27141 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
GITY•OInCUPF.RTINO 1113n,SIN i-ELECrRICAI, PERM IT No.
BUILDING DIVISION APPLICATION/PERMIT PLUMBINC•MF.CIIANICAL 27141
IIUILDINO PROJECT IIJEN'1'INICA'rl[JN
BUILDING ADDRESS: o SANITARYNO. APPLICATION SUBMI'ITAI.DATE
/psrigS UNI'ra ora l�
O NIiRS @ PHONE CO ACI'DR:SN ME: LIC NO: ZA/ C
OIY NJC ONTR a
ARCI..T, IENG LICNO: AD_ @G� �,{ \� �� ❑
CONTACT: PHONE:
QTY. ELECTRIC PF,RMIT FfiL• BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE'
LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL JOB UESCRFFI'ION
W00cstz IM1euhy ofnmsion het am licensedins,and irifes ors;Cyte,add
my Rectum
with � �
F 0N�0H Section e red of Division 3 of the Nusincss end Profession Code,and my licenx is in ppppl5
V V lull force unJ effect. �" I
FZ W Licenx us B Lic.p I UP T0200 AMPS
6y Dem Common, 201.I000AMPS
ZOr"is E' ARCHI'IT.CCS DECLA OVER 1000 AMPS SQ.IT.FLOOR AREA S/SQ.IT.
OZ-0 l understand my planssdall beused aspublic ascents.
r 4 t w SIGNS ELECTRICAL
4 �1cursed Promssional - -
L W, OWNIiR-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. '
e�ddge, I hereby affirm that 1 am exempt from the Contractor's License law for the
6130th folkwArt,reason.(Section 7031.5,Bmmc,aand Professions Cede:Any city or county TBMP.METER OR POLE INST.
L which resensentenceuires a permit to construct,alter,improve,demolish,or repair any stmu
}M priono its issuance,alsortquires Ne applicant for xch peamitmfleasigned aummrnt POWER DEVICES
<O that he,,licensed pursuant to the powismes.f the Cnnmweex License Law(Chapter
6• 9(commencin with Section]f1011)of Division 3ofthe Businessand Professions Code SWIMMING POOL ELECTRIC
o� gess ) VALUATION
:y or flat he is exempt therefrom and the basis for the alleged exemption.Anyvimmonof FIXTURES
Hza Section]031.5 by nny.pp11cantfmapertnif subjects the applicant civil penalty of 011'ILETS-SWITCHEg-
S S C ant more than five hundred dollars($500). / W
❑ 1,asownerofthepreper(y,nrmyanployeeswlthwagesasfheirsulecompensmion, NEW RESIDENTIALELECfR _SQ.FT. - STORIES TYPE CONSTRUCTION
a3. willAo the work,anJ the stmaum is not inlendedoroffertdfor sale(S<eJ094,Business
and Professions Crile:The Contractor's License Law does not apply to an owner of -
Property whohuildsor iamovesfhereon,aM whoduessuch work himselfor through his
own employees,pervidedthat such impevemenesamnot i,nemdedoroffemdforaale.If, OCC.GROUP EA
UNITS
however,the building or improvement is sold within one year of completion,the owner.
EFEE
builder will have the harden of proving Nat he did not buildor improve for puryou of
ale.).
QTY. PLUMBING PERMIT• FLOOD ZONEPN
consume,the project(Sm.7W,Business and Professions Cade:)The Contractor's PERMIT ISSUANCE
Liceme Lew docs not apply man menerofpropeny whobuilds or improves thereon,and
who contracts for such projects with aconuector(s)licensed pursuant o the Contractor's
License IawALTER (FA) PEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C burns mason PACK PLOW PRO'EC ICE
- SANITARY YN
Owner Dam pRAINS-FLOG OOF,ARI3A OND. RECEIPrp
CL
WORKMAN COMPENSATION DEARATION SCHOOLTAX Y N
❑ I hereby affirm that l have a cenificat ofcomenfto self insure,or o emireate of FlXTURP fR TRAP BECEIFfp
Workers Compensation lnsuranecorucenifedcupythereof(Sec.3801).Lab CJ which PARK FEE N
mversall employee's an&,this permit.
Pubic a GA .A.SYSTE-M-?INC. S4OUTL
Y BUILDI G V ION ISIS
Company GAN EA. :M-OVER (Ir PLANCI MCK HE
❑ Certified copy is hereby tumbled.
❑ Cenifal copy is fled with file city inspcetion Division. GR[A S'IRL WAS INTF.RCF OR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' :TRAP SOIL
COMPENSATION INSURANCE
(This suction need not becompleled lithe permit is for ora hundred d tars(g10pJ 'EWER'- NJ - TO EA.200Fr. ENERr
or less.)
I ttnify uhaf in the performance of lie work for which this peami,is issu WATER TER W/V' r/ELEC'IR
nm employ any person in any manner so or to hve me subject to the Work PAID
Z Compemmfion Lnwsof Califon.. Dam ATERSYSTF. EATING pun Receipt is
Applicant
O 0. NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you shouldNEW RES1,rATIAL PLMIL SQ.FIL TOTAL:
F` V) become subject to the Worker's Compensation provision ofthe Labor Code,you must
� ; forthwith comply with such provisions or this pcamit shall be deemedeevoked. BUILDING
0. Q CONS"!RUCTION LENDING AGENCY SEISMI ';E
Uz Ihereby M.Nat them is.commotion.lendiagageney fame perf—F-1aof \. 4 -
O the work for which this permit is issued(See 31197,Civ.CJ TOTAL: ELECTRIC I E /a
Landae's Nates
U" F Lender's Address - - QTY, MECIIANICALPERMIT FI?E PLUMBING Ar,
W1 'nify flat I have read his application and amts IIra,the above information is
rrcn.I.'reem comply with ell city and county ordinances and state laws minting m PERMIT ISSUANCE MECHANICAL .1?
_ y buildingconstmedon,and hereby authorize representatives of this city mentor upon the
U z above-mentioned property for inspection purposes. AL'fERORADDTOMECH. CONS]RUCTION kX
(W gree m save,indemnify cud keep harmless the City of Cupcnino agunst
hadailide,ju namts.ensts ands seswhic n my way eccrecagainm said City AIR HANDLING UNIT(1010,000 CFM)
eoff, grans off spa it.
�O AIR HANDLING UNrr(OVF.R 10,o00CPM)
Signature oT Appliumilc mmcmr am I EXHAUSTHOOD(W/DUCT)
PAID age
HAZARDOUSMATHRIA DISCLOSURE HEATING UNIT(T0100,(g BTU) Date R cipta
Will the applicant or Faure building occupant stomor handle harridan,normthl HEATING UNIT(OVER 100,000 RTU)
as definerl by the Cupcnino Municipal Ccale,Chapter 9.12,and the Health and Safety
Code,SectioO'5532nd? El N VENTILATION PAN(SINGLE RF.SID)
Neepplicantarfuwre huilding aeupantme equipmenmrdeviceswhich emit
ISSUANCE DATE
BOILER-COMP(3IIP OR 100,000 BTU)
h...omes air conpmimits as defined by the Bay Area Air Quality Management BOILER-COMP(OVER100,0(10 BTU) pp q
District? 1:1
4 6`b 6 t
Yes C)No _ NEW RESIDENT JAL MECII. SQ.FT.
1 have read the harmonicas materials te,nannems under Chaplet 6.95 of the OCT 101994
Cullfomla I ludth&Safety Code,Sections 25505,25an
533 d 25534. 1 understand that
if the building does not curently have a tenant,that i,is my msWnsibi lay to notify Ne
occupant of the requirements wh lch must be me,prior to issuance of a Certificate of
sm"n,. CITY UUr�/uyu/r�crlLll�i7
0,auto,awhorlaedagent Dte T AI.:aISSUED BY: 1 1�
OFFICE
.......................... ....................................... ................................ Job NO.
....................-.................... .............. .......... .............- .. .............
l0 30 q:
uNaeO�
SCOPE OF WORK !:'REDO EXISTING BATHROOM
• Replace existing the shower, with Corian walls/tile floor
* Replace tile floor
• Replace plumbing fixtures - same location
• Replace existing vanity and dressing table
• Install new Linnen cupboard
• Install new fan/florescehi ligb� fixture
R
• Replace existing,oveivanity lightfFE
ixture D EJE�
• Replace existing,door with same D
NOTE: Install AC Smo I ke..'d6ctectors in all sleeping room.s OCT 10 1994
BLOG- INSPEC
CITY 020N DEP
CUP6 ARrAf&vr
����� OPT 17NO
oPx1sting: 'BathtoPm� Rei�6deli For; RATTS CONSTRUCTION
Whi'lelaw,randi, Barbara,-i_Wright
DESIGNER - BUILDER
10325 'St6hyda16-p,Dr;ive ! C.L.0528619
Cupertino, Ca, 94087
Bud Raus
516 W. Portola Joni Ratts
Los Altos, CA 94022 941-1.544