29061_! .APPLICANTTO FILL IN INFORMATION WITHIN REDLINES r USE BALL POINT PEN ONLY.. .
CITY OF CUPERTINO I BUILDING•ELECTRICAL �PERMITNO.
BUILDING DIVISION APPLICATIONMERMIT PLUMBING-MECHANICAL � � 29061
BUILDING PROJECT IDET'TIFICATION
BUIEL!DI//NG AUDR65g: _ _ snxCCnRY NO. AP�I����AL DATE
OWNER'SNAME: / PHONE: CONTRACTOR'SNAMF.: LIC NO:
N/C - CON'I'ROT.M
ATIIJ 11100 "
CHI'rEC'I'/ENGINEER: .•I LIC No i ADDRESS: ❑ ; ,�]Y,�ti( '
r
b -Jaggacirlt
CONTACT: - PHONE' BUILDING PERMIT INFO
��
El Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
V J
LICHN17:1 El %- El
S[D CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby eiTitm that 1 am licensed under provisions of Chupmr 9(commencing •• ]OR DESCRIPTION
I,w2 with SeorceandO)uc Division Sof the ljusiness and Professions Codc,anA my license is RESIDENTIAL,
F O in full force and effect. - PERMIT ISSUANCE � a 0UEL^E. Liccnsc Chex s. tic.» ❑SFDWL t. [I KITCHEN REMODEL
yQ Date Contractor • APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
❑at ARCHITECTS DECLARATION - [I MULTI-UNIT ❑STRUCTURAL
F PANELS
,Z Z m 2 1 understand my pl...hall be usW as public records MODIFICATION
O Z`312 ,. UP TO Nq AMPS
I�e Licensed Professional - ❑INTERIOR C3 CHIMNEY REPAIR
y f..1 OWNER-BUILDRR DECLARATION 201-I"AMPS IMPROVEMENT
a 0.'a 6 1 hereby affirm that 1 am exempt from the Contractors License law for Ne OVER IMOAMPS O BATH REMODEUREPAIR ❑DEMOLITION
3 a v following rem n (Serio 7031.5.T . a il Pmf s .Code A y ty arty 1-1 OTHER
0. which requires putn t t h p demolish. reps y , lure SIGNS I'LCIECUpAL
0.Q prior to to issuance,also y thef such Fronto file a sign J.mt eat SPECIAL CINCUIT/MISC. -
�' Thoth I¢ns J ursuam mth p C/C W
I$p�lvy�i" p ofD tnn3 ofteBrom r'slsc cl worC mrY
(cnnnenr«ngwnh 5eninn 7(101)nl Divrsinninf@e Busincssand lrafosi onx Code)or TEMI'MCII:N OR I'OLEINST. � � � COMMERCIAL:
thio he is exempt therefrom wd the basis for the alleged'exemption Any vialminn of ;'. ❑NEW BLDG/ADDITION ❑DEMOLITION
^V, Section 7031.5 by any applicunlfor a permit subjects the applicant n a civil penultyof POWER DEVICES ❑TENANT ❑FOOD SERVICE
F Z Pnot rams,then five hundred dollars(5500). -
� SWIMMING POOL ELECTRIC IMPROVEMENT - -
Q Lmowner of Ne property.mmy cmployeex wiTh wages es Theinme cnmpcnmtion.
aC will do YlC work,soil Weawctum is not intendcvlmoRemlfor vie(See 704,1,Business DOTTER _
a3 and Professions Gds:The Contractors License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES
properry who builds m improves Thereon,and who does such work himself Ear Through -
his own employees,provided that such improvements ere not intended or offered for NEW RESIDENTIAL ELECfR SQ PT.
sale.If.however,the building or improvement is sold within one year of completion.the - SQ.FI'.FLIFR AARREs ® S/SQ.FT.
owner-builder will have the burden of Proving that he did not build or improve for par C'
pnscofaIcJ. - - I�
❑ I, Is nwnu of The)rope ty I i •ly atmmeting w W licensed wtiracmrs m �- ,- � nTOTAL: DECconsumer the project(Sce 9044 13 ncls and Professions Code)The Contractors Li- - - D1419
cense Law docs not apply to er of property who bnikho,Improves therinn and QTY PLUMBING PERMIT 'FEE
who conuacD Sciatica projuts wilha maa amaas)licensed pursuant m the Comicl CO11 s�
License law. - PERMIT ISSUANCE Cil l Vf LVI'tH CI
❑1 um exempt under Sec. ,B&P C for This reason
Owner Date
ALTER-DRAIN&VENT-WATER(HA) VALUATION
'r - � -
WORKER'SCOMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hereby affirm under penalty of Perjury one of the following declarations:
I have and will maintain a Cenificale of Consent o self-insure for Win on's Cnmpen. DRAINS-FLOOR,ROOF,AREA.COND. STORIESTYPE CONSTRUCTION
action as provided for by Sculim.3700 rthe Labor COole,fa the perhnnwncc of the
work for which the permit is anesd. I - FIXTUR17S-1'CRTRAP
❑ 1 have and will nammoin Workerx C n 1 ensu On Insurance,as reyu ted by Section +-
3700oftheLubarCede, or the perlmtwnce of the work for which Thi.,narntkkiral.. GAS-HA.SYSTEM-II 4OUTLETS OCC.GROUP APN
My Wmf CrIion1 mane c" d Policy
-Lf- GAS-EA.SYSTEM-OVECnrcrrc Policy ] 9
CERTIFICATE PEXEMPTION ROM WORKERS'
COMPENSATION INSURANCE )
'
GRPASVINDUSIR � NTERCRYTOR
(This section need not M1c completed if the Femait is ibrone hundred dollars(SIM) BUILDING DIVISION FRCS
or less) •, GR F RAP PLANCHIiCK FEE
I cenifythat in the performance olthe wnrk for which this permit isissued,Ishot l SCITARY-STORM EA.200 P1'. �Y
out employ any Formal,in any romor soyyt becy�suIT yk rkers'Cnmpen- �vD RNRRGYftiE
Z emion Lnwxtf Iifomie Dom ,p J�II. I .J— T7 'Wp'1' I 'Aim W/VENT/ELECfIi
GRADING PEE
° o Applicmo ���Lu-it�(t r t ,
N NOR'ICF?TO APPLicANn 11,afti,making this Certificate of Exemption,you should WATER SYS,EMOREATING SOILS FF.R
henum,sObject p the Workers Compensation prnvisianS of the Latin Cade,you most
forthwith comply with such pnlviaions or permit shall be deemed invoked. WATER SERVICE
q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ.IT, PAID
V° harry which
thi Theuhcrt isommSce.3nlending agency forlhe perrurmance of Date ReceiptV. g
0 (~ Thewnrk for which this permit is issued(Sec.31y)1.Civ.C.)
LenJel Name TOTAL:
°{U Lenders Address - - ` 'POTAL:
1 certify thatl havep.ad this application and state thin(Beninese i f Bion Is O BUILDING FEF.
V) correct,l agice to comply t II city andcounty adlnarnes andstatel w, lacing to QTY MECHANICAL PERMIT FEE
V 7 building cnn'in a ,dndh achy tl a representatives of this city it) t tpon the SEISMIC FEE
uMwe-mentionedproperty for m,cor 0purposes. PIiRMI'1'ISSUANCF.
(We)agree to save,indemnify vad keep harmless the City of Cupertino against. ELECTRIC FEE
iahilities.judgmtims,nGus andexist which may in any way sector against said City AI.TF.R OR ADD TO MECIL - •}S
in consequence of the gaming of this pconat. _ PLUMBING FEE (/
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,CW CPM)
SO RCH 1 NS. MECHANICAL FEE
qAIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUE ON TAX
Signs ore of Applicant/CUmmcmr. Dam IiXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE,
HALARUOIIS MATERIALS DISCLOSURE - - t
T l dteapplicam orlinum building 4ccupamsmrearhandle havardow iamenul' HEA)'INC,UNI'I'(10100,000 BTU) n
era Je t e I by the Cupertino M, aiphl Code.Chapter 9.12,and the Ilerltb and Safety
Code,Section 25532my? ' HEATING UNIT(OVER h)(L BBTU) -
❑Yea ❑No
VENTILATIONFAN(SINGLERESID) PAID
Will the vpplicam or future building occupant use equipment or devices which Data Reeeipt N
ren haaatdous air contaminants as defined by the Bay Ates Air Quality Management BOILER-COMP QHP OR 100.010 BTU) r `
TOTAL: ..) �J
Dlsln[I0 _Yes ONO BOILER-COMP(OVER I BLOW BTU)svi '
' Ihaveread Thehamtdownewenalsreyuiremen¢under Chapter 695of The Cid- AIR CONDITIONER .ISSUANCE DATE a "'
Iismiu Health&Safety Code,Sections 25515,-25533 and 25534.1 i ndendi I tbm if the NEW RESIDENTIAL MECIL t SQ.rr ••f
hailding does not currently have a Imam.that it is my responsibility to notify thmncup at
of,hc requirements which must be incl priono isaoance of a CeniOc at of(Rcupancy.
Owner,,uwhanzcd agent Dore TOTAL. - ISSUED Y.
OFFICE
1 =
APOOL GENERAL SPA GENERAL =_
SPECIFICATIONS SPECIFICATIONS
- - - - S E X AREA ❑ DEPTH_T — SPA PE: MOLT
SAkPE - DIMEN ION:
f C Lt R - DEPTH:
_ CAPACITY - ALS. COLOR TOTAL GALLONS
PUM SPA JETS TILE -_
f MOT M.P. N.P. HEATER: - - -
J FH.TE SO.FT. PUMP 6 MO OII:
-
VACUU11 LINE 6 SKIMMER " AIR BLOWE
I` - - - - -
RETUR INE " GAS LINE--
MAIN
INEMAIN DR IN " PLUMBING FOI SPA: _
SKtMMEAAODEL - ELECTRICAL: - CLO K: _
z ( �
SACKWAA LINE - EXCAVATION: - -
OF "FILL LINE - DECKING g
ANTI SfPHOh VALVE MISCELLANEOUS: - -
- HEATER SIZE BTu SOLAR OENERAL
SPECIFICATIONS
TIONS
-- — — -- - -- —� - GASLINE BY: - VE D BY: - -
LIGHT
1 - SO. FT. POOL - FT. PANEL
. -
CLOCK
PANEL TYPE NEL SIZE _ - -
-, ELECTRIC BY: -
_ - NUMBER PANELS I VLUMS RUN
ELECTRICAL BO ING Y: -
1 - AUTOMATIC ikANUAL - -
- POOL CLEANER
THERMOMETERS STER PUMP - - --
�- CHLORINATOR -
`� SINGLE ❑ DOUB ❑ EL TRIC BY:
- - `� - - - BOARD— SIZE - -
EX(5;.; , JOB NO.
- _ r� - i BOARD SUPPORTS -
r-1 MAP BOOK O.
_` LADDER— MODEL _
SLIDE - oa.r_ w LEGAL DEIRI
GRADING -
I
-- - - ( ��• ° i + - STUB PLUMS ❑ ES NO
DECK BY:
LOT N .
TRAC NO. _
► `= s• -
BOO PAGE BLOCK
( ti [ ESC OW CLOSE -
<< - EX ! „ i/EMY EXTEF
[ TE ATIVE DIG DAT
�_.1 � �t ,.•� - � P MIT OFFICE
01
4 _ • - _ "' OWNER:
TO DETERMINE
t • • { f mmev mTe APPROXIMATE ELEVATION OF
uroe wTe POOL ON DAY OF EXCAVATION
EX rte= VJAJJ Ay ^rt'` f� - — ti ' • ' 9 _ - -
1 ? - POOL AREA TO BE FENCED
BY OWNER PER COUNTY OR CRY '
_ ORDINANCE GATES TO BE SELF
•: t t NOT TO SCALE CLOSING AND SELF LATCHING. -_
F&K - - El
EX •• DO NOT TURN ON POOL LFGHT
Gi ti E a,�, JG�dAY EXTETJJN
.. '
1 I DEEP WHEN POOL IS EMPTY
� ( END SHALLO
END POOL OR SRA
I s F UNLESS OTHERWISE SPECIFIED: NAME M & ANN A TIRAY
#' # " ' t r 4 f • k ' POOL IS—SHALLOW TO_DEEP
ADDRESS
E- - _ �` -' 1 '• t I HAVE RECEIVED A COPY OF
`'' • ' •• i ' THIS PLAN AND HEREBY - B56 KM STREET
_ -
. _ i - - �A>'a i - ? ,- � ( . •_ � � ! � APPROVE POOL AND CX�ERTNd, CA 95014
EQUIPMENT LOCATION
S : J• r - - -
_
CROSS STREETS
��)�p'1 RES, PHONE
i BUS. PHONE
CUSTOMER'S SIGNATURE DATE -
APpR-
_ CUPER INODAN(JE w�N ED
f t .
t i
_ CODES AND tTY OF
DATE
ORDINANCES
Si -
-
This Nset
_ - - 0e kept P'' ua s o
-
_ _
lawful to rn e'a i ti S MOST .
Gwt tion
` - - - - - _ - - - - _ - - _ - -- - - - - - -- - - r r - • n - - - - - - - - - _ - - - _ _ --_ - - _ - - - • - -- - • _ •` - - Oq �a.77e .e Ye a.lV ^ie .- lues and It I, °n - - - - - -
EXTQ� -_ - _ _ _ _ E _ _ .y F" Y..-,7-,r 62S Of - -
` Lhe bu .:r; } _ alterations
_ - ��� ierin-
e ri' of C n fro
_ _ _ _. _ _ _ _ _ s • .• - • •� . • I !t`�Ei`3. - �'�iL - -t h "'Pertlno. m _
- - _ - - - _ i i` z`. - - - - - - - - - - - _ - - - - - - - ' . �` ' .. ♦. _ - - _
S. `f. .. i E7 - L 1 " d Y r, SPecificatio s
o
nd
-"711 n
_ EXIST. TFIEE - 00BBL E S 0rE 'j • .• • `e - , - . ° w n °j °r to be an
t - _ n • r e any Provi
t •.- . `' - r S a e Law, slon -.
FRONT YARD SCALE
L_ OAYZA 'S LANDSCAPING,
_ ' POOLS & SPAS, LNC. -
3016 S7UNE AVENUE, 01 .SAN JOSE,CA 96.125 - —
- - - - - _ - - - - - - - - - _ _ - - _ _ - - - - - - - - - •t lIAIIJNG ADDRESX: P.O. BOX 206M • SAN JOe6,CA 951604MG _
PHONE: (4UP4 26T-56M • FAX: (406)2eT-6676
LICENSE 1349014