19823 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ✓.
Building Project Identification PERMIT NO.
•' Bulldrng Address:
220, 93 STocht� .r. ,�T H23''
Name: - Phone: A
CITY OF CUPERTINO,BUILDING DIVISION,_„
Comrachm"N.me: Lm.Nce APPLICATION I PERMIT 3 —
SC/"iby�^/ S tib xl r� /SL)7 J Y.
Archlietl/Engineer. Lle No: BUILDING-ELECIRICAI PLUMBING-MECHAMCAL CATEGORY - CONTROL If
' O
IQIY'` ti ]t ELECTRIC PERMIT 'ti' �It '•�FEE't ..�1fBUILDING PERMIT'INFO'•'.;t .•4 .
Add.:
. - '_ _ PERMITISSUANCE •, E] ❑ ❑
Lm that Ism
CONTRACTOR'S DECLARATION
I heh Sectio irm )clam BcensedheBusiem.under od of CEai.t,r9dco,..d < APPLIANCESRESIDENRTAL JOB DESCRIPTION
it se 1.
7000)ofd offeon3 ofthe Businesaand Pro(e.eloneCode,and my 1
trans.lslnfuD rce and dfeR. PANELS '
Licenx Clan / Lk.N 4i S) )IAB' S
' Date 4 ARCHITECI•SD LAR 1 201-1OD0 AMPS - - �`, `
Is I understand my pians shall be used as public record.. OVER 1000 AMPS SQ.FT.FLOOR ARA $/S4.FT.
t;qLicensed Professional ' SIGNS ELEC L -
OWNER-BUILDER DECLARATION L �C
Z F., ?, I hereby affirm that l am exempt from the Contractor's License Law for the SPA _ -
R. following reason.(Section 70315,Business and Professions Code:An tl r
Fcmntywhichrequlresaper tWcmwtmcgalter,impmve,demolbh,orrepalr TSP EITR EIN
q Q anystruaure prlor wits Issuance,also requbealhe applicant forsuch permltto 'POWER 1
rye, U fila e la W
a signed statement that hlicensed pursuant to the prolons of the -
opp
OwFF Contractor's Licase Law(Chapter 9(commencing with Section 7000)ofDivi-
H�OJ sion3 of the Business and Professions Cade)orthat he is exemptthercfromand SWIMADN LELE C VALUA.L]ON
�i•77 the basis for the alleged exemption. Any violation of Se cion 7031.51 any 0 0 -
6X applicant fora permit.ubjectathe applicant to a civil penalty of not morethan O 7 I D_Q O s
five hundred dollars($SOD). NEW RESIDENITA LECTR ,SCO FS TYPE CONSTRUCTION
�n ❑I,as owner of the property,or my employees with wages as their sok
compensatloNwilldothe work and thestwcture la not Intended or offered for _
Osale(sec 7064,Business and Pmfessiom Code:The Contractors License law
$ does not apply to an owner of property who Wilda or Improves thereon,and
t +^ who does suchwork himself or through hisown employees,provided that such OCC.CROUP RES.UNITS
Improvements are not Intended oroffered for sale.IL however,thebullding or TOTAL:
Improvement is sold within oneyearofcompletion,the owner-bullderwlll have
tl�urden of proving that he did not build or improve for purpose of sale.). `Q7y� y�i PLUMBINGWWIT,3it, I�+FEE';4 FLOOD ZONE APN
u L as owner of the property,am exclusively contracting with licensed
' contractors to construct the project(See.7044,Business and Professions Code: PERMITISSUANCE
The Contractor.License Law does not apply to an owner of property who ALTER-DRAIN&VEM-WATER(EA)
Wilda or Improves thereon,and who contracts for such pW" with a
gIlVaRor(.)licensed pursuant to the Comodio is License Law. BACK FLOW PROTECT DEVICE i`..•r ,FEE SUMMARY'.'.,1
c Lf I am exempt under Sec. B&P C for this reason '
O Owner DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N—
Date
WORKMAN COMPENSATION D[CLRECEIPT N
ARATION PER TR
❑I hereby affirm that I have a cert10cate of consent to selLreFIX.TURFS AP SCHOOL TAX Y Ninw
,or RECEIPT If
380D,lcateLab CJ GAS-EA.SYSIEM-1INCAOUTLET5 of Workers'Compevatlon Wuonce ora renitled mpythemof(Sec. •'
330D, PARK FCIi 'V_ N—
_ pollry N GAS EA.SYSTEM-OVER 4(EA) -- INGD'T
Comp
a v BUILDING DIVISION FRES
entified copy V hereby furnished. GREASE/INDU5IRL WASTE INTERCEPTOR PLANCHECK FEE
Cent/led ropy V filed with the city Inspection dlvlMon.
CERTIFICATE OF EXEMPTION FROM WOR KERS' GREASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Date Remi p 19
(Thos I..) need na be completed IftM permit bfar one hundred dation
($100)oiless.) WATER BEATER W/VENT/EI.ECTR . 'ENERGY FEE Y N
(certify that o any Personhe i an the worknner sfor
aswhich b co penitis Owed, —
I shall not employ any person In any manner w u to berortr wbjM to the WATER SYSTEM/TREATING
Workers mpenvtion Iowa of California.Dae PAID _
Z Z Applicant - NEW RESIDENTIAL PLMB. Date Recei t#
Z O NOTICE TO APPLICANT.If,after ma king this Certificate of Exemption;you c"Q'FT'
Hshould become subject to the Workera'Compersatlon provisions of the Labor TOTAL:
W Code,you=at forthwith comply with such provisions or this pornJtehall be UIL '•E _(1
W > deemed revoked. .,
CONSTRUCTION LENDING AGENCY SEISMIC FEE
a Iherebyafflrmthattharebammtwnlon lendingagenry forth.pedorrry ELECTRIC FEE
7.Z sore of the work for which thispermlt la lswed(Sce.3097,Ci,C,) TOTAL:
U O LenaeraMaone PLUMBING FEE
IL — Lendre.Addres. QTY. MECHANICAL PERMIT• MECHANICAL FEE
O O Irer(Ifythatl have read lhLsappBraponand Gatethattheabovelnformatlon
Ismrect.lagree tocomply with all cityand county ordinances and state laws PERMIT ISSUANCE FEES PAID:
} 1 relating to bullding construction,and hereby authorize representatives of thisIn
-
Z oily to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. Date Ree¢i f#
— (We)agree to save,Indemnify an d keep harmless the City of Cupertino p
against liabilities judgments,rosreand expenses which may In anyway same AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: —
agairstaaid Clty ln.cm enceof the gr ng of this pe It
AIR HANDL(NG UNIT(OVER I O,ODO CFM) CONSTRUCTION TAX
S mreot loot ra Date FAHAUSTFTOOD(W/DUCT) CONSTRUCTION TAX PAID:
SMATERIAL ` 5 OSURE
Will theWill the app mb ilding occupant store or handle hazardous HEATING UNIT(TO 100.000 BTU)
material as defined by the Cupertino Municipal Code,Chapter 917,and the - Date Recei t# -
I kulth and Safety Code Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑YeaNo
Wiilthea pplicant or tum building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) IVII Na DATE
which emit haaardous air contaminants as defined by the Bay Area Air
Quality Management District? . - - BOILER-COMPOUPOR100,O00BTU)
4 Yes No 1v1Y �JSIJ
the 21have radthe hazar case materiab requlremenbunderChapter6.95 of BOILER-COMP(OVFR 1011,000 BTU( K (]J
ifdrnia Health&Safety Code,Sections 25505,25533 and 75536.1
understand that it the building does not currently have.tenant,that it is my- NEW RESIDENTIAL MECH. SQ.FT.
re,ponsibll try to na tty the occupant oft he requirements which most be met Cft'j of Dris ('ino
prior to Issuance of a Certs fi4a of Oc
Owneror aur age '� - ate
TOTAL: ISSUEDBY:�,. \; 1AVC'L
OFFICE COPY
March 1, 1990
City of Cupertino
Building Department
Cupertino, CA. 95014
Dear Sir:
The Meadows of Cupertino Homeowners Association approves the
installation of skylights in the master bedroom of the residence
located at 22093 Stocklmeir Ct. Sundance Skylights, contractor's
• license no. 457755, will install two 2x4 white double dome skylights.
No rafters will be cut.
Sincerely,
Ann Cleaver G GRAI m t�HL/N
Architectural Control CpresldeA'w ,
•�3oC+rB of O1rEU1�rS
Meadows of Cupertino Homeowners Association