S 0757 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO HDu,DING-F,LEM RICAL PERMIT NO.
ItU11.I"d"N"DIVI31UN AI'1'LICATIONfl'1':RMPf rl.umnlrvc-MI?cunNlc,v. S 0�]
BUILDING I'RO.IF:CP[DENTIPICATION v /
57
BUILDING ADDRESS: SANITARY NO. APPLIES]IONSGBMI I'I'AL DATE
7soz /Do,JCI-9 12,- 7-97
OWN 'S/ ?: VIIUNC: kq CONTRACTOR R NAME: _rrr� ��� b� NIC CONTROLe
ARCBI'I'ECUENGINEER: I,IC No ADDRESS: 6 ❑
CONTACT: PHONE: BUILDING PERMIT INFO
„�sF.'-o 6 yo aq9�
E:1 Consultant Fees Paid by Applicant(Initial) BLDG 1:1.1 CI' PLUMB MECH
Jim
ram ❑ ❑ ❑
LICENSEDCONTRAMOR'S DFCI .RATION Q'TY. EI,ECT'RIC PERMIT FEE
I herby mrrm mal l ant Benn.ol ander pmd.ntna nfChapter 9 Bntmnemm�g JOB DESCRIP'PION
�Z with SecJnn]B(I(pof Dlvinion3aflhe Busim,,rindf, resuans Code it in,
RESIDENTIAL:
W O PERMIT ISSUANCE
H W O fn II 11 force unJ.c11 t ❑SFDWI. ❑KI'I Cl FN REMODEL
aUV Lieeese CP ss CGS SXom 1 APPLIANCES-RF-_SIDE� IAL []ADDITION ❑PLUMBING RE-PIP"'
F Z W Doc 1117- — Cnnwctnr
ARCIII'1'F:C'I"SDE RATION ❑MULTI-UNIT ❑STRUCTURAL
IN.,aj y I'ANEf ti
Z O t^Z I umlervtand my plans.hall be u.wl ax public records MODIIBCAI'ION
OZN—a UPT0200AMPS [I INTERIOR [I CHIMNEY REPAIR
IMPR
Q�Fa LicensWQ Tama lSection]0313.Business vnJ l4oPexionsC 2111-II IsoAS Rl RI:MODE' C]SWIMMING FOOLS
a W OVER❑xkl AM1•SHRIiMQDl3UREPAIR ❑DEN10LlTIUN
W OWNCRtBUILDER DECLARAI[ON
Liacnse I.aw for the
1 hreaso .JEmt o nt I,un cBusine tram he Cunmaeer
a O W U ❑OTHf:R
W 3 Ya.F btllowm oJc:Any city nr anent/' SIGNS HLEM RICAL
WO,q
which requires avennitt t alt demolish, P Y:Incitim
Q prior to its'.aremcc.also requiresthe applicant lot suchpermit ,1 'guc l seatenuent SPECIAL CIRCUIT/M ISC.
�y4YJ
'bar he is licensed Eosa thet p filmContractor's License Lc (Chapter
9
�aa00 (oro,nmcncing w,h Scn nt]0(Xgof Di,ki Sof he 13 a'nacs and lrdnsaioav Codc)n 1'LMP.ME PER OR PULE INS'1'. COMMERCIAL: C
a a e C mat he is eminp theTfrom and the lasts for the alleged exemption.Any violation of [INEW BI,DG/ADDITION C]DEMOLITION
Ix+)^vi
Section 7031.5 by any applicant f«a permit subjects the applicant to a civil Penalty of POWER DEVICIiS ❑TL'NANT ❑FOOD SERVICE
1-?6ne,moa than Five hundred dollars(S5(p). IMPkOVIiAIENT
Q [,as owner of the preismy.or my emplgee,with wages as their sole compensation. SWIMMING IDOL ELECTRIC
will dolhe work.aud mesoucture kne,immuded,uo1I awl fol sale(Sec.9044.Buminc,s ❑OTIIIiR
W 3= and Profession,Ctdc The Contmcmr's Liceom faw Jens not apply to an owner of OUTLETS-SWI'ICIIIS-FIXTURES of
progeny who builds or nnprovck thereon,and who docs such work himselfor through
his own untpl,ee,provided Thai such ounnoutocnl,are not intended or o1ffimd lm NEW RESIDENT II Al.CLEM R S P
ode.IL however,the building or impnrvement is sold within ane year of cnmPl«ion.the ) I SISQ.ET.
r-builder will have the burvan of proving that he did not build or Improve far pnr-
01.re,o"` DEC 171997
❑1,as owner of the pmpeny,sat exclusively contracting witn IiccnwJ camp+<mn To TOTAL:
malar,tbn pr Ject(Sec,7044,Busines,trod Vu fcasinns CoJeO'Ihe Camrucnads I—
ecrot,Law des,s not apply to an ow net of prepedy who builds or improves thereon,and
-
selawdoesnotapplymanownerofprepenywhobuldsorimproveslhereon,and QTY PLUMBING PERMIT FEE
who counrox for such projects with a contracoup,)lwemmed roint m the Cnnlru0ou, Y:
License I.aw. PERMIT ISSUANCE 1
O 1 am exempt under Sec. .H&P C for this reason
Owner Doc
ALA ER-DRAIN&VENT-WNF17R IEA) VALUATION
rY O O
WORKER I
underSCBM of Tsq. ,u DECLARATION HACK Ilpl41'H(JI'PAI'.DEVICP. 4/'
[hereby allium nada Penalty of of Jury ane of the follnw,ng deda is Co
ion. ,,ovid, for Try
ibcme of he LauoCode.mr,hc Worker's Compmm DRAINS-FL(%)R.R(X)F.AREA.COND' Sl' ILS 'TYPE CON51'NUCI'IUN
weak,as pmvdal for by R«niao BJ(Xl of he talar Cndn,tiro the pedonnanec ul Nc
work far whim This .it is issued. I:IAT'URIS-PER TRAP
I have anA will twimain Wnrtr/s Compensation Innmmmce,as required by Section
Y71)0 of the Lthor Code.Ru the pcdinnence of the work for whichdo,permit uissued. GAS-13A.SYSTEM-1 INC.JOU'1'I.ETS OCG GROUP APIA
My Warker'n Conipenxatinn Insurance caner and Policy number am: GAS-IiA.SYS'fF.M-OVER4(EA)
Currier: Policy No.:
' CERTIFICATE 01'EXEMPTION FROM WORKERS' GRGSI%INWSTRI.WASTEINTLRCEI9T)R
COMPENSATION INSURANC12 f3U11.DING DIVISION FIJi.S
if biswclion nact not bea letW if ThclmmtiT is los to hundred dal larv(511 X11 GREASETRAP
or leas.) PLANCHECK FEE
I certify thin in nen perfannuncc nOM1c won,for which tI,odhcW dissued,
,,'ColaL:Jl SEWER-SANI'I'ARV-STORM EA.^_1X1 FI'.
not employ any person In any,nanner ae rat r ct m The H'nrk<rs Compmn- ENERGY FLI?
Z cation area,nr Celifomia. am WATER HEATER WIVEN 11TI.IY.TR
C)
GRADING FEE Appllv.l
N(TfIC TB APPLICANT:If,after making this Ceditieam of Exemption.You x WATER SYSTEMiTREATING
become wb)ea to the Worker',Cn,npens:nion pmvioul,old"IaMrt Core.you.nun, SOILS FEE
fair oh comply w'ithsuch proviainns ordiv peril shall M JccmcAovolad. WATER S17RVICE
LTJ 0
� ZCONSTRUCf1UN LENDING AGENCY NEW RESIDEN'1'[A],PLMB. SQ.FI'. PAID Date in,N
C.) z Ihereby stir thatthere is u construction lending agency for the performuneeof
the work far which this peril is issued(Sec.3097,Civ.C.)
tr.. F
TOTAL
OU LeridckName TOTAh:f.errdZAdd.i, :
r a I eenify,hut I have Tm1 This applicvlinn and elute that the above infnnnaGon is BUILDING Fldf
.H. rn conal.l ugee to comply with all city and county ordinances and nam laws relating to QTY. MECHANICAL.PERNIIT FEE
V Z building construction,and hereby autlome representatives of this city Rt enter upon the MASMIC FEEalms.-naendoncd property far inspection p.Fu,ca. PERMIT ISSUANCE,
(We)agree to save,indemnify and keep harmless me City of Cupertino against ELECTRIC FLIT
Bali lilies,jud,umns.convand expenses whntont,in any way ue.c againntsaid Cry A CIER OR ADD TO MECH.
VIDAIDING FEEFEEin conm,cncc t.of the omfiu,of this ermi _
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNIT(TO 10.000 CFM)
SOURCE REGULATIONS, MECHANICAL PET.
AIR HANDLING UNIT(OVER I0.000 CENT) CONS]RUM ION'1'AR
Signamrcof A,,1up VCu1umo11 Data EXHAUST HOOD IW/DUM) HOUSING MITIGATION FEE
H,UrAPEOUS MAT17RTAI S DISCLOSURE
Will l heaTTiwmor Lout hrd,fi,gtccupan..mrc o,'handle h:ordo-oderiul IIIiATIN .UNIT CTO 1041101 H'1'U)
as dcOncd by the Cupmino Municipal Code Chapter 9.12 and the Health and Safe,
Curie.Section 255121.)^ BEATING UNIT'(OVER 100.000 BTU)
[]Yea F-1 No PAID
VENTILATION FAN(SINGLE REST]))
WIII the u licum ur fare Naildiu•-lo l rine e 1 ur Jevlccs which Dann Receipt N
pp b pmt Area
BOILER-COMP(3HV OR 1M.000 B'TU)
mit hmarJnus air conw,ninvnu an JdincJ by the Buy Arca Air Quality Management
AL:
Disnin^ 13011,ER-COMP(OVER 100000 111 U)
❑Yen ❑No
I have read the lb,,ohus m.unal,anncn to under Chapter f 95 .1'he Cul,- AIR CONDITIONER ISSUANCE IJATE
air
6miu Heallh&Saf.y Code SectionsL!505,25533 and 255:04.1 undrnhthf
lanat Ithe NEW RESIDENTIAL MECH. SQ.FT.does
building J ,be( urrentlytly have
ao"be n, that it .mY'e itit'nite.to,ol the occupant nl
of tire myui¢mrnu which nwsTM tact pri�ro i.FuanccnlaCcnifrvm al Occupancy.
Ownelo,,inhmued alien, Dana DEAL: ISSUED fly:
OFFICE