25763 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO ' '•' PT:RMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING DIVISION BUILDING PROTF.C'1'MENTIFICA1'ION 25763
BUILDINQ ADDRRESSSS��J��py�\ SANITARY NO. APPLICATIONSUBMITTALDATE
U Z a� Y VV N LOT#
s O M
PHONE: CO CfOR'S NAME: Y N/C CONTRO
f
RCIUnUI'/UNUINEER! LIC NO: ADDRESS:
Z cz
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
'
ELECT PLUMB MECH
PERMIT ISSUANCE Lf�as
LICENSED CONTRACTOR'S DECLARATION pppLWNCES-RESIDENTIAL JOB DESCRIPTION
OKZ (hereby affisLICEN E licensed under DE LARATer9(mllunencingwith - eV/JI_ C��fY7—�Rg[s—J-
`1100 Section 7000)of Division 3oflhe Business and Professions Code,and my risme ism PANELS 1�`�, ��r�
Lcleforce andeffect. Lic.# �ZZ UP TO 2M AMPS f� \`
vFi<y Contmemr ra 201-IOW AMPS
Z 00 - ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.Ff.
OZ-0 I understand my,plans shell be used as Public retorts.
P:2x
LicendProfessional SIGNS ELECTRICAL
OWNER-BUILDER W
DECLARATION SPEC .CIRCUIT/MISC.
dOt1 hereby sham that m 1 aexempt from the Contractors License law for the ^
3 a y following reason.(Section 7031.5,Business and Professions Codr:Any city or county TEMP.METER OR POLE INST.
HSLL0g which re9uixs.permit to emeareet,Won.improve,demolish,mrepa4 anyswcture POWER DEVICES
prior l0 its issuance.Ms.rennins theapplicenl I...chpermd am
itlofl...ignemremt
Q O
than he is licensed pursuant to the provisions of the Contractors License Law(Chapter
Lyo1' 9(cnmmencing with Section 700(h of Division 3of the Business and Rofessiore Code) SWIMMING PoOL ELECTRIC VALUATI^ulj�
iWM onhal he isexempnhe.lrnmand lhebasisfonhe aIlegrdexemptan.Any violationof OUTLETS-SWITCHES-FIXTURES p� 71^�'�_
l— Section 7031.5 by any applicant for a parent subjects the applicant 4n a civil penalty of w
� C not mom l,nowfive ffiepmdollan(SSm). NEW RESIDENTW.ELECLR _SQ,PT. STORIES TYPE CONSTRUCTION
a, m ❑ Luawnrk.and epmpnry,ormyempinded withnedfor theimle(Sec.Tom,Business
L will dotheandthe structure isnotim kende Law
ntapply to an owner
^ and Professions Code:The Commcmre License Lew Jsv:a not epPIY to ns owner of
property who bui lds or i mproves thereon,and who does such work hi msel f or throu gh his
own employses,provided lhnsuchimprovementsarcnot imendedoroffmaiJ forsule.LL OCC.GROUP RES.UNITS
howev%H]havethe burden
ofemem ishan he did
noneyw improve
efor theowrrer- TO
builder will have the burden of proving that he did not build or improve far purpose of
sated' QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
❑ Iue,the pmjwt(Seeperty,1,Business
and ntracting with de:) rd Canna o.m
nems el the project(gra.tom
c meo and Professions Code:)The Convector's
License Lawdmanoh pmjmanowaerofpropeny waboadi paorimpmves thereon,and PERMIT ISSUANCE
whoemLt.. raw. such projecu withaconuaclorte)IiunaM pursuant mJr Contnmors ALTER-GRAIN&VENT-WATER(EA) FEESUMMARY
Lactims Law.
❑ lam exempt under Sec. ,B&P C for thia reason BACK FLOW PROTECT.DEVICE OUTKSANITARY Y DE FEE N
Owner Data RECEIPTp
DRAINS-FLOOR,ROOF,AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Ihemby effum thmihav<e<mificau of canxmto xlf-imam,ore cenificnm of FIXTURES PER TRAP RECEIPT
Workers'Compenxdon Insurance or a certified copy thereof(Sec.3800,Lab CJ which PARK FEE Y N
covers all employee's under Chia t. RECEIPT p
p penin GAS-EA.SYSTEM-1 INC,40DTLETS
Policy# BUILDING DIVISION FIiliS
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Certified copy is hereby famished.
❑ Certified ropy is filed with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
(Thissectian need not hecmnpleted if Ne permit isfor one hundred dollon($IW) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or less.)
I certify that in the perfomunce of the work for which this pe mut is amid.I shall WATER HEATER W/VENT/ELECTR
not employ any person in any summer so w to became subject to the Worker% PAID
Compensation Lawsof Celifomia. Dam WATER SYSTEM/IREATINO Data Receipt
O zr Applicant
z 0. NOTICE TO APPLICANT:If,after making this CmlRcere of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
ry become subject m the Workers Compensation provisions of the Labor Code.you must
., forthwith comply with such provisions or this Furnished]be devaad.vokM. BUILDING FEE /#
CONSTRUCTION LENDING AGENCY SEISMIC FEE
z1 hereby aff that there is a construction lending agency for the performance of
O the work for which This permit is issued(Sec.3007,Civ.C.) TOTAL: ELECTRIC FEE
lender's Name
0Lrndaea Add.. QTY. MECHANICAL PERMIT FEE PLUMBING FEE
L) 1 cenify that 1 have read this afflictions and sureIhm the above infomlatio,is MECHANICAL FEE
correct.Iugrec to comply with sll city and county ordinances and state laws relating m PERMIT ISSUANCE
L) Z building construction,and hereby authmiec repnsentnves ofthia city mender upbnthe CONSTRUCTION TAX
above-mentioned propmy for inspection psupmes. ALTER OR ADD TO MECH.
(We)agree to save,in rosily and keeP4urmJesa the City of Cupertino agaimt
liabiliria.judgmenu.c dex which arayinanywayacceass,s ilaml City AIR HANDLING UNIT(TO 1g)WCFM)
incnnxquare.. th bring pmm' AIR HANDLING UNIT(OVER 10,000 CFM)
Miamian u Applic 4Contrector Data EXHAUST HOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT TO UNLOO)BTU) Date Receipt It
Will the applicant or future building ex cupenr store or handle humorous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100,000 BTU) IOTA
Code,Section 25532D)I
11 Yes 1:1 No VENTILATION PAN(BINDLE RFSIO) RS
SU N E DAT
Wilt the epPlicanmrfmux buildingmcupentnxequipmemordevimawhichemit BOILER-COMP(JHP OR IW.IpO BTU)
bromrdons air contaminants as dented by the Bay Area Air Quality Management BOILER-COME(OVER IW,WOBTU) NOV 1993
Disrdm'1
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.M
1 have read the hvnrdbm mvaials u under Cha ter 6.95 of the Cu Y Ur UUr
.05,255n p Ch11IIvv
if the
uil Health&Safety Cale,have
Sections 25505,2553)and responsibility
I understand that
ifthebuildingdcesnot currently haveutenant,thato is myyrespocsiofa modify the
Ooccupant
ta of the requirements which must be mm prior ro issuance of a Certifies.of
Occupancy.
Owner or manorixd agent Date TOTAL ISSUED BY:
OFFICE
IEXIST ING FAMt LY ROOM KITCHEN
RARICIK RESIDENCE
22445 1L>["NDA ANN CT. CUP ERTM
4EA. EXISTING RECESS
LIGHTS ON 2EA. 3-WAY
❑_ SWITCHES _F1 11
1
KITCHEN / 1 �
z
`-+ LINOLEUM
HARDWOOD
5'-0 SLDR. DOOR
•� m o O ED
S IN ACCORDANCE WITH THE CITY Ot
CUPERTINO CODES AND ORDINANCES l
DATA J
SIGNED /
This set of plans and spscificatiom;-Mvr
a 6e kept on the job at all limas and it Is un
lawful a make any changes or aherationE a
0 on same withilut written permission from
the building Dept., Cit
The stamping of this p an and sP60 c NOV
SHALL NOT be held to speooicalions B z� 893
approval of the violation ofine�or to be do
of any City Ordinance or State LewrFsA-M I L Y ROOM �Ga N Qr ION D gR
�NQ
BRICK FIREPLACE
• DATE: 11-12-93
` O DRAWN BY: KRU
SCALE: 3/8" = 1'-0"
Ir"RCPCSED FAMILY ROOM / KITCHEN
RARICK RESIDENCE
22445 L,IN®A ANN CT. CUPERTINO
4EA. EXISTING RECESS
-�- LIGHTSON 2EA.
3 WAY
SWITCHES
KITCHEN / D 1
a
�., 3 DELETE EXISTING 3-WAY SWITCH
CAs
ADD 4X12 HDR #2 OR BTR. 1 5'-m SLDR. DOOR
W/ NEW KING It TRIMMER STUDS
0
— I
c o \�o
/ INSTALL 4 HALO HR7T ICT I
RECESS LIGHTS W/ DIMMER / \
SWITCH TO FAMILY ROOM
\e-24'
I
A I -❑
O \
FAMILY ROOM
I
[BRICK FIREPLACE
• DATE: 11-12-93
O
SCALE: 3/8" = 1'-0"
DRAWN BY: KRU