29475 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUIIAING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMB NG-MECHANICAL.
29475
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS 0 03 AD SANITARY NO. APPLICATION SUBMITTAL DATE
C-0 u0 wA,C M 6f,P 2- W434E
OWN.R:S NAM C PHONE: SIO_ w0 ON'TRACFOR'S NAME: LIC NO:
.7 'fC NIC CONTROL
RCHITECT GINEER: LIC NO. ADDRESS: ❑ 119 V
lit r ZIOQ COMa1 'EaCE ?b( L OR,.
CONTACT. F30NE: f1u111r� C-k '9179' BUILDING PERMIT INFO
C 909 ❑ Consultant Fres Paid by Applicant(Initial) BLDG ELECT PLUMB MECII
e A. P- E I[;K Ek/
LICENSED C'ONTRACIOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
1 hereby Orion mat I am licensed under provisions of chapter 9Onmmendng JOB DESCRIPTION
O fYZ Ili Sedion]IXMl)af Division the Business and Professions Code.and my divert is
RESIDENTIAL
cc with PERMIT ISSUANCE
m full forectud effect. ❑SFDWL ❑KITCHEN REMODEL
F.U V I.icenu Class,�—�—.. �"—fQ�Lie.b
NQ1 Dote ec-I�---Comacmr APPLIANCIS-RESIDENFIAI. []ADDITION [I PLUMBING RIiPIPE
11 \�ARCHITECPS OF,CLAJLKHON WC ❑MULTI-UNIT ❑STRUCTURAL
O Z h Z I undervtan m plans sh:Jl h us A as public records PANELS / MODIFICATION
s00� UP TO 2(X0 AMPS ❑INTERIOR C1 CHIMNEY REPAIR
r4twil Licensed Professional / 201-I0I0AMPS IMPROVEMENT
< -J OWNER.RUILDER DECLARATION
'S CL 9 Q I hereby uftinn that 1 um cxenrpt tram me Contrawnr's License Law for the OVER 1000 AMPS [I BATH REMODELIREPAIR C DEMOLITION
�aU followingSection]031.5,Business and Professions Code:An t or ❑OTHER
reason( Y city^ Y SIGNS ELECTRIC
3 LL rn which requires n permit re comlaeh rime improve,for such
demolish,w e a sig any swaum
U�OVS,g prior nm its issuance.also requires the applicant for such perminn rile aligned.vaement SPECIAL CBC 1
that he is heaviest pursuant o the pnwunms of the Contractor's Liceme Law lChapter9
W$po (communing with Section7000)of Division]ofthe Business and Professions Code)or TEMP.METER OR POI COMMERCIAL:
CLq c C mat he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NE BLUG/ADDITION ❑DEMOLITION
XgMa Section 7131.5 by any applicant for a permit subjects the applicant a civil penalty ofLE 'OWER DEVICES ENANT ❑FOODSERVICE
W m m more than five hundred dollars($501). r�N�'/r.l,
SQ ❑I.as owner of the property,or my employees with wages res their salecompcnvtion, SWLMMINGPOOLELECTRIC LMPROVEMENpI�'g �R leDYL Q'xr'O 4
F- will do the work.and the structure is not intended or offered for sale(See.]WJ.Business ` L ❑OTHER P a
is
L 3 m and Pronasions Cuda The Contractor's Uanxc Law docs not apply to an owner ofj-7-27K TLEUS-SWITCIIES-FI%TURES R aA1e6r
property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements are not intended or offered for 51tHS`DENFGAL ELECFR SQ Ef.
sale.If,however,the building orimprovement is sold within one yew ofednidetimrom- \ SU ( s �SQ'�'
r-buimor will have the burden of proving that he did not build or improve for pCar.
ry eof sale.k \ }[� UF GUrrm Rv
1,as owner ro the property,.B sines ad contacting with )The C enmanors um \ S CJ. n /
ormtrudtheproject(Scc.n an Businessandrty who
Cade)TheContractor's ut$ - 9lO
arrive Law does
or sucapply mnns owner ith recd'pooped whosedprsunt to the Conlon.aml QTY.` ' LUMBING.PERMIT FGIi
who contacts for such projects withacontrmmr(s)Iiccnud punuammmc Cumaaor'e)
License Low. \�l PERMIT'ISS_ \ B. \
❑ I am exempt under Sec. ,It ac P C for this rcasan
AL 1\N'a,\ > \WATER(PA) VALUATION
Owner Dare _ _ ^
WORKER'S COMPENSATION DECLARATION BACK FL ,TELT.DEVIL \ \ Q O QO V
I hereby affirm under ponahy of perjury one of the following declarriums: 1, O a
(have wilionamaaina Cenificoa,.07 crenoself-in sure lin Worker's Comped. DRAINS-FLOOR; ,Ak1iA,CONU. `� TYI'L CONS'I'NUC'I'ION
vdon, provided liar by Section J]W of me tabor Code.for the performance of rhe STORIES
war "which hispermitisisaed. FIK"URES-PER TRAP \� C 1-14
�( I
have and will inainwin Workers Compensation insurance,as required by Section Imo{
3 Wof the l�borCode,fur the performance of the work for which this permit is issued GAS-EA.SVS'1'EM-1 INC.JOUTLE'1:5� (XC.GROUP APN
all
MyW kee C�a�mpen. tin-nCl�suance carrier and Policy nWnher etq_ \
Curer.S'If1N�� "^sem Policy No.:A1WG 6 °JSP GAS-EA.SYSTEM-OVER4(Ii
CERTI PICA'FE OF EXEM PTION FROM WOR KERS' GREASI%INUUSTRL WAS'1'13INTERCL'I'l'OR
COMPENSATION INSURANCE BU1 ISG VIS N FERS
("This section need not he completed ifthe Permit is for one hundred dollars p$IBB) GREASETRAP
or IcxsJ PLANCHECK FEE
I cenily that in the perlimnunec^f the work lie which this permit is iscucd,I shall SEWGR-SANITARY-STORM GA.NXI IT _r
not employ any proven in any mmmner so as to become subjea m the Workers Compen- ENERGY hili
0 Z cation Lawn of Catboat..Date WATER HEATER WNENTAiLECIR GRADING FEVi
z O Applies"' o
NOTICE'rO APPLICANT:If,alter making this Cenificate of Exemption,you should WATER SYS'FEMG RCATING SOILS FEE
(•-' become mhject m the Workers Compensation provisions of the Labor Code,you must
Wrte. forthwith comply with such provisions or this permit shall be deemed covered. WATER SERVICE
Q
ns CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. LAID Dae Re
LJ O I hembyarlirm that there iso co..unna m lendingagency for the Feet.....f
the work for which this permit is issued(Sec.3097.Civ.C.) as
0 1.
C.) Lenders Name
lender's Address
fJ. I certify the I have rt 1 this application and sate ma the above information ix BUILDING FEE /
to correct.1 ugmc m comply wh all city last county oNinunccx and late laws rclming m QTY. MECHANICAL PERMIT FEE
V Z build'mg osmwction,and he yaudt representatives of this city to ether open the 51315MIC IsIiF,
above-mentioned property to mepection purtioses. ` PERMITISSUANCE l e�
(We)agree msave,I mmmfy and keep hanles,the City of Cupenino agaimt F.LECfRIC 'E
Ilebildies,)udgme....costs at expenses whlchomy in any wvy accmeauwd,I said City ALTER OR ADD TO MUCH. SG 1 a
in onscqucnce of the gantit
of
permit. I'LUMI31 I
APPLICANT UNDERSTA IS AND L COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO I0.0DOCFM) MECHANICAL FF. 6O
SOURCE,REGULATIONS.
(0 lu 9b AIR HANDLING UNG(OVER 10,000CFM) CONS'I'RUCRU TAX
Signemcoof Applica -/Date EKHAUST HOOD DODUM �� HOUSING MI GATION FEE
m ep s US MATERIALS DISCLOSURE
WBlmeappuemn^rm enuilJimmg tecupanl score or LunJk haenNnus material HEATING UNI'F('10100,0(X)B'FU)
as definal by the Cupertino M rapid CNB Calder 9.12,and the Health and Safety
Code.Section 25532001 HEATING UNIT(OVER 100.0010 BTU)
(]Ycx ' VEND'ILN'ION FAN(SINGLE RESID) PAID Date Receiplp
Will the applicant or forum building occupant use equipment or devices which
emit haeallous air eo ormoinamr as defined by the Ray Area Air Quality Management BOILER-COMP(311P OR IW.M RTU)
p YCS 13(IILEk-COMP(OVER IfM1,(NT
NI BU)
t
I have read the haysNous crials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANG DATE
foaia Hath&SrIa,CNe,Smf is 25505,25533 and 25531.I understand that it the NEW RE.SIDENI'[AS,MECH. SQ,FL
building does not currently have am.door it is my reapomibility,to n ify the occupant
of the requlren¢nt which must rssu.rnee of Cen sa of(kcupmtcy.
lioIQ
Owner or vnthonxeJ agent Date t ISSUED BY:
OFFICE
VIC
JAR
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V.Wrflf tratf. of W -frullawy
IR
TitH of Tapp rfina
19pliartmit of Nuilbing Tmipprfiall
This certificate issued pursuant to the requirements- of Section 307 of the
Uniform Building Code certifying that at the time of issuance this structure was
in compliance with the various ordinances of the city regulating building .
IR construction or use. For the following:
Use Classification 99 RANCH MARKET Bldg. Permit No- - 29475 Yy
Group M -Type Construction VN Use Zone Planned Development
10983 N. Wolfe Road all
OwnerofBuilding Welcome Market// 99 Ranch Address .
Building Address10983 N. Wolfe Rd, Bldg A Locality Cupertino, California
.
Eva BY: JQQ Ant:onucci
Date: July 23 , 1998
Building Official
POST IN A CONSPICUOUS PLACE
�,bk V/
/• `FPt°%`:-9E )ql�Y ?!Y TPIh��\���'3;///�•�\\'-.''\��/(/�\\Rcv r� � ��`p: � ��� v ��� _ _
- .LI n�4jj-L�n��F _e_�1//��9/ A�' •_ / \\ . _^ �r�j '�\T
'roy
98
+ Tity of Tuprrfina �f
This certificate issued pursuant to the requirements- o Section 307 o the -
P 4 .f f
K r Uniform Building Code certifying that at the time of issuance this structure'yffl �.
4 in compliance with the various ordinances of the city regulating building .
' construction or use. For the following:
Use Classification 99 RANCH MARKET Bldg. Permit No. 29475 1
!ItF ;� Yy•
Group MType Construction VN Use Zone Planned Development
y
OwnerorBuilding Welcome Market// 99 Ranch Address 10983 N. Wolfe Road
Building Address 10983 N. Wolfe Rd, Bldg A Locality Cupertino, California
BY: des—Aatezzucci •
Date: July 23, 1998
Building Grfidal
,,-
M� P09i IN A CONSPICUOUS Pt-AC[ _ /•
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