20787 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' CuF to Pro set ldentifleatlon - PERMITNO.
ewlalne^Aldare.,s; .� jO lj h2d� Ln 20787
ne el ams/6 l�f' ! �A one:
Tcl7`h
-vi 'ILcr CITY OF CUPERTINO-BUILDING DIVISION ^
CW�+eto'e Name: r LIe.Nu APPLICATION /PERMIT �-$5—Cco
Q W /3w ld.ers 6S3G� ( BUILDINGELECTRICALPLUMBINGMFCHAMCAL CATEGORY CONTROLN
Archltect/Fsglneer. - Lk.Na
QTY ELECTRICPERMIT FEE
.' BUILDING PERMIT INFO
Addena /0 2( N4 N.e@tN�q U! g. V. PERMITISSUANCE �y tRi ❑ 1:1LICENSED CONTRACTOR'S DECLARATION
Thereby affirm thatlmniknsed underprovWonso(Chapler9(mmmen APPLIANCESRESIDENTIAL JOB DESCKIPHON�/N
IngwithSMion7000)ofDldsmn3oftheBusisnandPmfnslonsCode,and m Vh�O Se (/1 A T
license Is In fullf and affects 5 3 _ PANELS -F
Lken"Clan _Lk.N
Date�..]1y-,�y�-Contactor rck
r YNRCIUT ;g ECLARATION 201-1000 AMPS 0
IQ+�rsO Z l understand my plane shall be used as public record, OVER I ODO AMPS SQ.FT.FLOOR AREA S/SQ.FT.
Eob Licensed Professional SIGNSELECTRICAL
7�! EL7o OWNER-BUILDER DECLARATION SPFLIALCRCUIT/MLSC �J
I., Ihereby.M.O
that lamexempt UILDEfrom the Contractor's Law for the 1'')
pp following reason.(Section 7015,Business and Professions Code:Any city or (!
O 21- TEMP.METER ORPOLE INST.
P� caystm hmpre tnaismancomomquimsth aprovntfors chper ttopair _ ,7 fy
�G any strotture statement
that he is else sed pas mans t the ece,ta nes of t e EWER DEVICES -`�2
K � file a signed atalement that he b licensed pursuant to the provislos a( the
Oµ Conlnctor's License Law(Chapter 9(commencing with Section 7000).f DWI-
30 slon3 ofthegualuessand Prefoaak raCode)orthal he b emmpttherefromand SWIMMING POOL ELECTRIC VALUATION
O the bash for the alleged exemption. Any Wolatton of Section 70115 by any OIITLETSSWITCHESE (0 40 �(.� 3 Q
applicant(Ora permit subjects the applicant to a Livil penalty of net more than (j
$ five hundred dollars(ISOQ).
❑I,as owner of property, NEW RESIDENTIAL ELECTR_SQ.FT. STORIES TYPECONSTRUCTION
p perry,or my employees with wages as their sole
7a mmpensatlon,w8ldo the wmk.and theatmcturs h not Intended or offered for
❑ ale IS..70K Business and Professius Code:The Contractors Llcese Law
$ does notappiy to an owner of propertywho builds or lmpmemsthereon,and A-
whodm suchworkhm tferth=ghhlsownemployeaa,providedthatmdt OCC.GROUP RFS.UNITS,
Improverrents are not Intended oroffered for sale.IL however,the building m i TOTE icl�
'a Improvementheold Mthlnamyearofcomplewb theowner-bullderwlllhave
11BI burden of proving that he did na ills
build or Improve for purpose of Q1'Y. PIx INGtERMIT FEE FLOOD ZONE APN
LJ L as owner of the property,am exclusively contracting with lion.—
mntrachastocastsct the project(Sec7004,Business and Profmaos Code: PERMIT ISSUANCE
The Cce teactr'.Llan"Lw don not apply to an owner of property who
Wilds or Improves thereon, and who contain for such pt♦o)em with• ALTER"DRAB)&VFIJ'f WATER 1� a
Coe,
licensed pursuant to the Contractors License Law. - 'e, m FEE SUMMARY
LJ I am exempt under See B&P C for this reason BACK FLOW PROW 6 C /'�®'
D 3WOOR'N- AREA, ND. SANITARY Y_ N
OUTSIDEFEES
Owner Date _ A RECEIFTN
WORKMANCAMPENSATIONDECLARATION SCHOOLTAX Y_ N_
❑I hersby film that I have a mrtNcate of consent to w1f4r oure,or a mMm \ RECEIPT N
certi0ateofWarken'Compesation lsunnce macertlfed capythemof(Sec. GAS-AA.SY91'FM-1 I0 Y N
7800,LbC.) NC4PARK FEE RTCER'I N
PolkyM G .SYSTEM-OVER 4(FA
Cm any BUILDING DIVISION FEES
oOCertllledcapyhherebytd. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHLCK FEE'
❑Certified ropy b filed with hth ted city Is)aection divlelon.
CERTIFICATEOFEXEMPTION FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE SEWER-SANrrARY-SMRM EA 200Fl. Date Remi t#
i
(This section need out be completed if the permit hfmos hundred dollen —
(It00)mfyth WATER HEATER W/VENT/ELECTR ENERGY FEE Y N
(certify thin o the person in an the wink fors t oh co permit is bated,
I shag not employ any person In any manner n as to became sub' to the WATER SYSTEM/TREATING
Workers nsedon fGBf onia.Date PAID
Z Z
Applicant
L/ CIJ J NEWRESIDENTIALPLMB. SQFT. Date Receipt
O NOTICETO PLICANT:ILaRer making this Certificate of Exemption,you
should became subject to the Workers'Compensation provbios of the Labor TOTAL:
N Code,youmuslfmthwithmmplywltheurhprovblosorthbpermltahallbe
> doemed revoked. BUILDING c
Uj f] CONSTRUCTION LENDING AGENCY SEISMIC FEE9-15
d L
I hereby affirm that there h a construction lendingagency for the perform TOTAL ELECTRIC FEE
7 Z aa..fthc work for which this permit b baued(Sec.3097,Civ.C.)
02 Landers Name PLUMBING FEE
H Lenders Address QTY. MECHANICAL PERMIT FEE
O W Icertllythat l have read thhapplicationand atatethatthe above information
MECHANICAL FEE
1 iscarrect.I.grn to complywlth all cityand milntyordlnancesand state laws PERMIT ISSUANCE FEES PAID:
relating to building construction,and hereby authorize representatives of this
F N city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADDTO MECH.
Z Me)agree to anus,Indemnify an d keep harmless the City of Cupertino Date Recel t#
V agaistlbbll s,jtdgments,mats and expenses which may In any way accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
agalryt ill m nting of this permit. CONSTRUCTION TAX
\/ see . [/ V_�_ �1��5'�OD AIR HANDLING UISM(OVER I O,OOD CFM)
I reof Applicant/Contractor / Date l EXHAUST HOOD M/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant mfwure building occupant stare or handle hazardous HEATING UNIT(TO l 00,0D0 BTI!) Date Rmelt#
material as de0sd by the Cupertino Municipal Code,Chapter 9.1 2,and the
Ikalth and Safety Code Section 25532(.)1 HEATING UNIT(OVER 100,000 BTU) TOTAL: s
(❑�Yee 9N.Wlli the a ppllant or future building occupant use equ[preset or devices VENTILATION FAN(SINGLE REED) ISSUANCE DATE
which emlt hazardous air contaminants as defined by the Bay Area Air
Quality Management Dist ct7 BOILER COMP DHPOR 100,000 BTU)
Yeao
ours
4have mad the bara materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
the GlBmNallealth&SafetyCode,&dlos25505,25M3..d255U.I JUL 2, :3199U
understand that ltthe building does not currently havealenanL that It my NEW RESIDENTIAL MECH. SQ.FT
responsibility to rally the occupant of the requirements which at be mot
prWrl uanceot 'ficateofOaupancy. City of Cunertino
Owner or authmbed agent DateA10 ISSUED BY: �E��_
IDTAL:
OFFICE COPY
PLOT PLANS
CHECKED BY
DATE — Z� °TD
OEM E��(� � D PLANN G DEPT.
U U DATE
- JUL
BLDG. DFPT.
BLDG.C,TyPOF ICUPERT NQL
ON MEN
0
..........
............
NEW ENCLOSURE
IN ACCORDANCE APCITY OF
CUPERTINO CODES AND ORDINANCES
DATE ! Z'S q-o
OWNER: SIGNED
1119 HOLLYHEEAD LN. beN WILLARD tke et of p!a�endE��aticn��S
CUPERTINO pt on the iob at a;l times and it
Chur;
lawful to make any
he buildzn;es o; afteiais n:
same without 'it,:n pe mission
hing Dept., G;ty ,I Cup Lm,.
A
The stamping of h-span, n.. ,P Ia..aii n<
SHLL NUl' he nt d ( p-Ad i ce an
1 nv
approval of the vi_1 .,.,n ., all: p"'Vision•
. ' aC,
OFFICE copy
'�pL�p pLAN9
cmc"D BY, BEDROOM KITCHEN
DA1B
HERED
DEe� T--.
LIYI DOM ARAGE JUL ti 1990
IN W
Bj®(„
DEPT. / PORCH BLDG. INSPECTION DEPARTMERT,
CITY OF CUPERTINO.
'WINDOW
IN ACCORDANPR�H E® ITY Ol
EXISTING HOUSE CUPERTINO CODES AND ORDINANCES
DATE
--------------------------------------•--------- ------- ----------------SIGNED----------------- ---
This set of pians and spsr,,lcations
be kept on the job ai a:; ti Re MUST
lawful to make any ct:nno s and it is un.
h same w4fu,u, w ; i1 'o' 01 alterations
the bm,d:ng hep; ° pe•m'ssion from
The siamp:n, . . Ise , r C`'po-Lino.
LIVING ROOM SHALL NCi b, r l specifications
' approval ,.;r or to be an
If , ,, n of any provisions
use or State Law,
REMOVE7's
TING DOOR ENCLOSE PORTION OF PORCH
AND ADD NEW ENTRY DOOR
1 ADDOCTAGONALWINDOW
CHANGE WINDOW TO
48' DOORW Y
2'8' DOOR— .1.1.::;.-:::::::::::::::::::: 5.8.
. .
UARAOH
PORCH
314' WINDOW BAY OR ALUMINUM SLIDER
tLA
S:
RIOR STUCCO,INTERIOR DRYWALL
INSULATIDN R-13
1 2'X4' 16' O.C. 2I 'X4'1 TOPPLATE
4 6' HEADER
11- MIN
374' WINDOWI nl E CH U E D
uU
JUL ;� 31990
T 2" BLDG. INSPECTION DEPARTKA1
CITY OE CUPERTINO
7-
34" MIN
MU SIL
TO'
J-EIDLTS 2' MAX FROM
CORNER A If MAX SPACING
PLOT PLANS
CHECKED BY APPROVED
DATE IN ACCORDANCE WITH THE CITY OF
CUPERTINO CODES AND ORDINANCES
PLANNING DEPTd DATE
DATE SIGNED
This set of pians and specifications MUST
be kept on the job at all times and it is un.
BUM. TIT,P'P. lawful to make any chsnges or alterations
on same w;thnut wdtlen permission from
the bui,ding Dept., City of Cupertino.
The slamp:ng of this pian end specifications
SHALL NOT be he'd to pe,mit or to be an
0ptove1 of the violation of any provisions
.9 mny City 0 finance or State Law.
EXISTING RDDFLINE
212-X4-1 TOPLATE
7- 2- I�
[732—DOOR JULJ U L ti J 1930 D
BLDG. INSPECTION DEPARTME(JT,
CITY, OF CUPERTINO
MLIQZ
7'8-
J-BOLTS 2'MAX FROM
CORNER A 8' MAX SPACING
PLOT PLANS
CHECKED BY
DATE APPROVED
IN ACCORDANCE WITH THE CITY 01
PLANNING DEPTr CUPERTINO CODES AND ORDINANCES
1
DATE
DATE SIGNED
This set of pans and specahcations MUST
Fy,DG. DEPTw be kept on the job 2, all times and it is um
lawful to make. any Ciisngss or alterations
on same ewth.u, w 1;ten permission from
he bui ding dept., CaY of Cupertino.
rhe stamping of ,h:s Van and specifications
SHALL NUI be herd to permit or to be an
pany City Ordinance lioor State Lawrovisions
i
i 22's'
5• .L 1890 SQ FT ;
(
Is,
I I
If
5'
�•5. 5.6. / ,i• fG ,
/ 2'
Evac/o 5u rR
1s'
�n L6f-
0 L-0 N o w
SIDEWALK
-------•-----------------------•-----------------•--------------------------•-----
1 s•
UPSTAIRS . ..
342 SQ FT