31187 1APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCOPERTINO BUILDING-ELECTRICAL PERMIT NO.
NUIhDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL
BUILDING PROJECTIDRNTIPIC1'1'[ON 31187
BUILDING ADDRESS. SANITARY NO, APPLICATION SUBMI'MAL DATI
i_ S T S (-71?1 r
1 W ER-SNA f Y Q PHONE: CONTRACTORS NAM- LI' OL
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C r$ GJ.Pt ff- N/C CONTR ,
all
iCl{ITECT/ENGINEER: - LIC NO: ADURSG 1UI� IT VfGW L/'1'" ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby W irm that I ande
t licensed unr provisions of Chapter 9(crmmenci"6 JOB DESCRIPTION
�0Z with "hon 700(a of Division 3 of the Business and tial cesions Code.und my license is RESIDENTIAL
to ill force and el L PGRMD'ISSUANCE '
Fa�.V L¢enx x Lica ����� CSFDWL KITCHEN REMODEL
col Dote Commctm�jt_g�_ APPLIANCES-1{FSIUENTIAL DITION PLUMBING RE-PIPE.
I-•p ARCHTIECPSDECI7 A PANELS - MULTI-UNIT CSTRUCTURAL ,
Z p�� I understand my plans shall be used as public records - MODIFICATION .
O Zt UP TO 2M AMPS
1-En Licensed Pmfexsmnel. ❑INTERIOR ❑CHIMNEY REPAIR
a 20F1000AMPS IMPROVEMENT
X .I OWNE&BUILDER DEthe CmeRAI'ION OVER H W AMPS C BATH REMODEUREPAIR C DEMOLITION
—y C 6 l I hereby aErm That I em exempt from the Contractor's License Law far the -
5d34V following Mason. 7031.5,Business and Prelbuions Code:Any ciDer enmity SIGNS ELECI LAICAL COTHER
4411
0 which routines a m
po ut res cwd
nnshe,improve, mol
demolish,or minor any southern
CION prior m its issuance,also requires the applietal for such hermifin file a signed dialraenl SPECIALCIRCUIT/M1SC.
Q� that Ye is licensed pmamant to the whoolims of the Contractors License Law(Chapter Y
(uommmcimg with Section 7000)of Di vision 3 of the Bounessand Prolexsime,Ctde)m TEMP.ME'T'ER OR POLE INST. COMMERCIALP
44 o C that he is exempt thcmfmm and the basis fur the alleged exemption.Any violation of CC]NEW WG/ADDITI/ DEMOLITION
i� tc Suction 7031.5 bynny applicant fora permilsubjects the oppliona ton civil perdly of POWER DEVICES
1„ZN hilt more than rive hundred dollarsFlood). CI'ENA FOODSERVICE
Q ❑ 1,as owner of the properly.or my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC OVE NPC•
^�¢• a will do the work,and the sauctore is not intendedorrffmed for sale(Sect7014,Business El
W m and Professions Cat The Contractor's License Law does not apply to im owner of ThETS-SWI"fCfIES-PI%TURES ` •Z n
6w^ property who builds or improves thereon,and who does such work hints...'..Through
his own employees,provided That such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ IT.
sule.IL however,the huildingmimmavnnem issolJ within one year of complctinn,the SQ.FT,FLOOR ARA $/Ski.FT
wner-buildcr,will have the buNen of proving That he did not hddor improve for Our- W '
post m sole.).
C 1,as owner of the property,an,exclusively contracting with licensed crnTmctors to
conduct the project(Sec.70M,Business and Professions Cade,The Commemr'1 Li- '
cense law does not apply to an owner ofproperty who builds car improves thereon.and QT'Y PLUMBING PERMIT FEE
whe rantmcls frrmch pr icet,wfdr s untoador s)licensed pursuant to the arnvmrors
License law. PERMIT ISSUANCE
CI am exempt under Sec. ,B&PCfmthismason
Owner Umc AITHR-DRAIN&VF, - AT (EA) VALUATION
WOR KERS COMPENSATION DECLARATION
BACK FL(IW PKOTIiCI'.
1 hereby af0rm under penalty of perjury ane of the following declarations:
C(have and will maintain aCenilicute of Consent msnlhinrure lit Worker's Compcn- DRAINS-FLOOR,ROOR REA.
0C STORIES U. STORIES TYPE CONS I RUCTION
tion,as provided far,by Section 37M of We Lubar Cole,Jordan pe,fannancu of the
won for which this permit is fxs rod. FIXTURES-PER TRAP a
C 1 have and will maintain Worker's Compensation Insurance,as required by Section
3900 of the tamer Cede,for the performance of the work for whiehthis permit is is sued. GAS-PA.SYSTEM-I INC.4 OUTLL'TS OCC.GROUT' APN
My Work AS ygTtpenjetiyp tax y�nce cumierolicy oJc -_ , �zb ,GAS-t
artlJI1..� CA Is7r Policy No. IA.SYSTL'MOVER4(IiA)
CERTIFICATE OF EXEMPT[ON IBD W RKERS'
COMPENSATIONINSURANCH GREASEANDUSI'RL WASTE IN'I ERCEPOR _ t IL GDIVISIUN FEES
meulnst h completed if the permit is for one modred dollars Sl W) GRHASETBAP
or less.) 1'LA 'E
leedily Na inlheperfonmancemflhewark fmwhichlbis permit is issued,Isbali SGWL•1t-SANITARY-STORM HA.2(q fT
Whoulloy,my plownimany mannersoasmbecomesuhjecl .We WarkeNCompem . > WE
smarm Laws of Calif..,..Date
zO Applicant WA'I[RIIEATER WNhNT/ELECTR GLNGFEE
py NOTICE TO APPLICANT.If,alter making this Certificate of Exemption,you should WATER SYSTEM,TRHATING a SOILS FEE'; became subject to the Wedmel Compensation provisions of We labor Code,you must
W Lortbwith comply with such previsions or this permnslanl be deemed revoked. WA'T'ER S URVICE.
L Q
5z CONSTRUCTION LENDING AGENCY NEW RES)DEN]IAL PLMB SQ.FT PAID
V Q I hereby notion Nat there is a construction lending agency for the perlourance of I Receipt,
1 the work for which this portal(is issued(Sec.3097,Co,C)
C U under',Name TOTAL:
W IaMeYs Address
4 I certify that 1 have read this application and state that ate above information is BUILDING 1' e
U) coned.l anew to comply with all city and county onimtnces andstale laws relalngm QTY. MECHANICAL PERMIT FEE
V Z huiidingconstmclion.and hersebyauthmice raptexntxpou;olthiscity loenterrpan the SEISMIC FET? I�-
above-mentiuned Property for inspection purposes. PERMIT ISSUANCE
(Wel agree nr cavo,indemnify anJ.rep hamdeu the City of Cupertino against, ELECTRIC PE '
liabilities,judgmerm.costs and expemes which may in any way leant against said City ALTER OR ADD TO MUCH. PLUMBINGP �
mance of thr granting of nrle permit.
APPI•C "UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT AIR HANDLING UNIT(TO lU,000 CPM) MECHANICAL IiF.
SOf CI If TIONS. r
i AIR HANDLING UNIT(OVER 10,000 CPM) CUNS'1'RUC'TIU TAX
Siamre AA,fcratoc v:rcurr Date IIHAUST HOOD(W/DUCT) HOUSINGMITIG TIONA.E.
HAZARDOUS MATERIALS D CI SURE
Will the applicmn or future building occupant s o or handle hamrdous material HEATING ON 11(TO 100.OW B'TU)
as defined by the Cupenfno Municipal Cale,Chapter 9.12,and the Health and Safety
Came.Section 25532hoo HEATING UNIT(OVER 100,000 BTUI
❑Yes No VEN'LLATION FAN(SINGLE RESID) PAID
Will the applicant or future building t use equipment or devices which De. Receipt,
PP dby the
Area
BOILER-COMP(3HP OR 100,000 B'DD
thatual
mit hmvduua air cumemimmhs as defined by The Bay Arca Air Quality Menagemcnl ,TOTAL: '
BOILER-COMP(OVER 100,0(10 BTU) -
0Yes No
I have mad the moradous naarimis requirements ander Cho(95of he Cali- AI R CONDITIONER ISSUANCE DATE
forma Health&Safety Code.Sections 25505,25533 and 25534.1 understand that nine NEW RESIDENTIAL MECH. SQ.FT.
building dues not ruffianly have a reran.that it is my msponsibilhy to mortify the trecup ht
of me requirchu nes which must be met prior to issutmrc of a Certiricum of Occupancy. '
Owmermoothonsedagent Date ISSUED BY:
OFFICE
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• RESIDENTIAL PROJECT COVER SHEET
Cupertino
Assessors Parcel Number:
Name of owner. Y,V,C#
Project address. -TaA STEWD H/'}I, 1,7%1 E-
Contact person. Phone.
Fax. fb 9q/
Net square footage of lot. � � 00
Existin Proppsl;
Square footage: First floor: — V�o
Second floor: �
Garage: 400
Are there at least two 10 foot by 20 foot clear spaces inside the garage? O N
•
On what floor(s) is work being done?
Brief description of work. -5M 4,A
erW(" VY)w ey'L34lY4 uvty�"
Code editions: 1994 UBC (Y -N)1994 UFC (Y-N)1994 UMC (Y- N)
1994 UPC (Y -N)1993 NEC (Y-N)
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Plan Review Process Work Book Page-7-