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02060134�CQ CITY' CUPEI,TINO CITY OF CUPERTINO PERMIT APPLICATION FOR /A 9' C5 ? o l K -r— APN # '31� - a + - v Y, � Date: Building Address: /, Owner's Name ,I e tA-�- V�/ U � Phone #: Contractor: ILicense d vv--k�(j L-tLf-)"m2 #: Contac -b 6 L C �- Ld Phone #: Applicant/Contractor: Fax #: uil `ng Permit Info: Bld Elect Plumb Mech Job scription: ,Residential: Commercial: Sq.F. t. Floor Area: S/Sq.Ft.: MEW Architect/Engineer: Valuation: Type of Construction: Occupancy Group: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUTLD'ING BCONSTAX IndlOff/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUMDTNG BCONSTAX.f I Hotel and Motel BUILDY-G BCONSTAXR Constax - Resi/Mobile BUILDING BE 'LEC 1000 Elec 600V <= l 001)A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL 13ELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Li neqZ BUTLDING BENERGYADD Enera Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BM.ITIGATC Comm. Rousing Mit. Fee BUILDING BMITIGATR Res, Ho -using Mit Fee BUILDING BMNENVMULTi New Multi-FanAy Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMMM New Comm Mechanical MLCHAIN I.CAL BNUCONVIMP New Corrin Plumb PLUMBTNG Carr OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BNUMULTI New Multi -family Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBNG BPCESSPOOL CesVool PLUMBING BPERMF'EE Bldg Permit Fees BUILDING BPFTXTURE Pblg fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPNTERCEP Ind Waste Interceptor PLUMBING BPLANCRK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee . BUILDING BPREPIPE Repipe Of Fixtures PLUMBING 13PSF-WAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Stonn/Rain Water PLUMBING BPTRAP Kitchen Tra2 PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstaWAlt'er Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BRLMAIRHAN A/C Units c= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighdng LightingFixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREN FURNOV Relo Furnace > 10K btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMNHOOD Installation of Hood MECHANICAL BREMMISC N isc Apparatus ELECTRICAL BREI WRAPP Rem Nan -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREIIVISIGNS Remodel Si , Mar uee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 2 of 3 ru CITY OF CUPER,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL 13REMV13NSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDENG BSEISMICRE Seismic Fee .Res BUILDING BSF&2FAM Single & 2 Family BUILDING BSFNA Single Family New Add BUILDING BSPECIAL S ecialInspection BUILDING BSVnM Swimming Pool BUILDING BTEMP Tempo Power ELECTRICAL BTEMPPERM TeT2 rary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL. BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE )`Zech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BB01LER3 Boiler > 500K to 1 M Btu MECHANICAL BBOILER4 Boiler > 1 M to 1.75 M Btu MECHANICAL BB01LER5 Boiler > 1.75 M Btu MECHANICAL • 0 111, so(v CITY OF C[JPERTINO CUPEi�F PERMIT APPLICATION FORM 6,zo6013Y ApN # U6 7 Date: l Building Address: (1614 WH"TaO BAPPLOTHER Other Appliances MECHANICAL Owner's Name: 5 6 � of a, 6 Phone #: 5(3-1 (, Contractor: Q License #: Ind/W/Comm/ nasi BUILDING Contact: �,k Phone #: Con. Tax for BQ Zane BUILDING Applicant/Contractor: o LJ Fax #: .its r o Ing Permit Info: Bld Elect Plumb BCONSTA.XR Mech Description: Residential: gyp' Commercial: Sq.Ft. Floor Area: q o -o $/Sq.Ft.: BELEC1.001 Architect/Engineer: ` Valuation: 16000i Type of Construction: Occupancy Gr t:� C Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/W/Comm/ nasi BUILDING BCONSTAX13Q Con. Tax for BQ Zane BUILDING BCONSTA.XH Hotel and Motel BUILDING BCONSTA.XR Constax — Resi/Mobile BUILDING BELEC1000 Dec 600V <=1000A ELLCTRICAL BELEC1.001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINIVESTIGA Investigation fee BUILDING B'NUT1GATC Comm. Housin Mit. Fee BUTLDINTG BMMGATR Res. Ho -using Mit .Fee BUILDING BMNEWMULTI New Multi-Famfly Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCQND/2v4 New Comm Mechanical MECHAARCAL BNUCOMMP New Comm Plumb PLUMBING 1of3 7� zoo 20 MY OF CUTIERTINO BUI LDING MLSTQN BUILDING ADDUF.S;3- 19844 WHEATO'N OR O 6Yi1.�`�l� V . WONG fr^ PHl1Nc_ Q O O ARCHIT'ECTIENGLNFF.R: F, N LlCF1V5F.0 CON'I'RACiUR'S DECLARATH}N Y * I b�e%YtIrltm riot l act lic6; d tm:kr pruvis;nis of Chnpier 9 (ennnicnring ^car dill Snllen 70'JU)af Divl:nn:uf the Bus'inesx and Prar�iiLri Cock. and mylirr..,-,ac g Is to full tome rattl effect. S aG y ucenze 0"s —_ Ll:. it O PAre __ (:nr!rurloi�_ A f HlTLCrS DECLARATION c y } I i cialetatand my plans F't=il kx ocfd as pnblx reerxrL% uW s x � ^� Lieeasxt prop:s;;tt::il -- " (AWEN-RULDER DECLAR:\ll(tY J Z. I Lienhy uLknin that 1 are. ezcnV, front Ler_ CueamctnrI license Larw fav the X r!Qlnwin;; nnur 18e -^rice 71131.^.•: Uitrnt rs"Pmkc g m CU.tw Any city arcdunty � + C which iC4+tires S re[rtil IoctvtsaltM. carr, Inproi.. dernaluh, av r[�ir ac} sL`ucr:te prior Win issuexs. alio rey�ir~n<r5-appl�wnnt ru;rlch perini [a rilee5iam:d;tntenuu; Charlie itlargsrdpEf r fsi.rrgltptFd'o. lo�iiirms of CR: Cow-a3:Nc "Ynce law lChapltt ti tcnrnnxrj hg with, $stisln.9(%of Division 1 A ar ate U'3.ne_e.nnd pnrrcxzians l;rxk) or !hal ix iA eic*.t 6-A6firsti'dnd the basis rm du 7ile5al l-xe"nFdui;.-Any 6 an -nf Su;lrm 7031 S by any applicnM fora permit subjwis the opplaninr in orivil penalty orae( rrva thnn five L.dred dallanQtiM1A1. Cl 1, t; own-^ of ll1r. p opapt ren .' (yttplytes %W1 w;rges as d:c(r sok cc [ I.snttinn -u•ILI'do ttd uV1X, ara the srrstctdiD I's nC,(lnr-`.ndcd or a?nCd fix'at.- {Sec�nld, B,jsin:As .:_d ft-Ceslous t,axL:'IT- Cuainictw'o L;eense Lea' doe err apply in on cmrerof pm;xns Y441i; builds orimpme cs [hereoY.;, and who dnei s-. r wurk. tiirux:f or Unwtgh _10 qua empla; ee3, pmvidetl that vch impro% rrxfLu at cot intended or ,L14 C l rut t7_'a W. youeter. ttie bzdrny it ia;iprn•.i;txCt it SOW >;sthia ttye Yctt M, cattnpletirm, the uwller-buildur tivill have the 1>,inkn of pnvirg d!ar he did leu bO- d car ilmprmit fir purime of solr.,l D! L as-tlwnctrif dpe plopery, on esclui':ely cuurraericZ wRh Lix*cd cocvra;tacs to CvnSRuct the propat t$M 760, Flvs;ntcc tm1 Cbkk.1'N CurJAelat't Lkense-law dura rt,•T nppty to an L r tier of piofirm• wl:n huil&or imirrums rherCon, _acrd -mica f;r='CIS (=A"h p[dgb:tz n tlt.n conttttinrin)-Lrtrazed pt:r�tailU the �Comrr:crtri s Deer= Lrr. O I nro .tr;L'jrt Se.. _ - S P C for 010 reasu l ate.. WOR &R'S COM N5„DECLARATION tcb}-Affil at ander penal , peijury fine of lbt fallrnaing dedauhmnx - hhkC and Wal n16waiA a c t -C= of t,Cnklll ra self -Irene tui Wa kol; Cli'77 pnicm, as provided for- y SwAm PLYJ of Lyle Lahnr -Coale, ru; the 'finTi nr-ince of rhe uvrlbr whi h 1�_ti rctinir is sutd 111 tare and 6CIl ritailmin R'url;Cr'f tC•n;penS:liYa1 11'Si1RrtiE. at re4V:ed ; y $asinn 37,00 of dan'Lhhar Code, 11a1 rhe. Iset?nluwxc of 61, work (m -.+iwch drii prrmi[ in Taxaed. NI) Whrkt Cm"tjx-firiricn lrifumntr- durier 3111 Pn81cy tiuolm- urea Curl"', Policy Yn :- C ekhR- A7'ION 0l• T! V lVrfON FNIIM wV ti?CMS• I•('I'hiz'si�tinr_d'nar he tmn'1dnied LI the pencil is fr.r a'tehvndr d drtlan � 1311H}j m, less,'; I c rkify dwt ;n the. r rlwnro 14 ifii, aur` for uilleh Chi, txrmii,iu 4,ip,ed, l shall wi-mp:ay'e;n• pawn ;n any htdnnetjrs is to � y_bjyt to th6 NFrkcfl' Cr11 sa!iuu UI; calif i:f, 6'u' : _--. Agi t cam ' T— ICp TO AFN ht; If, Llwr mzk re, ;his Cett• TM. 'of Eseetpua. you shwo Z. •oolre `='aic:c t �'A. ie Cf art et Ill- n prvvl. ahhe Labor CC&. }vn must Q O (rcthwidl A'1 y ,Ih zu:it pf ovislmu, nr chis fL r 1t hall he deemoi tesiaud- CONSTRUMO_N ]XI D AGENCY 7 h=bv arrcn Cly thew, l; d'amlrfttnion Inndine ugeay f v da perfunllunte •� of the walk fm a•hi4h :his FBrmit Ls is,4 iM (Sto. 3097. Civ, C.1 A. � •1$uAYz Nara:'_ •�- I cer+tf) dar I bA%u raid 06 npplfaLipn rind maic its the filer einrormaiion in kr:F eatfaa. I alive .o :onldy_aidl nn ;it; Arnr ecrn;Y ur f,i*-acxri L7j rtztt; Incas trlaa rip Q (, to tuld:ngcatuvtr-lbitr, mi here&,L-authnrixeMrftsenla4t>»C nr dli�CilymcniW upon yy_ ry Ir. ab,,tr.mrnGOnal Eavpen}• fo; na�r_eliun h'annses I V,4i 2.:fii: bi 3a1e; indtu_l;f;; and Icerp harut:tsc dye Cir, tt7 CStpatlno•;tgains -rr VJ iitivIines, and rNpcnics which airy in ay way accNe api�j Said UA Any in tt+asequcnN, nt"1w, orthk perma_ F?LtC4`rr C;NDG.IST.?N�S A.xD WILL Cty„V,PLY wTTF;, , -Mm spL . ; rcU • _'tT7C1N.)` ,y Si* ` e.arrtpplcag4'L'ontr c . ace HAZARDUI;S-IA7Ts'MLALS 00(;LOSURE Will ;he zppllaut or Nau2, AJIn5 occulixui; same at t:andle ha:nrdvas u;-jttid fim;d by thr'Cgnttind.1Aii ' :4 (:,de. Chapter 4-C3, and the H=lth add Safety C;rirle. Se�ircr?S.Si:fat"- ,. Will 4he npptirsrs er fet.1; imilt] Orctyu•i1 ¢s-_ �uiptnem ce 1};.vnces oh;rt cant hiautdogs air oonvirainam rts derrni: by L,H:ry Arc Ai1QJzi,itti' Manacz;ienl D;sai:4^: G Yes j� Iry _ I have Mae tic hnr ur rJus'aT;r •Y, roauiaerat;,:s tmdrr 04w. 695 u( ft C4:I1nrnia Hec'hh'$ Salary Cada; Sec6aus oi5lv_'_ 251ht =3 2557:0. 1 wldertand ^fns jf [hi b7ilk1r)3 &fS rim cd: f milt- base. a ¢nano bird itLc my rmparsilitifry W daub• the ti:Cur_.S 061U! rCGa11el1aCW whia'9 01W tc 1111:4 prior li, Lsiunno: of clic .e to otrt pax. t)w I¢rar;ZCd- ;1 ME, CONTRACTOR INFOR! JOHN P. WONG N: FE101 rr NO, 402060134 ,APPLLC:AT1ON S Al DA. T 0921 2002 5A4MTARY r, D. Cor,!TROL NO. BUILPINO PF.atD•trrI1 Wlrl TUXCT PLUMH ADD 498 S Q. FT , Job Description $150000 101A I 102 - 10 3 -- 104 - 105 - 106 - '202 - 203 - 204 - 205 - 301 - 302 - 303 - 304 - 305 - 306 - 307 - 308 - 3 0.c3 - 310 311 - 313 - 501 - 502 - 5G3 - 504 - 505 - 506 - 50-7 - 50- 5S issued bye Re -roofs Typc of Roof lr �s � -• a rn ft , TION Upancy UFER Required Insp£ctions REBAR ANCHOR BOLTS - - SEWER & WATER UNDERFLOOR -PLLWiBING l.%IDERFLOOR MECIP LNICAL UNDER -FLOOR -FRAM'- - - UNDERFLOOR INSU.TION ROUGH PLUMBING TUB & OR SHOD; ER ROUGE M.E.CHANICAL ROUGH ELECTRICAL F RA_ME HOLDOWNS INSULATION -SHEE`t'ROCK 'EXTEIR109 LATH INTERIOR- -LATH -- - - SCRATCH COAT ROOF NA I li_-• FINAL ELcCTRICAL ZNEROY FINAL PLUP,1BTNG ENERGY r INAL MECHANICAL ENERGY F'INA'L Bt✓ILDING ENERGY FINAL ELECTRICAL GAS TEST FINAL PLUMBING FINAL MECO-IANI'CAL INAL GRADLI I NAL /1tiG INAL -G RKS Date hfECy4 r 3 _ .All toots shall be inspected prior to any roofing material being installed. U a roof is installed without first obtaining an inspection, i agree to remove all new materials for ukspection. Applicant understands and will comply with all non -point source regulations, of Applicant_ Date All •f coverings to be Class 'B" or better OFRICS