29963 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECFRICAL PERMIT NO. /�
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL 2 9 9 6 3
BUILDING PROJECT BENTIFICATION v v
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
49-M-5-
OWNER'S NAME: 36('>— / RACIUR'S NAME L,CN N/C CONTROL
•ARCHE FR
FINELIC NO: ADDRESS. ❑
CONI Cr7/'N /- -moa PHONE' I BUILDING PERMIT INFO
VV�i/� YWW'�I� �25�3 � ❑ Consolteot Fees Paid by Applicant Un thd) BLDG PJ.6CF PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERh1IT FEE
1 hereby ali that I are,licensed umkT pnrvisium,of CTa,,cr 9(coney encing JOB DESCRIPTION
�QX with Section9Wd)uflNvisimlofthe Bmircn and Pmfcdom Gde,aoJ my licene ix RESIDENTIAL-
in
FSB fu 11 fact eM If PERMIT ISSUANCE.
�y.UZ�j Iucrn,e Lomas a--L Lic.N ❑SFDWL IUMBINREMODEL
NQS Doe 7C CnnVxtor APPLIANCES-RE.SIDENf1AL ' ❑ADDITION El PLUMBING R6PIPE
F,D Gra A CH3 TE'CTS UGC ATIOpr C MULTI-UNIT ❑STRUCTURAL
X p 7v- 1 on&ri nry'lons fall h:uacd ar a r PANELS MODIFICATION
OX`— Rr /,- ..�{may UPT020DAMN
[-�F-' LcensM Pmfeviuul El INTERIOR El CHIMNEY REPAIR
�y 201-10(a)AMPS IMPROVEMENT
OWNER-NUI UERDECIAkAT10N (a
yI Icm6y affirm that 1 em exemq from o
the Contrl«,Licerue Lew for d t OVER UX00AMPS
[I BATH REMODEL/REPAIR [I DIMOLRTON
5(3 . folk, ing reamer(K ctim 90315.Busieca and Prnfeaium Culp:Any c'ny rr e(unty SIGNS ELECTRICAL C OTHER
41 a which*resuira a Perron to comuuct,after,improve,demon W,or re car any,wnure
�LL�g 'm to its mance,oL requires the applicant fm,uch pemul 1,file.sig"swement SPF.CIALCIRCUMNIVIC.
f Ythat he is liccomdl pMvsea
mauare of ,,avtof the Con,relor'.Liao,law,Cloi,ber9
a_DO (canmvcingwith Section 9000)of Divkim Jofthe 9usircanvd Pmfdisua Cidefor TIME METER OR PoLE INSI'. COMMERCIAL
1.w dentbe is nem,,rherefmloom,unit five si,Gtr IAe id),,d cacmptiun.Any violation of C NEW BLDG/ADDHBON C DEMOLITION
1 Section 70313 by troy applicant for a'emtit 66ject,the apMiram to a civil penalty N POWER DEVICES
X} +Ire tome duan five hunolacd dollan($W. CTFNANI' CFOOD SERVICE
Q C1.as owner ofthe,,o,,,M,or my emPloyres with wega an t heir sok compenswion, SWIMMING POOL ELECTRIC IMPROVEMENT
O wEI JU Newurl.adl lb,.re,i,aNinfcrxldf err nlTcralfm.wk(Scc.96f4,Btaincsa [I OTHER
3 and Pmfnearo,Code:The C..&,License law due,owl apply to me.tamer of OIITIT:-TS-SWITCHES-Fl%'NRFS
pnycny why builds or impnnes thereon,and wbo dmn,uch work himself or through
H,ream employes.)vovidad dead ioch imf,ovcmcnu are rod fronded or offered for NEW RFSIDFNITAL ELECTR SQ ET.
vele.If.however,Netvildineosimpmvemmlis sold withinorie year Mcompinion,the SQ,FT. T.OUR AREA SRQ�F,
rcrhed,R,will huve Nc hroko (posing but he did not build,unloose for per, _ bb LLy IgJ�
pose of sell.
❑ Las owner of dha pmpaty,mer ndusively ammcling with licensed cmlroeun fa TOTAL:
ms.die pre a (Sec.1(114.Bu,inea,and Pmka,iona Cade,The Gnnerartor,Li- JUN 31996
creme law,diva notapply loan owner a parpmy who builds or impovx,demon,and QTY. PL GPERMIT FEE
whoammo,Ib,such MJec(,with amndaetor(n)licensed broeirt to the Convulnra
Lice.La. PERMIT ISSUA L'l1Y Urn l)NO
Cl I em eaempl under Site, B A P C for this reason - Laid-c
t ..
ALTER-DRAINA VE- (EA) VALUATION
Owrcr Fine
_
Wrier and NS COMPENSATION DECLARATION BACK ROW I' .CT EVI I I O OO '
I ItncbY adirm under pearl)M perjury are of the following thee Wmiw: � `
❑Iheveud:illma Wne Cmif teofCmm ttos f-ir ftWmkera Coni DRAINS-R � R ,GOND,v. STUR1 TYPE CONSTRULMON
.;on,a, witkit for by Section 51110 d d
the la ,Coda for that per...... of floe -
which dbi,permit is i.vaad. FIXTURES-PIER TRAP
I Use an
will mai ecin Wuker'.Cwnpenoliun laumnce,a,rryuired by Section
39W of than lzhr Costs,for the performuee of do work for which this Mmtit is i,sued. GAS-IA.SYSTEM-I INC.4 OUTLETSs. , OCC.GROUP APN
My
CuriWodkefa�oPolicy ry No.:
GAS-EA,SYSTEM-OVER 4 FA) \v
CERTIFICATE OF EXEMPTION MOM WORKFAS'
COMPENSATION INSURANCE GREASMSDU,STRL WASTE.INTERCEPTOR
BUILDING DIVISIONF'QS
(Thi,intim recd ma see cumpLtal b1he Period,i,5 oro hundred Ml lerv(S It 10)
m��) GREASE TRAP PLANCHECK FEE
Icenif,that in lheserformence ofthe work for whichdiixpermit i,Issued,I sha11 SEWER-SANITARY-STORM EA.200 FT.
and employ any penin in any manmr so v fu a core srbject to fireWatters'Gamlen ENERGY FEE
Z sedan Laws of Cdirmniti.Dade WATER HEATER WNENUELECTR
Z Q Applicant - GRADING FEE
UJ NOTICE TO APPLICANT:If,after making this CeniGcete a Eaem,,im,you shoed WATER SYS E!,LTRGTING
C ; bonne subject..the Worker.Curio sruuiom pmvi,ian of the Labor Code.rose must SOILS HE
fonhwivhcomply with such Pnrvi oroorthia Pctntitnhall he drenid rtvukcd. WATER SERVICE
CL
CONSTRUCTION LENDING AGENCY NEW RISIDENML PLMB, SQ,ET. PAID
I hereby dirm tivr,Nat k a amourechor lending agency for the perfonrunre or Deb, a
.. the wok for wbkb fhh permit Is issued(Ser.3099.C,C.1 ITZ
O H Lender',Nente TOTAL:
V lender,Addie„ TOTAL
y1 certify Nn I have read this application and mete that the above infmnetion is BUILDING "'
v9 coral. .gra u.comMY with all city and rnumy ddimnses and sate rows meeting m QTY. MECHANICAL PERMIT FEE ^ ^
V X FE
hwWing conwucliara end hcrehy authorize reprneauivn of Nis<idy to emn upset dse SEISMIC E 1
ebave-nentided Purifiers, spepur
for inction 'mes. PERMIT ISSUANCE
(We)agree er sive,irxlemnlfY msd kxP hmnlnr the City of Cupcnino agdmt ELECTRIC FEB
liabilitin.judgmede.svua and eapemn xhicb may in any xay,true againu said City ALTER OR ADD TO MECH.
conacqucnce of Nc grenling of this pcnnil. PLUMBING FEF
APPLY\NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PoIM AIR HANDLING UNIT(TO U)."CFM7
SOUR ERF - ATIONS. MECHANIC .FF.F,
n- ,,JN AIR FANDLINC IINIT(OVF.R 10,"CEM) CONSTRU
Si d eof AppGanlsCmuxto O/jl Date Ab EXHAUST HOODONMUCI) HOUSING MITIGATION
HAZARDOUS MATERIALS DISCLOSURE
Will to eppliunt o fudum building occupu,more or handle hnzvdnus metaiad HEATING UNIT(TO IM."BTT)
n def nal by due Cupertino Monici ryl Codec.Chapter 9.12,and Na He0h trod Sufcty
Code.Salion 25532(.)! HEATING UNIT(OVER 100.000 BTU)
0Tn MN. _ VENTILATION FAN(SINGLE-RESID) PAID
Will the Due Regi Ix
applicwu or ures re building or the Bay a tywpr Qu rc dcvim which BOILER-COME DUE OR I W.(Np BTU)
'mit hewdwu air emtnmirwu ea Iklrved hY the Pry A¢n Air Quality Mnnagunenl TOTAL:
Distrim?
❑Yes Cl No BOILER-COMP(OVER 1041"BTU)
I true rad the hvuddu m"„nals reyune,rcna Inde,Chagcr 6.95 of IN,Cali- AIR CONDITIONER -
ISSUANCE DATE
!moria Budd A Sefny Code.Sec ima 25505,25533 and 25514.1 undnvnM that if dile NEW RESIDENTIAL MECH. SQ.PT.
huilding dere,dg currently have a fe,nm,that let my raPmniNliry m miff,the uccupual
Udo,mquineoxu which muse be mer Prior to iawrce Me Curcur.'•a Occupancy,
Owar oautMrimd a gent Date TOTAL ISSUED BY:
OFFICE
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Home Owner:MIKE ANN CINDY Contractor: Showcase Kitchens Inc
KELLY
Address: 10425 DEMPSTER AVENUE 12333 Saratoga-Sunnyvale Road
• City: CUPERTINO Zip:95014 Sarataoga, CA. 95070
Project: KITCHEN REMODEL California Contractors License# 665395-B
New Cabinets, New Counters, New
Plumbing Fixtures, New Light Fixtures