29160 (2) CANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
2UPERTINO BUILDING-ELECTRICAL PERMITNO. w 0
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL L
BUILDING PROJECT IDE;YnFICAI[ON
R DINGADDRF,SS: SANITARY NO. APPLICATION SUBMITTAL DATI
� o49 � -g5 r I =�-9 �
NF. SNAMG: PHO G CONTRACTORS NAME: LIC NO,
A4
I N/C CONTROL#
ARCHITE /ENGINES '-7 ADDRESS ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLU HE PLUMB MECH
❑ ❑ ElLICENSED CONI RACIOR'S U17.CLARA'1'ION QTY. ELECTRIC PERMIT FEE
1 hereby uffrmt thn 1 an Married under provisions Of Chapter 9leommencing JOB DESCRIPTION
WOO with Sertlon)00(amf Division 3 ofthe Business and Professions Code,and my license is RESIDENTIAL:
E„�O in full force and effect PERMIT ISSUANCE
W� ❑SFDWL El KITCHEN REMODEL
aZW DanLicense Class LICN APPLIANCES—RESIDENTIAL ❑ADD]'170N ❑PLUMBING RE-PIPE
anQ e Contractor
Fprq ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z O rrn z 1 undecvmnJ my Nln ,h tll Mt used us Public records MODIFICATION
O Z UI"1'O 203 AMPS
W Licensed Pmfavinal ❑INTERIOR ❑CHIMNF,Y REPAIR
2UIIIXp AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION OVER I00OAMPS ❑BATH REMODELIREPAIR ❑DEMOLITION
Q 1 hereby affirm that I am exempt from IM1e Contractor'.,License Law for the
�d5((0M following mason.ISalion 7031.5,Business and Professions Gde:Any city or county SIGNS ELECTRICAL ❑OTHIiR �__�lRl�_.
Y13 V.yQ which myulms a permit to consumer,almr,improve,denminh or repair say structme (%� Y>R-•1_LJ
E'yO.J prior to its issuance,also raluires the applicant for such penniuo rile a signed statement SPECIAL CIRCUIT/MISC.
f oo that he is licensed pursuant to the provisions of the Coruucmes License law(Chapter 9
W (commencing with Section 7000)af Division 3 of the Business and Professions Code)or TEMP.METER OR POLE INST. COMMFRCIAI:
a q o c that he is exempt diamfmm and the basis for Nc alleged cxcnption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
W rn Section 2031.5 by any applicant for a permit subjwts the applicant to a civil penalty of POWER DEVICES ❑TENANT ❑FWD SERVICE
t mom than Five hundred dollars gNXE.
- 'SWIMMING POOLIiLE IC IMPROVEMENT
=Q wi Lnvawner of the propcny,or my cnpluycc with wogw un lM1cir sale enm.Business
�L.,O will Jn the work,wJ Neswemre isnn in¢nJed oroffemdfnr sale lSee.9M4,Business - []OTHER
L 3 m 9
and Professions Code:The Communes License Law does not apply in an owner of OUTLETS-SWITCH URCS
pmpmy who buikk or improve,thereon,and who does such war.himself.. through
his own employees,provided that such improvements are not intended or offered lire NEW RESIDUNTIAIAVECIR
sale.If,however,the building or improvement issoldwithmone yearnfcomplction.the SQ.FT.f1AORMiA &SQ.FT.
poeowner-bmilda will have the burden of proving that he did not build or improve for pun
ol'odeJ. N O
❑I,as owner of are profanity.am exclusively contracting with licensed contractors to 1 TOTAL: �A 3 1996
construct the project(Sec,7(W.business and Professions CoJc)The Contractor's Li-
con
x law does not apply to an owner of property who builds or improve%themon.and QTY. PLUMBING PERMI' FEE J��Y Uh
who trimmers fm such pmjcats with a contractors)licensed Pursuant to the Contr noes LlJr�f71 Jh(�
License Law. PERMIT ISSUANCE,
❑ lain unit ,I under See .,E3&P C for Nix masan
Owner Date 0jul • ALTER-DRAIN&VENT-WATER(EA) VALUATION
'ORKI: SCDMVN.A' ON )ECL.ARATION BACK FLOW PRO TELT.DEVICE
I hereby ufrirm undc penally of perjury one of the following dedafationr:
❑Ihavc andwillmaimain aCcnifaa¢of Conanunsel(-inseam for Workds Compcn- DRAINS-FLOOR.ROOF,AREA,COND.
STORIES TYPE CONSTRUCTION
sation,as provided for by Section 3700 of the LaMsr Cole,for the a for n mare of the
,.,it for which this peraft is,camd, FIX'I USES-PERI RAP
I have and will maintain Worlds Compensation Insurance.as required by Section
37W of the Labor Cade,for the performance of the work for which this permit is issued GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
My Workers Compensation Insurance carrier and Policy mumRr arc:
Cartier. Policy No, GAS-EA.SYST17MOVER 4(EA)
CERTIFICATE OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE GREASFANDUSTRI,WASTE INTERCEPTOR
BUILDING DIVISION FEfS
(Has swtionmwd of be completed mit if the peris frrone marked dollars IS 100) GREASETRAP
or les,] PIANCHF.CK FEE
toy any therm the any
as
becomewhich Nis the Workers
muted,[,hall SEWER-SANITARY-STORM EA.21X)FT.
not employ any person in any manner m as n become subject ns the Workers'Compen- ENERGY PIiE
z ,Z sm an laws of California.Dam WATER DEALER WNENTAlLECTR
Q App warn GRADING FEE
y NOTICE TO APPLICANT If.after making this Cenilicam of Exemption,you should WATER SYSTEMG BEATING
F become subject to the Workees Compensation provisions of the Labor Code,you must SOILS IES
Wforthwith comply with such provisions or this lwosit shall he deemed revoked. WATER SERVICE
Q
7z CONSTRUCTION LENDING AGENCY NEW RE.SIDENTIALPLMB. SQ.FT. PAID Date Receipt0
V Iherehy affirm lhm them isaconstmdiort lending agency for the performance of
the work for which this pennll Is issued(Sec.3099,Civ.O.)
0 h L) Ienlees Name TOTAL:
Lenders Address TOTAL:
�+ WBUILDING FEE
F I certify that 1 have read this upplireinn and,woe that the aMrvc information is
Iaq coma.l agree to comply withal]city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE
V Z building construction.and hereby auNorine representatives of this city to enter upon the SEISMIC IEE
&hove-nmmioneJ property for inspection purposes. PERMIT ISSUANCE
(We)agree n save,indemnify and keep harmless the City of Cupertino against ELfELTRIC PGE
liabilities.juJgmen¢,costs and expenses which may in any way vane against said City ALTER OR ADD TO MECH, PLUMBING FEE
in nm,c,.rncc of the gomfa,of this parrit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH At,[,NON-POINT AIR HANDLING ON]'I'(PO 10.000 CFM)
SOURCE EGULATIONS. MECHANICALFEE.
�x"o�� L--5-79L
• •J �/ AIR EXHAUST LING HOLD VMUCIT ERIO.p000FM) HOUSING
NTAX
Sigwt rcof ppbcaHA ver or Dam vTl_' P.RHAUSTHWU(WNUCp HOUSING MITIGATION FEE
NA' RDOe building,MATE IALS DISCLOSURE
Willy h e Cupant or furoreiploe.Chant r 9.12,handle Health a dSafrmaterial HEATING UNIT(TO 100.000 BILI)
C re,Sec io the Cupertino Municipal Cale.Chapter 9.12,and the Health and Safely
Cale,Section 25532(x)^ HEATING UNIT(OVER 100,000 BTU)
❑Yes ❑Nn PAID
VENTILATION FAN(SINGLE RESIU)
Dam Rwcipt p
Will the applicant nr future building Occupant use equipment or device,which
tan huamdous air conmminanls as crimA by the Bay Area Air Quality Management BOILER-COMP(3HP OR 100.0)(1 BTU)
TOTAL
Jamial
(X)
❑Yes ❑Nri BOILER-COMP(OVER 1 ,000 BTU)
AIR CONDITIONER
I have aurthe h odNomtion,2ls5.2553 ,undo Chapter 6.95 Cali- ISSUANCE DAT
funis building does&Safny Gdc,Section 25505,2s my and 25534.1 to nerstand Nat if the NIiW RFSIUENTIAL MEfll. SQ.IT.
OffiJews not 0.hich have linnat that it is mlrofa Crrinytonotify the Occupant
Of Ibe mquirantnls which intra M'n¢I prior m issuance of u Cenilicam nl'Occupancy.
Owner or authmnned agent Dme TOTAL: ISSUED BY:
OFFICE
City of Cuperdno '
Department of Community Development
7
10700 Torre Avenue, Cupertino, CA. 95014 (408) 252.4642
/ -L-2 - 9G
(DATE)
I am an adjoining property owner of Nn1r�PnPf
M (NAME)
whose property is located at AV,
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a g foot high fence facing my
(8 MAXIMUM)
property.
SIGNED: NAME: �.
ADDRESS: , Y!�/ Y;ro z?1i4 C/
PLOT PLANS
V,F7kE..�i�T
?4hF�5.3�•���
OFFICE COPY
A�,'IPnldnll ^^��
City of Cupertino -
Department of Community Development
�Y
10700 Torre Avenue, Cupertino, CA. 95014 (408) 252.4642
(DATE)
I am an adjoining property owner of in°>nm� h!( A�PN-oC FVT
(NAME)
whose property is located at -LQ-44,7,-JL rnPrnA1d[C2 �{
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a foot high fence facing my
(8 MAXIMUM)
property.
SIGNED: NAME:
ADDRESS: ���`/tel•
i
City of Cupertino
Agakk Department of Community Development
C —
A Ill 17)
10700 Torre Avenue, Cupertino, CA. 95014 (406) 252.4642
(DATE)
I am an adjoining property owner of J AME) I T_oi
whose property is located at 10 49a-qs I Yl err-[rno n
(ADDRESS)
I .govt (m der Ordinance No. 686. Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a foot high fence facing my
(8 MAXIMUM)
property.
SIGNED: NAME:
f
qSD ly
I'
j;
;z r
= C
k,a
City of Cupertino
- Department of Community Development
Fir
�y
10300 Torre Avenue, Cupertino, CA. 95014 (409) 252.4642(DATE)
I am an adjoining property owner of _ �o ra (NA
DME pnpi- { -Te PP,
whose property. is located at /0'Wa. -9S MeI-I-'f!\ 1 ,
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a _ foot high fence facing my
(8 MAXIMUM)
• Property.
SIGNED: NAME:
jig
ADDRESS: /D�f2$—COTIl�( � �gLV✓�
City of Cupertino
Department of Community Development
i y_yO
10300 Torre Avenue, Cupertino, CA. 95014 (400) 252.4642
(DATE)
I am an adjoining property owner of Dakcnro,k 1'IoOpty- e-4VrPP
(NAME)
whose property is located at 1049a.-AS Me6'd'i'rME)
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a (— foot high fence facing my
(8 MAXIMUM)
property.
SIGNED: NAME:
ADDRESS: _ /o y 6 o 5a,
Cvp¢nary ct :Z �—LJ%4/
. w