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S 0887 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY� " - CITYOFCUPERTINO - BUILDING-ELECTRICAL. PHRMITNO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL. S O H BUILDING ADDRESS: - BUILDING PROJECT IDENTIFICATION /O Q - ^ �/ / SANITARY NO. APPLICATI> ION SUBMITTADATE �•� jmo,`ter, 1 � KOkilli'SNAME; /Fal PHONE: - CWRACTOR'S NA LI.14. tJ I.ICNO� •G�S'icV5715 NIC COMHOLp AR ITBC 'ersaa N� LIC NO ADORESSI ❑ JAR 5014 'DL 25 (e8a 1Y040- 276 + s CT- RT-IiJ J 16tiJ I CONTACT. PHONE: • IB`—1 (m�a ^ BUILDING PERMIT INFO ❑ Consultant Fces Paid by Applicant(Initial) BLDG ELECT PLUMB MECII LICENSED CONTRACT'OR'S DECLARATION QTy ,ELECTRIC PERMIT FEE kt � � V 1 herchy affirm that tan licensed under provisions of Chapter 9(cennne.cing JOB DESCRIPTION W 0 Z with Section 700B at])ivisi n J of the Badness end Professions Csdc,orad my license is RESIDENTIAL F,WOZ in full forces. eRcct. PERMIT ISSUANCE 68o 116 mFzkIy� Licensed Lica DSFDWL KITCHEN REMODEL. VNQ6 Dmr Cont ) APPLIANCES-RESIDENTIAL CADDITION '�'i-T11ILI1MBING RE-PIPE: ARCHITECTS DECLARATION p re 2 I undersand my plans shall brecordse used as public records DMULTI-UNIT El STRUCTURAL OZ4UPTO200AMPS CHIMNE REPA P,� - L¢ensed Professional ❑INTERIOR CCHIMMING POOL iE OWNER-BUILDER DECLARATION 201-10WAMPS IMPROVEMENT ❑SWIMMING POOLS -y RB I hereby in.that I am eeempt from the Contaces Coe :Any c Law for the OVER I"AMPSELECTRIC D BATH REMOUEUREPAIR ❑DEMOLITION xxOyU followingmesa Sectierinit,n] gaiter, and improve. datudi Code:Any city orcountyurture SIGNS ELECTRICAL ❑OTHER W 3 Fya which 11,issuance, o permit na ere,"construct aper.improve,demolish,,r repair any ntecmre ym..lprior to issuance,eL rtquim thcepplicunt lorsucM1 permit filcasignW smsemem SPECIAL CIRCUIT/MISC. W} that he is licensed pursuant to the provisions of Ne Contractors Litense law(Chopter9 LL Q (commencing with Section 7")of Division 3 of Ne Business and Professions C,Ac),, . : 6 n ys that he is exempt therefrom and TIME METER OR POLE SST. COMMFRCIAI the basis for the alleged exemption.Any violation of C NEW BLDG/ADDITION D I]IiMOLITION LL• Section]831.5 by any applicant for a Permit subjects the applicam in a civil Penalty of POWER DEVICES mot more Than five hundred dl(5508), 0 TENANT C FOOD SERVICE p M Qhas owner ofthe Pmpeny,or toy employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT will do the work,and the structure is not intended or offered forsake(Sec.70,14,Busimss 11 COTHER 1 and Professions Code:The Contm.ars License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES Property who builds or improves these .rand who does such work himracHis through his own employees,provided that such improvements arc not intended or offered far NEW RESIDENTIAL ELEC7TR sale.IL however,the building err improvement is sold within one year ofcompletion.fle SQ.FE FLOOR AREA VsQ.EL owner-builder will have The bmdcn of proving that he did not build,r improve far Pur- pose,fsoe.). _ (d� a. l ❑ 6 t owner of the property,am exclusively Professions with licensed Pontoons i- @� A D inswn the project(Sec.]044,Business and Professions Code:)'Ifie Contractor Li- verve law does not apply to an owner of papery who builds or Witnesses There,n,and QTY. PLUMBINGPERMIT FEE DECm l who contacts forsuch Project,with a contracmr(s)licensed pursthe pennant to C,enrectors V e o['I1s� License Low. - PEHMIT ISSUANCE 1w(� C tum exempt under Sc:. ,B&P C for this asset CITY Owner Date ALTER-DRAIN&VENT-WATER IFA) 'VrA TFOATIOW WOR KER'S COMPENSATION DECLA RATION BACK FLOW PROTECT.DEVICE • I hereby affirm under Penalty of perjury one of the folleaving declarations: - 1V• m�� C l have and will maintain a Certificate of Consent msclf-insure for Warkets Compen- DRAINS-FLOOR.ROOF AREA,COND. union,as provided for by Section 3810 of the Lulsor Cele,for the Performance of The STORIES TYPE CONSTRUCTION ork for which this E.mie ix issued, FI%TURES-E'ER TRAIT have and will ma iddho Workers Crmpcnsaim almence,ns required by Section 3 ofthe Leber Goode.for NPermit The performance ofehe work for which this Peit is issued. M GAS-EA.SYSTEd INC.40UTLEIS OCC.GROUP ppry My WV y��eisrylWInsuJ�race cartierund Pub �"�iq �} Currie /C TV Policy No/�✓0jaIJ�-7' GAS-EA.SYSTEM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASFIINDUSTRL WASTE INTERCEPTOR or less,) This section need not becnmpleted if The pemtit is forom,hundredGREASETRAP dollars(SIM) HUILDING DIVISION FEES I terrify Thai in The Performance ofthe work for which thisPermit is sPLANCHECKIT?E 0— nae employ uny person in any mother so as to become wbje.m A Wodsrs'C Impenl SEWER-SANITARY-STORM EA.200 FT. z ApplLaws of Califomis.Data T/ i � O Applcant s WATER HEATER WNENF.LECfR ENERGY FEE GRADING FEE NOTICE TO APPLICANT:If,aper making this Provisions of of Exemption,you should WATER SYSTEM/TREATING a become subjecty the WorkersC,mpeor thisprovisions of did,LaborrCode.you most SOILS HE GQ fonhwithcomply with such pr,vixinnxor shispermitshall be decimal revoked. WATER SERVICE 7,Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT, PAID I hbK Dole Receipt is he wook U.0 Under's for which this Aramis is issued(sec.3097,Civ.CJ Lender's Naac �U TOTAL: y� Lendeh AJJress LJ G 1 certify that I have read this application and state that the above information is - - PSEISMIC G FEE Ei V1 roars.. eto comply want.11 cisy and enumy ordinances and sure laws n9utingm QTY. ANICAL PERMIT U build' cons cion,and Thereby authorize representatives ofthls coy m enter upon the FEE FEE aThr -mentis ed property for inspection purlroses jA1121ANDLINGUNIT(OVER E (We) gree ns save,indemnify and keep harmless The Ciry of Cupeninn against C FEE lou 'line gains,costs and expenses which in any way acerue.goant said City' ADD MECH. int q nccol the gmmingo ix NG FEE Sa"APINT UNDERSTAN .OMPLY WITH ALL NON.POST NIT(TO TO.fI(111 CPM) w SOU E IEGULATIONS. nICAL FEE 'LII / r NIT(OVER 10,(NM)CFM) UCTIONTA% Signe ofApplice nm�or - Datx EXHAUSTHOOD(W/pUCUHAZARDOUS MATERIALS DISCLOSURE G MITIGATION PEE Will theupplicane,f Not.Wiled.,eecipumnomor handle hazardousncered HEATING UNIT(TO I nobil0 B'fU) as defined by the Cupertino Municipal Cale,Chapter 9.12.and the Health and Safety Calc,SuIinn 255324)? HEATING UNIT(OVER 110,000 BTU) ❑Yes , VEN'fILAT10N PAN(SINGLE RES ID) PAID LM,,,6ut? � ill she applicam or future building occupant use equipment or devitts which Date Nmeipe H assail air contaminants as defined by the Bay Arta Air Quality Management BOILER-COME OHL OR 100,000 BTU) � TOTAL: Yas )(No BOILER-COME(OVER 100,M)11'fU) ave read the hazardous materials requirements under Chapter 6.95 ofthe Cali- AIR CONDITIONER hh&Safety Cade.Sections 255(15,25533 end 255]4.I understand that if the - ISSUANCE DATE es not currently have a tenant,that iT is my rcspnvibbity to notify the occupant N17W RESWENTIAL MECH. SQ.E.ax m s,which must ba met prior m i.ssuaaceofo Cendiane of Everpmry..No"Ad agent Dar ISSUIiD Br: OFFICE L i* RESIDENTIAL PROJECT COVER SHEET ®ryof Cupertino Assessors Parcel lNNumber: e Name of owner. J6XWf7E�Ar-,) Project address. I0Zo9 (2"Wf)Q� . Contact person. LRE{ &-e-t s o v-, Phone. 6 Fax. 6sa . nG V - s6 i6. Net square footage of lot. 4o Cl4dN 15 E 10-1 Existine Proposed Square footage: First floor: n!e ef 64*-J& Second floor: Garage: Are there at least two 10 foot by 20 foot clear spaces inside the garage? ® N • On what floor(s) is work being done? Brief description of work. CosrlETic P ,6 o F i'` Telu.� �//.�.up2�� NA (f 1�A-rneCanx . Code editions: 1994 UBC N)1994 UFC (Y-N)1994 UMC (5 N) 1994 UPC ®-N)1991 NEC N) APPROVED' iN ACCORDANCE WITH THE CITY 09 GypUMNO CODES AND ORDINANCES )A 21. 97 (his tot puns and specifications MUST so as hepl on job itM et •^0 lines And it is un ltwitll to male an, '.enges or alterations �D C 11991 Al NJ,410. "AUA4 :'1 „P,;n �'eflniSS10[I h E pEpPR�M NT :14� J 111V ii61,�l i ^u��(•�h .X })eClttt5'll"NC G�''��Qtt jyeL� :'ws z,: ,__ 7 •.: ;.a: cc to las ;Bn �pG.1NSY-�F��pEFt1W Plan Review Process Work Book Paae-7- a o � u OIL m N © Z 999 999 q � Ll b33 0 3 m m M W N ZO£M 9992 9992 d p w: >+N C o E OofvO�i . 0C c •M Z`� •� Aawo a E a� v � L ca a m � v . 0 rnm caw w CD V1 (p p - - U (p ,� � � N> � u _ � o mM as ° Y a H °� o >� w v O pp 0 p 0 m 0 M C J C a) �-0 C p - :a (� y Ol J m > ° c °' a) C9or o 0 06 ca a) � � o � +-. ui c > aE � a� o y � row0 4 0 S a� > a) o x ' E ap E mo 3 m � W M Hl E m c E 0 y v � � 3 � � p rrnn U m v ll.I C ACL o �a y Y 3 Ev LL n vei B N Cal 01 GI Wl 999 8992 MI U � N m co� x I \c. 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