S000120215 (2) APPLICANTTO 1[-ILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
1— PERM IT NO.
CITY OP CUPF:Si PINO HUILDI NO-MECHANIC L 2 0 2.1 5
RUII,DING DIVISION APPLICATION/PERMIT PING PRNG-MNIDENTIFIC S0001 L Cil.
BUILDING i•ItOJE6T IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUHMIrrAI.DA TE
a0/J '-/ 89C?iF/C4 v?. L x10, "R i/N6 diq - �'•-
OWNERS NAME: VHON CONTTRACf0R'S NAME: - LICNO:
Lp ' AT/�/NE ELMS «� to%J 7g N(C CONTROL x
CHITECI'/ENGINIiGR: LICNO: ADDIUISS: ❑
jS(iJ KiFE? RJ. SN'✓T9 &,YW4 CH•
UN'1'ACT PHONE. ❑ LDING PERMIT INFO
2 ❑ COBstiltant pets Paid by Applicant(Initial) BLDG ELECT PLUMB MECU
❑ ❑ ❑
LICENSED CONTRACT OR;S DECLARATION QTY. ELECTRIC PERMIT FE JOB DESCRIPTION
'
1 hereby aRrm that 1 am luarnad muter mosiiin.,of Chapter 9(commencing
,0Z with Secdoo](001 of Division Sof the Business and Professions Core.and my licens is RESIDENTIAL:
W p PERMIT ISSUANCE
CW� in full❑n:x and cffan. ❑SFDWI. ❑KITCHEN REMODEL
v I}ern.se �—/ Ln.a ti76/3 7G
F. M l� 7 %11^Contnnor OL t AI'I'LIANCES-BESIDE NTIAL ❑ADDITION ❑I'hUMIi1NG RG1'll'li
F.Z n Dine
read ARCHITECTS UIiCLARATION ❑SIULTI-UNIT []STRUCTURAL
F m y 1 undcotand my pions shall be u,W as public records IANEIS MODIFICATION
OZ�� UI"102(XIAMI'S ❑INTERIOR ❑SCHIMN17Y REPAIR
NG POOL
F=FW LicensedProfessimed 201-IIX0AMPS MPROVIeM1iNT �SWIh1MINGPOOIti
OWNER-BUILDER DECLARATION OVER IM AMPS [I BATH FEMODEIJREPAIR ❑DEMOLITION
C C 6 I hcleby union that I ani-eTTT,T from,he Cnmrncon's Liccnec Le.Tor me /
following reason.(Section]031.5,Business and Professions Cute:Any city.,county SIGNS ELECTRICAL OTHER
y which reforms a permit to cournol,alter,Improve.demolish,or repair any awemre
O)a pn.n t uF:rcy Ih pplic tf hpe 11 fl sig dot Cement SPECIALCIHCUIT/MISC. '
'Ery Ihull Jp rxu tl ,h p' n I,h C T' t sl' : 1' (CM1 pter9
f+1�00
(commencing 'tit Section700 fD . J ftha Bu dlnf. Cxi or TEMP.MITER OR 110 .INSI' R IAL:
L S ey that he is exempt therefrom and the basis for the alleged exemp ion.Any s aloin.of EW BLDG/ADDITION ❑UEh101,1 TION
Section]1131.5 by tiny applicant fbr a permit subjem,the applicant to a civil penalty of TOWER DEVICE TIiNANT ❑FOOD SERVICE
n,more than five hundred dollars(5500).
I-=Q I.as owner of The n SWIMMING OL ELECTRIC OTHERVIiMF;N'1'
I] props er or myvmpliarded W wages as aa.70,mpcmaiess []OTHER
F., will d.tbework.ande: he Comic tormd s License
Law does not apply to an Business
and Wnlnsxinnx Cute:TM Contractors License Lnw Unca urn apply to an owner of UIfTLE -SWITCHCS-FIX'T'URES
pro,wny,who builds or improve,Ihefeen,and who does such work himxcll'or Through
his own employees,provided that such improvements rue not intended To offered for NP RESIDENTIAL FLEC'TR SQ FT.
rale.if.however,the building or impovement is sold within one year ofenropletim,the SQ.IF.ELIXIR AREA &SQ.Int'.
,sur,-hander will have the burden of proving That he did nil harder inspmvc for a,
pro, salcJ. �i
-1 I.as nwner of the Mapeny,ran exclusively contracting with lice.sed contractors I.
instruct the project(Sec.7041.Business and Professions Code:)The Contractor's Li- ..F
.a Low docs nn e,pylnunnwnerof property who builds or improves Thereon.and QTY. PL U 11 MIT FEE
won contracts for suet,projects with a cnmtanor(s)licenced pursuant to the Contmclne,
License I.w. P12RNIIT ISSUANCE
1 am exentpt under Scc, ,B k P C for Ibis reason
ALTIiR-DRNN k VENT-WIG ER(EA) VALUA'Dl)N
Owner Data
F�
WORKER'S COMPENSATION DECLARATION
RACK FLOW PROTECT.DEVICE !/X (q
/
1 hereby affect under penalty of perjury one of the following Icelanders:
I have and will nudnminaCcnificvte nl'Coronnnnsclf-Insure fin Workcr'v C.mpun- DRAINS-FLOOR,ROORAREA.COND. STORIES TYPIi C(lNSTRUC'IION
lion,a,provided for by Section 37M of the Labor Code.for the performance of the
work for which This permit is issued. FI%TURL•S-PER TRAP
I have Emil will maintain Worker',Compensation Insumnee,as required by Section
J]W ofthe laborCore.forthe perfunnnnce of the work no whichmLsperatit k owed. GAS-EA.SYSTEM-I INC.J OCT S OCC,GROUT' ANN
My Workers Compe�tsane Inwrance conic'and Polity numbs
Carrier, A/H /C� Policy No.: N a i7— y GAS-EA.SYSTEM1LOVER4(' )
CFiRTIPICgTIi OP EXEMITION FROM WORKERS GR:ASPIN D STRLW .INIERCIi )R
COMPENSA'DON INSURANCE BUILDING DIVISION IDES
ss
(This section need not becomplered ifmc permit is for one hundre dollar,($Ilk) GREASE r'
r less.)
I'IANCHECK FEE
I coli 1,that In the perf...in cte The work for which this permit is issued,I shall SEWER NIT O .2
no,employ any pen..in any enamor m as o become sundae,m the Work...Compen- ENERGY FEE
Z nation Laws of California.Data WATER 1 A /GLECfR GRADING FEE
O O Applicant
Z. V, NOTICE 10 APPLICANT:If,per,making this CcnlBcam of lixcmprion Yon.should WATER: ."IEMn BEATING
SOILS FEE.5.1 become subject to the WICompensation provisions of the Luhor Cute,you must
[k7 fnnbwim comply with such pmvisions.nhis permit eballMJeemed revoked. Wq SEN 1�
Q PAID
CONSTRUCTION LENDINGAGENCY N RESIDENTIAh1'LMH. SQ.F1'. Unto Re'ripTB
U� I hereby Effimtthinberc is acomwnion lcrolm'ugemcy forthe performance.(
D+ F the work for which this permit is issued(Sec.30)7,Civ.C.)
OH)IAL
landur '
'X Name
U Lander,Address f0'fA h:
a. 1 tend,Thar I have read this application and smte mat the.Mme inf.rmadon is RUILUING iE
.Fi IaA correct.lagree m comply with all city and county ordinances and state laws relining to QTY. MECHANICAL PERMIT F.E SEISMIC FI'.E
m
L)7� huildn,conaction,and hum by amoulle repro,antellal of this calms cater upon rhe
abovcuntann red p,,,,ey for inspection purposes. PERMIT ISSUANCE ELFCT I I 'i
Dsoa)agree,at.save,indemnify and keep harmless The City of Cupertino against
Iiabilitics,judFmcnu,cosec and expenses which may in any way ac<rae against said City ALTER OR ADD TO MECH. PLUMBING iE
To oo.Tw,aane..t'The griming of this ITT,nnit.
APPLICANT UNDERSTANDS AND WILL COMPLY WFI'11 ALL NON-POINT' AIR HANDLING UNIT(TO 10.00 CFM) MHCHANN 1 FFI
SOURCE REGUI.ATIO
AIR HANDLING UNIT(OVER IO.OW D CONSTRfICf10. TAX
Signature of APPlicvnUC.mrvctor Dme EXHAUST HOOD(WIDUCf) IIDUSING MITIGA lON l9ili
HAZARDOUS MNI TRIALS DISCLOSURE
Will,heapplicamI,,future haddingrccupam store.,handle hamrdo.%material HEATING UNIT(TO 100.(1(10 B )
as defined by,he Cupertino Municipal Cole,Chup¢r 9.12,and,he Iluslth and$ul'ety HEATING UNIT(OVIiR It X0(1 BTU)
Cale.Section 255?2(a)1 7�
Yea I '• VENTILATION PAN(. :GLh HESID) PAID
Date RaCcaldx
Wi11the applicant or future had lding occupant use cynipmenl or devices which ❑OILIiR-CONI' IP OR 100,(00B'fU)
it hoarders air contaminants as defined by the Bay Area Air Quality Management 'I OTIC:
arictP BOILER-C 11(OVER 1(10.(X0 BTO)
Yes
I have real the bavrdcas ma¢rivls requirements under Chapter 6,95 of me C:Ii- AIR CO II'IONEH ISSUANCE DATE
'omia realm&Satiety Cute,Scni.n,255(15.25533 and 255:W.1 understand mm if the NEW ESIDENTIAL MECIL SQ.Flt s
hoildne,doe,nal,rer-,lly hoveuTenant.That It ie my re,rymnihili,y ora Hy meoccupmn 111 Xn
ofinetefuirerman whi c,primo issuance of a Cenilicmc.ff iN. _3 V
/: .3 9
aumn. agent Doc TOTAL: ISSUED BY-.
OFFICE
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G'6" x�0 � h�IT io LUvcP
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L'LO'I' I'LANS I /
CHECKED BY , GAP A Cf V
InTL
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RrEC � 11
YLANNIiiC ll PT. �
. �� NOV 0 3 1998 VO
. ATEA �
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® eLUG. INSPECTION DEPARTMENT
BLOC. DEPT. CITY OF CUPERTINO
' ' 73 / Lo- 7361orSF.
CUSTONIEQ LORRnINE FJ ELMS
ar,IlU PFlrlFlcn Ua .
CUVc.RT,klo CIA . 01501N
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