S 1223 - APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
JARCHITECUENGINEET
llY OMUPERTINO BUILDING-ELECTRICAL PfiITNO.
UILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. 1223
BUILDING PROJECTIIIENTIFICATION
LDING ADDRESS: SANITARY NO, APPLICATION SUBMITTAL DATE
E LI u
NER'S NAME: I�1NIi CON'[gAC'IYNAMIi: ' LIC NO:
N/C CONTROLp
LIC NO'. ADDRESS:NTACT. PHONE: BUILDING PERMIT INFO
3 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
AaALWZ,
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE:
I hereby affirm that I am licensed under provisions of Chapter (commencing JOB DESCRIPTION
yOy110Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is _
Fop fall faccand Offer,. y PLRMI'1'ISSUANL'E RESIDENTIAL'
RUU in ID SFIJWC CIIEN REMODEL
aUU License Class Lica []ADDITION ❑PLUMBING RC-PIPE.
<a Date-CommmOr APPLIANCES-RESIDENTIAL.
I„py ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL.
ZpyZ ]andeaand my dms,ball he users,pablu,mrood, MODIFICATION
O Z^ UP To AMPS
He��ual Lrtrnudl'mlesunnal El INTERIOR El CHIMNEY REPAIR
4OWNER-BUILDER DECLARATION 201-1000AMPS IMPROVEMENT C]SWIMMING POOLS
A 0.' QQ I hereby of irm that I am exempt from the Corm...",Litems I.aw for the OVER 1000 AMCS El BATH RF.MODEUREPAIR E)DEMOLITION
F LLO a U f Iluwing reason(Section]11315,Bushm,x and I'rom,ions Cede:Any city or county SIGNS ELECTRICAL ❑OTILER
0 y which requires o Permit do cbn,tma,vleq improve,demolish,or repair any sanctum
prior to its issuance,also requires the applicant for such permit to rile a signed statement SPECIAL CIRCUIT'/MISC.
aathat he is licensed pursuantto the provisions of the Commerce,l.icense law(Chapmr9
til 00C mon'numaing with Section 700d)of Division 3 of the llminecund Profession,Code)a, TEM I'.M ETP.R OR POLL I N ST COMMERCIAL
a a :
x n LL thin he is exempt therefrom and the basis far the alleged exemption.Any violation of ❑NEWBLDG/PDAIOP DEMOLITION
WAN
Section 7031.5 by any applicant for a permit subjects the applicant a civil penally of POWER DEVICES
F Z_D•, t mom than live handled dollars($500). ❑TENANT FOOD SERVICE
�y�dn ❑I,as owner of the proper) ,or my enipinyecv with wagesax their sale cumpcnsatimn. SWIMMING POOL ELECT RIC PR 'MEN
aF will Bothe wurk,vndthexnacture isnot imendedoroffered ...ts Stir.9044,Business O"I'H�[ �-••-�
Wim and Pmaviom Care:The Cmdawmr's license Iaw does nut apply to an owner of OUTLETS—SWITCHES—FIXTURES < OAS
property who builds or improves thereon,and who does such work himself or through
as own employees,provided monarch improvement,are not intended or atme d for NEW RESIDENTIAL ELEC!:R SQ FT {e1 �1
snlc.IL however.the huilJingorimprovenmm is sold withinone ycun,f cnnepldion.Ihc SQ.FT.171, 1�V $/SQ.IT.
owner-builder will have the burden of proving deal be did not build or improve for pa-
pou of sci
I, owner of the Insist umexclusively contracting licensed Fig 01 qWQ
JJmnavam the project(Ser.9(94,Runincvsaid Pnl'osseans CoOc:)TheContractors Lt. L
ceme taw does not apply In an owner of property who builds or mproves mcnnn,and QTY PLUMBING PERMIT FEE CITY
who contracts for such projects with a contractors)licensed pursuant to the Contractors Uf GUrtttI�NV
License Law. PERMIT ISSUANCE
❑ I our exempt under Scc, ,B R P Cfa this reason
Owner Date ALT(?R—DRAIN A,VENT—WATER IEA) VALUATION
1- WORKER'S COMPI!NSA'fION DECLARATION HACK FLOW PROTECT.DEVICE
I hereby affirm under penally of perjury mm of the fallowing declarations: 2
I forward will maintain a Cenifameal'ConsOn[msdf-insure lin Wader's Compere- DRAINS—FLOUR,ROOF AREA,CONI. S'D)kL1i. 'I'YI'Ii C(INSTkI1CT10N
sudor,as pmvidal fur by Section 3'100 of the Labtx Cale,fur the perfmincor a of the
work fa which this permit is issued. FIXTURES—PER TRAP
I have and will maintain Worker's Compensation Insurance,as required by Section
3]tl0ofth,LnM,r Code,tar the p�trn ancrof the work forwhich this permit i,isxued, GAS EA.SYS"SLIM-I INC.4 OUTLETS OCC.GROUP APN
My Worker's Compenmtlmn Insurance carrier and Tolley number are:
Cartier. Policy No.: GAS—FA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION(BOM WORKERS'
COMPENSATION INSURANCE GRCASEIINIIUFTRLWASTE INTERCEPTOR BUILDING Ill VIS ION ITEMS
or less.)(This section noodaso heconepleeJ ifthe pe man is furor,hundred dollar,($100) GREASETRAI'
PfANCHECK EEE
l cenify that in Ne pedormanceof the work forwhich this pcmlit is issued.)shall
not employ any person in any manner so `k c Worker, pen- HEmhecontc stile Com SEWER—SANITARY—STORM EA.2(p FT.
j ENERGY E
7, cation 1ava�Aljeli �� WATER HEATER WNENT/IiLEC IT
Z r pliant Y, + GRADING ItiE
ti OTICE TO APPLICANT:If,after make g this Certificate of Exemption.you should WKITR SYST ddrern AriNG
a , become subject to the Worker's Cmnpensntion provisions of the Labor Cale,you must SOILS FEE
I'unhwith enntply with such pmvisionxbnhis permit xM1#IlMdcenmd revnkul. WATER SERVICE
5Z CONSTRUCTION UC TION LENDINGAGENCY NEW kFSIDF'.NI'IAI.PLMH. SQ.FT. PAID
(.1 0 If which thi that them ixauedSo,ionknJis.agency Turtle performance of Doc NcmipdM
W F the work for which this permit is issue)(Sec.31n],Civ.C.)
p U Lenders Nude TOTAL:
LenderAddress A
. � I y cenify elle 1 have read this application and store elle the above information is BUILDING HE
Iti (n correct.I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERM IT FEE
L)Z hu'ddingconstmetion.:md hereby aathorim representatives of this city memer upon the SEISMIC FEE
above-mentioned property for inspection purposes.
(WO) m save,indemnify and keep harmless the City of Cupertino against PERMIT ISSUANCE
We ELECTRIC FEE
Iiuhilities,judgments,costs and expenses which may in any way accme against said City AITHRORADDTOMECIL `
in n,ca mence of the gcount,of this permit PLUMBING FEE
AP "UNDERSTAND. ND WILL COMPLY WITH ALI.NON-POINT AIR HANDLING UNIT(TO 10,000CFM7
SE E ,NIATI S MF.CIIANICAI.IBE
Z 1 AIR HANDLING UNG`(OVER 10,00()CPM)
CONSTRUCTION TAX
ignature n Applkanl/Commemr Dae EXHAUST ILOOD(W/DUCrI HOUSING MITIOATIN PEE
HA9ARDOUS MATERIAL DISCLOSURE
Will the applicant or future building occupant stare or handle haaandous material BEATING UNIT(TO 100,000 BN)
:is defined by the Cupertino Municipal Code,Chapter 9.12,and the Health unit Safety
Code,Section 255320)1 HEATING UNIT DvEEk B),M)BTU)
E]Ys IDNo PAID
VENTILATION PAN(SINGLE RFSID) Use kecciptX
Will the applicant or future building occupant axe equipment or devices which BOIL ER—COM('(3HP OR IOO,WO B'ru)
#ardl hwarmas air cuntnninae as defined by the Bay Area Air Quality Manigemrnl TOTAL
istnnl
❑Yea ❑No BOILER—COM P(OVER 100,000 BTU)
I have read the haeunlous mwerials requirements under Chapter 6,95 of the Cvlb AIR CONDI'GONE R ISSUANCE_FA TE
(olein Health K Safety Code,Sections 35505.25533 and 25534.1 understand that if 0e NEW RESID17N'rl AL MF.CI I. SQ.FI'. L/
building does no currently have a tenant.that it is my responsibility to bodily the occupant
of the rear,mcmene which must be met poor m issuance of a Certificate of Contrary.
Owner or amhmoc l agcal Dam ISSUED BY:
OFFICE ` - F
r �
x
TONY & KRISTINE PHAN
866 LILLY AVE.
CUPERTINO, CA.
FRI
1 . ADDING 9 NEW CAN LITES IN
KITCHEN&DINING ROOM
0 2.MOVING OVEN FROM PANTRY
CABINET TO UNDER COOKTOP
3.ADD NEW ELECTRIC CURCUITS FOR
0 COOKTOP AND MICRO/FAN
4.RUN NEW GAS LINE FOR COOKTOP
e
00 DISH
00
EX. FLOUR.
LITE
O EN 0
NEfN CAN I.ITES
EX. LITE �B 1 �ggg
O T101�DErT N�NtNZ
BL G.1C�0��PEP
I
NEW GAS LINE TAPPED INTO LINE AT
WATER HEATER
is
sElEl
NEW
MICRO/FAN
,
BOOKSHE LF COOKTOP
CABINET FRIG
PANTRY
NEW
• LOCATION
FOR
OVEN