31268 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. ^ /�a� /�
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL JK L 16 VX
BUILDING PROJECT IDENTIFICATION
BUILDING A/DD��RESS. SANITARY NO. APPLICATION SUBMITTAL DAI
V �X� 'e -F E 4 J ell, U V✓
O ER'S NAM : J� PHONE: CONTRACTOR'S NAME: LIC NO'.
(f f 1 7 ri.f�cI ei )' 62 y p NIC CONTROL
ARCHITECT/ENGINEER: LIC_ :
�� N(>. ADDRES ❑
CONTACT: / PHONE- BUILDING PERMIT INFO
^G�`�
El Consultant Fres Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby arfmt that 1 am uemxed tomer provisions of cnagmr v(mmmmang JOB DE IPTION
FWWOO with Smtion]t111f))mf Division3of the eusiners end Professions Cwle.endo 1¢enm is RFQII)F
� in fullmareundeffic. r' L� PERMITISSUANCE RESIDENTIAL
aVV License Class `•��x tic.p ��� 1�6 ❑SFDWL ❑ TCHEN REMODEL
tFia Zw Date Contractor APPLIANCES-RESIDENTIAL
ASCHI'I'ECPS DECLARATION ❑ADDITION tMBING RE-PIPE
Z OnZ I understand my plans shall be used as public records PANELS ❑MUhTIANIT ❑STB 'TUBAL
CZ-2 UP TO 200 AMPS MODIFICATION
I— Umnsed Pmfesnon.I ❑INTERIOR ❑CHIMNEY REPAIR
�yE-t OWNER-BUILDER DECLARATION '-01-10110AMP5 IMPROVEMENT
C uI 6 I hereby affirm that 1 am exempt from the Contractor's License Law for the OVER IINp AMPS ❑BATH REMODEL/REPAIR ❑DEMOLITION
°x' a U following y13 reason.(Section 9131.5.Business and 1'nd'essions Code:Any oily or county ❑OTHER SIGNS IihliC'I'RICAL
❑-� which requires a permit to eonswm,alter,improve,demolish,or repair any structure
f"W0S prior m its issuance,also requires the applicant forxuch permit to file o signed statement SPECIALCIRCUIT/MISC.
to not he is licensed pursuant m the provisions of the Commctots License Law(Chapter 9
9 M (commencing with Section 701 of Division 3 of the Business and Pndecshm,Cade)a, TEMP METER OR POLE INST OMM R IA
C.a n C Nth
at he is exempt therefrom and the basis for e alleged exemption,Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
:2 art Section 7031.5 by any applicant for a permit subjects the apn
plicano o civil penalty of POWER DEVICES
=� not more than live hundred dollars($500). El TENANT ❑FOODSERVICE
❑I,as owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTS IMPROVEMENT
it will do the work,and Ne structure is not intended mothered for sale(Sec.]BM,eminess ❑OTHER
3 m and Pofessions Code:The Contractors License law does not apply to an owner of OUTLETS-SWITCHES-Fl
property who builds or improves thercan,and who does such work himself or through
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECT FT.
sale.If,however,the boildingor improvement 1,sold withi n one yomof completion,the SQ.FT.FLOOR AREA S/SQ.Er
ter-builder will have the burden of proving that he did not build tar improve for par-
poseofsale.). PAID
I D
❑I,s owner of the progeny,am exclusively contracting with licensed contractors to TOTA . r /�
c nsaua the p Jcct(Sat.901 Business and Profex,imn,Code:)The Contractors Li. A 5 n
cense Law dors not ap,1ym an nwner of pmpmy who builds or improves thereon,and QTY. PLUMBING PERMIT FEE r1PT to �9JC�
whoconloodsforsuch projects with a mntoact )licensed pursuant m the Contractor's vsv IA VV
License Law.
❑ I an exempt under Sec.' ,B&PC for th,mmon PERNor ISSUANCE
ALTER-DRAIN&VENT-WATER(EA) r FII IIYU
Owner Date ---T VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DFVlrF
1 hereby toff tat under pcnahy of perjury one of the following dedaations:
]I have and will maintain a Certificate of Convent to self-insure fin Workers Compcm RAINS-FLOOR.ROOP.AREA,CON-.
action,us pnwiJcd for by Section PW of the Labor Gds,for the pedi,rmance of the STORIES TYPE CONSTRUCTION
work for which Nis permit is issued. USES-PER TRAP
❑1 have and will maintain Worker's Compensation Insurance,as inquired by Sccdon
3]OO of Ne Labor Code,for Ne performanmofthe work forwhich this permit is issued. S-lips SYSTEM-1 INC.4 OUTLETS
My worker Vnppensationlvurance carrier and Policy numFerrq�aI WC GROUP APN
Carrie[ II x+rC4-4 Policy No.: I Au, GAS-EA.SYSTEM OVER 4(LA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASUINDUSTRL WASTE INTERCEPTOR
(Tait section need not be completed if the ge.it is bureau,hundred dollars IS 100) BUILDING DIVISION FEES
or lees.) GREASE TRAP
1 certify that in Ne performmoomf Ne work for which this PLANCHECK FEF.
permitiss Conshall
rugby any personia any manner sun as to become subject the Workers'Compcn- SEWER-SANITARY-ST(IRM EA.200 FT. ENERGY FEE
O Z Appli Laws mf California.Dalt WATER HEATER WNF,N'IfELECTR
0 Applicata GRADING FEE
N N come suTO APPLICANT:If,toner making this Cisionse of Exemption,you should WATER SYSTE REATING
? become suomty it Worker's Compensation provisions of themed Cede,you must SOILS Flit
Forthwith comply with such gmvisimmx or this permit shall be deemed rcvuked.
aW `� WATER SERVICE
] z CONSTRUCTION LENDING AGENCY NEW RES]DENTAL PLMB. SQ.PI. PAID
U 0 l hereby affirm that is a amstruction landing agency for the puHbrmance of Date Ree'
CA F Nc work for which this permit is i oned(Sec.3097,Civ,C.)
0 U Lender's Name
D.1 Lenders Andres, .TOTAL TOTAL:
y 1 codify that 1 have mad this application and state that the above information is BUILDING FEE
rA correct.1 agree to comply with all city and roomy ordinances and state laws totaling to QTY. MECHANICAL PERMIT
U Z building construction,and herebyaathorlot reprewoun es ofthis city m error upon theW
FEE SEISMIC hEE
ulwve-mentioned pmpeny far inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino againstIT ISSUANCE ELECTRIC FEE
Iiabilides,judgmetns.costs andexpenses which may in any wayaccrveagainst said CiryR OR ADD TO MECIi.
in cadaquence of Negood"go thispermit. PLUMBING FEE
APPLICANT,Of
r pND WILL COMPLY WITH ALL NON-POINTHANDLING UNU(TO IQ000 CFM)
SOUR ,GULATIO' �� MECHANICAL FEE
Q-��O-�� ANDLING UNIT(OVER Ig000 CFM)
CONS'fRUCTIONTAX
Sign arc of van Camra DareAUST HOOD(W/DUCI')
HZIt US MATERIALS DISCLOSUREHOUSING MITIGATION FEF.
W llt applicant oifuwm building occupant stem or handle hazvdous mammalING UNIT(TO I(X),gK1 BTU)
as definN by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(u)? ING UNIT(OVER Iq 000 BTU)
❑Yes 0 N
ILATION FAN(SINGLE RESID) PAID
Will Ne applicant or future building occupant me equipment or devices whichDae Receipt p
emit extension,air contaminants as defined by Ne Bay Arca Air Quality ManagementER-COMP(3HP OR 100,1p0 BTU)Lbuilding
e., ❑No ER-COMP(OVER 100. 00 BTU) TOTALve round the harando,mamdals requirements mle,Chapter 6 95 of the Cali- ONDITIONERth&Safety Cade.Sections 25505,25533 ant 25511.1 undersand that if NeISSUANCE Es not currently have a moan,that it is my bodmosibility mono.fytheeeeopantRESIDENTIAL MECH. SQ.FT.
mments which man ba tan I norm isuancemfa Certificate of0aupamcy.tbonseJ agent Date TO]AL :111UE1BY:
OFFICE
o
T
OL FD c9
• _ 3CD
m °a
x �
� O
A (� � 0C'RD
ffo _0 ff 00A
� O
� � $ iy0
ol
-�
�br
no o Q s
o °o
oC.0
w
• s
Z
o
obig"
o �
x
o
N lV
r
rD
p z
CL ® G O
a
C4Ak Ok a
1 �
B X ' J
W
a
z
A
s
A J
CODISI N
CYI
err-
INI INI I � I
P
BOB LOVES SIGNS
CA LIC # 626064
SITE DIAGRAMS
Homestead
Sidewalk 8'
3'
S
I
G
25' N
12'
2 Lane ntry Planter 2 Lane E it
New Monument td--sign-toeertio
Centered in Planter along Longer Axis
3' Off Curb Closest to Road
C)
O
C)
Q FD n
0 T
7
a tz
co
tz
� o
0C4
hCG r
a O (D O O c 1�]
c0 10 Q n O
A n
o txl
o � & CD b
0 o o Q
o oO N J4
W
W O ,,^^
• y Vl
2
Q
� � w
o � �
x
� 0
N
U OD
X
OD
A
W
7
O• Q
A
A
cyl
co
ISI N
V7
BOB LOVES SIGNS
CA LIC # 626064
SITE DIAGRAMS
Stelling
Sidewalk 5'
3'
S
I
rr -
G
25' N
12'
2 Lane ntry Planter 2 Lane E it
New Monument
Centered in Planter along Longer Axis
3' Off Curb Closest to Road
Q
J a
A (D (7
O T
C
D 7 (D 7
D
OD
33
x �
O
� � bd
r r (n
0 c o
y O
a' D
(D
0
T
• W Q
% y. 3.
SG) :
(D c �
0
7 �
W
N O
•
W Cn CD
Q .
� W
A
N
7
CD
_D
•
ISL-TI N
3