28504 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMUTING. O
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL.
BUILDING PROJECT IDENTIFICATION
BUILDING<ADDRESS.. �;FZy 0.+I/_ �{ i SANITARY NO. AP .Ir T10N SUBMITTAL DATE
W Z15
OWNER'SNAME: PHONE: )NTRACTOR:S NAME: LIC NO:
�tlAJ l:a Q£S IW21.GC E/•i+f/.�V:.rl /�A -1 �L' `l3�`/7.�, N/C CONTROL.#
.4RCHITECT/ENGINEER:. LIC NO: ADDRESS: ❑
L2333 S/'M.4�`CksA-SaUv JML 3tU, �T
CONTACT: r PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BE ELECT PLt;F4C
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE ITj
I hereby affirm that 1 tan licensed under provisions of Chapter 9(commencing JOB D SC IPTION
I,y0Z with Section]00(oid Disnion 3 efthe Business and Professions Cade,and my license is - RESIDENTIAL
O in PERMIT ISSUANCE
FBF full from aM effat. ❑SFDWL ❑KITCHEN REMODEL.
�UU License Class LIC.N
yZ L Dan Con.. gppL1ANCFS-RESIUGNTIAI. ❑ADDITION El PLUMBING kE-PIPE
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ARCHITECIFSDECLARATION El MULTI-UNIT []STRUCTURALZ p N Z 1 understand my plans shall be used so public records ' PANELS MODIFICATION
OZ-O UPT02fIf1AMPS E)INTERIOR [I CHIMNEY REPAIR
F�2 t.W Licensed Note....al 201-100I)AMPS - - 7y1PROVEMENT
g w f d "OWNER.BUI LDER DECLARATION- OVER 1000AMPS - TH REMODEUREPAIR ❑DEMOLITION
C C< 1 hereby affirm that I am exempt inscribe Committee's License Law for the
X3�WU following reason.(Section]031.5,Business and Professions Cale:Any city or county SIGNS ELECTRICAL OTHER
O m which rtfants a permit to conswct,alter,improve,demolish,an repair any structure
Mart prior to its issuarectalso requires mcapplicaut for such permino li lc r signed stamment • SPECIALCIRCUIT/MISC. -
�,y that he is licensed pmmunnuo the provisions rids,Comradm's License Ltw(Chapter9
WCp� (commencing wiN$mion]OW)of Division3 o(Ne siness and Profession CORD, TEMP.METER OR POLE DIST. COMMERCIAL:
6 a e that he is exempt therefrom and the basis fowhe site it exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITIONS
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Section 7031.5 by any applicant for a permit subject applicant'..cisit penalty of POWER DEVICES
W^m ❑TENANT El FOOD SERVICE
EG nm mom than five hundred dollars 1$5(0).I,os ownerof the propeny,onny emplo es agesaethcirs c mpe ation, SWIMMING POOL ELECTRIC IMPROVEMENT _
wild the k nd thetructu t R cif al ($$ ❑OTHER
ad and Rofeton. Code C oenelr not ebply tolztt mer of LETS-SWITCHES-Fl%TUHFS
a i m propcny.who
h b t d h 1 k h 11 th mgh
nis a ply . d that Ituc p cn t n' tanded,oulfiened for NEW RESIDENTIAL EI.ECTR " SQ
sale If h thebud in prov in . nhinianeyearstifemn,denim the SQ.RTIq- RARE $/SU FT.
e 6 Id 11 have Nen of p v but M1 did not build - prove for par P /� I
als
I owner
as owner of Ne pr perry am exclusively contracting iN licensed< m cora to A '
con suua the protea(Se.9044 Evenness suit ProfoWn.,CoJ )1 le.0"..-L.",s L- UG 23
1995
muse,Low does not utility to fprpeny h builds n ' protherm,and �99 QTY. PLUMBING PERMIT FEE 5
whocontrmts bounds pmjecr ithaconmect ms)live adpu....ti the Cummctors YS'IY
License law. - PERMIT ISSUANCE �+ N UI" (f
❑I am exempt under Sec. .B&P C fo this rvnsm
Owner - Dat ALTER-DRAIN&VENT WATER(EA) ^ VALUATION
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
I hereby affirm undo penalty of pert' ry nm fine following
d 1 eons: CCJJCC//
❑Ih d II m Crit tuff s n If' t urkc:Comyea- DRAINS-MOOR,ROOT'AREA,COND. STORIES TYPE CONSTRUCTION
salion p d d f mi S mi n i]IS) tiro L M Cad ft th pert col the
or whichthis pot J FIXTURES-PER TRAP
wo 1 have and]will maintain Workels Comparison..Insurance s requvN by Section
3]00olthe LaWr Cale,fa Weµmnrmana of Ne work for which tris permit is issued. GAS-EA.SYSTEM-I INC.40fITf.LTs CCC,GROUP APN
.My Worker's Cmnpematirn Immunce,carrier and Policy 9a
Carver: -1'tAT r.«v/N Policy No.: J�—r as x+�Q1 GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR
BU 1 D ISION FEES
(Tris section need nutbe campletW if Ne permit is tar me hundred dnllart FS into GREASETRAP
or less.) � "' PLANCHECK FEE`. l
IcWfythatintheperfrrinanem ofthe work,ayshichmispermit islssudL l shall SEWER-SANITARY-STORM EA.200 FE
not employ any person in any norma.-as m become vunjecnn the Workers'Co.,.- ENERGY FEE
Z salion Lawsof Califomia.Dare WATER HEATER WNENDELEMR
Z O Applicant CF'E
DIN
y NOTICE TO APPLICANT:IL after making this Ciummum of Exemption,you should' WATER SYSTEMOREATING becnmesubject m the Worker's Compensation provisions of the labor Code,you must LS PII
LLCd 1 forthwith comply withsuch provisions or this permit shall ha deemed revoked. WATER SERVICE
Z)
CONSem is acONLENDINGAGENCY NEW RESIDENTIAL PLMB.
= Z (hereby affirm that is u cunnmedw landing agency for pedonnonce of m Remlpt p
the work for which ma,permit N uoued(Sec.3097,Civ.C)
Q H larder's Name TOTAL:
WLa does Address
1 certify that 1 have read Nis application and state that the above information is LDING Eii (A beater,l agree to comply with all city andeounty ordinances and state laws relating m QTY. MECHANICAL PERMInC.) Z building construction.and hereby authoom reresentatives of this city m enter idem the !d a Vabove mentioned property for inspection purlows. - -
(We)ag.to save,indemnify and keep harmless the City of Cupertino against PERMITISSUANCECTR( FEELiabilities,judgments. s and expenses which may in any way accrue against sail Ciry ALTER OR ADO TO MECH.an ooscyuenceof gruni ,this permir �I MB( PEE
APPLICAM'11�� DGR:TA DS ND WILL C g f1P I 1 ALL NON-POINT AIR HANDLING UNIT( W-M CPAL FEF.SOU G LULAT O� _ AIR HANDLING UNIT(OVER 10,(Xp STRUCTIO A%
Sign5m=ofppplicanVCrntreanr Dec ))'' EXHAUST HOOD(WNUC) SING MITIGA'1 NFF.Ii
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant or future building occupant store orhandle hicusinficars material HEATING UNIT(TO 100,000 BTU)
as defined by she Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Code.Section 25532(a)P HEATING UNIT(OVER 100,000 BTU)
❑Yes ❑NnPAID
• VENTILATION PAN(SINGLE RI:SID) Date cmipt Vim)
Wilt the applicant or future building occupant use equipment err devices which
t hazardous air eontaminaats n defined by the Bay Arca Air Quality Management BOILER-COMP DHP OR ItJXXI BTU) '
T
It it
-Yes ❑No BOILER-COMP(OVER 100.0110 B'rU)
I have reel the hmardensmmeriWs is under Chapter 695 M the Cali- AIR CONDITIONER ISSUANCE
5.25
Tania buildingHealth aides&Scurry Code.a mime 25505,A my and 25534.1 undersuml that if the' NEW RESIDENTIAL M[CH. SQ.FT.
ofhedao no¢uwhich have a tenant that o is my ce ofa Cartty to notify the occupant
of the mluiremma which man be incl prior to issuance n,a Cenilicrm of Occupancy:
Owner m aulaozed a gent Dam L' ISSUE
OFFICE
PROPOSED MASTER BRM./BATH
22588 LAZY OAK CT. CUPT. i?p
AUG 23 95 o
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MASTER BRM.
• CARPET /1
TILE
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En
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GENERAL NOTES: ��
TILE BATH FLOOR 8'X8' FLORIDA #8402 CAMEO/NO BASE ATE: 4-24-95
INSTALL ALMOND MYSON TOWEL BAR WARMER MRS7
INSTALL 2 EA. NUTONE 267 WB MEDICINE CABINETS SCALE: 3/8' = 1'-0'
INSTALL KOLHER L5 GAL ALMOND SAN REFEAL #3394 OWNER: YOUNG RESIDENCE
INSTALL 2 EA KOLHER KZ210 ALMOND BOWLS
INSTALL GROHE WIDE SPREAD FAUCETS 20.610 WR BONE
INSTALL GROHE PRESSURE BALANCE VALVE BONE/SINGLE CONTROL
INSTALL GROHE 24' BAR W/ SHOWER HEAD 3 DIVERTER/LOCATE CTR.BACK WALL
• ADD DIMMER SWITCHES TO MASTER BRM. CAN LIGHTS
ADD NUTONE FAN .79905 HEATER W/ EXHAUST
INSTALL CULTURED GRANITE SHOWER PAN PT. REYES SANDSTONE
ADD CULTURED GRANITE WALLS TO CEILING PT. REYES SANDSTONE
INSTALL 22' X 5-11' VANITY TOP W/ CUT OUT FOR BOWLS/ 1 1/2-SQ. BUILD DWN.EDGE
EXISTING MASTER BRM./BATH
22588 LAZY OAK CT. CUPT.
MASTER BRM.
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NOTE
R/R ALL EXISITNG GALV. PIPE TO COPPER DATE: 4-24-95
• MASTER BATH LOCATED ON 2ND FLOOR SCALE: 1/2' = V-0'
OWNER: YOUNG RESIDENCE
EXISTING SHOWER UNIT FIBERGLASS 2'-10'
PENINSULA HOME IMPROVEMENT
12333 SARATOGA•SUNNYVALE RE) STc. e
SARATOGA, CA 95070 3072
(408) 255-3140