24482 I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-F.LF.C'I'RICAL PERMITNO. /1 /1 /I HZ
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
IIUILDING PROJECT HBINIIFICAIION L[F LF
BUILDINGADDRISS SANITARY NO, AP1PLICATION SUBMEITALDATE
UNIT# LOT is I II I
OWNS AME: # P ONI?: ) CONTRACTOR'S NAMIi: - LTC NO: I Ila
NA] CONTROL#
•ARCHITECT GINEER: LIC 'O: ADDRESS: ❑
ISLM 606
CONT PHO 1. QTY. LLL4'f
a „ RIC PLR MIT FEE BUILDING PERMIT INFO
LDG ELECT PLUMB MECH
PERMIT ISSUANCE '�`•
LICENSEDCONTRACTOR'SDECLARATION APPLIANCES-RESIDENTIALOU OISCRIPIION
py�Z I hereby affirm that l ten licensed under provisionsof Chaper9(commenting with L'
u100 Section 7")of Division 3 of the Business and Professions Code,and my license is in PANELS `
y'bE full forcemd chisel. Wp�/
F^ µ1 license Class I'le.0 UP TO 2110 AM PS
ao,y Dat, Cmmmmmr 201-IINX)AMPS
zIyz ARCHITECTS DECLARATION OVER IIXIOAMI'S SQ.FT.FLOOR AREA S/SQ.IT.
O Z—O I understood my plans shall be used m public records.
P H F; SIGNS ELECTRICAL
q'g; Licensed professional
�J OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
4 a F I hereby affirm.(Sc that I am exempt in from the Connector's Limens,Law for the
3 LLy fihich requires a.Perini
frim to lB3LS oi,alter,
land ve,de fissions Cmle:Any city or county TEMP.METIi t OR POLE INS']'.
which requires issuance,ealso m constrthe aper,ud farar su demolish,nr repair any suucwrc
bathe slicenedIF also ...th the provisions
Co permiuofile Lice sinned!smmment POWER DEVICES
w,,C) that he is licensed pursuanno me pmvrsmre of the Contractor's License low(Chapter
as 9(commencin with Section 7" (Division 3ofthe Business and Professions Code SWIMMING POOL ELECTRIC
Ko� (commencing )m ) VAI.Uy((yy
y)_y or in.,Sectio 7031. byon,mpt re(rom end the basis fmbpri,dbe thedexemption.Any violation of IITLETS-SWITCHES-FI%TURE:S C.JG.�
4 Section]than
anydred donors $p;rnitsuhjects the u.plicannoecivil.,Daly of C)Cr)�►'��
not mare Than live hundred dollars yemp. or, NEW RRSIDIXI IAL ELECTR 5 .FR L('�✓/
ca ❑do the
wrk,anhepropeny,gnnyempinded!wilhwagexaslhei(See eompensiness Q STORIES 9'YPG CONSTRUCTION
v. will dothcwon,and ie swcturelsom intended! Law does not
ply to an .e,of
and Professions Cnle:The Contractors License Iso does not upp1Y to w owner of
p Arent whnbuildaorimprovesthcreon,andwhodcesmch work himslfonb..ughhis
ownemployms,Woyided that smchimprmvementimenot intendcloroffered forssle.if. OCC.GROUP RES.UNITS
however,the building or improvement is sold within one yeonfei mpletion,the Owner-
builder will have the harden of proving that he did not build or improve for purpose or
sle').
❑ I,as ownooftbcprnpeny,umexcblsivdyconvactingwith licensed amtmctors In QTY. PLUMBINOPERMI'T I'liv FLOOD ZONE APN
construct the project(Sec.7044,Business end Professions Code:)'The Comment's
License Lawdoanat apply to an ownerofpropenywho builds crimproves thereoq and PERMIT ISSUANCE
whoconrwas forsuch projects with a contractods)licensed pursu into the Commissions
License Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ Ion exempt under Sea ,B&PC for this reason BACK FLOW PROTECT.DEVICE I SIDEFEES
SANITARY YN
Owner Dam DRAINS-FLOOR,ROOF,AREA,COND. RECEIPTN
WORKMAN COMI'IiNSA'1'ION DECLARATION SCHOOL'1'AX Y_N
❑ IM1ereby aflirm rhmlhave acenificum of consenno self-insure,nrucmi6catc of FIXTURES-PER TRAP RECI71PT#
Workers Compematian lrlsurance orucenificJ copy therwf(Sec.3go11,Lab CJwhich PARK FEE YN
vers all emdiwa e's under this perron. GAS-FA.SYSTEM-1 INCA 0If1'LtTS RECEIPT X
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FE
C] Cenifed copy is hereby fumishW.
❑ Cenifed copy is fled with the city inspenian division. GREASE.NDUSTRL WAS'T'E IN'T'ERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE MAP SOILS PER
COMPENSATION INSURANCE
(This a,aion need nm becompleted ifthe permit is forms,hundred dollars($160) SEWER-SANITARY-STORM EA.200FT. ENERGY IEE
or less.)
I certify that in the performance of the work for which this permit is issued,I shall WATER I]EATER W/VENT/ELF.CIR
not employ any person in any• mtnner so as to become subject to the Worker' PAID Compensation Laws ml'Culimmin. DateWATER SYSTEmirREATING Dom Receipt#
p z Applicant
Z 0' NOTICE TO APPLICANT:If,aficnnakingthis Certificxmof Exemption,you should NEW RESIDENTIAL PLMB.—SQ.F .TOTAL
V], becomemlicorto the Workers Compensation...visions ofine Libor Gtle.you most
formwirh comply withmch provisions in this permit shall be,centered revoked. BUILDING FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE:
z I herehyaffionhut them I,.construction lendingugency Ionic performance of
O the work for which lois permL is issued(Scu.3091,Ci,C.) TOTAL: ELECTRIC FEE
Lender's Name PLUMBING FEF. ]
OO Lenders Address QTY. . ` MECHANICAL PERMIT' FEF.
1 cenify mot I have read this aprlicafimn and state that the alwve information is
correct.l agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE MFC11ANICALMEE
building construction,and hereby authorize representatives ofthis city to enter open the CONS'IAUCf10N TAX
U 7 above-mentioned property for inspection purposes. ALTER OR ADD TO MECH.
r7 (We)agree m save,indemnify and keep harmless the City of Cupenmo against
labil' talonents,costs..draperies whichmay In any way arenon,marea aid City AIR HANDLING UNIT(TO 10.000 CFM)
thegr ting this c it.
' AIR HANDLING UNIT(OVER IO,IXXI CFM)
Signature of Applicant/Contractor Dale EXHAUST HOOD(W/DUCI)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,1100 BTU) Date Receipt Is
Will the applicam or future building occupant store or handle hazardous material
as defined by thu Cuponino Mun'Ipxl Calc,Chapter 9.12,mid the health and Safety HEA'T'ING UNIT(OVER I(RI003 BTU) T
Code,Section 25532(x7! VEN9'ILATION FAN(SINGLE RFSID)
❑Yes No
Will the applicant neonate building occupant uu equipment nr devitts which emit
BOILER-COMP(311P OR 100,000 BTU) ISSUANCE DATE
tiazodous air commissars as deE d by the Bay Area Air Quality Management BOILER-COMP ICY MI Ioo,o1N1 B1 U)
IsrdcB
El Yes No NEW RESI DENITIAI.MECH. SQ.FT.
1 have read the hazardous materials regairemems under Chapter 6.95 of the P A I D
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that AAl1 �/ 1
if the ]ding drcs matt carrawyI lava tenano
.chat it is my responsibilitymnmYfy me IY01! i 3 19
f the r uirc u w 'civ r met prior to issuance of n Certificate of
�I i #
owner Maul n and agent Dae TOTAL: ISSUED" Ill
OFFICE
4r SANTA CLARA COUNTY .
• CENTRAL EIRE PROTECTION DISTRICT CONTROL NUMBER
O 14700 WINCHESTER BLVD.
LOS GATOS.CA 95030-1818 (408):178.4010 PERMIT NUMBER
SERVICE tdA SINCE 1947 FAX(409)378 9342
PLAN REVIEW COMMENTS
CODEbEt. SHEET NO.
•
i'
.KRIS. PUNS SPE .NEW REMODEL AS C T.DESCRIP. BY -`J DATE PAGE
❑ ❑ L0 I II OF
8E JFLOOR FZ �qCC 000. OAD AREA ARCI4ENGICONTRACTOR�OWNER Tp
JICJ)1 �—
ACt
I��r�c
4 I LOCATION
Serving West Valley Cities of:
Cupertino, Monte Sereno, Saratoga, Town of Los Gatos, and Adjacent County Areas i.
Palem.s H3002
TOILET MEET i
�{ _s`o(RAGE TO Et�T
/ d �
r
4
f f� I�
OFFICE
4 040.
SCOPE OF WORK
Move existing wall on
right side to right approx.
1' }" and move front wall
approx 2! }" forward.
Move ceiling light fixture
to accomodate wall movement ;
Move electrical wall switch
and replace in same location
when wall is moved.
Repair ceiling grid
APPROVED
IN ACCORDANCE WITH THE CITY Of
QPJERTINO CODES AND ORDINANCES 10
DATA 1 J�+r—G_7 OPEN OFFICE
SIGNED-
,This
IGNED This set of plans and speciilcstion MUST
be kept on the job at all times and it is un
lawful to make any OnnW, of alteration.,
on same without Wti1t,,1 porm,ssion from
the building Dept., City of Cepa 0G.
The stamping of this p:.n,,nd s;tttUtcations 0
SHALL NOT be %liol M p: ae 0: 0 n❑
vbe er. n
. approval of the ioatir.n ril pfd`
of any city OFV'R�l?6f IY VFfthOIAL 1I0U 16 1992
20375. Stevens Creek Blvd
:.Cupertino, CA
BLDG: INSPECTION DEPARTMECyT
CITY. OF CUPERTINO.
CONSTRUCTION PO
OFFICE COPY AND- FINISH PLAN
)ARD DUPLEX OUTLET I
.S 1°" ALO\'E FIN . FLY .
LLU—
_J)
CRAMP