B 0620 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POIIJ7 PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION PLUMBING-MECHANICAL.
urPLlcnrlovmr:RmlT 50001
D1101
I ��y�J ('N� /� I�IUrI�LUI_NCr�PRD,p;CTIUEN'1'IN'ICATION
BUILDING ADDRESS: ` 1517 R'llpkl /�� OR, C-Uk� �IRltlx0? C gSOr4 SANI'T'ARY NO, APPLICATION SUBM ITI'A L DA TE
_1
.7 <--L f°-- 9 1
OWNER'S NAME: ^ n` I'fIONF.: )NTRACTOR'S NAME: ''I Itawcwu/' I.IC NO:
ff'v I1 si21kVMIA2 446 I CC CIIofJ bo \ Z N/C CONTROLp
sRCHIT bC]/I:NGINI:LR:ower F_2 LIC NO: ADDRESS: X10 MT. cT; 1-�'pla T ❑
CONTAW PHONE: BUILDING PERMIT'INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MliCH
C� Ir CT 0
LICENSED CONTRACTOR'S DECLARATION
QTY. ELECTRIC PERMIT IeEE
1 hemby aRrm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
yVOyIWZ with Section 7")ofDivision 3ofthe Business and Professions Code.and my license is RESIDENTIAL' ,.�,,��••
Fwr in UP force unit epen. PERMIT ISSUANCE ❑SFDWL ITlkttCHEN REMODEL
TUU in
Class Lica APPLIANCES-RESIDENTIAL
❑ADDITION ❑PLUMBING R1iPIPE
�aQi G 4 Date Cement., 3
F.7w ARCHITECTS DECLARATION PANELS ❑M111.TI-UNIT ❑MODW[CAT16
Z O In d. I under mnd my plans shat[be used as public remods h10DIFlCATION
oz_� UPTO100AMPS [1191 PRIOR El CHIMNEY REPAIR
W I.icensad Pndfircannal 201-1000AMPS IMI'ROVBMHN'r F]SWIMMING POOLS
C6 �� OWNER-HUILDER DECLARATION OVER 10(X)AMPS ❑BATH REMOUEIJREPAIR ElDY.MOLI'I'ION
Q I hereby affirm that 1 um exempt fano the ContractorsLicense Law for the
iV following reason. T(D1.5,Business and Professions Cole:An t t ❑OUTER
g m Y city or county SIGNS ELECTRICAL
x13 LL y which requires a permit to eonswe,aper,impmsu demolish.ch ametor mash my swment
path.isits i,enonce, ,monlso ui lot nivionhe applicant forthe Counts nnit toicamele a signed statement SPECIAL CIRCUIT/MISC.
p�jsd
that h)Isllo,wit ponmint7000)of Disintu nfof t Gmisirus's License Law(Chuptu9
(m he is exempt
pt iereSonfrn and of basisor3 oltheeged exempton.Profession,Code)of TEMP,M13'1'13R OR POhIi INS'L COMMERCIAL:
Mn he is 31.5 b they applicant
and the basis for the ats the
exemption.Any l Penalty of ❑NEW BLDG/ADDITION ❑DEMOLITION
44.• Sedion]U3 LS by any applicam forapermit suhjxts the applicam macivil penalty of POWER DEVICES
FN..•Z t men than rise handfed dollars($500).
TENANT
n EOnpSyyYN-
Tj Q t,as,.nr,.f Ne preload,or my employees with wages us dmir sole emopennati)n, SWIMMING POOL ELECT RIC �j��
CYY2JWLr1I, IdoOhe work,and themomome is tern intended orolTered Iter into(Set,7044,Itusineas OT i- /—
3 and Professions Code:The Contract.,',License Law does not apply to an owner or �f.. OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through 1jul 11111
his own employees,provided that such improvements sm not intended or offered for NEW RESIDENTIAL ELECfR SQ IT.
sale.If.however.the building or improvement is sold within tent yea ofttrmpletmr,the T. AR $
m
Mr
owner-huildea will hovo the harden of pnrving that he did nm build or improve Impur-
PPPPPP999999�����N77
ooLsule).
$'1, f owner of @e property,am exclusively cnnaating with licensed enmrunnrs m TOTAL: -
tkc stmd the project(Sec.mW.Business and Pmfessians Crile:)The Cnmmcmr's Li-
sclnwduesnotapplymanowner ofpmpenywho buildsorimproves mereon,and QTY. I'LUMBINGPERMIT I FEE By
who contmets for such pn9ects with a mnaeOun s)licensed purmant m 0he Contmemr's
License Iatw. PERMIT ISSUANCE
❑lam exempt mull
d Sc. .B&P C for this mason
ALTER-DRAIN&VENT'-WATER(EA) VALUATION
D
I WLSJIHBR S'COMP• SATION DECLARATION BACK FLOW PROTF.Cf.DEVICE 6 A-'LT
1 heathy affirm under pcmhy of perjury one of the following dedke",Cts: V A"
on,as and will forbyhtection 3700 of the LaImCeifor the Wmkcr'sce of the
DRAINS-19.0012,ROOF,AIt13A,COND. STORIES 'TYPE CONS'I'SIXI ION
firm,as provided for by Section 3]00 tel the Labor Code,for the pednnnunce of the ))
work 01linr which ill permit is issued. FTXTIIRES-PER TRAP
I hove and will role,for Wmkera ante claw
l w w Immman,h required by Semina I/
My orke Lobar Cosationhsuran anter and Policy
forwhichpcmtitisissued. GAS-EA.SYSTF.A1-1 INCA OUTLETS OCC,GROUP ty�6 PN
C.Workers Compensation lmurancenmicrand Policy nunthn arc: ���///��� .3J
Corrin: rIONy FROM
CAS-13A.SYSTFM-OVBI24(BA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCIi GRGSI%INUUSTRL WAS'I'L INTERCEPTOR
HUILDING DIVISION FEES
(Thissation need nm be compldeA ifthe permit is forme hundred dollars fSl W) GREASE TRAP
or less.) I'LANCHECK PER
Iccnifythat intheperfonnamee ol'thc work for which his pemtitis towed,I shut] SEWER-SANITARY-S'IOR M EA.21X0 F I'.
not employ y person in any manner so as m become sahject m the Worked Cmnpem ENERGY PLC
Z
enmotion laws of C.ffomia.Date WATER HEATER W/VF.NT/ELECTR
z Applicant 1 GRADING FEE
.N. NOTICE TO APPLICANT.If,after making this CeriGcae of Exemption,you should WATER SYSTF:M/IRENUNG SOILS FEE become subject to the Workers Compensminn provisions of Oe Labor Code,you must
fethavuh comply wuh such pmvisicm or this permit shall he deemed revoked, WATER SHRVICP,
Q
5z CONSTRUCTION LIiion lNGAG1'NCY NEW RESIDENTIAL PLh1H. SQ.PT. PAID
C.J kfor:whichthithanhem isaconswe.construction agency for the Performance of ReceiptM
the work for which this ps'mtit is issued(Sec 309].Civ.C.)
Lender's Nome TOTAL:
V Lender',Address A f
I cenify that 1 have read this application and state that the above information is HULL PP s
N correct.l agree to comply with all city and county ordinances and state laws mining to QTY. MECHANICAL PERMIT FEE
U Z building construction.and hereby suthnrio,representatives ofnhis city to eicrupon the SEISMIC FE
above-ntcrmmal property for inspection purposes, PF.RMI)'ISSIIANCE 3
(We)agree m save.indemnify and keep harmless the City of Cupertino against ELECTRIC EE
liabilities,Inlgroars,cnsmnnd expemevwitich rtay in any way ucene,against said City ALTM OSSUNTO CEMECIL O
in emrsoqucnce f the granting of this permit. PLUMBING
APPLICANT NO TANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT'('TO MAXI CFM)
SOURCIi REGI L 'S. MECHANICAL F ai t
4 AIR HANDLING UNI'I'(OVEN In,(XIB CIM) pp�� CONSIAUCfION TAX
Signature of Appl a Dom EXHAUS"T IIOOD(W/DUCT) LJ HOUSING MITIGATION FEE
n AFARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle harundous material HEATING UNIT(TO I W,(XX)BTU)
as defined by the Cripcnino Municipal Cole,Chapter 9.12,and the Health and Safety
_ Core,Section 25532m)? HEATING ONIT(OVER 100.00 BTU)
❑Yes ❑Nn PAID
VENTILATION PAN(SINGLI3 RES ID)
=.�,W BI the applicam or fume building occupant use equipment yr devices which Dam Receipt a
4,prdou,air mnmmirmnts as defirwl by the Hay Arca Air Quality Management BOILER-COMP(3HP OR 100,(X10 BTU) 'TOTAL:
C°' BOILER-COME(OVER 100,001)BTU)
Yes ❑No
--
1 have read tie hwariteoa metand,requirements order Chapter 6 95 of the Cali- AIR CONUI'I'IONER 1 ISSUANCE DATE-
fcaur Halth Sa@tyC'xH,5srniom25505,25533nm125534.1 madersend that ifthe NEW RESIDENTIAL MECH. SQ.r..
buildingdmn mly have a emant,that it is myle"rodbihns'm notify the occupant 2— i
of the tequireme a hlth mm' to 'or m ismace of a Cmsi c cof P,cry. -
9
weer ter uuthon-' pert Date T<> k ISSUIiD BY: /
OFFICE
10'6 177 11-10
137 Tl 5'9- T'11 Tl 1 5.9----.: —_--g-1__--_
ry
ry MASTER BDRM
15'9 X 11'8
LIVING
17'11 x 137
ROOM
10'4 x 107 FAMILY
UMASTER 10'11 x 137
BATH CLOSET
4'l 1 x 77 6'4 x 7'5
WALKWAY CLOSET
3'8x176 SET
I L 74____
MASTER
CLOSET WALKWAY Puja Room I
BATH 10'8 x 3'8 Area
9'5 x 37
F3 10'111 x 63
CLOSET
LOSETOX
BATH BATH DINING
117 x 10'9
I I I
5'5 X 6'8 6'x 68 ENTRY
n 'k. �
5'4 x 15'4
Fk.. � ry
BEDROOM
:LOSET BEDROOM 10'5 x 121 TO Ove__
Loser
13'x8'11 -e1 NOOK
7'2 x 9' 12'8x14'10
L
UP. Fridge Pan"
7
5'1014 -
Notes:
1. Proposed layout of 21517 Rainbow dr. Cupertino, CA 95014
2. Drg,for construction permit to remodel the Kitchen
3. Moving landry area, currently, next to the kitchen and place it in garage.
4. New kitchen primary lighting will be fluorscent lighting.
5. Construction to be done and managened by owner builder. GARAGE
6.Actual work to be done by indivuldal ficeneced contractors 20'x 22'5
7. Contractor Company: JAC Construction Co., San Jose 95127
8. Contractor Name:Javier A. Cano
9.Contractor Licence*B-566242
10. Contractor Worker Compensation-Exempted by Contractors State Licence Board,CA 95286
LIVING AREA
2032 sq ft
WPIPIR01*450 DO Uk
gCORWACEts�Njj"AND r,C`
ni)
ro.V.tR11tAo C
pes)
SIGN set 01
Thisouns ,1 e4\
too 10 Y\z
be 'OPk on n
lawful 10 l""ni6sto
1tum P
0 �'poitmo-
on same
no e
k1l
t 0'r to
The 'tamp ovisio
State.
CM DrJinanc
,T*T— --- }` -„ •,U— --�
168
MASTER BDRM _— — ------ -- —
H-
169 x 11'8
LIVING FAMILY
17'1 x 137 1011 x 16'5
-- BEDROOM
10'4 x 107 -
(� CLOSET
MASTER 6� 4 x 7'S
STM ALKWAY aOSE
ATH411 f LO cLesEr
0 3'8 x 17'6 -----
• .....__ 310.ze r
_._.....
-- MAH .
BA /1 WALKWAY
CLOSET cane,
J\ z,r 10'8x3'8 n
CLOSET L00
°e°z�T DINING ceMu
—.
16.z .r-.:xer.. ....... 11'5 x 10'9
BATH BATH o
_5'5 x 5'8 6'x 5'8 ENTRY KITCHEN =
v
...__.._....... 5'2 x 15'4 14'6 x 11'
• _Po4Qe _. Colder
Oven
BEDROOM
LCSET BEDROOM 10'5 x 121 i NOOK
n--._._._.
13'x 8'11 88.61 - BATH
- -- _ LALINDRYe� ,.s,
. ... —u—P __.—._. 5'6x6'1
—T,__—. 271 596"1
ss —
Note:
1. Current House Plan for 21517 Rainbow drive, Cupertino, CA 95014
2. Garage Door entry is to the side and it is manual operation door-unsafe
3. Kitchen cooktop is close to edge and kids can accidently touch hot surface-unsafe
4. Laundry is next to Kitchen
GARAGE
20'x 22'8
LIVING AREA
2034 sq ft
” Y