardous maerial
or defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
,dmlkdc,Section 25532(x)?
Yes �I,�.�x1U All roofs shall be inspected prior to any roofing material being installed,
❑
FWill the applicants future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
u havamous air contaminans as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes pNu
I have read to hmardnus materials requirements under Chapter 6.95 of the Caliba-
niaHealth&Safety Code,Sections 25505,25533 and 25534.1 understand that,ifthe Wilding
does not currently have a tenant,mat it is my mspmnsibility to needy the Occupant of me
require whmhmustbcmetpriorm anaemisCeelfiaammrom.,kney. Signature of Applicant Date
UMrtil rte Zh'ol- All roof coverings to be Class"B"or better
Owner or au,horiretl aha^ Dam
CITY OF CUPERTINO � t� u� '" �'
BUILDING DIVISION pE CLINTRATNFOIi ®N
�..cvA..z's9v%
BUILDING ADDRESS: PERMIT NOO 5 0 2 0063
(;92 rARVT71? DP
ERS NAME: PERMIT ISSUE DATE
EMANUEL
PHONE: SANITARY 9 CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
u00 LICENSED CONTRACTOR'S DECLARATION
wF 1 hereby affirm that I am lirenscd under provisions of Chapter 9(commencing .lob Description
i a`i with Section]WB)nfDivi,mr3ofthc Bvemessand Professions Code.md my license is
6
in full fame and cnect. ADD 10 ' REMODEL FRONT ENTRAN. /WINDOWS/
p License Class.Lac.a
am
�c DContractor
ARCHITECTS DECLARATION REMOVE FIRE PLACE, INSTALL HEATER
Y ty
YI undersand my plans shall Wua.J a public meads
JyU
G� Licensed Pm(ecsional
OWNER-BUILDER DECLARATION
ot
I hereby affirm Ihod I on exempt from to Contractor's License Law rot the
0 o following mean.(Section 7031.5.Business and Profeivimu Cate:Any city at county
v m which requires a permit to construct.alter,improve,demolish,or mparr-any ssrucmm
prior In its issuance,also requires the applicant for such permit to file a signed sum,mat
that he is licensed pursuant In the previsions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valua"O00
�$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or
_ that he is exempt themfrom and de basis for the alleged ecomption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of APN Number Occupancy Type
not mom man Gw hundred dollars(SSW).
❑I,as owner of the property,or my employee,with wages an their sole compensation. 37532013 . 00
will do Newark,and the smcw¢is oat intended at offered for sale(Sec.70,14,Busioas
and Prefealons Codc:The Comrumrs License law does not apply in in aunt,of Required Inspections .
oopenywha builds or improves thereon.end who Ooxaueh woh himself or through M1is
own cmployea,provided that such improwmenu arc not intended oroRered forsale.IL
however,the building or improvement is sold within one year of completion.the owner. non
builtic,will haw the Burda of of proving that he did not build or improve far purpose of
wild)
fl T.as owner of de pmpeny,am exclusively contracting with licensed contractors to
consmet the project(Sec.on Business and&ofauons Code:)The v Contractor's Li-
<crtve law dos not apply m an Owner of pmpenY who builds or Improves demon,and
who Contacts tot such pmjcms with a contracmr(s)licensed pursuant to the Contractors
se aw.or
f
vnapt und "er Sec. ( _Date PCrt /O i
WORKER'S CCOO I Dow
DECLARATION
I hereby afnrre under penalty of perjury ane of the following declarations:
❑1 haw and will maintain aCerdfiam or Comenuo self-insure fa Workers Compere
sa im.On phavidead for by Section 37W of the labor Cade,far the performance of then
work for which this permit is issued.
❑1 have and will maintain Worker's Compensauon Insurance,as required by Section
37W of the Labor Code,for de information of Ne work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number arc: .
Cartier, Policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
frhE eeaion need not hecompletea d din permit is farone hundred dailam(51 W)
or less.)
I certify that in the porformance of Nen work for which this permit is issued.I shall at
employ any person in any manner in as ty�come subject ft Workers'Compcaauon
Laws of Califhnia.D• 1(
Applicant "KL/A •osiN
NOTICE TO APPLICANT.X fterlinaking this Certificate of Escmption,you should
become subject in the Worker's Compensation previsions of the Labor Coda you most
.JO foMwith complywith ouchp,ovivinns or Nu
.it that[W Contract mvokcd.
z� CONSTRUCTION LENDING AGENCY
rr I hereby affirm that there is a construction lending agency Or the performance of
a 7 the work for which this pcsmit is issued(Sec.3(197,Civ.C.)
W0. Q Lenders Name
Z
U Lcndcr'1 Address
U Q 1 certify Nat I haw,cad this city
and county
and sante Net the above information is
0 U torten.1 agmen m comply with all city and caumy oNtivot of and sum laws relating he /\/`
pU movengcotionod Construction.and hereby authoriumoses. tisu of this City in enter upon lM �
HCL ahovc(We)are property for inspection purposes. `�/
L1a (We)agrees,save,indemnify and men h harmless the City n e against against
N incomes,unne,o the Standing a thin cwhich may in my way aecme against Mid City
U Z APPLI ANT of the granting of Nis permit. �'(J
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat _ L�
SOU CE REGULATIONS.
Re-roofs
Signature of ApplicanUContrcar Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building uccupanumre or handle harardous material
defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
otic.Section 2553](91 All roofs shall be inspected prior to any roofing material being installed.
❑Ya Eno
Will the applknot orfuture building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit M1anrdous air comacrou nu as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Yes a
Ihavd real the ha]allous materials requirements under Chapter6.95ofthcGalifor-
meHealtha Safety Code.SeNons 25505.75533 and 25534.1 understand the if lM Wilding
Jens net Currently hove a tenant,that it is my responsibility m ratify the acupant of the
mquimmen bmmastbeme,pd.,ml6mmceoraCertficateofOccupancy. Signature of Applicant Date
,aq"t'f X -1, 101' All roof coverings to be Class "B" or better
Owner or aubodvcd agent Y Dte
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . . . . . . : 37532013 . 00
DATE ISSUED. . . . . . . : 02/09/2005
RECEIPT # . . . . . . . . . : 28534
REFERENCE ID # . . . : 05020063
SITE ADDRESS . . . . . : 10692 CARVER DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . .
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : EMANUEL BAGNAS
ADDRESS . . . . . . . . . . : 10692 CARVER DR
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : OSCAR TAYO
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- ---- --- - - - - ------ ---- - ----- ---- - - - - - - ---------- - ---------
BPERMFEE VALUATION 2 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BPGAS OULETS 1 . 00 5 . 40 0 . 00 5 . 40 0 . 00
BPLANCHK PERMIT FEE 83 . 16 1104'98 0 . 00 110 . 98 0 . 00
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
BREMHEAT NO OF HEATERS 1 . 00 7 . 02 0 . 00 7 . 02 0 . 00
BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00
BREMPOWER POWER UNITS 1 . 00 47 . 96 0 . 00 47 . 96 0 . 00
PPLBG SQUARE FEET 28 . 00 2 . 24 0 . 00 2 . 24 0 . 00
13SEISMICRE VALUATION 2 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
ELECTRIC SQUARE FEET 28 . 00 2 . 24 0 . 00 2 . 24 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMFEE SQUARE FEET 28 . 00 2 . 24 0 . 00 2 . 24 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
TOTAL PERMIT 431 . 08 0 . 00 431 . 08 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------- -- - - - - - - - - ------------ ------------- -- ---
OTHER 431 . 08 VISA
TOTAL RECEIPT 431 . 08
(WNER-BUILDER VERIFICATWN
S1. (Check one) I or my immediate family (parent,spouse or child) will perform
A. All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City. Phone # State License # Type of work to
✓c acc::u:a:c
S3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
_performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: Date: ?'�y IDS-
job Address: I Q G,1 a?— 'D2_i G t P E;P—T l f l0 Permit#
• Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
i
City of Cupertino Building DepartmenO
CITY Of 10300 Torre Avenue
C O P E kT I N O Phone: (408)777-3228
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect vourself from possible liability if that person applies for the proper permit in his or her name.
j Contractors are required by law to be licensed and bonded by the State of Califorua and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and •
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish, the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours, •
Building Department,
City of Cupertino
Printed on Recycled Paper
*CITY OF CUPERTINA d S-7i Zb a
UPEf�TINO PERMIT APPLICATION FORM
APN# Date:
�J1r- 32 - D ( 3 z�q �oS
Building Address: Mailing Address (if different from building address):
p 2 c-Aj,,veDiz.. Cm G-R.TINO GA cAspi4
Owner's Name: Phone#:
1^t J L4 EL 2,/%t6 N S CaO13
Contractor: License#:
4e+4-tt w i.J V- 6 U 1 1. C N rr
Contact: Phone: - ZO-IOzO Cupertino Business License#:
OSC,kf- TA--(o Fax: p. coS-
Building Permit Info: RCvtfl\)e V-0-C- k7LACi Ai 17F00I96 6p,G FL.kP2t 4CZ -NVt� RG-ATe2
(0 AbDUTtoP - tIST'6 NVA-TCR . 1ZC-ndopELVJ,0J CtsiPZarJGE :ggµlOv6OLDvJ1>0W �
Bldg 14 Elect ( Plumb Mech ❑ P � N
Job Description:
_Residential N Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
10 00
Cost of Project: Occupancy Group:
LF. -
ype of Construction: Please check this box if the project is a
,erppl T W0 0 L'I0 " ' second-story addition: ❑
Project Size: Standard S Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERl Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/ uasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3 e� U (i
1. d
t CITY OF CUPERTIN(*
C1W OF PERMIT APPLICATION FORM
UPEkTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Re eat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Stom]/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER InstalUAlter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT , Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREN EAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREN MISC Mise Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2of3
C 41ITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO •
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSW1M Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
/ MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3of3
." '` `"i'� 4LI'&,h I'`t s ^N.k 5, j�rs � a '` ti .+a' •w.s4 ^seep-ter S 1£e
SM
"�a� RES�IDENT4 ALPROJECT�CVE^RS_HEEfT '
!i sY. Y-.: ry ,r zi Pte` g�tA±�ys W.
CITY OF wc'Y'.Y�i ++ ',—_ M.-
Assessor's Parcel Number: 7S Z -0)3
Name of owner. cLA fJ Lt E t- t3 q 6N P�cS
Project address. JorSq 2 r At2N/cR ZD- Gt k&?e i I p.1 G I GA q S-0 i 4-
Contact person. n���rL �( O Phone. NOS -7-2,0 -102,0
Fax. Swo e1'-1 q n -- cMb C -
Net square footage of lot. Sro� 5Q j
l ( I Existing Proposed
Square footage: First floor: sF
Second floor: l I A
Garage: 2w: P Sf--
TOTAL: I to l 3 tiP
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N'
Is privacy protection planting required for the project? Y
On what floor(s) is work being done? 1 S�
Brief description of work. Em—( U3JfJDocu�'rj,37" TioPCi3 . e4�n FuRt'kcrc-, ADbrn
Code editions:2001 CBC- '':(Y -N)2001 CFC (Y - N)2001 CMC (Y- N)
2001 CPC ;(Y - N)2001 NEC (Y - N)
APPROVED
INpCCDEffectiverliIi/, /W,1Y0 j
CUPERTINO )ORD 1
DAT _Z_
i
SIGNED
This sot . to"hUST be
aw
.:PI on , .�lawltil to
lake arg on serf f copy
hom 618 buftng FEB 0 A /005
�Pu 0"•
„) Lt.. =dficaftla q`C;
=.4u. ."! -a Of to ne an
rival of the VINT!1011 of any provisona of '
:'w Ord.^•P^9C Uf S'a'n LaW
i I
(: Plan Review Process Work Book Page -8-Revised 4/28/04
i
j
REVISIONS BY
/ r:�(F�n Anne I�f�
CO2EStE n _ 'y
�-
c?o- Lot Av y R•?: .- Rely .,•`
.. �— --
,I . rI
Run,CflVIG�� -
.—„QeReoKo Cir 6,udel y I� +=.f
wi ILJ 1 Tilton Ave NPhil 1e ad n �, esW—'tt I Ili "---FIN�C.L'!L-.Lhte l
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