S0261 APPLICANTTO FILL IN,INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CaNAN
RTINO xuu.ulNc-Pa.ECPRICAL PLRMITNO,
ISION APPLICATION/1'F.RMIT PLUhunNG-MECHANICAL S 0261
,g BUILDING PROJECT IDEN'TIFIC'ATION
' B : I„ X J ` SANITARY NO. APPLICATION SUBMITTAL DATE
oLD +01 6y CL hU `k � . �OPHONE:^ ' A CONTRACfORSNAME: LIC NO:MN/C CON TR(ILp
AEE : LICNO'. ADDRESS. ❑
��� 111
1 ONTA : 3. - PHONE: BUILDING PERMIT INFO
r O El Consultant Fees Paid by Applicant(Initial) H IR_ECT PLUMB ME❑CH
LICENSED_1CONI RACTOR S DECLARATION QTY. ELECTRIC PERMIT EEE.
I hcrcby affirm th t I m I c n:d d p : T chapmr o annttn Ing __ _ J 3 DESCRIPTION
OZZ with Section 700ai D icon 3 oOhe Bur es.end Professions Cide,anJgylc : RESIDENTIAL.
aOO Pf:RAfIT ISSUANCE.
CSF in full force andefect. ❑SFDWL ❑KITCHEN REMODEL
it—u License Class_ 1.icrt APPLIANCES-RESIDEN'HAL Ll ADDITION El PLUMBING RE-PINE
P Z w Dam - Cn amclor
r <Q ❑MUCT-UNIT ElSTRUC'I'URAL
ARCH111(7I"S DECLARATION
F,pm PANELS MODIFICATION
Z O y Z I undcmand my plans shall he uxul au public records UP TO 200 AMPS
O Z..O ❑IN'I'liklOR ❑CHIMNEY REPAIR
bEnLZi U'raialPml'e"cool 201-JR)CAMPS IMPROVEMENT []SWIMMING POOLS
OWNER BUILDER DECLARATION OVER IIXNIAMPS ❑BAI It REMODEIJREPAIR ❑DEMOUPION
y' I h b ITrm that I pt( the C ttaao l Law(nr the
d pdU Y �(1T(iI;R
'K t libdi 6 (S ct ](131 5 R al a J.. f::'ons Code:a y ity or county SIGNS EL[CTRICAL
i n]31L F-' wh ah re t to ron.aruu.'ille tdean balirl (mut m
F�OQ prix t f N yu aapplicantf hPermit' fl psigned statement SPECIAL CIRCUIT/M ISC.
E TA
that be licensed pm tl are provision, f he Cmdamune,Iulcmuc Law(Chapter9
(commencingw'N Section 7000)of Dvxi n3of the Buz nese and Rolcss on:CWa)or TEMP.METER OR POLE INST. COMMERCIAL:
Q.y e C mart he ix exempt dmmt'nnn and the basis for the allege)e,ent,don,Any vidiiia of ❑NEW RLDGIAUI]ITION [I DEMOLITION
W 5' Section 7031.5 by any upplicam for a permit subjects me applicant m e civil penally al POWER DEVICES Ll TENANT ❑FOOD SERVICE
not mom than five hundred dollars ISSIp). IMPROV EMEN'I'
SSD ❑Lar owner of the pmpcny.or my employees with wages ns their este mmpensrinn, SWIMMING POOL F.LECfRIC ❑OTHIiR
F+ willdo Inewmk.and thcsac,,.m onto intendedoralfred hatiale(See.9194.Business
a 3 m and Nefewinns Coda:The Commrors Licenu Law does nm apply It,an mina of OUTLETS-SWITCHES-FIXTURES
eel
property who bould,cor improve,themmamal who J e. w ch weak hire elf through
--c—
his own arrnpdoycas,provided coal such improvements am not intended or offered for NEW RESIDENTIAL FLLCfR SQ
,de.if l the buildingmin,proccured is sold whoroom y I plmion the SQ.FT PLOD \RRA SISQ_Ff.
menter-buolder will have the burden of proving that lie did notb Id car m,m,a for par-
Pulse
ur � —,t
a
Abse f I 1 Y
1,as owner of the properly,,Business s ad come soon,w anCod .)The Cenn,leme,i- TOTAL:
e me Lt the pnbjem(Sac.]W4, fand cy who lam iii or The Gbm fficram. Li- / D
whoc Law Jteorwichapply loan With
a commucany whoseduorimprovsc Centucturs cad QTY. PLUMHING PERMIT
License raw.forsuch pmjec¢witharomtacmgM licensed putcuanuothc Conuacmrs t \gam
License Law, PERMIT ISSUANCE ` II
❑ Ian,exempt urger Se .B&PCfnnnis rennin
ALTER-DRAINk VI3NT-WAII2R(EA) L•U VA_UA'I'ION
Owner — Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE: ft D
thereby affirra under penalty ofperjuryoneoflhe followingdeclarations: -
Ihavarrad ill mairminnCenif,mi,of Conwbmmnelf-in...c for Worker's Campus- DRAINS-FLOOR,ROOF AR HA.COND. S'IORIIL4 TYPE CONSTRUCT ION
cation,as provided for by Scnion 3]W of the L aKo Cade,for the perfo rnea cc of the
work for which this pemtit ix is,red, FIXTURES-PER TRAP
❑ I have and will maintain Worker"Compensation Invurance,as required by Section
3]W of the Lul*br Code.liar the perlimnance of the work fnr wh'uh Ibis perual tx issued. GAS-HA.SYSTEM-I INC.4(lU'IIETS jENERY
G GHOUL' APN
My Workers Cnmpenerios Insurance cattier and Policy number ar¢
Cama: Policy Nu: GAS-EA.SYSTEM-OVER 41EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASEIINDUSTRI,WASTEINERCEPOR
COMP17NSATION INSURANCE BUILDING I. VISIONFEFS
(This section need not Its,completed tithe proam is for one hundred dollars($100) GREASE TRAP
or leu.) K 19]i
I cenify that in the performance afthe work forwhich this permit is iswed,l shall SEWER-SANITARY-STORM IiA.20017.
not employ any person In any manner sn as at becameobject ,,0e W..kcru'Cony air E
ZZ aria.Wws of California.Dam WATER HEATER W/VENT/ELLCTR GRADING FEE
Applicant t
NOTICE TO APPLICANT:If,after making his Certificate of Exemption,you should WATER SYS'I'Eh1/fREATING
SOILS itif:
.a , become snbluct y the Workers Cmnpcav This provisions n1'the Labor Cole,you nmxl
fanhwtth comply with such promxlnnx or thlx lxrmit shall he deemaJ revoked. WATER SERVICE
0
n' CONSTRUCTION LENDING AGENCY NEW RESIDENT IAL eceip4
PLMB. SQ.ET. PAID 1 ¢ Rt
_J 0I hereby affirm that here ixa construction lending agency for the performancerf
Cu
haw-k fnr which Ibis parmit is issued(Sal.3097,Co.C.)
i b Lender's Name TQI'A L:
O'V TOTAL:
>` {TJ Lender's comityAddox
6. I cenify that I have read this application and sane that the above information is pUl(DIN 'F G
(n hove«.lagree to cotnplywith.11 city and countYuninuneea and 11.11 Inwa Tdringm QTy, MECHANICAL.PERMIT FEE
V Z building construction.and hereby aathudu repowwrio Lives of this city to upon um the SEISMIC FEE
— educe-mentioned property for inspection purposes. PERMIT ISSUANCEJ�
(We)agree to sm'e,indemnify and keep harmless the City of Cupertino against ELECTRIC FEE
holailitax,judgments,ensu and expenses which may in any wary accrucaguinst said CityALTER OR ADDIO MFCH. PLUMBING FE
in onsequence of the Starting of this Fcrmit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO Uk000C_FF) MECHANIC Bili
SOURCE REGULATIONS.
AIR HANDLING UNI'T(OVER 10,000 CFM) CONS'I'RU IONTAX
Signature of Applicar Conuacmr Date EXHAUST HOOD(W/DUCT) HOUSIN MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will theapps letmor home huildtngnaepant,lote trundle haaallousnainnal HEATING UNIT TO IUI,IXXI Et'TU)
as defined by the Curymin,Municipal Crile,Chapter 9.12,and the Health and Safety
Cade,Section 25532(a)^ HEATING UNIT(OVER I00,fXX)BTU)
0Ya )(No VENTILATION FAN(SINGLE RC.SID) PAI Date RcceiplN
Will the appllcat nr more building occupant u,ce cyuipmem nr iii whieh pO1LEH-EOMI'131{POR IIH13XX1 BTU)
mit havallouu air !m mminant,as defined by the Bay Arta Air Quality Management T
�Diztdetq BOILER-COMP(OVER 100,000 BTU)
❑Ya.. To
L nave mad the hmrdoux nnttenals recarenteros under Chatter 695 of the Cali- AIR CUNIJIT10NliR ISSUANL DA'll3
r mono Health k Safety Code,Sections 25585,25533 and 25534.1 undersmrid that if the NEW RESIDENTIAL MECH. SQ.FI'.
building does not currently have ittenant,that it is my responsibility,.notify the occupant
ofmareyuireesu 'hich must he ma Farmisacanec of a CediOc_tc a Oceu
s authonzeJ 46ent Dat at TOTAL:
OwISSUED BY:
OFFICE
i
DESK E R
NORTH
CORNELIA
STEVENS CREEK BLVD. PROJECT DATA "�R
Tg: ►lf4lq,g1a
ORT PROPERTY ADDRESS: 21199 LOMITA AYE.
'IS' 'G LOT SIZE 5037.5 SQFT.
=X[S I AG HOUSE 2000 SQFT.
q
owe Nous SIM ueL1
TMw-wTWO°1DE' E,0 FT. X � EXISTING SEWER CONNECTION
---.—•—.—.—•— —•— —• _ — —• — --•—•— -----•—•—•— x Q WITH CUPERTINO SYSTEM
lu NO SEPTIC TANK ON SITE
U I O LOMITA AVE. ZONING R-i-6
.(N) Q I O O
GARAGE = u�
SUBJECT
- PROPERTY
LOCATIONMAP
(21
NOT TO SCALE
_ SIDE j
SETBr CK
I I I I
I
=S1 E
F SEIfB CK ! W
+�I _ I. 0 I SN\N(pLT rl,2'
ADJACENTADJACENT W
PROPERTY 0: qPROPERTY �T
4 EXISTING I61_g11 I � � �
1 ^I I HOUSE I (E) I 00 3-
ALUIr�Maurtele
Koen flu WAM -Wak
- - I rxA•WOOD OflD*.Ir•OG, - I
I �V� WM w EXTEPWR CEM?!r MLAGTM
&M TWO LAYEM Vt•FW&GYP.DD. '
I I I AM%CD MM CALLY OR HORIZONTALLY
JOf(T6 M YER
AG4EIED.NA0. LA
2 aASE
I
COOItI!OR WALLDOA�NAIL! .
AT Y'O TAC!LATER Od
L NA"AT Y OG. WITH 9MILAR 4•CONCRETE K-AD
WM4"or ep�ED - CN r n14.POLY
WII�rew _
I I - ON 4'PEA ORA1T1
VY X 10'ANCHOR DOLT -y-—————— -
AT 4'OG. N I I • - Lo
- - ------ ---- --- ---------- -j (E) I r0ARA0QDOOR
10 i 11
TYPICAL FOUNDATION GARAGE FLOOR PLAN
111, ILtu
AND EAVE DETAIL
of
I =
u � I � DATE
_
POWER
FY Ecovn
POLEi ) F NG
I •rda �a�g O JUL 71997
Y✓� ('"1'... ._. BLDG.INSP CTION DEPARTM T
h L aLva CITY aF CUPERTINO
SdB_a `.1Nit1'�'7d
alva
OTt Hol!! - - Ott HOl1!
LOMITA AVE. CHI Tm 6m
i slJv�a JLOaa 12'
SITE PLAN
JOB COPY SCALE '118u �� ,,J�'
A 1
FRONT AND RIGHT SIDE ELEVATIONS
THIS PLAN SHALL REMAIN ON
rHE JOB AT ALL TIMES DURING
CONSTRUCTION.
S
i
IDESKIE R
NORTH
WINEIA
STEVENS CREEK BLVD. PROJECT DATA HABER
TEL. 4jae etI+7°9 I+ .
ORt PROPERTY ADDRESS: 21I99 LOMITA AVE.
EXISTING LOT SIZE E7031B SQFT.
EXISTING HOUSE 2,000 SQFT.
4
—•—• — —•—•—•—•—•—.---•— EXISTING SEWER CONNECTION
THE!!Two s1oEs - $0 FT.
CN
C WITH CUPERTINO SYSTEM
uu NO SEPTIC TANK ON SITE
I LOMITA AVE. z
Y
V O ZONING R-I-6
(N)
GARAGE - IY w
SUBJECT
PROPERTY
LOCATION MAP
NOT TO SCALE
SIDE 112 -SETB�C :K
i 1 I i
I
I i
=S1 E }. I =
SE15 CK -q1
i 1 W , lu
i-- I 0 1 -N z
I , I I cA i o &-om
ADJACENT alj 1 ��1 I 10 ADJACENT
PROPERTY 0: I ? I = PROPERLY Tai•�
OCN N W.my O
W.R„ _
QI + EXISTING I (o'_g11 I ONWiRAPTEM vr•oTt•eo. _
_ s•Ovesaar,
1 HOUSE , (E) I wrtN ALUTNl7 nUrrM
LoIWrAGACVWD.HAL DAM LAYlUt
I i 'AT
. u°Ri�eiuTN°O�
gcyY '/ S'oa WT024CRM GLAD
N r WIR
(r •ec�soON 4 ML. u�w~AVUL
�
WffW
ii i i Qi ANCHOR aml — �-—————— �cC pN�FA
i I I I OG _ • - No
\ \v/ LQ a
• = Q U
1 I 4lu
'-8" 1 O
I
Z
TYPICAL FOUNDATION GARAGE FLOOR PLAN
a! " "' ' AND EAVE DETAIL
tLi - i
Coll I DATE
CE)
POWER I / 3 / 97
POLE (E) F I
O
_.._ ._.. ._.._.._.._ ._.._.._.._.
_ - OIC NOIR OI! wow
LOMITA AVE. GN � CN T"SM
CP GbAMAk= 4X4 li '01' _CF GLAPAW
tarvvyo�y�-:�-�
• c �tva
spa Zola SITE PLAN
SCALE '118"='1'-O" FRONT AND RIGHT SIDE ELEVATIONS Al
OFFICE COPY-