05070030 CITY OF CUPERTINO 'karT.ry� w�•Ir {'y�t
BUILDING DIVISION PERI �Y1'^`L•t Wi° 1:/ lNA• lVtY1 01\i!�e
X!r .'1•n.,'2.a .<r.Z' k d>T+e i✓.s4f✓4. m
Bu1LDINGADDRESS: KITTY SZETO PER"'%5070030
NER'S NAME: PERMIT ISSUE DATE
PHONE:KITT SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION JobDescri tion
I hereby affirm Nat 1 am licensed under provisions of Chapmr 9(commencing P
with Section 70(M or Division 3 ofW Busircuand Profusion Code.mad my licensee
I.fall rmree ad ellen KITCHEN REMODEL
Zng License Clan Lk.Is
0 Dau C'S ractor
DECLARATION ARCHITECT'S DECLARATION
oI mancrsund my Plant shall he used u public remadt -
ittd Licensed Pmrusionel
OWNER-BUILDER DECLARATION
0 S I hereby affirm that 11. exempt from the Caniractofe License Law for the
p o following reamo emit WA 1.5.Business and Professions Code:Any city Or county
$ which its u•issuance,also re cores the.alter,)mFmw,h Permit i,ar rtpalr ed ummure
inonn
�n "he i u cnwdpnatant requires the islom of f Con mwr'n,file a ccnm lgned autemcm
a< (comma lkswithSmumtmNepmvisision3 MCanuamr'anicenmhw(ChaPter9 Sq.Ft. Floor Area Valuation
(commencingwtLbeta1mm70n0)of basis far
ar NCBminesaandon.An vi Cartel tion or
of
��.. NU Mit...mpt Wm(roan and the bas(w tite alleged exemption.Any violation of
Sedan 7031st by toy apPllant for a purelt mbjecu W application,a civil Forestry of 3 590sBI'®Iib *0 Occupancy Type
not mom than five hundred dollars,(MOO),
❑h as owner of the property,or my employees with wages u their sok compensation.
will dothe works.and Wstructure Is not intended woffered rorask,(Sec.7aa,Business RequiredIns actions
property
Pnfnilom Code:Th Conmeonts License law don or apply il rt awnr as ^ _� P
P�Pmywh .proorlmprowa NesmImprovemeho dmme Inch er�t Mmaelfor W ughWeeks.
he 'l1fl.%yllle\F\5V'Ig'T `p1,
however.the
euilding rint!Nnnecment1,wmontaare not leterMrdmORered am owner.
builder
11
howder .Nebuilding orimprovementl[sold withinamyear ofImproefor Ne owner- e�
builder will have Use burden of proving Nn M did not build w improve for purpose of
ED
sat.). ,.,�,/
Q 1.u owner of the Properly,am uclusiwly connecting with licensed containerstto AU V 2 .,z pp(o
Construct the project(Sec.7044.Business and Profusions Cade:)The Conuactw's LI-
cuse law does not apply 0 an owner or property who builds or Improves Wmon.ad,
whaconvecu for ouch projects wiNecontncuKU licensed pudwmro WContratoh "INN,ti l� }I
License law. cuu
{U71I(I'��IIyLI'Yl\t/\I U tUI\\\\Vii l' '
❑1 am seem under ere. B&P for Nb won
owner Date) m
R Q P NSATION OFLLARATIO
lMmbyamen, tarp.wlyafperjurymec (f fallawingdeclamonc
IhawandwillmalnuinnCenlfinmofConsentMulf-Wumfm Workce,Compen- -
sation,as provided for by Section 3700 of W labor Code.for the performance of the
work for which this permit is Wood.
❑1 haw ad will maintain Worker's Compensation Insurance.a requirrd by Section
3700 or the labor Cade,for the performance of W work for which this permit it lamed
My Workers Compensation Insunnot carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This motion nand not h completed if Ne permit is for one hundred dollars($I Om
orkes)
1 Unify Olio In to perfomunm of W wart for which this permit a IssUd.l shall oat
employ aypermn in my mann become abject in ft Worked'Compensation .
Laws of csAroMe�pilc
Apall
A
NOTICE TO�P I ICA If,a ler making the Certificate of Exemption.you Weld
became subject in Ne comes Comp list doo provision of the Lahr Code,you meat
.J O forthwith comply with Inch provisions Or this permit mail h demand!decked.
CONSTRUCTION LENDING AGENCY
l-•a I hereby affirm that there Is a consumetinn lending agency for W performance lir
a 7 the work for which this permit Is lewd(Sm.3097.Civ.C.)
W�Q landela Namc
z Lender's Adder
V t] 1 cenlfy Nal I haw read this application end stale that the&have information Is
ret tercel.I agree to Comply with It Lily and county a dinarteea and soak Iowa resting to
0 building construction,and hereby authorice representatives of this city u enter upon the
I27 move-menfiOned Property for inspection purposes.
(We)agree to saw,indemnity and keep harmless W City of Cupertino against
y7 liabilities,judgments,tato and expenses which may in any way acme against said City
V F7
APPLICANT in COf the UN ERSfANDSAOf NDWILLTWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEA ATION
Re-roofs /�f -N
Signet m Acolic V on err em
AznaoouS MATERIALS DISCLOSURE Type of Roof
Will the applium w future m
Wilding oupat team orhandle hanrdon material
as dented by tau Copulate Municipal Code,Chapter 9.12,and W Health and Safety
• Cosa.Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yet jdNu
Will the applicant at future building Occupant useequipmealordevices which If a roof is installed without first obtaining an inspection,I agree to remove
- man Itaardous air contaminants Is darned by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes PN.
I have reW W huardma mandatsrequiremenu undmoupter 6.93of thc Califor.
nia Halth&SectirCode,Section 25505,25533 ad 2553/.1 undcdund dectifW Wilding
does not currently how a knew,that It is my responsibility n,amity the omupat of W
require c which must meIpdorn,eaamanCer0cauarOcnpmc. Signature of Applicant Date
our rano 'adage t Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO -V "i~W" EVAer'" I"A"
BUILDING DIVISION PERI C� (TRACTOR X].VFURiVI ;Ol�i
R Qat
BUILDINO ADDRESS: KITTY SZETO rtRMrrNcb507003O
NER'S NAME: PERMIT ISSUE DATE
PHONE:KITTY SANITARY NO. CONTROL NO. -
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p O O O
yozp LICENSED CONTRACTOR'S DECLARATION lob Description
M1 hereby afOrm t 1 am licensed under pmvislons of Chapter 9(commencing
a� w
with Section TOM)of Division 3 of the Business and Professions Code,and my license4
License rceCt. cRen KITCHEN REMODEL
j License Clan Lk.N
G Date Gont
ARCHITECTDECLS DECLARATION
I undcrxu rd my plans shit ho hand As public records
c�,S Licensed Professional
3 OWNER-BUILDER DECLARATION
S I hereby affirm that I am exempt from the Convector's License Law for the
EON
following mason.(Section 7W 1.5.Boinesund Professions Code:Any city or county
$�' which requires a permit On eonRmet,Wer,Window,demolish,or repair any stmnure
rag
r^ prior a i4 issuance,stand requires theapplicant for such pesmil to file a signed comment
< dm he 411mosed punuanito the pmvisiomof Nc Contrectnri License Law(Chaper9 onn
Sq.Ft.Floor Area Valuation
$ (commencing with Suction VOD)M Division 3 ofuc Businessand Profusions Code)or
Nat he 4 exempt therefrom and the basis for da alleged aluminum Any violation or
Section 7031.5 by any applicnnt for a permit subjects Ne applicant to a civil penalty of 3 5�e10 0 Occupancy Type
Am mare Nan Rus hundred dollars(5300). _
❑6o thewric Ne treatment.4 nosh ayeu withwagesatheir rete compewtim,
will Pr Newonk,ande:To,Care4a0r's Lia ar offereds nor apply us an Owned Required Inspections
and Ro who ba Cada:The Canuereon.License Lew dot not apply lf an owner is - q P
Property who builds ar ire pawn Numb,and who doh a tach work himsel f or tiuoogh his
Own employees,provided thatinechimpmwmenuamnot intended oroffemG forsakeliveow.r,
builder,.the owshbuilding or improvement Is sold within one yeti or mmmlefo,the ore of
bonder will ham the burden of proving Nu h did not Wild or Improve for PuTem of
ate.).
❑1,as owner of the propny,am exclusively mntmmdng with Ilcaesed comments;to
construct the pmjen(Sec.7044.Business and ProfcWom Cotler)Tin Cmlruteri U.
Co.Law data ret apply m an owns of pmpcny-who bends or Inques u thereon.and.
who contracts for such projects with a eonhaemr(a)Iicem dl pursuant to the Contractor's
License latw.
❑1 em nem undt ee B A 7P for Nis wan
Owner Dau/
y�e RiRI Qk P NSATION DECLARATION
1 hereby alfnm dcr penalty of perjuryom of Na following dcci mdottc ,
❑1 have and will maintain a Certificate of Consent to self-insure for Worker'sCompcn-
adon,u provided for by Section 3700 of the Lebo.Code.for Ne performance of the
work for which this permit is iaueN
❑I Saw and will mainuin Workers Compensation fineance.as required by Section
3700 of the Latour Code,for the perfarmancc of the work for which this permit 4 issued.
My Workee,Compemadm Laurance unit and Policy numbs am:
Carrier•. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This sccsim bond notbecompleted If the permit Isfomne hundred dollars(6100)
or less)
1 cerdry Not in the prrormance of Ne work for which Nis prelim 4 Wood,I:lull out
employ any person In any mann (beeomc aubjmuo NC Wortcn'Compnaadan
Lawsof CaRfa A5
- Applicanm '
NGTICE TO P IC :If,a e.making this Cenificate of Exemption.you Would
became subject m the orkees Compensation provision of Ne Labor Code,you mot
,JO forthwith comply with such Provisions or Nis p.mitahall be deemed remkod.
CONSTRUCTION LENDING AGENCY
(—t (hereby a Mm that there is a coastmcGnn lending agency for the performance of
f5i 7 the work for which this permit is issued(Sac.30ST,Ci,C.)
W�Q Lender's Nam. ,
z Lender'sAdd^..
-
U0 I certify Nat I have and Nia application and sue that the W.information is
Un coronet.I agree to comply with all city and county ordinances and sok laws relating to
O building construction.and hereby ataborlm mprmrenutiws of this city m cuter upon the
W above-manti.om property for inspection purposes
(WA)agree On an.indemnify and keep humlea the City of Cupertino against
fy y
liabilities.judgments.costs and expenam which may In any way accrue again mid Cly
V 7 in comequcnce or the grousing of this permLL r
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by; Date—
SOURCE ATION
Re-roofs J1,14
H
Signa m Applimentor ate
AZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building Occupant sere or handle hmurdom material
As defined by Ih Cupertino Municipal Code,Chapter 9.13.and tM Health and Safety
•
Code.Secdon25532(e)7 All roofs shall be inspected prior to any roofing material being installed.
I]Yes 14 No
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit haandnus it mnumlnarts a defined by the Bay Area All Quality Management all new materials for inspection. '
Disuicl7
❑Yes N1No
I haw mW the hmallous materials requirements under Chapter 6.95 of the Cxlifor•
ole Health A Safety Code,Sections 25505,25533 and 25534.1 entlentsnd that if the building
Jou Out correctly how a temnk that it 4 my responsibility At notify the occupant of the
mqulrt c with mum met Painful iauance ora certificate ofoccupw Signature of Applicant Date
Ow or ramh ndagent Dak All roof coverings to be Class"B"or better
OrER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
A. All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
• portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City . Phone Number Type of work to be
erformed .
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature Date:
Job Address: . 0114 it t Permit#
Any changes to the information Provided on this form shall be submitted to the City of Cupertino Build
Department.
•
City of Cupertino Building Department
CITY40 10300 Torre Avenue
CU PEI�TINO Phone: (406)777-3228
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits arenot required to be signed by property owners unless'they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors,then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation •
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers'compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration).. For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professingowner is contractors
_r his o secure owner-builder her own labor and materia
building permit,erroneously implying that the property providing
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
` Very truly yam,
Building Department, .
City of Cupertino
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CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35903017 . 00
DATE ISSUED. . ... . . . : 07/06/2005
RECEIPT # . . . . . . . . . : 30245
REFERENCE ID # . . . : 05070030
SITE ADDRESS . . . . . : 869 LILY AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER KITTY SZETO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : KITTY SZETO
CONTRACTOR LIC # *OWNER*
COMPANY KITTY SZETO
ADDRESS
CITY/STATE/ZIP . . . . ,
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 169 . 56 81 . 39 0 . 00 81 . 39 0 . 00
BPERMFEE VALUATION 10, 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00
BPLANCHK PERMIT FEE 1 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
BELEC200 METERS 1 . 00 0 . 00 0 . 00 0 . 00 0 . 00
ELECTRIC SQUARE FEET 190 . 00 15 . 20 0 . 00 15 . 20 0 . 00
PPLBG SQUARE FEET 190 . 00 15 . 20 0 . 00 15 .20 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMFEE SQUARE FEET 190 . 00 15 . 20 0 . 00 15 . 20 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 495 . 82 0 . 00 495 . 82 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 495 . 82 1519
TOTAL RECEIPT 495 . 82
•
� - *CITY OF CUPERTIN* \
• CUPEI�TINO PERMIT APPLICATION FORM 0-S' ;7 o
APN# Date:
- 03 -ol
Building AcWress: /J Mailing Address (if different from building address):
Owner's Name: Phone#:
Lj SlD - 777-
Contractor: License#:
1 er
Contact: Phone: Cupertino Business License#:
i Fax:
Buildin ermit Info: krkS)C.D
Bldg ❑ Elect I, Plumb ® Mech ( ]
Job Description:
Residential 0 Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
/DoOD—
Type of Construction: Please check this box if the project is a
e/I hlb second-story addition: ❑
Project Size: -Standard El- Large ❑ - -Major
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
• BINVESTIGA Investigation fee BUILDING
1 of3 r
OCITY OF CUPERTIN(*
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING .
BPLANCKADD Plan Cbeck Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C'Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREWMAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rcpt), Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
• BREMREPALT Repair/Alter Heating MECHANICAL
13RENMSAPP Remodel Res Appliance ELECTRICAL
2 of 3
OITY OF CUPERTINO
CUPEIZiTWO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power. ELECTRICAL
BTEMPPERM -Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
/1;70 ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
O MPERMFEE Mechanicals . foot MECHANICAL
MPERNUTFEE Mech Permit Issuance MECHANICAL
/ PPERMITFEE Plumbing Permit Issue PLUMBING
qo PPLBG Plumbing Fee sq foot PLUMBING •
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
3 of 3
3 6)'rx - ` r 11%a h �' C ,1 r4 K �iLt: - R x}
A 'tip{+ 4L, 1 r/' �f L �n b y5�'
ao
r..AWCUPERINO
Assessor's Parcel Number:
�L s / D 3 — 67
Name of owner.
Project address. db� c� i C6j&.zU , l' g50/e f
Contact person. � � Phone. qod— 7 77—NPq
Fax.
Net square footage of lot. A/A
Existin Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL: Z3
I
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N
Is privacy protection planting required for the project? Y N /�f`,4
On what floor(s) is work being done?
Brief description of work. 1�17li1�D.1✓ Y/!ILKQ C
Code editions: 2001 CBC _ (Y -N)2001 CFC (Y-N)2001 CMC (Y-N)
2001 CPC (Y -N)2001 NEC (Y -N)
Effective 11/1/02
Plan Review Process Work Book Page-B-Revised 4/28/04