B 0620 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POIIJ7 PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION PLUMBING-MECHANICAL.
urPLlcnrlovmr:RmlT 50001
D1101
I ��y�J ('N� /� I�IUrI�LUI_NCr�PRD,p;CTIUEN'1'IN'ICATION
BUILDING ADDRESS: ` 1517 R'llpkl /�� OR, C-Uk� �IRltlx0? C gSOr4 SANI'T'ARY NO, APPLICATION SUBM ITI'A L DA TE
_1
.7 <--L f°-- 9 1
OWNER'S NAME: ^ n` I'fIONF.: )NTRACTOR'S NAME: ''I Itawcwu/' I.IC NO:
ff'v I1 si21kVMIA2 446 I CC CIIofJ bo \ Z N/C CONTROLp
sRCHIT bC]/I:NGINI:LR:ower F_2 LIC NO: ADDRESS: X10 MT. cT; 1-�'pla T ❑
CONTAW PHONE: BUILDING PERMIT'INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MIiCII
C� Ir CT 0
LICENSED CONTRACTOR'S DECLARATION
QTY. ELECTRIC PERMIT IeEE
1 hemby aRrm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
yVOyIWZ with Section 7")ofDivision 3ofthe Business and Professions Code.and my license is RESIDENTIAL' ,.�,,��••
Fwr in UP force unit eRem. PERMIT ISSUANCE ❑SFDWL ITlkttCHEN REMODEL
TUU in
Class Lica APPLIANCES-RESIDENTIAL
❑ADDITION ❑PLUMBING R1iPIPE
�rQi G 4 Date Cement., 3
F.7w ARCHITECTS DECLARATION PANELS ❑M111.TI-UNIT ❑MODW[CAT16
Z O In d. I understand my plans shat[be used as public remods h10DIFlCATION
oz_� UPTO100AMPS [1191 PRIOR El CHIMNEY REPAIR
W I.icensad Pndfircannal 201-1000AMPS IMI'ROVBMHN'r F]SWIMMING POOLS
C6 �� OWNER-HUILDER DECLARATION OVER 10(X)AMPS O BATH REMOUEIJREPAIR ElDY.MOLI'I'ION
Q I hereby affirm that 1 um exempt frmn the ContractorsLicense Law for the
iV following reason. IID1.5,Business and Professions Cole:An t t ❑OUTER
g m Y city or county SIGNS ELECTRICAL
x13 LL y which requires a permit nee urs the aper,impmsu demolish.ch ametor mash my swment
path.isr to its i,enov!e, ,monlso ui lot nivion applicant forthe Counts,nit toicamele a signed statement SPECIAL CIRCUIT/MIST.
p�jsd
that hi1s11o,wit ponmint7000)of Disintu nfof t Gmisirus's License Law(Chuptu9
(m he is exempt
pt iereSonfrn and of basisor3 oltheegedexempton.Profession,Code)of TEMP,M13'1'13R OR POhIi INS'T COMMERCIAL:
Mn he is 31.5 b therefrom and the basis for the allege)exemption.Any l Penalty of ❑NEW BLDG/ADDITION ❑DEMOLITION
44.• Sedion]U3 LS by any applicant for apermit suhjxts the applicant macivil penalty of POWER DEVICES
FN..•Z t men than rise handfed dollars($500).
TENANT
n EOnpSyyYN-
Tj Q t,as,.nr,.f Ne preload,or my aun,h,ces with wages us dmir sole emopennati)n, SWIMMING POOL ELECT RIC �j��
CYY2JWLr1I, IdoOhe work,and themomome is tern intended orolTered Iter into(Set,7044,Itusineas OT i- /—
3 and Professions Code:The Contractor's License Law does not apply to an owner or �f.. OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through 1jul 11111
his own employees,provided that such improvements sm not intended or offered for NEW RESIDENTIAL ELECfR SQ IT.
sale.If.however.the building or improvement is sold within tene yea ofttrmpletmr,the T. AR $
m
Mr
owner-builder,will hovo the harden of prrving that he did nm build or improve Impur-
PPPPPP999999�����N77
eoLsum
$'1, f owner of @e property,am exclusively cnnaating with licensed enmrunnrs m TOTAL: -
tkc stmd the project(Sec.mW.Business and Pmfessians Cnle:)The Cnmmcmr's Li-
sclnwdoesnotupplymanownerofpmpenywhobuildsirimprovesmereon,and QT'y, I'LUMBINGPERMIT I FEE By
who contmets for such pn9ects with a mnaeOun s)licensed purmant m 0he Contmemr's
License Iaw. PERMIT ISSUANCE
❑lam exempt mull
d Sc. .B&P C for this reason
ALTER-DRAIN&VENT'-WATER(EA) VALUATION
ns.
I WLSJIHBRS'COMP• SATION DECLARATION BACK FLOW PROTECT DEVICE 'LT
1 hemby 6 A-affirm under pcmhy of perjury one of the fnllnwing dedomunns: V A"
TION
4on,
ker's Compcn- DRAINS-FLOOR,ROOF,AREA,COND. 'as provided for by Section 3700 of the Labor Code,for the perfor since of the S'I'ORII?S 'TYPE CONS'fSIX
work for which Nis permit is issued. FIXTURES-PER TRAP
1 have and will maintain Witters Compensation Insurance,as required by Section I/
3700 ofthe labor Cale,for the performance claw work for which this pcmrit is issued. GAS-EA.SYSTEM-]INC.4 OUTLETS OCC GROUP ty�6 +LPN
My Workers Compensation Insurance metier and Policy number arc: ���///��� .3J
Carrier: Fclicy No.: GAS-17A.SYSTEM-OVER4WA) Q �LL Z$�e72Y
CERTIFICATE OF EXEMPTION FROM WORKERS' 1
COMPENSATION INSURANC17 ORGSUINDUSTRL WASTE INTERCEPTOR
HUILDING DIVISION FEES
(Thissation need nm be compldeA ifthe permit is forme hundred dollars fSl W) GREASE TRAP
or less.) I'LANCHECK PER
Iccnifythat intheperfonnaice il'thc work for which his pemtitis issued,I shot] SEWER-SANITARY-S'IOR M EA.21X0 F I'.
not employ y person in any manner so as m become subject m the Worked Cmnpem ENERGY PLC
Z
enmotion laws of C.ffomia.Date WATER HEATER W/VF.NT/ELECTR
z Applicant 1 GRADING FEE
.N. NOTICE TO APPLICANT.If,after making this CeriGcma of Exemption,you should WATER SYSTF:M/IRENUNG SOILS FEE become subject to the Workers Cnmpemminn provisions of Oe Labor Code,you must
fethavuh comply wuh sigh pmvisiim or this permit shall he deemed revoked, WATER SHRVICH
Q
5z CONSTRUCTION LIiion lNGAG1'NCY NEW RESIDENTIAL PLh1H. SQ.PT. PAID
C.J l for whihthisEnhemissued(See.construction agency for the Performance of ReceiptM
the work for which this ps'mtit is issued(Sec 309].Civ.C.)
Lender's Nome TOTAL:
V Lender',Address A f
1 cenify that 1 have read this application and state that the above information is HULL FP s
to correct.l agree to comply with all city and county ordinances and state laws mining to QTY. MECHANICAL PERMIT FEE
U Z building construction.and hereby suthnrio,representatives ofnhis city to eicrupon the SEISMIC FE
above-ntcrtiomal property for inspection purposes, PF.RMI)'ISSIIANCE 3
We)agree m save.indemnify and keep harmless the City of Cupertino against ELECTRIC EE
liabilities,Inlgroars,cnsmnnd expemevwitich rtay in any way uceme against said City ALTM OSSUNTO CEMECIL O
in emrmqucnce f the granting if this permit. PLUMBING
APPLICANT NO TANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT'(TO MAXI CFM)
SOURCIi REGI L 'S. MECHANICAL F ai t
4 AIR HANDLING UNI'I'(OVEN In,(XIB CIM) pp�� CONSIAUCfION TAX
Signature of Appl a Dom EXHAUS"T IIOOD(W/DUCT) LJ HOUSING MITIGATION FEE
n AFARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle haundous material HEATING UNIT(TO I W,(XX)BTU)
as defined by the Cripcnino Municipal Cole,Chapter 9.12,and the Health and Safety
_ Core,Section 25532m)? HEATING ONIT(OVER 100.00 BTU)
❑Yes ❑Nn PAID
VENTILATION PAN(SINGLI3 RES ID)
=.�,W BI the epplici m or fume building occupant use equipment yr devices which Dam Receipt a
4,prdou,air mntamirmnts as defirwl by the Hay Arca Air Quality Management BOILER-COMP(3HP OR 100,(X10 BTU) 'TOTAL:
C°' BOILER-COME(OVER 100,001)BTU)
Yes ❑No
--
1 have read tie haaNteoa materials requirements order Chapter 6 95 of the Cali- AIR CONUI'I'IONER 1 ISSUANCE DATE-
fcaur Halth Sa@tyC'xH,5srniom25505,25533and 25534.1 madersend that ifthe NEW RESIDENTIAL MECH. SQ.r..
buildingdmn mly have a tenant,that it is myle"rodbihns'm notify the occupant 2— i
of the tequireme a hlth mm' to 'or to ismace of u Cmsi c cif P,cry. -
9
weer ter uuthon-' pert Date TO k ISSUIiD BY: /
OFFICE
10'6 177 11-10
137 Tl 5'9- T'11 Tl 1 5.9----.: —_--g-1__--_
ry
ry MASTER BDRM
15'9 X 11'8
LIVING
17'11 x 137
ROOM
10'4 x 107 FAMILY
UMASTER 10'11 x 137
BATH CLOSET
4'l 1 x 77 6'4 x 7'5
WALKWAY CLOSET
3'8x176 SET
I L 74____
MASTER
CLOSET WALKWAY Puja Room I
BATH 10'8 x 3'8 Area
9'5 x 37
F3 10'111 x 63
CLOSET
LOSETOX
BATH BATH DINING
117 x 10'9
I I I
5'5 X 6'8 6'x 68 ENTRY
n 'k. �
5'4 x 15'4
Fk.. � ry
BEDROOM
:LOSET BEDROOM 10'5 x 121 TO Ove__
Loser
13'x8'11 -e1 NOOK
7'2 x 9' 12'8x14'10
L
UP. Fridge Pan"
7
5'1014 -
Notes:
1. Proposed layout of 21517 Rainbow dr. Cupertino, CA 95014
2. Drg,for construction permit to remodel the Kitchen
3. Moving landry area, currently, next to the kitchen and place it in garage.
4. New kitchen primary lighting will be fluorscent lighting.
5. Construction to be done and managened by owner builder. GARAGE
6.Actual work to be done by indivuldal ficeneced contractors 20'x 22'5
7. Contractor Company: JAC Construction Co., San Jose 95127
8. Contractor Name:Javier A. Cano
9.Contractor Licence*B-566242
10. Contractor Worker Compensation-Exempted by Contractors State Licence Board,CA 95286
LIVING AREA
2032 sq ft
WPIPIR01*450 DO Uk
gCORWACEts�Njj"AND r,C`
ni)
ro.V.tR11tAo C
pes)
SIGN set 01
Thisouns ,1 e4\
too 10 Y\z
be 'OPk on n
lawful 10 l""ni6sto
1tum P
0 �'poitmo-
on same
no e
k1l
t 0'r to
The 'tamp ovisio
State.
CM DrJinanc
,T*T— --- }` -„ •,U— --�
168
MASTER BDRM _— — ------ -- —
H-
169 x 11'8
LIVING FAMILY
17'1 x 137 1011 x 16'5
-- BEDROOM
10'4 x 107 -
(� CLOSET
MASTER 6� 4 x 7'S
STM ALKWAY aOSE
ATH411 f LO cLesEr
0 3'8 x 17'6 -----
• .....__ 310.ze r
_._.....
-- MAH .
BA /1 WALKWAY
CLOSET cane,
J\ z,r 10'8x3'8 n
CLOSET L00
°e°z�T DINING ceMu
—.
16.z .r-.:xer.. ....... 11'5 x 10'9
BATH BATH o
_5'5 x 5'8 6'x 5'8 ENTRY KITCHEN =
v
...__.._....... 5'2 x 15'4 14'6 x 11'
• _Po4Qe _. Colder
Oven
BEDROOM
LCSET BEDROOM 10'5 x 121 i NOOK
n--._._._.
13'x 8'11 88.61 - BATH
- -- _ LALINDRYe� ,.s,
. ... —u—P __.—._. 5'6x6'1
—T,__—. 271 596"1
ss —
Note:
1. Current House Plan for 21517 Rainbow drive, Cupertino, CA 95014
2. Garage Door entry is to the side and it is manual operation door-unsafe
3. Kitchen cooktop is close to edge and kids can accidently touch hot surface-unsafe
4. Laundry is next to Kitchen
GARAGE
20'x 22'8
LIVING AREA
2034 sq ft
” Y