29903 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OIl CUPERTINO BUILDING-ELECTRICAL I'll RM TF NO: 0
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING PROJECTIDF'NTIFICATION
1111.DING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
�3�� ��1�� ✓F r,-Lit-q,�
V(NER'S AME: r PHONE ���I� CONTRACTORS NAME: LIC NO:
IL•�•! G NIC COMI'ROLO
4HCH1 I GIN P 1 LIC NO: AD 13
CON]'ACP. PHO
G�2�� ��� 1, �� BUILDING PERMIT INFO
/IwV, ��,3 I ❑ Consultant Fees Paid by Applicant(Initial) BLp(i.. ELECT� pLDMg_ MECH
. LICENSED CONTRACTOR'S DECLARA'HON J QTY. ELECTRIC PERMIT FEE I`—'/�f�r
Z 1 hereby affirea mal I am Ilcensm under p..vmam of chapter 9(commencing JOB DESCRIPTION
�qO with Section]Wn)of Division 3 of the Business and Professions Code,at my licenseis - R_F.SIDENTIAL
O in full forceand effect. is— PERMIT ISSUANCE
�U`fx,") License Class 1.IC.k ❑S )WL ❑KITCHEN REMODEL.
F. ul Dam Contractor APPLIANCES—RESIDENTIAL. TION [--I PLUMBING RE-PIPE
7h ARCHITBCPSOECIARATION PANELS ❑MULTI-UNIT I]STRUCTURAL
Z O�Z 1 understand my plans shall be used as public records MODIFICATION
OZ--0 - UPT0200AMPS [I INTERIOR ❑CHIMNEY REPAIR
r-4f" W Licensed Professional 201-I001 IMPROVEMENT
gY j OWNER-BUILDER DECLARATION OVER 10000 IPS [I BATH REMODEUREPAIR [I DEMOLITION
yy$4 W Q I hereby efficm mot 1 am exempt from the Commences License Law(or the
p(a 0.F fullnwing reaom.(Section 7031.5,Business and Professions Core:Any city nr county SIGNS El.li RIC ❑OTHER
4411 WO y which requires a Permit m construct,alter,improve.demolish.or repair any swmure
F..y J prior to its issuance,also«quires the applicant for such Permit file a signed sentiment SPECIALCI ISC.
� Qthat he is licensed prournl to the provisions of the Contmcmrs License Law(Chapter 9
{{0Oay44ll !commencing with Semon]INXpofDiviv,m3.fWe Bmvinessund Pmfcssinm Codelor '1'IiMP.h1EfER OR I'Oh. COMMERCIAL'
6tiy5 c-,C that he is exempt therefrom and me basis lar the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
W�H Section by any applicant in lwrmitsubjan Neapplicomtoacivilpenaltyuf POWER DEVICES .❑TENANT
yyyy} nm mthan five hundred dollars($500). ❑FOOD SERVICE
om
O ❑ I,as owner of the pnip,ny,or my employees with wages as their sole compensation, SWIMM TNG POOL ELECTRIC IMPROVEMENT
_ will do the work.and the strcture is not intended or offered for said(Sec. Business HER
and Professions Code:The Contractors License law does not apply to an owner of OUTLETS—SWITCHES—FIXTURES
proPcrty who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvcmcars ore ono intended or offered for NEW RESIDENTIAL ELECTS SQ FT.
sale,If,however.the building or improvement is sold within one yearofcompletion.the ��aa Q. ^ OOAREA www� ESQ.ET.
wnerbuilder will have the burden of proving mat he did sol build or improve for put \-y o 'J
V
pose of seleve `
L ns ow rut the pmpmy,am eacluaively contracting with licensed commdors m �
construct the project(sec.7144,Business and Professions ewe:)The comracmra u. Y 22
centt law docs nm apply et en owarer of pmpmy who milds or improves thereon,vnd QTY. PLUMBING PERMIT FEB 6i eggs
who contracts for such proun
projects with a nrdu
etous)licensed pursuano the Contractors
License Law. - Gl�r
❑ lute exemp under Sas D&PCfor this 1'L'RMIT ISSUANCE IJf' l'V_L1j
1Y1 1
ALTER—DRAIN&VENT—WATER EPA) VALUATIO
Owner Dam (^—^' /
WORT IR'S COMPENSA] )N I CLARA'DON BACK FLOW PROTECT.DEVICE V Y 1 �
I hereby off re under penalty of perjury one' the following declarvtions:
❑l have and will maintain a Cerificam of Consent to self-insure forWorker's Compete DRAINS—FLOOR.RODE AREA,COND. STORKS TYPE CONSTRUCTION
smion,as provided for by Section 3700 of the Luton Code,for the performance of the -
work for which this Permit i.s issued. FIXTURES—PER TRAP
El I have and will maintain Workers Compensation Insurance,a retracted by Section
3700 of the LuMlr Godo,for the performance of the work for which this Permit is issued, GAS—EA.SYSTEM-1 INC.4 OUTLETS OCC GROUP APN
My Workers Compensation Insurance carrier and Policy number are:
Currier. Policy No,; GAS—EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR UI DING ISION FEES
sectienmsdmol b,completed if the pcom,is foram,hundreddollnrs($1 up) GREASETI(AP
or less.) PLANCH FF.. ,
I cenifythat in the Performance of the work far which Ibis permit is issued,l shall SEWER—SANITARY—STORM EA.200 FT.
not empleyaryporom many amou,so a on become subject to the Wnrken.'Comp,m ENERGY FEE 1 O
Z solicit Laws of California.Data
O0 Applicant WATER HEATER W/VENT/ELECTR GRADING FEE
F7 y NOTICE TO APPLICANT:IL after making this Ceniticate of Exemption,yoi should WATER SYS'fF.M?BEATING
abecome subject to the Workers Compensation pmvi.sions of the Labor Code,you must SOILS FEE
W forthwith comply withsuch pooisineso,his permit shall be deenned revoked. WATER SERVICE
az CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.IT. PAID
L)O l hereby affirm that here is a construction lending agency for the Performance of Date cipp
t,4 r me work for which this pemtit is issued(See 3N7,Civ.C.)
Q U Lender's boom, *TOTAL
tYaL V Lenders Address T(
'{fir 0. I certify Out I have ret this application and state that the above information is BUILDING FEEIA correct.l agree to comply with all city and county ordinances and state laws relining to QTY. MECHANICAL PERMIT FEE
building construction,and hereby authorize representatives of this city m enterupon the SEISMIC FEE
.ave•mentoned property for inspection purposes. PERMIT ISSUANCEI Wry agree m save,indemnify and kap homeless the City of Cupertino against ELECTRIC FEE
liabilities,judgments,costs and expenses which may in any way seer,against mid City ALTER OR ADD fill MECH.
in mmsequerec of the grunting of this permit. PLUMBING PEB
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON�POINT ALR HANDLING UNIT(TO 10.000 CFM)
SOURCE REGULATIONS. MECHANICALFEE
AIR HANDLING ONE'r(OVER 111,1X10 CFM) CONSTRUCTION TAX
Signature of Applicari/Conreamr Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FF.P.
HAZARDOUS MATERIALS DISCLOSURE'
Will th.rr,,hcuntar future buildingmeupummorcor hurdle haranlous material HEATING UNIT(TO OD,(mu BI U)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the health unit Safety
Cade.Section 25532(.)? HRATING UNIT(OVER[MORE BTU)
❑Yes CINo VRNTILATION FAN(SINGLE RE Sit)) PAID
Date Receipta
Will the applicant or fintionrots a M1uilding occupant use cepva Air Qu lily Management
which
,mit hexudous air conmminams as Defined by the Bay Arca Air Quality Management BOILER—COh1P(JHP OR 100,0(1(1 BTU)
TOTAL:
District^
❑Yes [:j No BOILER—COMgpgl BTU)
P(OVER Il
I have mad the hatuardoa materials requirements under Chapter 6.95 of the Cali- AIRCONDITIONER ISSUANCE DATE:
fomia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.Fr.
building does not currently have a tenant,that it is my responsihility or notify the scup on
of the requirements which must be mel Print to issuance of a Ceni licute of Occupancy. 1p
Owner m uumonzed.,net Data ] ISSUED BY:
OFFICE
- � r
T��r
SANTA CLARA COUNTY CONTROL NUMBER 8059
CENTRAL FIRE PROTECTION DISTRICT
14700 WINCHESTER BOULEVARD BUILDING PERMIT NUMBER 29903
�GTecnoN��� LOS GATOS, CA 95030-1818 (408)378-4010 PLAN REVIEW NUMBER 96- 1282
SERVICE SINCE 1947 FAX(408)378-9342
PLAN REVIEW COMMENTS
CODE/SEC. SHEET NO. REQUIREMENT
Review of plans for the proposed addition to an existing residence.
1 No fire department impact.
Recommend upgrading the existing smoke detectors to 120 vac with battery
back-up.
Approved: Okay to issue the building permit
No fire department inspections required
DISTRICT PLANS SPECS NEW RMOL AS OCCUPANCY CONST.TYPE PERMrrTEE DATE PAGE
CUP ® [I E] ® R-3 V -N Design Forum 05/29/96 1 DF 1
SECJFLOORAREA LOAD DESCRIPTION BY
706 sf Residential Construction Barnes,George
t1AME OF PROJECT LOCATION
SFR - YEH 10300 Portal Av, N
Proudly Serving Santa Clara County and the Cities of.
Campbell, Cupertino, Monte Sereno, Morgan Hill,
Saratoga and the Town of Los Gatos