21018 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Building Project Identification PEAVBT NO.
Buildbg Addtcu: - 21018
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,Jwar Mrra, CITY OFCUPERTWO-BUILDING DIVISION ��JJ
Contcades Name: / Lie.N. APPLICATION / PERMIT q--
JC7 MCJ BI1fIDINGELkCf1UCALML BINGMDCHANKC CATEGORY CONTROL,
Architect/Isgineer. Lk.No:
Q ELECTRIC PERMIT PEE BUILDING PERMIT INFO
Add. ^�
PERk9T15SUAFJCE I law
LICFNSEDCOe"edu erpS CIARATION _ r ,
I herebydf 70mtl ivtM 3ofthduMp aonaof Chaptcr9(mmmm A]elel.IANCFSRF3DEMTAL
ingwlm Sedbn7000)ot DldAon3 oftheeualrtaaand ProfeWomCode,and my 1...
Lice. nrue to and cited. PANELS�` r. �7- �)05 0 V
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Date muracorMIPS
ARCHITECTS DECLARATION 'Y -1000Ah1
re
I uderatani my plans aloe be welt.publi`.,— OVER1000AMPS SQ.FT.FLOOR AREA $/SQ.FT.
� ii j LLicensed I'rolmns
elol SIGNS ELElCIWCAL r
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6 OWNER-BUILDER DECLARATION ��•.'� SpECIALCIRCUT[/MTSC 6
Iherebyafflrmthat lam exempt from the Coodractofa Liner.Lw for the
�pp following rtawn.tSectlon 7NIS,Bwin®sod Pro(eslons Coda:Mydtym I" '
6Z ' � ITFMP.MErv 1TFR OR POLE INST.
F (j cvuntywhkh requbvapemdt tomratruct,ilter,improve,dermlbhor repair
�5� any atmdurt statement
he ince,aboredpurtheappecantfmwcA prnNtto /
rG tele a signed mtemmt that'lie b}larued pursuantto the pmvbbns of'tlie' - TOWER DEVICES
Gµy Contractor',Licenx Lw(CAapmr,9(mmmencing with Sertion71100)ofDivl-
F,30;J Mon 3 ofthe Buenas and Pmf®bnsCode)orth9 he lit exempt therefromaM 'SW�tiNG POOL ELECTRIC VALUATION
Eh ...77777 the baab for theillegd exTigtfur. Any Wdatbn ofGb
Sen 7m1.Sby any
ffjj <�p• applicant fora Permit aibjecte the ipplbnt toadvll pi hydnotmorethan OUIMS-9VR ]`D(I'URES + c
WG I`c ate wndreddollanfW=. `aJ /! )IV _aRE9DENTIALEfE{7R C.J .
WW u 1,u owner of the property,or mytempby.with wages a,tl sole SQ'Fr STORIES TYPE ODNSIAUCTION
nsa
rempetlon,welelothework,and theedU 6ture b nd intended or offend for I t�
aO sale 5ee 7616,11witeu ami Pm(eaelons Code:The GOMPdar'a Umnx Ljw
p$$ dceenotapplytoano mrdpmpertywWWiwarlmp^nthireon,and'v� OCG GROUT' RFS.UNITSwhodonwchworkhlmeelforthmaghhlaownempl provided ttiteud
Immve
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earenotlntenciedorofferedfm le'II h '� L
ever,thebulWinga TOTAa
Improvement badd wehinorcyeardcorrryl n,thit :bullderwW have
tla-¢rden o(proving that he did not Wed or p f«p,rpnaeorwe.). QTY. PLUMBING PERMIT FEE pLGOD Tprrp
LJ[+a•owner of the property,am eacWa ly c racting with Ilcan d PERMR ISSUANCE 1 qt
11,e C.toratom Lice.Law d (See apply to
APN
ad Prdesbns Cdr. 4a.Y�
The crimp/s Lktnsv Lw duce not apply ct m owner d property who YL=-DRAIN&VENT-WATER T_M
W lids or Imptwea thereon,and who mninda !a each p.ojecu wBh a
mLJIeWllmnsdnderSe to the ContnctalaLk& P Law.for
BACK FLOW PROTECT.DEVICE FEE SUMMARY
LJ I ns exempt undo Sec B 4 P C for thb reason
DRAWS FLOOR ROOF,AREA,GOND. SANITARY Y N_
Owner Dale RECEIPT g
WORKMAN COMPENSATION DECLARATION pIX.NRF$pFJy TRAIN (� SC100L TAX Y— N
(OLhemby affirm that 1 have a anificate d consent to eelf-Isom,m. �
I 'oertRiot,of WorkerVCvmwroMa w
petlml luaartlfkd copy thereof(Sec. RECFFJPtI,
3800,LbC.) GAS EA.SYSTEM-1 INC6OUTLETS PARR FEE Y— N_
PoIkyI W o�03��SJ RECEPI',
Co���mppp+++n A / A/ GAS EA.SYSTEM-OVER 6(EA) BUILDING DIVISION FEES
I I CertWd copy b hereby filed ded.
GREASE/WWSIRL WASTE INTERCEPTOR PLANCHECK FEE
LFJS CertWd ropy b Ned with the city Inspection dWlalmt.
CERTIFICATE OF E)(EMFTION FROM WORKERS GREASE TRAP PAID
COMPFNSATIONINSURANCE SEWER`,SANITARYSIORM EA M(IFT Date Recd 111
tThe aedbn need ata be campletd B the pemW b/more handed down
(5106)nrlem) WATFRHFATERW/VFN7/177TR ENERGY FEE Y N
I anw the Inthe pedma
oanof theworkforwhich rola emdtla lewd, —
I aha,col empec any person In any manner at u to become subject to the WATER SYSTEM/TREATING .
Wmkertt
ra'Copenun Lwad
tbGWmla
o .DatepAlp
Q Z Applicant NSE,RESIDENTIAL B. SQFF. Date Revel til
Z O NOTICE TO APPLICANT.If, mki
after angtw Certlrlaofte Eacmptbn,you
Fy shmld become wbjMbme Worker,'compens,tlnn pmwwna or the Lbnr TOTAL:
_
Code,you rrout forthwith comply witheuch provisions orthb permit shallh,
LU 7 deemed rooked. BUILDING FEE
LU
G CONSTRUCTION LENDING AGENCY EISMIC E I
I hereby aWrmtr w there i a mtawdlsu lerding 097,Ci for the pedortry
2 Lend alms work ler wnldrtw permit bfewd(see 3097,Civ.G> TOTAL Il.t�(� ELECTRIC FEE e(v'
V O "•N•nc PLUI FEE
LL H Lnder'a Addraa QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W lart8ythatl nem rcadtw eppeationad natem+tmeabovembrmatlon
b corrud.Iagreetocanplywhh all dryad muntyordlnanmannif-demes PERMIT I:sDANCE i`]i C1� FEES PAID
rN relat
FU = city oenter
ildingmthe ansbotmvcdmlonem,ionedproperty fc,
ropertyfc,Werpeepresnpurpossson(thb
ATER OR ADD TO MECF
(WORgret0aav, rdemnuy.na keephamdeumeCity.fCuprtbo
Date RecelptN
r agaWtllabWtln,ydgmew,metaad eapenam which mayN any wayamue AIRI{ANDUNGUNTT(TO10,000CFW SUBTOTAL:
agod RY n con f the ganting d W a
y>g e.atn AIR EUNDLING UNIT(OVER 10,"CFM) CONSTRUCTION TAX
Slgoeum iTAppecant//CCcntractm Date / EXHAUST HOOD(W/DUC'D CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the appllcant a futum Wilding occupant alone or handle harardau HEATING UNIT(TO 100,000 BTU) Date Revel tit
material as deflrad by the Cupertino Municipal Code,Chapter 9.1 Z and the
I lealthad Safety Code Section=(.)? E TING UNIT(OVER 100,000 BT-U) TOTAL: _,LT
❑Y. o
Will the applicant of future Wmse
building orpant uequipment m m devlVEN71LATION FAN(SREED)NGLE RED) Qj ISSUANCE DATE
whlcheMthaair contamWnbaa deflrid by the Bay Area A4
Qu Reye vgemermen;�Wt 7 eOILFR-0DMI'OI-B'OR 100,0(9 BTU)
4HYYvereadtheh. materiabrequirements under Chapter 695of BORER-COMP(OVER I 00,000 BTU) AIn
the California Health&Safety Code,Sed lens 25505,25533 and 15531.1 S
urdedta nd that if the bu11dlng don not m rrently have a tens n4 that it e,my NEW REST DFNf1AL MEC{. SQ.FT. EPI 2 7990
resporoibiley to not f9c occupant of the requirements which must be mot
prim y'n�'( dlficateof Occupancy.
ir4 gb
Owner ma thoRced agent ' are 1 ISSUED BY: -
TOTAL \ ( --
OFFICE COPY
�a f
R,PPROE�
IN ACCORDANCE YJITH HQ CRY OF
CUPERTINO CODES AND ORDINANCEa
DATE
August 19, 1990 SI( � �\19GC�
This sat of plans end specifications MUS(
be kept on the job at all times and it is un-
lawful to make any changes or alterations
Mr. and Mrs. Gary Sepulvo-dalme without written permission from
10285 Farallone Drive the building Dept., City of Cupertino.
Cupertino, California 9N0INIMPing of this pian and specifications
SHALL NOT be held to permit or to be an
approval of the violation of any provisions
ai a"ft OidifuM of Stag Latif.
Dear Mrs. Sepulveda,
As per our conversation at your home on July 06, 1990,
the following is our specifications and proposal for your
master bath updating.
SCOPE OF WORK - MASTER BATHROOM UPDATING
1. Remove existing shower including tile, shower pan, faucet
assembly, door and sheetrock.
2 . Provide and install new moisture-resistant sheetrock
to prepare surface for new tile.
3 . Provide and install new faucet assembly.
4 . Provide new ceramic tile on 3 walls of shower to
ceiling height, but not including ceiling. Included is a
shampoo shelf or soap shelf in matching tile color.
5. Provide and install new swanstone shower pan and new
shower door of trackless design.
6. Replace existing electrical wall outlet with a new
GFCI outlet per current building codes.
7 . Provide and install a Nutone light/exhaust/heat fan
in ceiling with separate switch controls.
. 8 . Provide and install a new light bar over medicine
cabinet.
9 . Provide and install new vanity cabinet
w/doors/drawers configuration.
10. Provide and install new cultured onyx top and splash
and set almond or white oval Kohler Farmington (Oval)
bowl.
11. Provide and install new vanity faucet and recessed
medicine cabinet in existing locations.
12 . Provide and install two (2) ( (one each bathroom)
horizontal sliding windows. Windows to be Milguard
dual-pane glass or equivalent. Window may be bronze or
white framed. Confirm w/owner sliding window direction.
Patch and repaint exterior stucco surrounding affected
window areas. owner to supply matching exterior paint.
13 . Remove and reinstall existing toilet and seat.
14 . Remove and replace existing vinyl flooring with new
coved, vinyl flooring.
15. Paint entire room including walls and ceiling in one
stock color of Kelly-Moore painting materials.
16. Install cabinet over toilet in hall bath.
ALLOWANCE AMOUNTS FOR ITEMS NOT PREVIOUS SELECTED
Shower faucet $ 125. 00
Ceramic tile 3 . 50 per sq. ft field tile
(American-made, 4 x 4 , 6 x 8 " square) ((QUI Vltp►d
Liget bar 80. 00
New vanity cabinet 225. 00
New sink faucet 100. 00
Vinyl flooring 25. 00 per sq.yard
ALM IPo�3F� DEPARTKU
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OFFICE COPY