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31547 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-.SIECIIANICAL 5 �1 7 BUILDING PROJECT'IDENTIFICATION VLF UILDINGADDRFSS: - SANITARY NO. APPLICATION SUBMITTAL DATE o YTq 141V V I26g6 W 'R'S . E PHONE f CONTRACTOR'S NAME: LIC NO: AIAWU . D NIC CONTROL%\RCHI CT/ENI GINEEk ' LIC ADDRESS: ❑ CONTACT: PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE Q C Z 1 hereby affirm that I am licensed under provisions ofChapterCopmr 9(commencing JOB DESCRIPTION pap with once]itcff.Division 3oflhe Business and Professions Cade.and mylittnse is RESIDENTIAL' F O in full tome and eRan. PERMIT ISSUANCE — C-F- - OSFDWLITCNF.N REMODEL aUgU Licenu Class ❑C.N APPLIANCES-RESIDENTIAL F G W Date Conamemr ❑ADDITION PLUMBING RF.-PIPE. unSARCHITECT'S DECLARATION ❑MULTI-UNIT []STRUCTURAL[.DH ' PANELS Z p rn& 1 understand my pIam,,hall be,sed as padde moral, - - MODIFICATION Oz--, UP T02011 AMPS DINTERIOR El CHIMNEY REPAIR Licensed Professional X201-1000AMPS IMPROVEMENT yQ,y F,.'atr OWNER-BUILDER DECLARATION OVER IWD AMPS D BATH REMODEUREPAIR [D DEMOLITION C C Q 1 hereby affirm that I am exempt from the Contmcmre License Law for Nc 34 FU- following reason.(Sation]OJLS,Business and Professions Cade:Any city or county SIGNS ELECTRICAL ❑OTHER F LL Q oei- which req is tt construct. Pte improve,J m ikh or repair ony swmum J pnort t,i,mance.itau rx,ima he photon fr M1pe.am file.,ifursedoemancra SPECIAL CIRCUIT/MISC. Wylima he slicensed pu mant to 11m,noi,varomtheC t t C,License L (Chapmr9 d0 C0 (commencing with Section]IM0)of Divisioni of the Business dProfessions Code)or 'fF.MP.METER OR P0161NST. COMMERCIAL: ta q m C that he is exempt therefrom and the basis for the alleged exemption.Any violation of D NEW BLDG/ADDITION D DEMOLH'ION iC k. Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of POWER DEVICES []TENANT o, TENANT OFOOD SERVICE not more than five hundred dollars(8500). FZ>' - IMPROVEMENT _Q Fl SWIMMING Ne no summ.mmy employees orofered for rafe(sole 0o1.Business SWIMMING POOLE C f F. will dolhewons and Ne he Coma torintended icense La class rot apply to Business OQTHEk 63 m and Professions CWe:The Compactors License Law does not apply to an owner of - Of71LLTS-SWITCHES-F RE property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELEC R SQ IT. _ sale.If,however,the building or improvement is sold within one year m complmmo,the - LVRAREA b/SQ.FT.' er-builder will have the burden of proving that he did not build or improve for par- VV Poe moria.).- . - - - ❑I,as owner of the popery.am exclusively contracting with licensed cnntmnors 1. - .TOTAL: EC "B i construct Ne project(Sec.]044.Business and Professions Code:)The Carr oac ors Li- 996 mrac,Law does not apply to an owner of property who builds or improves thereon.and QTY. PLUMBING P•R PEE !s' V who contracts for such projects with a contractors)licensed pursuant to the Contractors V f (JI- License Lzw. t PERMIT ISSUANCE \. (.Ur�f1f JIVU ❑ I am exempt under Sec. ,B&PC for this reason ALTER-DRAIN&VEN'r-WATER(EA) VALUATION � mer - Dete + N wWONKER'S 'OMPENSATIONDELARATION BACK FLOW PROTECT DEVICE ©� 1 hereby affirm order under Penalty of perjury one of the following declarations,claration I have and will maintain a Certificate of Consent or self-insure for Workers Corscn- DRAINS-FLOOR,ROOF.AREA,COND. STORIES TYPE CONSTRUCTION sation,as provided for by Section 3700 of the labor Code,for me facommmmce of the work fur which this pemmit is issued. FiXTURFS-PER TRAP •D 1 have and will maintain Worker's Compensation Insurance,at required by Section - 3VWofthe Labor Code.for the pedomunce of the work for which this permit is issued, GAS-CA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN My Worker's Compensation lawmnce carricr and Policy,amber a i, Carrier: Policy No,: GAS-IiA.SYSTEM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASE/INDUSTRL WASTE INTERCEPTOR BUILDING DI SION FBPS (Thissation need not hcompleted if Ne permit is formic hundrddollars($IW) GREASE TRAP err less.) PLANCHECK FEE �•' Toy any mom in the piefformaccanymannro theas Becomerk for which this permit Workersed I shall Co.,.- SEWER-SANITARY-STORM EA.200 F-E not employ any pcnun in any manner so as m become wbjem to the Workers Compc- ENERGY FEE Z Yliion Laws mCalifornia.Date WATER HEATER WNENT/ELECTR O Applicant GRADING FF, y NOTICE TO APPLICANT:If,after making this Cenilieuta cf Exemption,you should WAITER SYSTENVIREATING become subject to the Worker's Compematlon provisions of the Labor Code.you mum SOILS PEE G fonhwah comply with such provisions or Nis Permit shall IN,deemed revolmL WATER SERVICE a � CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PI-MB. SQ,ET. PAID U Z I hereby affirm that Nem is a construction[coding agency for Ne performance of Irate Reecipt# EL EL O Ne work for which this Permit is issued(Sec.3097,Civ.C.) F` Lenders Name TOTAL: I U Lenders Address - TOTAL I.. as 1 certify(list 1 have read this application and stunt thauhe above information is BUILDING FEE k y! FI y correct.1agree to comply withal)city and county ordinances and state laws reluingm QTY. MECHANICAL PERMIT FEE V.2 building construction.and hereby authorize mincomotives mNis city m enter upon the SEISMIC PEE above-tim uoned property far inspection pmPnes. PERMIT ISSUANCE (We)agora m save,iru cmoufy and kap hann[ess the City of Cupcnino against ELECTRIC FF i liebilities,judgmenu,costs end expenses which may inanywayaccmeallainst.usid City- ALTER OR ADD TO MECH. in onse p ence of Ne gmming of this permit. PLUMBING 3F. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IDJHO CFM). MECHANICAL FE SOURCE REGULATIONS. m AIR HANDLING UNIT(OVER 1(1,1x10 CFM) CONS'rRUC I'ION TAX Signature of Applicanl/Comotmor Dam EXHAUST HO6D(W/DUC'1) HOUSING MI'TIGATIONF HAYARIIOUS MATERIALS DISCLOSURE ,Will Nc.,heant an future building oecupxm000mhandle housecoat mammal HEATING UNIT GO 100.000 BT U) as defined by she Capetian Municipal Code,Chapter 9.12,and the HeAth and Safety Cade,Saoon 2553200? HEATING UNIT(OVER 1015.000 BLV) .DYes ONo VENTILATION PAN(SINGLE RFSHH PAID Will the applicant or future building owup:mt use equipment devices which Dote Receipt a emit hacmdous vir,oamotiomic,as definui by the Bay Area Air Quality MhmngememtHOILER-COMP(3HP OR I(N),INIH BTU) District, 'TDTAL: DYes ONo ❑OIhER-COMP(OVER IlO.IMq BTU) I have read no hmaodous materials preformation,under Chapter 695 of Ne Ca i- AIR CONDITIONER ISSUANCE DATE fomia Health&Safety Coda.Sections 25505.25533 and 235}1.1 understand taut if the NEW RESIDENTIAL MECH. SQ.FT. building does nm carpi have a team,dun it is my mspomibllity to notify the occupant of Ne requirements which must be met poor m issuanceofa Certificate of Occupancy. Owner ar uuNorized agent - time 11 i TOTAL- ISSUED BY: OFFICE r i • 12917 Q ' 7 8 W333OW W3015W W3030W W3615W A 367 7 PD30W 30" RAN�E B30W 36" REFR-1 33 a 8 APPROVED IN ACCORDANCE WITH THE CITY 06 CUPERTINO CODES AND ORDINANCES GATE l2 q 6 SIGNED 32 31 } This ciet rf pan; and sprc:ficaiions MUST be kept Or Me jc4 at ili Nires and it is un, 120 120 tac:'ia{ to ma.' crny ci:a;;+,es or alterations on came sc.,i w± F:,;;rez i;erM;SSiun from the bu.dine !;rpt., i::y cf Cupertino. rhe siamp<ng cf;y:s,:en ours sPecifiptions SHA,L NOT be t,e;° to Pa.mit or to be an approval of Cee of 2;;y provisions If any C..•7 ^ :ra cs Slate Law, W3330 633W W 52 54 a DISH. SB33W DBI W1830 DW243OWR A2 22 to WR WL A78 387' B27W 387' wa330 WG 56 48 B27W 2W R .— OFFICEno COPY- min. 12/0.5/98 Dwg nn Date 1 rroba,a a,emm Scale maximum olmensiIXts E size nesig><aia>s TME 9� glen are vo,ea to verllaetpn an nal be ltle8aee a oopi¢E Mess pbsieeneaepmmemiolapb HOME DEPOT applcaise lee nos been paw a pb Desgw caldalcm ager placers 0 _ as oa ° e f Q o 1. o ote: This drawing is anartistc Dwg no. nterpretation of the general TME appearance of the floor plan. It is HOME DEPOT of meant to be an exact rendition. e 0 O • O O O o Note: This drawing is an artistic Dwg no. nterpretation of the general THE HOME DEPOT appearance of the floor plan. It is of meant to be an exact rendition. IT o ` o \ ' o � o 0 ' i . i 0 0 Note: This drawing is an artistic Dwg no. nterpretation of the general THE appearance of the floor plan. It is HOME DEPOT of meant to be an exact rendition. 1 o O if r drawing is an artistic Dwg no. n of the general THE HOME DEPOT of the floor plan. It is o be an exact rendition.