23318 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Project identification
PFBTNO.
Building Address: �
' ^ qL 'A . � R23318^J1u
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oss:
Parse. � o r LCt`IS 'aCal? .CITY OF CUPERTINO-BUILDING DIVISION
cano-atlaraN�f�j APPLICATION / PERMIT 2
(X,Llt.1 wk KITS-4�� BUILDINGELECTRICAL-PLUMBING-MECHANICAL CATEGORY
Architect/Engineer. LM.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: PERMITISSUANCE TO
LICENSED CONTRACTOR'S DECLARATION
[hereby affirm that lam Bcrnsed under providonao(Chapter9(commrnc APPMANCESRESIDENTIAL ]OB DESCRIPTION
ingwithSeMon70M)ofDiA.ion3aftheBmlmmandProfemiomCode,and my PANES 1000/ G U� ��u/
license is in full fora and died. �L``l1VV Is _
License Clam Contractor
Dale Contractor UP TO 2DO AMPS
701-1000 AMPS `
ARCHITECTS DECLARATION OVERIODOAMPS SQFTFLOORARFA $/SQ.FT.
0 qOin m . .
q I understand my plane shall be used public records S�ass Ift
z(7 tv
Licensed Professiowl SIGNS ELECTRICAL _ L.tS
6] OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MLSC ^ 6$
to'yA� Iherebyafflrmthatlam exemptfromthe Contra dor',Licenselawforthe l {1 y ?
❑❑ following reamm.(Section 70315,Buslnem and Pro(esslone Code:Any cityor
neuntywhich requires a permittoconstruct,alter,improve,de sellsh,orrepalr 'TEMP.METER OR POLE[NST. /
$ a nystm=mpdortoits ame,alsomquimtheapphuntforsuchper tt. POWER DEVICES. `oma 9
�1 p V file a signed statement that M is licensed pursuant to the provisions of the
5!'$! u, Contractors License Law(Chapter 9(commenciagWith Section 7000)ofDist-
�"�OS sion3ofthe Businm,and Profemiom Code)orthathelsexempttherefmmand SWIMMING[VOL ELECTRIC VALUATION , .
the basis for the alleged exemption. Any violation of Section 7MI.5 by any
Gapplicant fora permit subjects the applicantto a civil penaltym
of not ore than OUTLE
o �ve �ndreddollare($5(111. NEW EC STORIES [TYPE CONSTRUCTION
(((ililil (Q''��11��as owner o(the property,or my employees with wages as their sok
w�pdnutf Uldo the work andthestrudure is not intended or offered for
qsssuaaa((((¢eee(Sec.7Wq Budaasaand Prefessloru Code!The Contmetor's Licerue law
does not apply to an owner of property who builds or Improve,thereon,and i7CC.GROUP RES.UNITS
a whodoessuchworkhin=Uf thrwgh Nsownemploym,providedthatwrch
Improvements are not intended proffered for We.If,however,lhebuilding or TOTAL:
ImprovementbwldwithinomyearofcompldloMtheowner-buBderwill have
t rden of proving that he did not build or improve for purpose ofule.). (M. PLUMBING PERMIT FEE FLOOD ZONE APN
"L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to construct the project(Sec.7014,Business and Profeadom Code: "
The Contractors License Law doss na apply to an owner of property who -
Wilds or improves thereon,and who contracts for such ptofects wfth a ALTER-DRAIN&VENT-WATER(RA)
cgn*dor(s)licensed Ferment to the Contrador'a License Law. FEE SUMMARY
LJ I am exempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE
DRAINS.FLOOR ROOF,ARRA,COND. SANITARY Y N_
/ Owner - Date RECEPTIt
WORKMANCOMPENSATIONDECLARATION SCHOOLTAX Y N_
( ❑I hereby M.that I have a certificate of consent to self-insure,or a FD(TURES PER TRAP RECIDa'f N.
certificate olWorkers'Comperwtlonlruuranceora certified copythereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N
3300,Lab C.7 '
RECEIPT N'
Polkyk GAS P.A.SYSTEM-0OVER BUILDING DIVISION FEES
Com any '` Y10
�Certifled copy is herebyfurnished.thehed. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE V
❑Certified copy V filed with the cityImpectlon division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID 40�b%`14
COMPENSATION INSURANCE SEWER-SANTEARY-STORM EA 700FE Date eCel f�F
(This sedion need not be completed If the permit bfor one hundred dollars
($100)on lee..) WATER HEATER w/vRNT/ELRcrR ENERGY FEE Y_ N—
I certify that In the performance of thework forwhlch this permit Is Issued, WATER
I shall not employ any person In any runner an as to become subject to the WATER SYSTEM/TREATING
Wmkera'Compensation Laws of Callfornia.Date PAID
o Z Applicant NEWRESIDENTTALPLMR, SQ.17 Date Recei t#
Z O NOTICETO APPLICANT:If,after making this Certificate of Exemption,you
should become subject to the Warkars''Compematlon provialoru of the Labor TOTAL:
P
N Code,you moat forthwith comply with such provisions orthis permit shall be 'BUILDING
deemed revoked.
'LU > CONSTRUCTION LENDING AGENCY SEISMIC FEE'
a e I hereby affirm that there is a comtrudlon lendingagenry,forthe perform- TOTAL: _ ELECTRIC FEE �ea
3 Z ance ofthewark forwhich[hh permit lslesued(See.3097,CIV.C.)
(,) O Lenders Name - PLUMBING FEE
LL f• Lender'a Addreaa QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W Imrtifythatl WvereadthlsappBmtbnand statethattheabovelnformatlon -
fl Is correct.I agree to comply with all city and county ordinances and gate laws PERMIT ISSUANCE FEES PAID:
} (A relating to building construction,and hereby authorize representatives ofthls
H city to enter upon the above-mentioned property,for inspection purposes. ALTER OR ADD TO MECH.
? (We)agree to save,indemnify keep harmless the City of Cupertino Date Receipt#
V a galnstliabllities gments,ro a expen hlch maylnanywayaccrue AIR HANDLING UNIT(TO 10,ODO CFM) SUBTOTAL:
against cold City' lmar gent of thla permit. CONSTRUCTION TAX
NWn AIR HANDLING UNIT(OVER 10,000 CFM[
rc of Applicant/Contractor Date EXHAUST HOOD(W/DUCE CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or hand le hazardous HEATING UNIT(TO 100,000 BTU) - Date Recei
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
Health and Safety Cade Section 75537(a)? HEATING UNIT(OVER 100,000 BTU) .. O
F-1YesNo
Will the applicant or lure building occvpard use equipment or devices VENTILATION PAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air .
Tlity Management District? BOILER-COMP OHP OR 100,009 BTU)
J Yca n No
(LpAi�aa A
[have read the hazardous materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100PA
,000 BTU) - Iv
the California Health&Safety Code,Sections 25505,75533 and 75534.I V
understand that lithe Wilding does not currently have a tenant that it is my NEW RESIDENTIAL MUCH. SQ.FT.
AR
mponsibllity to notify the occupant of the requirements which must he met �.la
primtoL uanceofaCertiflceteofOavpanry.
Owner or authorized agent Data TOTAL: ISSUED BY:
OFFICE COPY
�Lot= 15198 sq. ft. HEWED
18 1992
BLDG; iNSPECTIOt DEPARTMM
CRY 0E cm M
32'
20'2"
�---------
1
21' 1" 4' 10
25' 11"
2-3- 18'7" 19'2"
' 10"
20 °i1 nXiga 7 YL T PLANS
caning
L
2296 sq. ft. 40'2'IS'3" PL G DEP�a
APPRO D �p
IN RDANCE WIT T
G!P NO COD$S1RN ORDIN So"g'"al 81101,
Built-in AwningBLDG. DEESa
DA . . •
SIGNED
36 I" 18'3"
This setrn
and spe ifications MUST
be keptob at allti es and it is un 22'2*
lawful to make any change or alterations ~i
on same Without W68%-I emission from Garage
the buildi g Dept, City of upertino.
The stem ing of this plan al d specifications 363"
SHALL NI T be held to per iit or, to be an
Approval i f the victaticn of any provisions 803 sq. ft.
Of any Cit 04,161140 or St to Law
ff
ICECOPY 1 =--
ops I1' 11"i
H
5'5"
Notes:
• 1. Note that both original awnings are part of the house construction.
They can be seen into from the attic. Both have 2"x6"joints,
plaster-board ceiling,and tar-and-gravel roof.