S 1880 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUI'IiRTINO BUILDING.-ELEC'IRICA I, Pli tl NO q Q
BUILDING DIVISION APPLICA'T'ION/PIsRMIT rl.unnurvr.-MECHANICAL 1880
BUILDING PROJECT IDEN'T'IFICATION
BU1LDINGADDRESS: /���`� ��� SANITARY NO. APPLICA'I'IOONN SUBMITTAL DATE
OWNER'S NAME: /In p110NG: CONT�ACI[l�. ,li<'i " `' LICh1O: NIC CUNTROLp
,I'!I1'ECT/EIJGINF.ER: �J LIC NO: ADO(RP,$$(/A� 'L/Y` �N(�/S ❑ � /
CONTACT': PHONE: �'•f/Lr -BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG F.LP.CI'., "I.IJ(.1N/ MF.CfI
IV
I.ICENSIiI)CONTRALTORSDFCLARAI'ION QTY GLIICTRICPERMIT- u E P-- 'L(J/
Thereby officiation 1 anh licensed under pmvisions of Chap¢,9(conunencin6 JOB DESCRIPTION
O rYZ winSit nfUivision lnf the Business ural l'rnfeseinre Code,vnA n'y ncense is RESIDENTIAL'
f^00 FERMI'I'ISSUANCEC-F in full foaca deB'cc. /' (�a y�3 Y P ❑SFUWL [I KITCHEN REMODEI.
aVU Limns Lic.p (�a APPLIANCES-RESIDENTIAL FFZW Dam ContractorGKn ❑ADDITION C3 PLUMBING RF.-PIPE
AIICIII'I'ECIN UECLARAI']ON ❑MULTI-UNIT ❑STRUCfURAh
F 7 m PANELS
ZC) z I understood my plans shall be used as public records MODIFICATION
O Z .. UP TO 2W AMT'S
ay F,q []INTERIOR ❑SWIMMING POOL
C u�V� PAIR
hicinwJ Professional 201-IIXX)AMI'S yfAl'kOVEMfihT SWIMMING POOLS
OWNIam exempt
DECLARATION ,tW�l
� Q 1 hereby alien that 1 am exempt Imm the Contrnnor's License Law frame OVlilt I,N)AS11'S IAI'H klihlOUF:IJ AI [ F:MOLITI N
ax O6 U following reason,(Sutinn 7011.5,Business and Probacions Cosi Any oily or county SIGNS ELECTRICAL ❑OfEER
W a�m which h'ry"i res a Peron,m....struc,aIle';improv..demolish,or Leal,any structure
prior its issuance,also requires the applicant for such perma to file a signcdseammcm SPECIALCIRCU['I/M ' .
�} that he is licensed pnnuam to the provisions n(mc Cnntrxtnr'.a License lrw(Chap,ar9
(emnmenaingwuh Section 70W),olEa,sinm3ofthc Business and Pmfuriau G:da)nr TEMPMETER 0- -LEINST. COMMERCIAL:
A.W m LL Jim he is exempt Ihcmrmnt and the basis for dm alleged uxumption.Any vinlalinn nr ❑NEW BLDG/ADD["f ION ❑DEMOj'jrHON
iC Section 713156 any applicant for a permit subjects the applicant to a civil penally of POWRR DEVI :S
m—w ' y ❑IMPROV' ❑FOOD$IiHVICE
1[-.. oat more Than Evehundred
pedollars($SW). OTHFR IMPROVEMENT
C O ❑Lox nwnirk.thc pnopeny,mmyot alayces wi'bwages rsado(selcuunpeaaninn, $WIMh11NG POUT.9I.ECI
in ce will do,fie wark.and the shnnmarromn Livenstcaded Lave does not See
oUd.easiness ❑O'T'HER
63 m and l'mfexsions Calc:Thea,taemr's License Law rias not apply In un,thou n( OUTLIiTS-SW I'I'CH6.S-19XTU h O
If, who builds,......ver thereon,and
po who does re n tock himself m though
I'll Louown anmce,th,provided,bat such impros sold within are nine iyear a or offered far NP.W RI?SIDEN'I'IAI.ELIiC'B SQ IT.
onvaseLhnwevepll hvethlmimpmvancntisat heddnncild or improvetiorlar,on,late 50.Fn FLOOR AREA $/SV [IF.
her-builder will have she buNen of proving that he did not(wild or improve for pur-
e.corsulcl.
❑ L o owner of the pmpeny,.,it cxd,,Livoly ennhnc,ing wuh licensed cannart 1, T(y O
mumu the pooped(Sce.70,U,Bmeinear and Profts,ians Coca:)The Coutadnrs Li.
cense Law Jces out apply to an owner(it property who builds or improves thereon.and Q'I'Y. PLUMBING PERMIT FEE
Mile couniars basalt pot with scomn¢mgx)licensed pnaunm m,he Cmmo¢mr's
Li10cense[aw. PERMIT'ISSUANCE el
I am exempt malt,See ,H&P C for mnnou,nn
Owner
ALTER-DRAIN&VENT'-WA9'9H(EA) VALUA9'ION D
TIO
Aq WORKER'S COMPENSATION DECLARATION BACK FLOW 1'ROTIiCI'.DEVICE
I hand walarm under Penalty of ofCoyene nfthe following Worker
Cor
`:Ima,molded
maintain,Certificate nf the Lin,Code Iniref,rncOmmouce or du- DRAINS-FLOOR.ROOF,AREA,GOND. S'I'( S TYPE.CONSTR IICI'[ON
moron,as hick afar by Seaton371X1 nf,he Lmlwr Gyle,fnnhe perfonnana of rbc
work for which This permit is issued. FIAT 11RE.S-PER TRAP
1 have and will m,inmE Wnoo fs Cnmpenvnion rk for hi as required l i Section
.I7Wnf,hclaba ak,l furl¢perfnnnunccoflhc work l,r throb thiel" Iia issnal CAS-IiA.SYSTEM-I INC.i OUTLETS
My Wn set's C nsa nt Insurance emricr and Policy manb9r-�rye n OCC.GHOUL' qPN
Came[ policy N,.: IL�67�7 GAS-BA,SYS'IHalf OVER J(HA)
CERTIFICATE OF EX EMPTTON FROM WORKERS'
COMPENSATION INSURANCE GRIiASE/INDUSTRI,WAS TE INTERCEPTOit
BUILDING DIVISION FEES
flits section need not W rimplmed Base Natal is fnronehunded dollars(UIH)
or less.) GREASETRAP PLANCHECK PGE
I canify Iloam hapeflo.mtanccol the work for which lids perm LO,inruad,lx hall GpWL'R-$ANI'I'AItY-S'IDIiM Iib 2Uf11Tf.
not employ any person in any moaner se as m)scum,subject to the W..kars'Compan- ENERGY FEE
zZ salmon Lows of California.Dam WATER HEATER WNFNT/ELVMR
O Apprcam "GRADING FEE
.a pJ NOI'ICE'I'O APPLICANT':ILmlter ranking(his Cer,ilicwc of Exionsion,you sbauld Will ER SYS'I 17Mll'REST ING
become subject to the Worker's Compensation provisions of on,labor Code,you mwst SOILS FEE.
forthwith comply with such provisions(it his permit shall Tax deemed revoked WATER SERVICE
Q
� Z CONS'I'NUCTION LENDING AGENCY NEW BE IDEN'I'IAL PLMI. SQ.I'1'. PAID
U Thereby afimuhauhem iso rons,mction lending agenry for the performance of Dam ReceiplM
Lks the work for which this pe.ID is i.zvaoil(Sic.3097,Civ,C.)
Q U Iendefs Name 11TOTAL:
Iumder's Address 'IOTAD
I crafty that I have read ap
this plic,tinn and some that the abuse information is BUILDING FEE O
UZ correct.I mgree,o comply wmtalt city mail Local,ordinanax and xtmc lnw,rehningm QTY. MECHANICAL PERMIT FEE �-
Z building consionaction.and hereby authorize reMesimm''vexnf This city m enter upon the SEISMIC FEE O
above-mention prnpeny for inspeniun purposes. PERMITISSUANCE
(We)ag 'c m save, end ly and kap harmless the City of Cupcnino against IF FLECI'RIC Plili Z O
liabilities,pad boos,one and cxpcnecs which nwy inenyway accrue mgainstound City gl:fElI OR AUU YO MHCIi.
nseyucnc he ming of tis permit. NI NO FIE. r �•0
APPLICANTL ' F STANDS AND WILL COMPLY WITH ALL ON DINT ARTHANDLING UNIT GO 10.1X)CFM)
E U..... .FEE
SOURCE:REGU 1 NS.
AIR IIANDLING UNI'I'(OVER III,B1)CFM) .( S '1'A%
Signmure ofA plica Dole EXHAUST HOOD(W/DUCI) JUL- HOUSI MI'fIGATI(IN FP.E.
k ABOGUS MATFRIALS DISCLOSURE U1- \ IrV
Will,heapplirnnt outman bulldiagnecupmn smreorhandle haeaNminaterid HEAPING UNIT(TO 100,000 ITT ID
ax deem!by the Cupeniw Municipal Code,Chapter 9.12,and the Health and Safely h "r—ch f IIx-
Code,Section 25532(a)' HEATING ON]'I(OVER I(to,(" 11'1'U)
❑Y F)No VEN'IT LATION PANS I NOTE RES I D) PAID
Date Reeeip'M
ha
Willapplicant mfuture Wilding use BOILERCOMP(BEPOR1W,0001M)
D') zun!ua,us oraminu
mtanex os Achby the B -
ncd by me Buy Area Air Quality Management "OTAL:
T1 inP
❑Yu C]No BOILER-EDMP(DVEH IW,gX11iTU)
Love reed the cojohix mmen,A as mead no u Tor Chu oar h95 ofdm Cali- AIR CONDITIONER
I 1 ISRUANC:DATE
calfomiugdoss.&Sally Code.Satinst.that,is my and 25531!unotifyth that it NEW HI31DIiNTIALMIiCH. $Q.FT. 1 ��
buildingJcesnot currently have atenant,Thato ismyorof. coificanotifymepaccy. i-
o(theregniremems which must be met priormisxu,ncc nf,Ccnifime of Occupancy. ? /�
Owneroraumuried agent Date TO < ISSUEDBY: V�d T/` _ r k i!Q
OFFICE
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PERMIT#: ARCHITECT: iALUATION:
ICENSE A
APN: 35709051 ISSDATE: 07 20 98 #
"US STREET: SCENIC I 3UBDATE: 07 20 96 j
SITUS NO#i 10012LCHKDONE: t( 1
TYPE: RSX ATE CODE: iJ
/E,CTST,RD: BL 0 I�f �� f
3LDGDEPT: t
N,S,E,W: ESCRIPTION:
NO# :NGDEPT:
: N11it+I�J J�I�f Pil
CITY: CU PLAN, 1,
ZIP: 95014 'LCHKREO: CMA:
;ATEGORY: CTRFIRE:
-OT#: 0 )ATEDUE: SANDISTIII� 1
1LTHDEPT: I�I
D: mmercial M
OWNER: BEARD STEPHEN CAI CA-sq#ft#: iTRCTENG: it�llYl�, t �l�Jal
TOTAL:
OWNER 100125CENICBL CE-sq#ft#:
NSPHOLD:
ADDRES CN-sa#ft#: f fIf�I �I IIf
YSTREET,ZIP: CUPERTINO CA
'HONE: -sidential
RN-sq#ft#: � I t
)NTRACTOR: 680463 INO KTCHN' RE-sa#ft#: 0 ......
�IIII,I�IIy)
LIC#: 660463 .US-sa7/fl#: 0 , 'Search by q Irt�rlf
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