B 0307IPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
ITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING, DIVISION APPLICATION/PERMIT PLUMBING_ MECHANICAL
❑ Consultant Fees Paid by Applicant (Initial)
pW 1 hereby a18rm Out 1 ton licensed under provisions of Chapor 9 (commencing
F ud- with Scetinn 9deffecDivision3ofine Business mJ fessiona Co� de, on s
ly in full 4rree unit effect. (P/�f�
Iiictanae C Lic. N fit_
+dam DateCommcmr
ivi��''�`��� ARCHITPCT'S DECLARATION
T,. 1 understand my plans shall he used as public records
z
^i 1"W Licensed Professional
OWNER -BUILDER DECLARATION
a � 1 hereby affirm that I am exempt from the Contractor License Law for the
O S U U following rectum. (Section 9onstr Business and Pmfessinns Code: Any city or county
Cb' which requires a permit to construct, the ahem improve, demolish, or repair any tWemre
'hiormsliccnancgeNoregoithe the 0v such Contractors
Lfile aicense ned Law
�� (cot me cing wit%edh
pursuant 70Nepmviainm of the eBusiness nd Prof Law (Choptm9
(cat he is
(commencing Section ]111() of basisoo r th al alleged
unit on. Any
Cale) of
y eL that he is exempt therefrom and the basis for the alleged exemption. Any violation of
�.. m Section 71131.5 five
any applicant for a permit subjects theapplicant m a civil penalty of
or more than fivcprimhandled Dollars y employees
C a0 ❑ I, as owner of and
property, m my emplended with weeds as their sole compensation,
will dothe wors ande: The onn.,atinreicense Law
does noted for sale
44, Business
da ro and Professions Code: Theeroves then' License Law dues not apply to an owner, of
his own who builds or improves thereon, and who does such work himself or through
his own employees, pmdNat such improvements ore nm intended or offered for
sale If,however,thebuilding ingorimprovement issold within one year ofpprove fothe
condo-bulk.)r will have the burden of proving that he did not Wild or improve for pury
'
an of svleJ. '
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
I construct he popect (Sec. 9044, Business and Profession Cade:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon, and QTY
who oomeacts for such projects wird a contractor(s) licensed pumuem m the Commemle
License Law.
❑ I not exempt under Sec. ,B& P C for Nis reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby eMo. ander penalty of perjury one of the following declaratiens:
❑ I,{uve and will maintain a CertiOateofConem o self-actim for Workei s Commit-
snim, as provided for by Section 37M of the Labor Code, for the performance of the
t,1 for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
37M of the Labor Cede, for the performance of the work for which this permit is issued.
Mj Worjmr'a Comp ion Insurance min and Policy
Carrier: `�>` _• �y 'nroy Ne.: A= area D o4oQ!,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissecoma reed no. be completed ifihe permit is [Drone hundred dollars ($ IOOj
rt, loss.)
I really that in the Performance of the work for which this permit is issued, l shall
not employ any person in any manner so as to become subject to the WorkersCampari
0,Z sation Laws of California. Dam
Applicant i
y NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Comparison. Provisions or the Labor Code, you most
Forthwith comply with such provision,
ur this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
U Q I hereby affirm that there is a concoction lending agency forthe performameof
the work for which this permit is issued (See. 3097, Civ. C.)
0 U Lender's Name
Lli Lender's Address
I certify that 1 have read this application and state Nat the above information is
w 00 correct, 1 vgree m comply with all city and county ordinances and sole laws refuting to QTY,
U z building mrsomptic., and hereby uuthorizd re,newmvtives of this city memoupon Ne
alwve-mentioned Property for inspection purposes.
(We) vgree to save, indemnify snit keep Includes the City of Cupertino vgaimt
liabilides,judgments, costs and experts. ue which may in any way accragainst sviJCity
In consequence of Na
e grnting of thispermit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
w- L,I'iAZARDOUS MATERIALS DISCLOSURE
Will the applicant or mmre building occupant store .,handle hazardous mmenal
it, defined by he Cupertino Municipal Code, Chapter 9.12, and the Health unit Safety
Cale, Secden 25532(x)9
❑Yes
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
Distrlet?
❑ Yry
I have red the hazallon materials requirements under Chapter 6,95 of the Cali-
fornia Health & Safety Cade, Sections 25505, 25533 and 25534. I umlerstand Out if the
building does not currently have emouq that it is my respm.ibility to notifYNecccupant
f egq�rroy a ntsllylfftpriA1p issuance o[a Cfpl�.pz r/Caw11wA
ELECTRIC PERMIT
PERMIT ISSUANCE
APPLIANCES - RES IHENTIAL
PANELS
UP TO 200 AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC.
TEMP METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS - SWITCHES - FIXTURES
NEW RESIDENTIAL EIECTR
SQ FT.
50001
0307
$ISQ. FT.
TOTAL
JOB DESCRO
RESIDENTIAL
❑ SFDWL ❑ KITCHEN REMODEL
El ADDITION ❑PLUMBING%E-PIPE
El MULTI -UNIT ❑STRUCTURAL
MODIFICATION
TERIOR 11 CHIMNEY REPAIR
MPROVEMENT ElSWIMMING POOLS
❑ BATH REMOD sL/REPAIR E OLITION
❑ OTHER
FEE
SEISMI 'EE
✓ d [iMBI MIT FEE
PERMIT ISSUANCE `' ` BLDG. INSPECTION
OR
ALTER - DRAIN & VENT- WATER (EA
C
BACK FLOW PROTECT DEVICE
DRAINS - FLOOR, ROOF, AREA, COND.
COMMERCIAL: "
❑N WBLDG/ADDITION ❑DEMOLITION
NT ❑ FOOD SERVICE
IMPROVEMENT
❑ OTHER
TYPE CONST
311
�eL AP6
x0
3/ r 0.'•2
FIXTURES - PER TRAP
GAS - EA. SYSTEM -I INC. 4 OUTLETS r
$ISQ. FT.
TOTAL
WAY 18 1999
DEPARTMEN
y1l; CI TINGVALUATION
SEISMI 'EE
✓ d [iMBI MIT FEE
PERMIT ISSUANCE `' ` BLDG. INSPECTION
OR
ALTER - DRAIN & VENT- WATER (EA
C
BACK FLOW PROTECT DEVICE
DRAINS - FLOOR, ROOF, AREA, COND.
STOVIESt
DEC. GROUP
73
TYPE CONST
311
�eL AP6
x0
3/ r 0.'•2
FIXTURES - PER TRAP
GAS - EA. SYSTEM -I INC. 4 OUTLETS r
GAS- EA. SYSTEM -OVER 4 (EA)
GREASFIINDUSTRL WASTE INTERCEPTOR
AIR HA NO UNIT (To Io,OnO CFM)
BUILDING DIVISION FEES
GREASETRAP
MECHANICAL EE
PLANCHF.CK FEF.
SEWER -SANITARY -STORM EA. 200 FT.
ENERGY FEE
WATER HEATER WIVENT/ELECTR
'GRADING FEE
SOILS FEE
WATER SYSTEMO BEATING
WATER SERVICE
HOUSING MITIGATIO
,
PAID _
NEW RESIDENTIAL PLvIB. SQ. FT.
TOTAL:
MECHANICAL PERMIT
FEE
SEISMI 'EE
PERMIT ISSUANCE
ELECTRIC FEE
`AWti
.R OR ADD TO MECH.
PLUMBING FEE
AIR HA NO UNIT (To Io,OnO CFM)
MECHANICAL EE
AIR HANDLING T(OVER IBM() CFM)
CONSTRUCTI
EXHAUST HOOD(W/D ')
HOUSING MITIGATIO
EE
qt�1
HEATING UNIT (TO 100,00) B
HEATING UNIT (OVER 100,000 BTU)
PAID
❑um
imerimig�
—
VENTILATION FAN (SINGLE RESID)
BOILER -COMP (THE OR 1 W,000 BTU)
-
BOILER -COMP (OVER 1110,(X1) BTU)
AIR CONDITIONER
'
ISSUED
ISSUANCE DATE
NEW RESIDENTIAL MECH. SQ. FT.
TOTAL:
OFFICE
_
SPECIFICATIONS LINDA NEWTON&
ASSOCIATES
1050 Autumn Lane
V-1 Armstrong VCT P-1 Kelly Moore Paint I=Ate, Califomla 94024
25 Blanco General U .O. N . _ 650/965-9030
Standard Excelon 650/965-9228 Fax
H 51910 Classic Black P-2 Kelly Moore
E (NIC) KM 120-D
LwaterCooler (NIC) V-2 Armstrong VCT
SINK P-2 LP -1 Formica
Standard Excelon -
1 51941 Polar White 840-58 Black
Cabinets
427 Install vinyl tile in 4 -tile
checkerboard pattern. LP -2 Formica
2468-58
PLAN VIEW RM 1427 B-1 Burke Topset Base Mouse Dust
1/411 _ 1 1-019 Black Counters
Q
uj
W o
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a
`. 0
U8 OZ
Qd c+A UJ
SOFFIT 08=)
ISSUE:
J
OVED rn
IR ACG ITH THE CITY 8F
CUPERTI AND O
RDINANCES' o
Coffee Microwave
DASIGNEDThis set of sprl3hs'a11011f MUST v
be k* on ft ' at ai *-cies and It a un /per
MYdW ipa min i rd &m -Ws a off am" D w 0
FAN" wets m from
m►� r ,� rw �>c.aa to MAY 181999
° � � %iz � kAw" �, t4 Paper Trash Cans Q
�dMAll0. tl� "' u mad ar Un Ula as N
aggfqY�l tlta: a!Ir. LM d aw r B
�1r amy ® (D ii enea mr SS.iN� U�w.
W
Z
m
H.C. Accessible Roll our drawers cQi
Knee Space under Sink w/ Recycling Bins
DRAWN Y: SL
CHECKED • LDN
ELEVATION AT CABINET ELEVATION AT CABINET SDATE CALE: AS NOTED
31, 11999
o .. _ . it o
1 /2 - 1 -0 1/2 _ 1.011
I.���� - SHEET 1 OF 1