S 0102 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL PE§IT NO. 0102
BUILDING DIVISION APPIACATION/PERMIT PLUMBING.MRCIIANICAL
BUILDING PROJECT IIIFINTIFRIXFION
BUILDING ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL.DATE
6 -coq
N I'S NAME. PIED CO (IRS LIC NO:
-NIC CON'TBOL a
C ITECTIENGINEER: .CND: AD ESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
��� (�//V ❑ Conathan/Fees Paid by Appiican[(Initial) BLDG ELECT PLUMB MECH
_7 J VX 14 ❑ ❑
LIC17NSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT PEE
I hereby aRrm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
��y�Z witb Smfion]llflBtrif Division3nfrhe Business and Rofessions Code.vnd mylicenu is RESIDENTIAL:
FOO in full foreennd effect. PERMIT ISSUANCE
❑lS�SaF__DWL ❑KITCHEN REMODEL
aVt1 Livable Class Lic.M APPLIANCES-RESIDENTIAL DITION ❑PLUMBING RP.PHM
6 tLL� Dam - _ Cnntruc \
ARCIIHECTS DECLAA TIO LTI-UNIT ❑STRUCTURAL
ZOI�� PANELS
Z lundersmnd my plans shall he uuJ as'puh�lie recoNs MODIFICATION
OZp UPT0200AMPS ❑INTERIOR El CHIMNEY REPAIR
rE"s LLI Licensed Profcssiumel 201.100DAMPS IMPROVEMENT 0SWIMMING POOLS
•.1 OWNER-BUILDER DECLARATION
ce 6 1 hereby affirm that I am exempt from the Con ractor's License Law for the OVER]"AMPS ❑BATH RFiMODEI/REPAIR DEMOLITION
O U following reason.(Section 7031.5,Business lend Professions Code:Any city lar coumy SIGNS ELECTRICAL ❑OTHER
3 LL which requires a permit to emoutmc4 alter,improve,demolish,or repair any Imanum
^�Oa piia".naisshouncalso requires theapplicaal forsuch permit to file a signednammcrn SPECIAL CIRCUIT/MISC.
Nthat he is licensed pursuant to the....isinrmof the Contmclnrs License Law(Chapter 9
m p0 (commentingCOMMERCIAL
with Scetion]000)nf Division Business and Pnsfcssions CndO or TEM)'.METER OR POLE INS'1'.
Nat he is exempt therefrom and the basis for the alleged ascription.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Statim.7031.5 by any upplicam for. crunitodi is the applicamma civil pvnahyof POWER DEVICES
4,X4
not mom than Live hundred dollars($500). ❑TENANT ❑FOODSERVICE
1X
< Las owner of the property,or my employees with wages as their tele compenmtion, IMPROVLMEN'1
SWIMMING POOL ELECTRIC
'
_Fq�� will do thework,end Ne slrmmure is not intended nrn(Feredfor salt(Svc.]044.Business ❑OTHER
e. and Professions Code:'I he Contractor's License Law does not apply m an owner 0 OUTLETS-SWITCHES-FIX'I'U
pmpeny,who builds or improves tber,on,and who does such work himself m through
his own employees,provided that such improvements am net intended m ortemd for NEW RESIDENTIAL EI. SQ F .
sale.IL bowebcethe mildingor im,nowment insold within one yeurof completiaa,the SQ.Ff.FLOOR AREA $/SQ.IT.
pose-builder will have the burden of proving that he did not build or improve for par-
of sale.). A O
❑ 1,as owner of the pmpeny,nm enclu.sively contracting with licensed contractors to
construct the projces(Sec.7044.Business and Professions Cade:)The Contractor's Li-
came Law does not apply loanowner ofpropenywho builds orimpmvesther al.and QTY. PLUMBING PERMIT FEE P A I D
who contracts for such projects with a surnactorfa)licensed pursuant to the Contractor's
License Law. PERMIT ISSUANCE
❑IammmpI yg'er, a ,B&P C for this reason T
ALT)?R-DRAIN&VENT-WATER(EA) VA
whet Data (�}y
WORKER'S COMPNSATION DECLARATION BACK FLOW PROTECT.DEVICE C rUI- (iIJrCN�IN
I hereby affirm lander penalty of perjury one of the following declmations:
I have and will maintain a Certificate of Consent alf-insure for Worker's Compel. DRAINS-FLOOR,ROOF,AREA,CONI) STORIES TYPE CONSTRUCTION
tion,as provided for by Section 3]00 of the Labor Cale,for the performance of the
work for which this permit is issued. FIXTURES-PER TRAP
0 I have and will maintain Workers Compensation Insurance,as required by Section '
37M.f the Labor Cade,for the pefo.....f the work for whichlhis permit is ismed. GAS-EA.SYSTEM-I INC.4 OUTLETS IXC.GROUP APN
My Worker's Compensation loomance,amer and Policy number art:
Cartier: Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GRLASF/INIIUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(This section need not he compined if the permit is forene hundred dollars($BM8 GREASETRAI'
or lecsJ PLANCl1ECK FEE
I sanity that in de performance ofthe work for which this permit is issued,Ishall SEWER-SANITARY-STORM FA.2W FT.
not employ any person In any manner so as to hcenn,subject to the Workers'Compcn- ENERGY IRE
Z satin.Laws of California.Data WATER HEATER WNENT/ELELTR
O Applicant I GRADING FEE
tiNOTICE TO APPLICANT If,after making this Certificate of Exemption,you should WATER SYSTEMOKEATING
become subject to the Worker's Compensation provisions of the Labor Care,you nun SOILS FRE -
�' s.,,r forthwith comply with such provisions or this pimantshall N licensed revoked. WATER SERVICE
p Q
CONSTRUCTION LENUINGAGENCY NEW RESIDCNTIALI'LMB. SQ,FT. PAID
r�7 Z Date Receipt q
V k for which
Isanit is agency far the performance of
the work far whleh this permit is issued(Bee 3(19],Civ.CJ TOfAI.
V I<ndars Name
O Y<nder's Addmss TOTAL:
t Im7 BUILDING FEE I�
1 vanity ohm I have mad This application county
ordinances nal,ohm the above information is
Uh cmrecnlagree inonstruc comply with all city and coumytati .of and stem lawsr upon the
QTY. MECHANICAL PERMIT FEF,
V Z building cnnstrvetion,end hereby motorize repreumativu of this city mentor upon the SP.ISMIC FEE
F-u abave-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)same ,,save,indemnify and keep humde,a the City of Cupertino against ELECTRIC IEE
liabilities.judgmems,costs and expenses which may in any way occur,against said City ALTER OR ADDTO MECH. PLUMBING ERE
in ono Lance of the gmnting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CPM)
SOURCEP GU ATIONS MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signature of Appma Contmaor w 1 Data EXHAUST HOOD OW/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicam or future building occupant store or handle hazardous material HEATING UNIT(TO 1100,0x)111'U)
as defined by the Catania.MunioiNA Code,Chapter 9.12.cad the Health and Safety
Code,Section 25532m)? HEATING UNIT(OVER 100.0X)BTU)
❑Yes ON.
VENTILATION FAN(SINGLE RISID) PAID
-Date Rc¢ipl M
Will the applicant or future building rampont me,qulsocal or devices which BOILER-COMP(3HP OR I M,000 BTU)
nit hazmam,air alumna nulls ors defined by the Bay Area Air Quality Management TOTAL:
Israel? BOILER-COMP(OVER 110,00K)BITll
J ❑Yes FIN.
I have mad the hazardous mamnals requirements under Chapter 6a3 of the Cali- AIR CONDITIONER ISSUANCE DATE
found.Health&Safety Cele,Seniors 25.W5.25533 mW 25534.1 understand that if the NEN'RESIDENTIAL MECH. SQ.FT.
building does not currently have a tenant,that it is my responsibility to notify the occupant
of the s.quimme.m which must he met prim to issuance mf a Canlficam of Occupancy. )/�� -
Ownena umhnnuJ legate
Data TOTAL: ISSUED BY: �a��
OFFICE
t
RESIDENTIAL PROJECT COVER SHEET
Clly of
Cupertino
Assessors Parcel Number: l )?
0019
/
Name of owner. /� Vtl z u r 1���I LI�1 ✓I
Project address.
Contact person. jg 1'C `C ��rZ(JP l Phone.
Far.
Net square footage of lot.
d
Square footage: First floor: a 330-, .a, c�3 a
Second floor:
Garage:
wo ,
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N l
• On what floor(s) is work being done? / n t— rr A// / [ /
Brief description of work. wtu�CP �r9pSSa q f- /MAA Wap LCI ( cAt4P
a�(.�ic� 4- t�vlc�lKt� n ,ty ! t O 1�7Qu 95�iCfi�a�CesS'Qo0/�
Code editions: 1994 UBC (Y -N)1994 UFC (Y -N)1994 UNIC (Y-N)
1994 UPC (Y -N)1991 NEC (Y -N)
•
Plan Review Process Work Book Page-7-
File No. E40212
ver/Clint ' Kiadeh Mansur B.
rty address 22286 Hartman Drive
Cupertino County Santa Clara State CA Zip Code 95014
r Relocation Resources Inc. File 2-3-0-4-00 0031
30 .5
BEDROOM BEDROOM
POOL
30 .5
BEDROOM 14 .0
11555
59 .0
KITCHE11 FAMILY
R; BEDROOM NOOK 24 .0
18 .0
LDRY
LIUING DIttING 14 .0
ENT DETACHED
ROOM 26 .0
GARAGE 22 .(36 .0
11 .0
nn n 18 .0
Laing Area 2361 . 2 SquaFeet •
TOTAL LIVING AREA 2361 . 2 Square Feet
Detached Room 468 . 0 Square Feet
Garage 476 . 0 Square Feet.
22286 Hartman Drive
Cupertino , CA 95014
SQUARE FOOTAGE CALCULATIONS
Living Area
-11 . 5 X 30 . 5 = -350 . 7
-14 . 0 X 24 . 0 = -336 . 0
14 . 0 X 48 . 0 = 672 . 0
6 .. 0 X 42 . 0 = 252 . 0
36 . 0 X 59 . 0 = 2124 . 0
2361 . 2 SQ . FT .
VWY .YLAIN5
Detached Room ���IMU9 Ay
18 . 0 X 26 . 0 468 . 0 Offs
468 . 0 SQ . FT . _
"-MI_
fY DEP .
Garage 0.
20 . 0 X 28 . 0 = 560 . 0
-14 . 0 X 6 . 0 = -84 . 0 LLDG. 11ART1
476 . 0 SQ . FT .
TOTAL LIVING AREA 2361 . 2 SQ . FT .
OFFICE COPA
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