30311 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECI'R ICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL 30311
ItUI LDING PROJECT'IDEN'TIFICA'TION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
/D/6 oV v -��/' UE
OWNER ME PHONE CONpJ' ACfOR'S NAME: LCyQ��
NIC CONIROLp
ARCHITECT/P.n� i`�N�I�J R� LIC NO: DDRE55: ❑
2333 A-�v
CONTAGC7 AOW /uZ PHONE: BUILDING PERMITINFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
;ir ❑ ❑ ❑
LICENSED COMHACTOR'S DECLARATION QTY ELECTRIC PERMIT FEF:
1 hereby affirm that 1 am licensed under provisions or chapter 9(commencing JOB DESCRIPTIO
awZ with Section 9XXb,41ANsinn 3 ordhc Businessatd l'mfcssions Code,suit m hcemcis - RESIDENTIAL'
x100 PERMIT ISSUANCE
F in full force and effec 3 0 SFDW I. 1'TCHEN REMODEL
QUU Liccnsc Clas LIaN APPLIANCES-RESIDENTIAL ❑ADDITION O PLUMBING R6PIPF.
FZ Data Contractor.tt//II ILS ARCHITIi I"S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
'Dot PANELS
ZOmz10
mndmyp nsshal uscdaspu MODIFICATION
OZ=� UPT0200AMPS ❑INTERIOR O CHIMNEY REPAIR
1' n cl PoAtmional 201-1000AMYS IMPROVEMENT
�<<//
OWNERBUILDERDE .ARATION pVIiH In(X)AMI'S ❑BATH ftIiMODEIIRCPAIR ODEMOLITIQN
•+C , I hereby afford Lha,I Ie exempt from tine Comracmr's Liernuu Law far the
aolluwing mtion.(Section7031.5.Be%inecs nod Professions Code Any city or county SIGNS ELECI8ICAL ❑OTHER
u1 O vFi which requires a permit to construct,alter,improve,demolish,or repair any"Porro s A
F.. Q prior to its issuance.also requires the applicant for such pemetto File asigned statement SPECIAL CIRCUIT/ i
o" 'him he is licensed purameuo the p,P,icom of the Contmelor's User,Law(Chapter
ad00 (commencing with Section]000)of Uivision3 ofthe Business and Professions Code)or TEMP METER OR POLE INST. COMMERCIAL:'
d a�d c C that he is exempt therefrom aryl the basis for the alleged exemption.Any violation of 0 NEW BLDG/ADDITION 0 DEMOLITION
WIm Section?031.5 by any applicant for a Permit subjects the applicant to a evil penalty or POWER DEVICES
al nusre than five hundred dolhus($5n0), []TENANT ❑FOODSERVICE
`Z Y IMPROVEMENT
=Q Dl.as owner d the prupcny.or my employees with wages as their sole cndpBusinen. SWIMMING POOL ELECT RIC
Is: will do the work.and Oe structure is not intended moRered for sale(S«.]uW.Business OQTHER
HES-FI%TURES
Wim and Professions Cade:Tapply m a,o
True Contractor's License Law dues not appwner of OUTLETS-SWITC
Property
who bands or improves theram,and who does such work himself for through
his own employees,provided than such iaprovenents are not intended or offered far NEW RESIDENT[Al.T:LECTR SQ Elf
sale.IL however the building or improvement is sold within one yeararcumpletion,the SQ.FRPLOOR AREA s/SQ.PT.
cr-builder will have the burden of proving that he did nod build or improve for pur-
pvo,of aIle.).
0 I,as owner of the Property.am exclusively enameling will,licensed....rumors to TO'i'nl.:
construct the project(Sec.7066.Business and Professions Code:)The Contractor's Li.
ase law does not apply to an owner of property who builds or improves thereon,and QTY, PLUMBING PERMIT FEE
who contmms for such ps bleats with a contractor(s)licensed pursuant to the Connactia's
License law. PERMIT ISSUANCE t
Ihm exempt under Sec. ,B&P C for this rearm
Owner Date
ALTER-DRAIN&VENT-WATER(EA) VALUATION
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE /'JlM
I herebyaffirm under leaahy of perjury one orthe following declamnim,
C3 l have and will maintain IsCerificsm ofConscnuo self-imam for Worker's Compeer. DRAINS-FLOOR.ROOK AREA,COND. STORIES TVPE CONSTRUCTION
40,v'tion,as ovided far by Section PW of the labor Code,far the performance of the
h¢h this permit in issued. PI XTU RES-PER TRAP
w r have find will maintain Workers Compensation Insurance,as required by Section
37M of the labor Code,for the performance of the work for which this permit ix issued. GAS-EA.SYS TEM-I INC.6 OUTLETS OCC.GROUT' APN
My Wmke- Ca� onhyimmpTyC-er and Policy nu
Curiae ?r1w1 �r—Ai Policy Nu.: GAS-EA.SYSTEM OVER 4(EA)
CEKI'IPICArE OF EXLMPTION FROM WORKERS' GREASF%INUUSTRL WASTE INTERCEPT OR COMPENSATION INSURANCE BUILDING DIVISION FEES
(Thiseecti .end nod bo completed if the permit is farm.hundred dallars(SIIX) GREASETRAP
for less.) PLANCHECK FEE
Icertify that in the performance Orme work lin which Insinuator is i.ssued.lshnll SEWER-SANI'T'ARY-STORM EA.21X0 FT.
wt employ Illy it in any rmaare,so as to become subject to the WorkerComped ENERGY ITE
Z inion laws of C.1ifcandu Dam WATER HEATER WNENT/ELECTR
Z Applicant GRADING FEE
N NOTICE TO APPLICAN'1':If.afar making this Cemd'cme of Exemption.you should WATER SVSTI:MGKCAT ING
h" ? besubject to me Worker's Compensation provisions of the Labor Code,you muss SOILS FEL
come
.� forthwith comply with such previsions or this permit shall be,domed revokN. WATER SERVICE
Q
7z CONSTRUC is.I']ON LENDINGAGF,NCV NEW kF.S1UENTIALPLMB. SQ.EL. PAID Dato Recciptp
UO work
this Knouts isaeal(See 3nlemaing agencyfor the lerl'ormance of
0 (•' the work fm which mit pernit is issued(Sec.Jly)].Civ.CJ
Lender's Name TOTAL:
lender's Address TOTAL:
6. I<etily that 1 have read This application and,clam that the above inturninun ix BUILDING P[E
y correct.l agree 1 to Com With all cit and count ordinances and state laws relminS m
g Comply ye. yon QTY. MECHANICAL,PERMIT H:L SEISMIC PLC
V z building construction,and hereby authorize representatives of this city to rnmr upon the
above-menthane d property for inspection purposes, 11I7RMU ISSUANCE
(Wc)ngrm m save,indmnnity and keep haonless the City of Cupertino against ELECTRIC FEE
Iiimilities,judgments,costs and expenses which may in any way recruit against said City ALTERORADDTOMECH.
PLUMBING FEE
in asequence of the gaming f,his permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNTT(TO IO.OIIOCFM)
MECHANICAL.FEE
SOURCE REGULATIONS.
AIR HANDLING UNIT(VVER 10.1Xx1 CFM) CONSTRUCTION TAX
Signature of Applicaa/Contmctor Dare E%HAUST HOOD(W/DUCU HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant for future building occupant store for handle h a.rdous material II LATI NO UNIT(TO!I00,000 BTU)
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)'( HEATING UNIT(OVER p10.000 BTU) yA,
❑Vex ❑NnPAID
' VENTILATION FAN�(SINGLP,RES ID) Date . 9
Will the applicant or future building occupant use equipment or devices which
-mit haardum air contaminants as defined by the Bay Area Air Quality Management BOILER-COME(SEE OR Bill BTU) TOTAL:
i.onvC BOILER-COMP(OVER 100,000 BTU)
[ c ❑No
1 have resod the insertionsinsertionsmateial
materials requirement under under Chapter 6.95 of me Cath. AIR CONGO'IONER ISSUANCE UAT
four health&Safety CIA.,Sections 25505,25533 and 255N.1 understand that if thc NEW RESIDENTIAL MECH, SQ.ET.
hail f d Pat contend haves temantnhat his my Purports iPlay da Pauly th acPart �
no
art Illi menu whjgn last etnriar mix. IEcam yt){) ups
O n umbodxedsgenI J D TOTAL: DBY
OFFICE
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& . SMOKE DETECTORS ARE REQUIRED
AS PER 194UBC I ALL BEDROOMS §
AND HALLS LEAD NG TO BEDROOMS . q
. .
Home o_« Tim and Emily Maslyn Contractor: Showcase Kitch_, ec
.
Address: 1016 Novembern a . 12333 Saratoga-Sunnyvale Road
\ .
City: cRm_ z m95 N# Rrat_g CA. 95070
Project: KITCHEN REMODEL California Contractors �s _e■ «e9, B .