29035 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITYOriCUPERTINO BUILDING-ELECTRICAL PERMITNO. -
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING.MECHANICAL. n
BIIII.DINGPROJFCTIDENTIFICATION 29035
BUILDINGADDRESS: - SANITARYN(y APPLICATION SUBMITTAL DATE
1\ OWNF:Ij'fA`AME, i / ^ PIIONF.: ���� CONTRAC BR'S NA 4 �,� LIC N(1:�^O
1 0 C/aV• N ' NIC CONTROL#
ARCHITECTMISGINEER: LIU NO: ADDRESS: II O _
126 8 YYI Gr
CONI'A ' PHONE:, BUILDING PERMIT INFO
+'. ❑ Consultant Fees Paidby Appllcunt(Initial) B .CT PLUM ME 1
LICENSED CONTRAC'TOR'S DIiCLARAFION Q'pY. ELECTRIC PERMIT FEL
1 hereby ufftm thio I am licensed umlar provisions of Chapter 9(commencing B DESCRIPTION
"Z with Sution]Otln)ofDivision3ofthe Rosiness and Profexsiona Coda and mylieense is RESIDENTIAL
OO infullforce and cIf ec - 11 PERMITISSUANCH
.Ur License Cla Lic.p '��� OSFDWL HEN REMODEL
<zU "'APPLIANCES-RESIDENTIALIM []ADDITION PLUMBING R&PIPE
�U, Dale Conwetor
.„ otI ARCHI3ECTS DECLARATION . PANELS r y I s MUM 1-UNIT ❑STRUCTURAL.
Z O ❑ I understand my plans shall he used as Public record. MODIFICATION
UPT02WAMN
02—Q INTERIOR .. ,�CHIMNEY REPAIR
F.F'. Licensed Professinmd - - - - 2Ub1000AMPS-. - IMPROVEMENT,
s'�( OWNER-BUILDER DECLARATION
C�IY� I hereby affirm Nat I am exempt fore the Cmnrat License Law for the OVER IMIAMP$ 0 BATH REMODEUREPAIR 0 DEMOLITION
�y(O y U following mmme:(Seen..7031.5,Bnsmess and Professions Cmle:Any city or county SIGNS ELECTRIC 1. ❑OTHER
LLl a W I. which requires-a 1 rmn t construct. Iter,improve,demo)shrepair any l cture
F'yOJ Anon is issuance, I y theepplicu(for such permnt file geed statement PLCIAL CIRCUFUMISC. •-
y, (hath licensed pu amt Nep rsi the mmanrs Ll en eLa ICh Ptcr9
p0 (cam g with Section]IXI(IJp-1v inf cNm aces JP f sCWe)m TEMP Mf?'l1iR OR IY)LF.INST. COMMERCIAL: '
6 o C that pa is exempt themfmm ungtl( u m alleged exemption Any violation of ❑NEW BLDG/ADDITION '�' DEMOLITION
yx LL• Section]WLS by any apPlicad foFFFu t subjects the applicant to a civil penalty of POWER DEVICES
u1^rn ❑TENANT ', FOOD SERVICE
not more Nan five lmndred dollars( ). - IMPROVEMENT
�O
>eel
owner of the property,or employees wiN wages astheir sole rompemmiari, SWIMMING POOL ELECTRICewmk,andtheztm isnotintended orofferW for sole(Su.]044,Business ❑OTHER
Leaslm i CndeT Cnhnemrs License Law does not apply mon owner of U'TLETS-SWITCHES-FIX Many
who build., mprovesthereon,and who docs loch work himself ar throughemploy ,Provided Nm such improvements arc not intended or oITcred for NEW RESIDENTIAL FLECTR SQ FT.ow i,the mildingorimpmvemem is sold willim.reycmofcumpletin.the _ gQ.FT.F1.00R ANP.A - $/SQ.FP..
er will have the burden y(aprovingNat he did nm build or Impmve for pur-le.).own r of the property,oro exclusively cnnwcting with IicenseJ cnmmcucx to + TOTAL:
me th'e project(Sec.7114,Business and Professions GadC:)The Csmtmctur's Li- OV
cense law does not apply to an wner ofpmpmy who builds m initiatives daemon,and QTY PLUMBING PERMIT FEE A
who convects for such pmjcros iN ncontr clorts7licensW pursmmno the Comracmrs Com• i ", 1J 5
License law. .' , . '.. /e'7 8 #
PERMIT ISSUANCE I, -
❑lam exempt under See. ,B&PCfur this reamb - Uf•(a�l�f!/, t -
Uwncr [).toALTER-DRAIN&VBNT=WATER(E,,) VALUATION. '
' '
WORKERS COMPENSATION DECLARATION BACK FLOW PRCTIiCLDEVICE ^ T••,.��
1 hereby affirm under Penalty of perjury one of the following dealmations (�
•Elhavc andwill maintain aCertifentcofCnnsenun.rdGinsure lin Workers ComPcn- , DIIAINS-t>I.00R,R(IORAR17.A.COND. ' STORIES TYPECONSTRUCTION
smion,er provided for by Section J]W of the Labor Cede,for the performance of the
weak for which this permit is issued. FIXTURES-PER TRAP
0 1 have and will owlmain Wmker'x Compen2mion Immoreve,as required by Section
3700 of the Labor Code,for the performance of the work for which this Nunn is issued. GAS-PA.SYSTEM.I INC.40ITTLLrfS UCC.GROUP - APN
My Workers C pens n lnmmnw carrier and Polity number�s{� p -
Camer.�/r. Policy No.:(/,.IS•LV 6 1 GAS-EA.SVSTEM OVE (Bp) Y
CERTI CAI':OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE G R EA S M N D USTRj,.WASTE RCEPfOR
• (Losoutinn necdnotMcna,dolediftbupermit is promise hundreddollars($100) BUILDING DIVISIONIFESsss
or]cvs) GREA569'RAI' PLANCHECK FEE
I certify that in the Pofornicance of the work for which Nis Permit is issued.l shall SEWER .A -STORM EA.2IXI FT
not employ any person in any manner so as to become subjectn the Workers'Compen- . ENERGY FEE
ZZ ronin Lowsof Culifomie.Data WATER ;R W/VENTNLCCPR
2 Applicant - GRADING FEE
M NOTICE TO APPLICANT.IL e(ta�r a rte Cor"' to of Exemption,you should WATER$YSq'I?M/1'RI3ATING
,a' become mrhjea m the Worker's J(Qmn` at in prop ns" the
Lutwr Cnde,you must SOULS FEC
r forthwith romply wish such pn or Nis Par"
Ee deemed revnkW. WATER SERVICE
Q
CONSTRUCTION sNINNGAGENCV - NEW RFSIUIiNTlAh I'LMB. SQ.14. PAID
V Q I hereby affirm Nat there iso on con
lending agency for the PeAuareance of Data Receipt#
F the work for which this permit is is d(Sea 31X4.Civ.C.)
0U Lender's More TOTAL:
HJ Lender's Address TOTAL
I cenify that I bav M Nis application end stem Nm Ne above information i2 BUILDING PER -
T0.p cnrrccLl agreemcom with all city undcnnnty ordinunccs and xmm lawsrebningm QTY. MECHANICAL PERMIT FEE w
U Z building comtructi ,and hereby omtiorize representmivesof Nis city menter upon the SEISMICFEE V
r above-mention ropmy for inspection purposes. PERMITISSUANCE
(We) rec m save,indemnify nnJ keep hamdew the City of Cupeninn againxt ELECTRIC PCP.,, ,
liuhiliticadgmemi,costs and expenses which may in anyway accme against said City ALTER OR ADD TO MECH.
in consequence of the granting of this pmmit. PLUMBING FEE
APPLICANT UNIIBRSTANDS"AND WILL COMPLY WITH ALL NON-POINT AIR HANDI.INGUNIT ITO 10,000 CFM)
SOURCE REGULATIONS. I. 'MECHANICAL FEB Cie
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signumreof ApplicunVCommnor ` )a EXHAUSTHOODONMUCk. '
HAZARDOUS MATERIALS DISCI-OSURE �� ?'C HOUSING MITIGATION FEE
Will to applicant or future building ocorrpma store ort Ito hizht`. merial HEATING UNIT ITO 100.000 BTU),
m defined by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Section 25E32(a)7 HEATING UNIT(OVER 100.0110 BTU)Dyes VIC ,, VENTILATION I'AN(SINGLE REST[))
PAID
Will the applicant or f num building occupant use eqipment ordevwce which Date Rueiprp
tir pazvdnus eircnmanrinams as defined by the flay rentAir Quality Managemcel BOILER-COh1P(311P OR 100.00 BTU
istncl'! I / - I TOTAL:
❑Yes kfNN BOILER-COMP(OVER 100.000 BTU) _
t. t.l have read the hdrmdous materials acuirememts under Choler 6.95 of Nc Cali- -
AIRCONDTfIONF,R
q F ISSUANCE DATE
firm F1ealtti&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL.MECH. SQ.FT.
building dr.not currently have u tenant,that it is my responsibility beautify Ne occupant i
of ihemcarroa 1' s t e tat prior to isnuuncc afnCmifrim Ocv mcy. 1,
Owner or oudrood e nl ]Sam, ISSUED BY:
OFFICE _
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DRAWING NO: i UPJ fi-i tiK 7pV� lD�d7%�vJ
APPROVED:
OFFICE COPY ;, 1��;� 2 I �,�� -� � 0
SCALE" =�FT, CUSTOMER: Totf., ;{-I U��VMJ BY: KITCHENS b MEWR •
REVISED: 1Z1Z MEMBER OF ��ORLCEWA THIS IS AN ORIGINAL DESIGN AND
ALL DIMENSIONS& SIZE DESIGNATIONS ���/D ��� LAS ® 96a-8318 MUST NOT BE RELEASED OR COPIED
'SUPERSEDESDRAWING GIVEN ARE SUBJECT TO VERIFICATION Chi hiZTlii ��`` 278CASTROST. UNLESS APPLICABLE FEE HAS S BEEN
ON JOB SITE AND ADJUSTMENT TO FIT _ r.�rR.vtEw•CA 9a0at) '
- PAID OR JOB ORDER PLACED.
NO. JOB CONDITIONS. =•- Lli �� Y2 � � DESIGNER: P\- �-�?
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1 SCALE "= FT. CUSTOMER: �01 '1 ,>v Kr�rnlily MEMBER OF BY: KITCHENS by MEYER
REVISED: _ TORUGENSE3�309 THIS IS AN ORIGINAL DESIGN AND
ALL DIMENSIONS& SIZE DESIGNATIONS 10 )o ✓ <T m, ur ® 18 MUST NOT BE RELEASED OR COPIED
SUPERSEDESDRAWING GIVEN ARE SUBJECT TO VERIFICATION IV ���� Z7gc8-8318 T. UNLESS APPLICABLE FEE HAS BEEN
NO. ON JOB SITE AND ADJUSTMENT TO FIT �Y���= / tlVb nrttr. CASTROIEW,Gn 94040
JOB CONDITIONS. 72`� i `� ��(� DESIGNER: j�/;-�J PAID OR JOB ORDER PLACED.