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19463APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification PERNTNO. 19463 nen ante: • Phone: /1 • 9 3-4?qS* CITY OF CUPERTINOBUILDING DIVISION APPLICATION / PERMIT BUILDING-ELECTRICAL.PLUMBINGMECF N7CAL p Contra ors Name: LIe.No: FhseNeR 76., ) r &etl • 33NN. CATEGORY C Architect/Engineer. Llc. No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addreoc 12N im ❑ PERh0TIS5UANCE LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am Rcenseci under provisions of Chapter9(commene Ingwlth Seeion7000)Of Dlvislon3ofthe Busineeaand ProfemionsCode,andmy Llcenac Cla®amen, lc.g license le Ino force e d effect _y � Date 1_r !r AgCmuraRor ARCHITECTS D C ATION I understand my plan shag be used ss public records APPLIANCFSRFSIDENTIAL JOB DESCRIPTION 'T 1� •r/ � 'r �u8 /'S� P p11W0 I'S OVERI000 SQ. FT. FLOOR AREA $/SQ. FT. SIGNSELRCTRI L Licensed Professiowl SPECIALCIRCUI / OWNER -BUILDER DECLARATION thereby afRrmthat I am exempt from the Contractors License law for the =Ion TEMP M pOL fallowing reason. 70315, Business and Profession. Code: Any city or county which requbesa permit too entrua, after, Improve, derrolbh,orrepair anystmct mpdortoiblawance,aborequim.theappBuntfwsuchpermitto file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Stolon 7000) of Divi- sion3Ofthe Businessand Prolessloro Code)orthath.13onmptthercfmmand the basis for the alleged exemption. Any violation of Section 7031.5 by any no applicant for a permit subjects the applicant to a civil peruhy of nr' mizy PO CES G O VALUATION / O6D.Wj five hundred dollars ($.500). 1, as owner of the property, or my employees with wages as their $ok E]' W RE51 A � C/V STORIES TYPE CONS AUCTION compensation, will do the w°rkand the structure Is not Intended or offered for sale (Sec. 7044, Business and Profasslon Code: The Contractors License law 5 �� does not apply to in owner of property who builds or improves thereon, and who don such work hlmselforthrough his own employees, provided that such OCG GROIIia RES UNITS improvements are not Intended oroffered forsale. It however, thebuliding or Improvement b sold within one ycarofcompletion, the °wnenbu0d erwill have TOTAL: tfw.kurdenof proving that he did not build °` Improve for purpose ofsale.) u 4 as owner of the property, am exclusively contracting with licensed contractors to corolmR the project (Sm 7044, Business and Professions Code: The Contractors License Lw don not apply to an owner of property who plojem with a builds t r Improves thereon, and who contracts for License rgR[�aciorexemtunderpursuant to the Contractor's Lk&P Law. Sec, Lj I am exempt under Sec B & P C for this reason QTY. PLUMBING PERMIT FEE PERMITISSUANCE ALTER -DRAIN & VENT- WATER (EA) FLOOD TONE APN FEE BACK FLOW PROTECT. DEVICE OUSUMMARY EITES DRAINS. FLOOR ROOF, AREA, COND. SANITARY Y_ 1.4 RECEIPT N Owner Date WORKMAN COMPENSATION DECLARATION QI hereby affirm that I have a certlfiate of consent to sail -i uce, or 3800, 3800, lC.) aofWorkers'Compersatl°nlneuranreorattrti(led ropythemof(Sec. Lab FIXTURES PER TRAP SCHOOL TAX Y_ N R_ ECEIPT _ GAS EA SYSTEM -I INCA OUTLETS PARKFBE Y N Policy M RECEIPT' N GAS EA. SYSTEM -OVER 4 (EA) Com any BUILDING DIV] SION FEES Certified copy is hereby furnished. C2[ is i copy b filed with the city Inspection division. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE GREASETRAP CERTIFICATE OF EXEMPPION FROM WORKERS' COMPENSATION INSURANCE (This section need rad becompleted ifthe permit is (atone hundred dollars (S10a)mr less.) ce I rtBythat In the perfomunceof the work forwhich this permit is jawed, I shall not employ any peraon In any manner n m to become subject to the Workers'Compensstion Laws of California. Date PAID Date Recel t# SEWER -SANITARY -STORM PA. 200FIL WATER HEATER W/VENT/ELECTR ENERGYFEE Y N PAID WATER SYSTEM/TRTATING Applicant NOTICETO APPLICANT: If, after making this Certlfkate of Evemptbn, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provision orthb permit shall be deemed revoked. Date Rernl t# NEW RESIDENTIAL PLMIL SQ.FT. TOTAL: BUILDINC MEW SEISMIC FEE CONSTRUCTION LENDING AGENCY Iherebyafflrm thatthereba construction lending agency for the perform- anceo(.Nennom work whkhlhbpmat b i.sued(Sec. 3097, Civ. C.) Landers Name In A Ixraero Address L��G tion ave mad comply is with allatynanddc statethat the above dgat lam Is Iit mect. I hat I agreecomplywithcityand county gate lam TOTAL: aslal K/r� ELECTRIC FEE QTY. MECHANICAL PERMIT FEE PERMIT ISSUANCE PLUMBING FEE sC]9 MECHANICAL FEE reWl.gtlagreetO relating tobullding conswRion,and ion representatives autnorizerepremnttlivn oftnb Imux`hereto city to enter upon the abovcmentlonedp sty for lvpecilon purpose.. (We) agree to save, IMemN(y an d p harmlm the City of Cupedlno against liabilities, judgments, cost ... d race which may lnany wayaccrue against said City In cons sof th ..ting of this permit. LTER OR ADD TO MECH. Date ReCel t# AIR HOLING UNIT (TO 10,000 CFM) SUBTOTAL: AIR HAN NG UNIT (OVER 10,BOBCFM) CONSTRUCTION TAX Slgrslure o! pl°r Date E%I IAl15T HOD"/DUCT) CONSTRUCTION TAX PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO ,000 BTU) Will the applicant or future building occupant store or handle hazardous materials. defined by the Cupertino Municipal Code, Chapter 9.12, and the Date ROCCI I# HEATING UNIT (OVER10 00BTU) TOTAL: I ealth and Safety Cade Section 25532(2)7 E]Yea AN. VENTILATION FAN(SINCLE ID) ISSUANCE DATE Willtheappllant or future building occupant use equipment ordevlces which coat hazardous air contaminants as cleaned by the Bay Area Air BOB.ER-COMP OHPOR 100,000 BT Quality Management Districi7 4 Yea 'Fu nave read the Fazarous.terlalsmqulmmentsunderChapter6.95of F� BOR.ER.COMP(OV)R 100,000 BTU) the California Ilealth & Safety Code, Sections 25505, 25533 and 25534. I f NEW RESIDENTIAL MECH. SQ. understand that if the building don not currently have a tenant, that it is my resp°rulbillty w notify the occupt of the requirements which must be nrct prior to}t duan rtl0ate fOccupanry. ISSUEDBY: Z "— OwnLTr or authorlud agent Dire TOTAL: OFFICE COPY n I SGhSP 129lnmbiaq General Contractors 0 0 - City of Cupertino Building Dept. 10300 Torre Ave. Cupertino, Ca. Joe Antonucchi Listed below is the proceedure used existing location at 10355 Plum Tree job is 19463. January 16, 1990 to install new stall shower in an Lane. The permit number for the After the removal of the existing stall shower the following was completed. A. Installed Florestone Neo -angle shower receptor, (connected new shower pan to existing drain, the drain is visible from from under the house). B. Installed new Delta # 622 shower valve, (all connections are visible from the escutcheon plate opening). C. Installed water resistant sheetrock in the enclosure. D. Installed craft paper according to local building codes with proper overlaps, (Note: care was taken to assure that there were no tears in the craft paper). E. Instal. led wonderboard, (wonderboard was visible to the inspector on the job site). If you have any further questions as to the above work completed please call me at my office. The phone number is 727-2426. JAN 16 1990 D BLDG. INSPECTION DEPARTMENT, CITY, OE CUPERTINO. Sincerely, �j 14 Terry Fischer 2764 SCOTT BLVD. • SANTA CLARA, CA 95050 • (408) 727-2426 MAILING ADDRESS: P.O. BOX 360 • SANTA CLARA, CA 95052. • CONTRACTOR LIC. #335614