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20884 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building uneIlre"ct°/rE''n r. Prate aIdentification 77777 PER [TNO. BildingAd y LCY )(VV 20884 0RR4 me; Pf , S�llOST^° g6 � NameLIic. APPLICATION /PERMIT _ _1 LNNoBUILDINGELECTRICALPLUMBINMCAL CATEGORY NTROIQ QTY ELECTRIC PERM FEE BUILDING PERMIT INFO ld,�l PLUM Address: of (� PERMTISSUANCE K71 ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION IATJ —II IherebyafflrmthatlanficansedunderpmvWomof Chapter9(commac APPLIANCES D JOB DESCRB'1 ION inense Ia Section 7000)o(Dlvielon3e(the Buelncuandl'ro(eealenaCode,and my license I. full f and dfect. PAN©S 'nWznseC LIONAle e I ntncter ARC"IECI`S EC A ON ?(11-1000 AMPS gyppp!!N O I understand my plem sbzllbe used as public records. OVER 1000 AM11 SQ.FT.FLOOR AREA $/SQ.FT. Llrensed Professional SIGNSELECTRIC <<�6 tEi7c OWNER-BUILDER DECLARATION SPECLILCIXCUIT/1,19C Is' Ihereby a(RrrnthatI am exempt from the Contractors License law for the qq foHowingmason.(Sedion7m15,Busineaand Profewbns Code:Anydtyor F'ul muntywhlch requUesa permit tomtutruct,alter,Improve,demolish,orrepair TEMP.MEI'FJ4OR POLE INST. 5 'ii anystvcwre pdortolts issuance,alsorequlrestheapplIant forsuch per at to t� Q ]OWER DEVICES , V file a signed etatement that he s licensed pursuant to the provisions of the Owl Contractors License law(Chapter 9(commencing with Section 7000)of Dlvl- SWIMMING POOL ELECTRIC VALUATION slon3oftheSusimsand Pmfemlom Code)°rthathebemmpttherefmmand p Y3 the bass for the alleged exemption. Any violation of Section 7m1.5 by any sOO rM pS apphant fora pet subj btheapplicant to a civil penalty of net morethan OUTLETS-SWITCHESFIXTURFS (f five hundred dollars;($50Q. NEWRESIDENDALELECTR SQFT. STORIES 7YlsE GDNSIRIICTIDN �n [:]I,as owner of the property,Or my employees with wages as their sok compensation,will do the work and the structure gnat Intended or offered for O sale(Sec.7044,Business and Professlomba Code:The Contractors License Law 3 docs not apply to an owner of property who builds or Improves thereon,and OCC.GRO RES.UNITS who doe aeuchworkhlmsaBorthmagh Neownemployea,provided that such improvemcnb are nm Intended oroffered for sale.If,however,thebulldingor TOTAU improvement'soldwithinombayearofcomplmt mtheowner-buHderwlllhave tflektrden of proving that he did not build or Improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD TONE APN LJ I,as owner of the property,am exclusively 0011—Hng With Ilmved PERMIT ISSUANCE contractors to construct the project(Sec 7014,Business and Profesdom Code: The Contractors License Law does net apply to an owner of property who ALTER-DRAIN k VENT-WATER(FTU builds or Improves - thereon,and who contracts for such pwoots with a FEE SUMMARY corVctor(s)limnsed pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE 1_I I am exempt under Sec B h P C for this reasonOUTSIDE FEES • Owner Date DRAINS FLOOR,ROOF,AREA,GOND. SANITARY Y N_ RECEIPTRIECEIPT p WORKMAN COMPENSATIONcaniflge DECLARATION FO(`rURFS-PER TRAP SCIiOOLTAX Y N_ ❑i hereby affirm that I have a l rt rune of convent to pytherre,ora RECEI'T 0 MoD'L.�difiatealWorkers Compevatlonlwuranaaacertifled copythereo(PBec. GAS EA.SYSTEM-1 INC4 OUTLETS PARK FEE Y N 3800.Lab C.) - P°Ilcy Y RECEGAS EA.SYSTEM-OVER 4(EA) DING Df N Com any - BUILDING DIVISION FEES �Ce'[tied copy s hereby furnished. CREASE/INDUSfRL WASE IN77➢TCQ'TOR PLANCHECK FEE ❑c mfied copy s filed with the city inspection dlvslon. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE IRM PAID 9 COMPENSATION INSURANCE SEWER-SANITARY-SHAM P.A.� Date Recei t# ($110)cl� (Ihssen ss.) eM nal be<ompl"ed If the perMt'torose hundred dollar WATER HEATER W/VENT/ELECTR ENERGY FEE Y N ]certifyifythat tithe performance o(the work for which this permit bssued, I shall not employ any person in any manner sa as to become subject lathe WAT'FT4 SYSTEM/TREATING Workeri Compensation law.cf GRfoms.Date PAID ZZ Applicant NEW RESIDENTIAL PLMB. SQTT. Date Reeel I# O NOlicant AI'1'LICANT:IL after making the Certificate of Eaem)rtlon,You should become subject to the Workers'Compensation provslmu of the Labor TO AL: F' W Code,you must forthwith comply with such provisions or this permit shall be W > deemed revoked. N TW d c CONSTRUCTION LENDING AGENCY SEISMIC FEE 4 1 hereby afflrmthat there s a corutmction lending agency for the perform ELECTRIC FEE L) Z anatithework(cam which this permits Wued(See 3097,CIv.CJ TOTAL: PLUMBING FEE () 2 [enders er'sNName LL F Lendcr's Addrns QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW 1 artllythat I haveread this appllationand state thattheabove lnfomuHon a srorreci.Iagreeto complywithallcityand countyordlnanceaand nate laws PERMTI ISSUANCE FEE$I?AIU_ } relating to buildingmrutructlogaadherebyauthmismrepresentativesofths e�q_(� ._7k-Z 12 city to enter upon the abovcmentbrud property for Inspection purposes. ALTEAORADDTOMECH. Date ReCel t# e)agree to save,Inde as d keep harmless the City of Cupertino agalml habil ,? gore sand expcnan which may lnanyway.ocue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: .it CI I co era ofthegrantin It. AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX I ammo p ontrac[orr Qlfiv EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle haaardous HEATING UMT(TO 100,000 BTU) mstedalasdefl dbylhe Cupertino Municipa)CW,Chapter9.(Z,andthe Date Recef t# FlealthandsafciyC Ian Z5532G)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: ❑ Yes Will the applicant er tum buildingmcupant me equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE whichemlthazardous rcontaminants..defined bythe Bay Arca Air • Quality Management -lict7 BOILER-COMPOHPOR1DBOMBTU) TI Yee uo have mad the hazy ous materials rreqrequirementsN requirements under Chapler6.95 of BOILER-COMP(OVER 103,000 BTU) ABr the California Health k Safety Code,Sections 75505,75533 and 25534. 1 understand that if the building does not currently have a tenant,that it is my. NEW RESIDENTIALMECA. SQ.FT. ��,.m a 190 responsibllllylo the of the requirements which must be met r ❑ 1 prior to baa cots .'E o(Om an Own or th ate TOTAL: ISSUED BY: J OFFICE COPY DESK14ER - - NORTH CORNE STEVENS CREEK 5LVD. PROJECT DATA HABER w TEL. '415rAvM�`I9 t4 . OR7 PROPERTY ADDRESS: 21-I99 LOMITA AVE. .. EXISTING LOT SIZE 503-IB SQPT. 4 EXISTING HOUSE 2000 SQFT. Ow NOu Pm UALL T`�°�Tw Goy° 50 FT. EXISTING SEWER CONNECTION —•---•---•—•— —•— --• — —• — ------------------ 4 WITH CUPERTINO SYSTEM Lu ui NO SEPTIC TANK ON SITE Y j 3: I LOMITA AVE. Z - U O ZONING R-1-fo (N) - 4 m 1LL - O - GARAGE _ SUBJECt PROPERTY 1 LOCATION MAP NOT TO SCALE SIDE 21 SET5ACK I I i I . I :51DE } I = SEi5 CK I I ADJACENT Wj I D I j 0 ADJACENT ' u PROPERTY PROPERLY TAR 4�WL ROOF ON So PCLT a oN IR'rL„UOOD W Orr.Go. _ �I 10- EXISTING 16'_$I I I ON Dei 16LAM - HOUSE I (E) I wTN GUTRre :'%4•WOOD.TIDO.lr•OL. - � . sTVERTICCe.Y O ea` ewe uiTALLe r I I i _ I I �r or.�ORWALLBOARDL&WTWBOAR swLA.�re NwiL�AT.'OG - 144i'TCC*iCPMM SLAB N Oxo"L"m 14 .NON 4'PEA CMIFAVUL - < ON 6 Mil-POLY o I Qi to'x W'.,HONOR DOLT AT 4 Or— WO L ❑ - T L _ I I ,( O Z L— ----------------- --- (E) I rMRLld ooOR ri ' (E SII 0 m I TYPICAL FOUNDATION GARAGE FLOOR PLAN m - � a! ' AND SAVE DETAIL (YI j I DATE lE) = POWER I 1 1 / 3 / 91 POLE (E) F NC O - oreNOIR - - - - - - Ore NOIR jLOMITA AVE. "m 11141L MW WALL OP.GAPILAM SLJ" -OF GOP~ ua�a �Nrrrvr�a C �tvo as ardx)am, n= sed sod SITE PLAN SCALE 118 '=1'—O" Al FRONT AND RIGHT SIDE ELEVATIONS flffluftE COPY p - , I DESK W. NORTH CORNELIA STEVENS CREEK BL1/D. PROJECT DATA . "� ORT PROPERTY ADDRESS: 21799 LOMITA AVE. 'Ir=`G LOT SIZE 5037.5 SQFT. �cXIS1ING HOUSE 2000 SQFT. q ONEWCXM f." Weu Two eroEs50 FT. X EXISTING SEWER CONNECTION - TFeee —.—.—....... —•— —• _ — —._. _ .—.--- —.—.-----.— x q WITH CUPERTINO SYSTEM ` NO SEPTIC TANK ON SITE J � LOMITA AVE. z v I O ZONING R-1-ro (N) LL I' I GARAGE - W j . I SUBJECT PROPERTY — ------ -- ---� '` -- I LOCATION MAP I: I NOT TO SCALE SIDE _ ( SETBACK i' SERBICK � 3 W I Ll I N ��y�fsr ,QtLam W .. �,,. ADJACENT ADJACENT rRl ��1 �0 ! PROPERTY 9: } PROPERTY ''�' Q 91 I q EXISTING I II I `CON � V2.oYR eo. _ E ro -s ;l HOUSE I CE) I .LUHH„0AMMUMIRLo 1 I um W009)61UP6 Or- �Ih AeTae WrrW AI'l4klD VtRTIGALL?W LAYEM M7_OR NORITOMALL7 JONM 6TAa0E1CD.NAIL 0O!LAYER - um W ODOLM OR W4LLOOMO NA" ! AT All oc.MOE LATM VM Od 4r L AR I - NAILO AT M 06. - - 4•GONG@7E KAO - _ I I WTN&XA"WIC t*64 wm tow SCREWCH 41 F" IVUL - - oN•MIL POLY I I I rc------ . . . AT 4'O ANr<CR DOLL r+ Lo a I I I-all c zL— — ---------- -------- ---J (E) I _ - - - YOARA9E DOOR - - _ J �o �. (E) �m i TYPICAL FOUNDATION GARAGE FLOOR PLAN m AND EAVE DETAIL MIN tfl DATE (E) EcaVu a POWER ,• , POLE (E) F NC ry Idaa •naffs JULJU71997 BLDG. INSPECTION DEPARTM T �LVa CITY OF a � CUPERTINO - nmil __ ora Noce •, ,! , oNe N0.R mw OF AVE. oN T µO ®grz2� 4x4 xywt a Ill"oISIS Gb I slsv ra sora � 1 - 12, SITE PLAN c , JOCOPY , 211x:3 SCALE 118 " " FRONT AND RIGHT -SIDE ELEVATIONS Al I THIS PLAN SHALL REMAIN ON + THE JOB AT ALL TIMES DURING CONSTRUCTION ,