29311 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO BUILDING-ELECTRICAL PERMIT NO.
BUII•DING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL 1
BUILDING PROJECTIDENTIFICATION
II BUILDING AD%RI?SCCLQ SANITARY NO. AI'PLICA'f NSURMITI'AL DATE
:S NAME: PHO CONTRACTUR'S�NA��pa, LIC NO: - 's(
A11i 01-W
RCHITECT/ENGINEER: LIC NO: ADDRESS: "'a✓✓a�"4../// ❑
CONTACT PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG - ELECT PLUMB MECH
LICENSED CONTRACIOR:S DECLARATION QTY. ELECTRIC PERMIT FEF, IfLjll`- „Y�li
1 hereby afford that I am licensed under prom
visions of Chapter 9(eomeneieg JOB DESCRIPTION
WIZ with S«rice it
sion3of the Business end Professiom Code,and myliceazeis RESIDENTIAL•
�FU L ease lass cR«t. PERMIT ISSUANCE. ❑SFDWL ❑KITCHEN REMODEL
U�j License Class _ Coma APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RIS PIPE
i Dale Co DECLARATION
ARCHITECTS arose DECLARATION [I MULTI-UNIT ❑STRUCTURAL
PANELS
Z Z-Z I undersand my plans shall be used az public rtcorda MODIFICATION
O Z UPTO 2f1(I AMPS
A ' [I INTERIOR � ❑CHIMNEY REPAIR
F%� LLI License)Professional 201-1000AMPS IMPROVEMENT
OWNER-BUILDER from
m the Commerce's
CC 6 1 hereby affirm that I am exempt from the Contremar's License Lou for the OVER 11%10 AMPS El BATH REM ' AIR DEMOLITION
C)G,U following reason.(Section]031.5,Business and Professions Code:Any city or county O OTHER
m SIGNS ELECTRICAL
t4 which trquircs a permit m renewer alma improve,demolish.rn repair any swaure
prior to its issuance,also requires the applicant for such action to file a signed statement SPECIAL CIRCUIT/MISC.
mut he is licensed pursuant to the provisions of the Contractor's License low(Chapter 9
m ',
X00 (comencing with Section 3 of the Business and Professions Code) TEMP.METER OR POLE INST COMMERCIAL:
c.pr e z mat he is exempt therefor.and the basis for the.11,tal esemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
ro
Sciatica 1011S byamy applicant for a permit subjects the applicant to a civil Penalty of POWER DEVICES []TENANT ❑FOOD SERVICE
W } oat more than five hundred dollars($500). IMPROVEMENT
G ❑1,vs ownerol'ni,propeny,or my employees wind wages es their sole compensation, SWIMMING POOL HE
_ will JO the work,andtheswmureis not interdcdmmRertd for sale(Sec.7044,Rosiness []OTHER
Professions Coale;The Conerm c License Law does napply to an owner of OUIL
-SWITCHES-Fl%
�'^Z proprny,who builds or improves thereon,and who does such work himself or through
his own employees.Provided thin such improvements are not imended or offered for NEW RESIDENTIAL ELECTR
side.It.however the buildingorimprovement is sold within one year of completion the SQ.FT FLOOR AREA $/SQ.FF.
rmerbuilder will have the burden of proving that he did not build or improve for pvo
posaofsaleJ.
❑1,az owner of the propeny,em exclusively contracting with licensed csntmcum
wCode) oro TOTAL:
onaet the project(lice.)vaq 13ueiness and professions 'fha Comnmmr's Li-
censeLawdoesnotapplymanownerofpropertywhobuildsorimproves themcn,and Q'I'Y. PLUMBING PERMIT FEE
who contracts for such Projectswithacmn to(s)ifcenudpunuanttothe Con,.,.es
x Law. PERMIT ISSUANCE
Elc rapt undcrS«ties, li
. , &PC nhi)re '
aeon 'ALTER-DRAIN&VENT-WATER(EA) VALUATION
Dat
WORKER'SCOMP 'CLARAHON BACK FLOW PROTECT.DEVICE
• caner l hereby aRirm under penalty of perjury on of the following declamations:
❑I have and will mainmin a Certificate of Consentto self-insure for Worker's Compen- DRAINS-FLOOR,ROOF.AREA,COND. SMILES 'fYPG CONSTRUC3'ION
satin.,as Provided for by Section 3701 of the Labor Coda,for the performance of the
work for which this pcnnit is issued. FIXTURES-PER TRAP
❑1 have and will mainmin Workers Compensation Insurance,as received by Section
37W of the LaMrCale,fords,performance of the work for which this permit is issued, GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN
My Worker's Compensation Insurance carrier ad nPolicy number arc: ,
Carrier Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE Olt EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEINDUSTRI.WASTE INTERCEPTOR BUILDING DIVISION FI?ES
('Ihissa It..card not be completed ifthe permit is forms,hundreddollars(51001 GREASP.TRAP
or IazsJ PLANCHECK FEE
lar my tat inthe anyPerformanceo as to
for whichthis promotees'Camer- SEWER-SANITARY-STORM EA,200 FT.
not employ any person in any manner so az to become subject nm the Workers'Camper- ENERGY FEF.
Z salon Lows of Celifomia.Data
C WATER HEATER W/VPNT/ELECTR
t� Applicant GRADING FEE
NOTICE 3 bj APPLICANT:If,after tensing this Certilicnm of Exemption,you. as[ WAl'IN SYS'IEM/1'REATING
CHai become momply the Worker's Compensation this provisions of the Labor Cade,you must SOILS FEE
/s
Forthwith comply with tech provisinm or this permit shall be deemed revoked. WATER SERVICE
aP CONSTRUL DON LENDING AGENCY
tU- Z NEW RESIDENTIAL PhMB. SQ.14, PAID
U l herebywhich
that there isned(Seeri0trading agency for the peAmnnanee of Uma ReceiptN
U. l-+ me work for which this permit is issued(Sec.709],Co,C.)
O U Lenders Name TAL:
W Lenders Address TOTAL:
C. LL i certify that I have read this application and state that the above information is BUT ING FEE
4r (A correct.Ingree to comply with all cdy and county ordinances and state laws relating to Qrl'Y MECHANICAL PERMIT FCE
UZbuilding construction,and hereby authorize representatives of this city in enter upon me SE.MIC ME
ra slave-mentioned propeny for inspection purposes.
(We)agrarm save,indemnify and keep harmless the City of Claudia.against PERMIT ISSUANCE E.ECTRI
liabilities.judgment,costs slid expenses which tatty in anywayaccrne against said City ALTER OR ADDTO MUCH. .DMBING FEL
in ..sequence of the granting of nits permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,0%1 CPM)
IV
SOURCE REGULATIONS. r,,, CAL FEE
AIR HANDLING UNIT(OVER I0,000 CFM) - )NSTRUCTIONTAX
Signature of Applicant/Cmntrector Date E%HAUSTHOOD(W/DUCT) H SING MRIG N E
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store orhandlehvardoes material HEATING UNIT DO 1 xl,ofia B'TU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Croda,Section 25532(0.1 HEATING UNIT(OVER 100,000 111U) -
❑Yes ❑No
VENTILATION FAN(SINGLE RES ID) PAID
Date ReceiptN
Will rhe applicant or future building occupant use equipment or devices which
emit District?
-us air contaminants as defined by the Noy Arco Air Quality MammgemBOILER-COMP(311P OR 100,000 BTU)
ent TOTAL:
Dd aleft
❑Yes 0 N BOILER-COMP(OVCR IW,000 RTU)
I have read the haraNcus materiels AIR CONDITIONER
r5,25533
an under Chapter r 95 of me Cali- ISSUANCE
fondle g oes&Safety Code,e a tions 25505,is my esp 25514.1 t odersy nd mat NEW RESIDENTIAL.MHCH. SQ.Fr.
buildingquiremats which have otenant,that it ismyresponsibilityasnotifythepancy,vacation
of the requirements which must be ten prior m issuance of a Certificate of acuPaay. -
Owner or authorized agent Date TOTAL: ISSUED BY:
OFFICE
UPI IA GLAKA GUUIII F n01ULVI IIAL UNI I YNUYtKI Y NLGOKU nLUUnu un Ih
— ADDRESS 7/ fel' ee�✓5 ZA O kE S /�C� 20 MULTIPLEREC.
;)6124 p DISTRICT No. TRACT No. ,2 LOT & BLOCK 21 co-op CONDOMINIUM
DESCRIPTION OF BUILDING 22 TRACT No.
ROOF 8 1 FIREPLACE .~121 ROOM AND FINISH DETAIL 23 AREA
M jyj L I NUMBER PDL. ROOMS FLOORS I ROOM FINISH INTERIOR FINISH 24 SUBAREA
MOLT.OPENINGS 811121 MATERIAL GR WALLS CEILINGS REMARKS 25 EMPLOYEE No.
BARBECUE ALL ♦ .2 f` 26
P RAISED HEARTH ENT. HALL T LG BUILDING DATA
IED METAL BRICK LIVING 27 A.P.N. S /�� Q
IT-UP STONE MARBLE DINING 28 COST DATE 9 S'
)X EAVES FREESTANDING FAMILY /� //y'0 29 CONSTRUCTION DATE 9/p O
TINGLE KITCHEN 1— 30 DESIGN p0/
TAKE BREAKFAST ✓ 31 EFFECTIVEYEAR 7 0
)MPO-SHINGLE 9 1 HEATING ISEDROOM 32 LIFE TABLE (p C)
IMPO-ROLL FORCED X CENTRAL 33 DEPREC.TABLE a
,R AND GRAVEL WALL GRAVITY 34
LE FLOOR PERIM, UTILITY �, 0 35 FUNCTIONAL PLAN. 1 2 3
)NCRETE ELEC. CEILING 1131 KITCHEN DETAIL 36 CONDITION 1 2 4 3
,NCRETE TILE RADIANT BSSD. IKITCHEN CAB. IMETALI I O.P. I I H.W. GFLJ I WALL CAB. W 37 WORKMANSHIP 1 1 1 2 A 3
)CK THERM. JOR.BD.&CABTOPI TILE X MICA I I LINO.I SPLASH BASE CAB. FT. 38 TOTAL ROOMS
JTTERS X,ENGR. >ECONO. 1141 BATH DETAIL 39 DINING O
FLOOR FINISH I FIXTURES 40 FAM"RUMPUS-DEN
EXTERIOR I 10 COOLING BNo. FLOOR I WALLS W,C. LA. TUB ST. O.T. G.D. FINISH IGRADEJ PULLMAN 41 NO.SEDROOMS S
'UCCO X SHEATH.I I REFRIG. ICENTRAL 1-2 N/j/ �1 '�, I / l �/ ) VA ) 42 No.BATHROOMS 3
DING V SHINGLE I I EVAP. WALL (/LE S / / 1. ✓R 43 UTILITY ROOM
IAKE ASBESTOS ENGINR. ECONO. 44
SB ALUM. I I 45 CENTRAL HEAT No YES
I.VEN.y STONE V. 15MISCELLANEOUS STRUCTURES 46 CENTRAL COOLING No JXJYESI
OBE'V. I 1 111 LIGHTING ITEM FND CON EXT ROOF FL. INT. S44 UNIT-COST REM 47 GAR.ADEQUATE NO YES
FEW I JFAIR I GARAGE G° SI ff ,� .16%/Y 48 GARAGE CARPORT CAR NONE
STRUCT:WALLSAVG. AVG. 49 GARAGEATTACHED NO YES
GONG BLK MANY GOOD 50
tl ADOBE REC.FIX. 1720
51
EEL CONC. 52
16 COST DATA SUMMARY 53
FOUNDATION APPRAISER AND DATE 8 COST FACTORS
)NCRETE RAISED K ITEM FACT, AREA UNIT COST COST UNIT COST COST UNIT COST COST 54 COST LEVEL BASE YR.
)NCRETE SLAB FIRST FLOOR 6�3 55 QUALITY CLASS _v/'// 0
)N R T BLOCKY r/
A/fD FLvo. / 0 56 AREA FOR MOD. '6
)DENT PROOF I GARAGE "A'7b 57 EST FLOOR AREA 1693
HEATI G .Z41 5�3 .3 C) 58 2ND FLOOR AREA S'
GARAGE FIREPLACE fi7b 0 59 2ND FLOOR FACTOR [)
)0RS wALS PORCH d.:8 8
60 3RD FLOOR AREA
FO CUi S.R.WALL FLATWORK .g.2 O J 3 61 1 3RD FLOOR FACTOR
FTACHED FIXED E U P. '40 0 62 ATTIC AREA
FTACHED E A� H )O 63 ATTIC FACTOR
)OM OVER 64 FINISH BSM'T.AREA 0
)FT OVER
65 FINISH BSM'T.TACTOR 0
IflPORT 66 UNFIN.SSM'T.AREA 0
67 UNPIN.BSM'T.FACTOR 0
WINDOWS 68 ADDITION AREA 0
H. WOOD
69 ADDITION FACTOR
;MT. STEEL
70 GARAGE AREA (7
.IDE ALUM., 71 GARAGE FACTOR .3
IRS. TINT
72 PORCH TOTAL COST
A G 73 COVERED PATIO COST 0
.IDI GLASS DR 74 UNCOVERED PATIO COST 0 .
75 FIREPLACE COST 5700
TINS TOTAL F.C.N. 76 AIR-CONDITION COST
IRBECUE NORMAL%GOOD 77 EXTRA KITCHEN COST
TCHEN FAN R.C.L.N,D. 78 EXTRA RLBG,COST
)DD 1 171 BUILDING PERMIT ACTIVITY 79 FLATWORK AREA 3 2 0
INGE TOP PERMIT No, DATE CONTRACTOR DESCRIPTION OF WORK AMOUNT 80 FLATWORK COST /S
/EN 4 ,Ij's p. S -G D e dti ✓Z. - 000 81 MISC.COST Q
)USLE OVENS 2 S _ V D V 02 POOL COST Q
.ECTRONIC OVEN 1 3C1Z2 2'1I'q tT lzo d2 1}6-0 83 HILLSIDE CONSTR.COST O
tOP"IN R 8 0
84
.IDE-IN R 8 0
85
1RBAGE DISPOSAL 86
SHWASHER
181 REMARKS 87
iFRICEMTOR
= o
Of BAR
m s
)CUUM CLEANER ~
ET BAA or
ATER SOFTENER
TR.HTR.GAL.
T y
r
'PRAISER
ONTH-DAY-YEAR 114 SIDEWALK NO YES
C.N. 115 STREET LIGHTS NO YES
.C.L.N.D. 116 PARKWAY NO YES
6ND VALUE 117 PARKING STRIP NO YESpq
UMMATION IIB ZONING CONFORMITY NO YESVI
ATE OF SALE 119 ZONING(ACTUAL)
OIDICATED SALE PRICE 120 VIEW NO YES
ISTED SALE PRICE 121 TYPICAL VIEW 1 2 3
IARKET DATA INDICATOR 122 TRAFFIC FLOW 1 2 3
123 DIST.TO PUB.SER. 1 2 3
TOTAL PROPERTY 124 LANDSCAPING 1 2 3
OTAL PROPERTY VALUE 125 HIGHEST b BEST USE R
AND VALUE 126 LAND USE CODE D
APROVEMENT VALUE 127 ACTUAL USE 0
ERSONAL PROP.VALUE TOPOGRAPHY
128 LOW I I EVEN X1 HIGH
129 SELECT ONE
. . . LEVEL I
HILLY 2
. . . . SLOPE 3
BANK 4
OTHER 5
. . . NEIGHBORHOOD
130 OWNER OCCUPIED NO YESVq
131 TREND 1 2 3
132 CITY SERVICES(TYPE) 1 2 3
. . . . . . . . . . . . : ' : ) : 133 TAX RATE 1 2 3
134 PLANNING 1 2 3
135 MARKET DEMAND 1 2 3
136 RESIDENTIAL AREA NO YES
53`^ 37 SINGLE FAMILY NO YES
' ® 138
z� 139
33G TOTAL PROPERTY
. . . I . . 140 ARCHITECTURAL ATTRACT. 1 i 3
141 UNIT CONFORMITY 1 2 3
. . . . . � . 143 IMPROVEMENT 1 2 3
144 TEMPORARYVALUE NO YES
2I cP. . UTi! ; as SELECT ONE
. I • I . . PARTIAL COMPLETE 1
. . : . . .2�6 DEFER.MAINT. 2
27
. . . .y BOARD ACTION 3
OTHER 4
146 APPRAISAL DATE Q g 00 (0
. . . \. . . . .I, . . . . 147 EMPLOYEE No.
. . . . . . . . . . . . . . 148 LAND VALUE
. . . . . . . . . . . . .\\ G . . p O
149 IMP.VALUE :3
. . . . . . . . . . \. . . . I. 150 -Im . Velue Ratln
. . . . . . . . . . . . 151 BASE I OT VALUE <)CI I)
. . . . 152 BASE LOT PERCENT ) ��
. . . 153
PLA7OF BUILDING SCALE _ /�T CALCULATIONS
e-
REMARKS L x 27 = .256
S6 x X ; ✓>`
L
s.Ask
yr �d c i�d4i
/968 AODIJ __-•._. —
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z�9s �