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21473 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Proud Identification PERMIT NO. Building : aw/Tr �R cr �'v�� 9. o i� 21473 nems come: y ,qonr I WATSQ(V 4E�J`7 q CITY OF CUPERTIN0.BUILDING DIVISION Contacma.Name: Lie.No: APPLICATION / PERMIT OMDINGELECnUCALPLUMBINC-MFCI1AMCAL CATEGORY CONTROL Y Architect/Engineer. Lk.No: QTY ELECTRICPERMIT FEE BUILDING PEPERMIT INFO Address: - PF"TISSUANCE `I�7 ❑ ❑ PLUMB M1LH LICENSED CON3RACTOr pr DECLARATION JOB Ihereby cetionaffirm that fDivfi licensed hellusrovWomof Cssions9de,and A['t'I.IANCESRE9DENiTAl JOQB(DISC ON e It...11.full to" effct.gon 3oftheBusines,and ProlnslaneCode,and my f _ licence is In full fora and effect., PANELS License Ch® Lk.Y / Dale Contractor a ARCHITECPS DECLARATION 2014000 AMPS q�u DCO I understand my plans shall be used as public records. OVER1000AMPS, SQ.Fr.FLOOR AREA S/SQ.FT. Licensed Professional SIGNSELKIPNAL 666�<(P6TI OWNER-BUILDER DECLARATION SPECIALCIRC MISC Iherebyaffirmthatlam...mpt(roes the Contractor's License law for the O Z following mason.(Seal,7015,Business and Professions Code:Any city or �p M O LE I F'4 county which requ lees a permit to construct,altep Improve,demolish,or repair q any structure prior to It.Issuance,a bo requlrn the applicant for such permit to Pc WER`D P file a signed statement that he is licensed pursuant to the proalloss of the 3u, sin.lactora Ll ceveLaw(Chapter 9(commencing with Section 7000)o(Dlvl- pqN L E C Tt..sI'� VALUATION slon3 oflhe Business and ProfesslonsCode)orthat bets exempt therefromand V V a V V 6 S the basis for the alleged exemption. Any violation of Section 70315 by any O IiES FS applicant for a permit subjectsthe applicant to a civil penalty of not moa than ^ flu downer dthepr). - NEW • ALEL SQFr. STORIES TYPECONSTRUCTION owner of the property,or my employers with wages as their Bole rompensatioN wllldothework andthe slmctum b not intended or offered for Osale(Sec 7044,Buelnees and Profenloru Code:The Contadoe.License Law $ docs not apply to an owner of property who Wilda or improvo thereon,and OCC GROUP AIS.UNI IS whodoessurhwork himsel(orthrough hisewnemployces,prbvldedthat inch improvemcnts are not Intended or offered for sale.If,however,the Wilding or TOTAL: improvement fs rold within oneycarofcompidiory the owner-bulderwill have ttkr*rden of pmving that he did not build or Improve for purpose of sale.). QTY. PLUMB114CPERMIT FEE P170DZONE APN Lf I,as owner of the property,am exclusively" ' trading with Ia-.— contrsctorstoconstructtheproject(See.70K Business and Professims,Code: PERMITISSUANCE, The Contactors License law does not apply to an owner of property who Wilda or.lmproves dumcm, and who contracts for such projects with a ALTER-DRAIN&VENT-WATER IEA) cg0(pdo 0)Banwd punuantm the Contractor'.Llanae Law. FEE SUMMARY Ll l am exempt under c. B k P C for this rcaaon BACKFLOW PROTECT.DEVICE OUTSIDE FITF� DRAINS.FLOOR,ROOF,AREA,GOND, SANITARY Y_ N_ D ` D — OR KMAN COMPENSATION DECLARATION .�RES.PER.�P SCHOOLTAX YCCEI JY ❑l hereby affirm that 1 have a certificate of consent to opytne,re,ora FD( RECEIPT Y a00,Lid,of Worken'Comperoatlanlruurance ora certlfled copythemof pec. GAS EA,SYSTEM-1 INCA OUTLETS PARK FEE Y N 3800,Lab CJ Coliq Y GAS EA.SYSTEM-OVER 4(EA) RECEIPT Y Cany BUILDING DIV]SION FE ES FCertlfled copy b filed hereby the cityed. GREASE/WDUSML WASTE INTERCEPTOR PLANCHECK FEE ❑CertNed ropy V filed with the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-MRM EA 200FT Date RCCCI t# (Thlssedion need nm be completed If the permit b forone hundred dollars (SloWcrlero.) WATER HEATER W/VENT/ELFLTR ENERGY FEE Y N I certi(ythat in the Ndmememof thework forwNch this permit is onsed, I shall not employ any person In any manner coo n to become subject to the WATIA SYSTEM/TREATING Workers'Compensallon laws o(GII(omla.Date PAID O Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date RCIxi t# Z O NOTICE TO APPLICANT:]Lager nu king this Certlficeleof Exemption,you Fshould become subject to the Workers'Compersatkn provisions ofthe Labor TOTAL: W Code,you must forthwith comply with such provisiom orthb permit shall be W > deemed revoked. BUILDING FEE a c CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affiwrm that thea b a construction lending agency for the perform- ELECTRIC FEE O ance aftheork for which this permit is 9sued(Sec.3097,CIv.C.) TOTAL: Iendsea Name PLUMBING FEE LL Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW 1mettly tNtl have read thbapplicatlonand Astethattheabove Information IL is correct.I agree to complywlth al cityand countymclinmme and state laws PERMIT ISSUANCE FEE$PAID. >. N relating lobul'ding construction,and hereby authors,representatives oflhb - F Z city to enter upon the above-mentioned property for Inspection purposes. ALTER OR ADD'R7 MECH. ' (We)agree to save,IndemNfy an d knp harmless the City of Cu pertinu Date Receipt# V aga Wt liabilities,judgments,roarsand expenses which may In any way accroe AIR HANDLING UNIT ITO 10,000 CEM) SUBTOTAL: against said City In roneequena of the granting of this permit /1 ossa /-y/_t�fl AIR HANDLING UNIT(OVER 10,000CIT1) CONSTRUCTION TAX Slgrutu of Applicant/Contractor Date EXt TAUS"T fI00D(W/D[KT) CONSTRUCTION TAX PAID: HA7A fummb MATER IALS DISCLOSURE Will the defined bor y ure buildingnicipan ode, hhand lc hazardous IiFATWG UMT(TO 100,000 BTU) material as defined by the Cupertino Municipal Code,Chapter 9.1 3,and the - Date RCCCI t# Health and Safety Cade Section 25S32(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: ❑Yet i�l Na Will the applicant orfumm building occupant use equipment or devices VENITLATION FAN(SINGLE RESID) ISSUANCE DATE which emit haurdous air contaminants as defined by the Bay Arca AU ' Quality Management District? BOILER-COMP OHP OR 100,OM BTU) 4 yrs Na hamad lhe ealth&Safety Coed ls Sections n05, b5533 and 255 .I of BOILER-COMP(OVER IW,OW BTU) the Californiaifnla health&Safety Code,&ctlone 75505,25533 and 25534.1 understand that if the building does not currently have a tenant,lhal it is my NEW RESIDENTIAL MECH. SQ.PT responsibility to not ify,the occupant of the requirements wh lch must be met prior to lasoence of a Certificate of Occupancy. ' Owner or authorised agent Date TOTAL: I ISSUEDWY. OFFICE COPY CUPERTINO ROUNDTP•EE ARCHITECTURAL CONTROL IMPROVEMENT APPLICATION FORM • TO THE ARCHITECTURAL CONTROL COMMITTEE: Owner(s) : Thomas Watson Date: November 1, 1990 Property Address: 21105 Whito Fir Court Owner Address (if different) : 8117 Presidio Drive - Cupertino, CA 95014 � Owner Phone: Home:d77.5_�?-T 7 L L Work: Description of Improvement Applying For: _72,10 ./,2-) /JW01V7 /G/CHT-s Color(s): ._ P,0/V7_ Location(s) : P2h7772 - f UE? -1)11,11VI"rr AI.2,f-A Dimensions: -A 2 x Construction Materials: Contractor: 'A scale drawing of all improvements, showing location and dimensions, must be sub- mitted with this application and attached to application. • Affidavit: I/We are the current owners of the above described property for which this application is made. I/We understand the restrictions contained in the Declaration of Covenants, Conditions and Restrictions and agree to abide by the decision of the Architectural Control Committee on this application, including all conditions which may be put on approval . I/We agree to be solely responsible for the events creat- ing the improvements, maintaining the improvements in good condition, and any encroachment this improvement may make on adjoining unit owners' property and/or common elements areas. I/We are responsible for obtaining all permits that may be required, complying with any building codes or regulations that apply, and will re- imburse Cupertino Roundtree for any liability or costs arising because of this improvement. I/We understand that final approval is conditional on an inspection of the completed improvement for compliance with the description in this application and the conditions of approval . If the improvement does not meet the final inspection criteria, I/We, at our sole expense; will restore the property to its condition before work began on improvement. If necessary for repair and maintenance of the structures andiareas, I/We will be solely responsible for removing and replacing the improvement to make way for such repairs and maintenance. I/We will notify successive owner(s) of this property of this unique improvement, the conditions of approval , that Cupertino Roundtree assumes no responsibility for this improvement, and of their duty to likewise notify further successive owner(s). All Owners of Property Must Sign Below: Date: / ov )_X4 tsSigned':-. moi-Li ce (jaYc Printed Name: 7. D. WA ,50 r/ Date: Signed: Printed Name: • ARCHITECTURAL CONTROL COMMITTEE USE ONLY Date Application Received: a U Received by: rr• Date Approved: Date Disapproved: White Copy - Committee Canary Copy - Unit Owner Pink Copy - Management Co. I ' i, BRoNz FrIAME sKYu�r�T(s� - - /� ' bATTS J- sMerT-ROCK - SHAks R&OV H °= + ---tet L` Q / �p15 ova Y• @ " x 2,.4 OCL bH ammm (R'iT5 SNE''Bd JLOld OFFTE C PINNING ARSAI 70i� - .2l/oS Guy/7r F/ti. rar. e T/Nd �9 911�Jd/y u4tN LE"Mot; 6UARFlNTE'ECLIFCTIh,EJ p ALL •HELIAMC. W6Lbgb <oK9T6lucnow- 1 �� AA ANOpl2E'b 6AON2_ MILL FlN/yfl • �IZ`f, I•C• 3.0 . AVPAGVel (# -f 257) (L'AyT ExPOSOR6� I y ' I FLA5+W4 KITS - TOP(C3T1M SgDDLES i - �