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31407 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY t CITY OF CUPERTINO - BUILDING-ELECTRICAL PERMITNO, BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL .. 31407 BUILDING PROJECT'IDENTIFICATION-81J ILDING ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DA' A71 T AkOOK OFEDVE W x.5-9 G 0 NER'SNAME: e pp -, P�H�OI�NE -1 V C NTRACTOR'S NAME: LIC NO b KJ L u. R ISHNmp( �of Sy0 -Q W NG N/C CONTROL# ARCHITELT/ENGINEER: LIC NO: ADORES: ❑ CONTACT: . ' PHONE: - BUILDING PERMIT INFO MSH ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH ❑ ❑ LICENSED CONTRACTORS DECLARATION QTY. ELECTRIC PERMIT 1 ionher7 off rut that I am licensed ander d Professions of Chapter 9 toy i M FEE D P P ( B W�Z with Section moo>ecDivtston3onhe Business and ProtessmnsCWe,and my fcenaeis JOB DESCRIPTION . FSO in toll force and effect. ` PERMITISSUANCE RESIDENTIAL <UU License Class Lic.4 DSEDWL D KITCHEN REMODEL F�u1 Datc Contractor APPLIANCES-RESIDENTIAL " FSH - ARCHITECTS DECLARATION ADDITION ❑PLUMBING RE-PIPE PANELS MULTI-UNIT El STRUCTURAL I 'Z O y& I understand my plans shall ha used as public meutds MODIFICATION oz—, UP T0200 AMPS r.`&.,Ipppp'u1 Lmensed Professional ❑INTERIOR• DCHIMNEY REPAIR �^y'�•� OWNER-BUILDERDEtCLARATION 201-1000AMPS IMPROVEMENT yyx CC r 1 hereby affrm that I am exempt fond late Contractor's License Law,for the OVER 1000 AMPS ❑BATH REMODEUREPAIR El DEMOLITION W qty,FU following reason(Section 7031.5,Business and Pmfessinns Code:Any city or county a [_1 OTHER ul GG SIGNSELECIRICAL which claims a perm t i .true It proved demolish,or repair y.uncture FSO prior t ts'su al quiretheapplicant for such permit toll signed statement SPECIAL CIRCUIT/MISC. } thathel licensed p nu theprovisions ftheContractor's LicemseL (Chapter9 GCq (commencing withSecu 9000)ofDt 3 ofthe Business andPrf Cods)or TEMP.METER OR POLE INST. .COMM R -IA 0. n that he's exempt therefrom and the basis for the alleged exemption.Any violation of Section 7011,1 by any applicant men permit subjects the applicant to sell, Ityof POWER DEVICES �DNEW BLDG/ADDITION El DEMOLITION y not more than five hundred dullars($5W). - ❑TENANT ❑FOOD SERVICE C3 T,as ovneruftha property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC - IMPROVEMENT Oo will do the work,and the structure is not intended ureffered for sale(Sec.J044,Business DOTHER 63 anand Professions Cade:The Contractors License Law does not apply to an owner of UTLETS-SWITCHES-FIXTURES property who builds or improves thereon,and who dries such work himself or through his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR -SQ FT. sale.If.however,the building or improvement is sold within one year ofcompletion,the SQ.FEE FLOOR AREA $/SQ.FI'm owner-builder will have the burden of proving that he did not build or improve for par- _ powidelleJ. O '❑I,as owner of the pmpeny,an exclusively council,with licensed emorndars to AID construct the project(Sec.9044,Business and Professions Coda:)The Contra cdr's U. Law does not apply to an owner of property who builds or improves thereon,and QT-Y. PLUMBING PERMIT FEE " who contracts for such projects with u cdnractodo licensed pursuant the Contractor's License Law.nsPERMIT ISSUANCE—, Nov 051996 ❑lam exempt under Sec. B&P C for this reason ���. Date"I/ ALTER-DRAIN&VIE WATER(BA) - tttVt----ArrrrLaaaaUATI$q�N� . WORKER'S COMPENSATION DECLARATION, BACK FLOW PROTE E CR UI'�,['II IIVV I hereby affirm under penalty of perjury one of the following decimations: �O�� ❑I have and will maintain a Ceniftcate of Consenuo self-insure for Worker's Counter- DRAINS-FL R EA,CO cation,as provided for by Section 3100 of the Labor Code,for the performance of the STORIES, TYPE CONSTRUCTION work for which Nis permit is issued. FIXTURES-PER TR ❑I have and will maintain Worker's Compensation Insurance,as required by Sxtiun 3100 of Ne labor Code,for the perfotmancc of the workfor which this permit is issued. GAS-EA.SYSTEM-IINC40 OCC.GROUP APN Co WorkeYe Compensation Insurance carrier and Policy number are: Carries Policy No.: GAS-EA.$YSTEM�OVER 4(PA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASF/INDUSTRL WASTE INTERCEPTOR ' (Thissecti000eed not bawmpleted ifthe permhis for one hundreddollam IS 100) ILDINGD ISION FEES or less) ll GREASE TRAP PLANCHECKFE Toy any that int he pa,andommacew,nce as 1.ork.subfor chthis the W is issued,Contend- SEWEk-SANITARY-STORM EA.20)FL ENERGY FE Z Applicant Laws of California.Dam O O Applicant WATER HEATER WNENT/ELECTR GRADIN y NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should WATER SYSTEMITREATING abecome subject m the Worker's Compensation provisions of the Labor Code,you must SOILS It W forthwith namely with such provisions or this permit shall be deemed revoked. WATER SERVICE {L (] CONSTRUCTION LENDING AGENCY UO Ihereby affirm that there is a construction lending agency for the performance of NEW RESIDENTIALPCMB. SQ.FT. PAID a Receipt# L4 F' the work for which this permit is issued(See.3091,Civ.C.) O Lender's Name - TOTAL: y yV Lender's Address TOTAL: 1 verify in.1 have read this application and state that the above information is BUILDING FEE rA correct.l agree te,variety with all city and county ordinances and stare lawsrelarmg to QTY, MECHANICAL PERMIT FEE V z building construction,and hereby autherizampresenmtives of this city m enter upon the SEISMIC FEE above-mentioned property for inspection purposes.. - PERMIT ISSUANCE(We)agree to save,Indemnify and keep hornless the City of Cupertino against ELECTRIC FEE Iiahi lilies,judgments,costs and expenses which may in any way areae against said City ALTER OR ADD TO MECH. !an onsequence of the grant)r,of mi,permit. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO IB,000 CFM) SOURCE REGULATIONS. - MECHANICAL FEE r ' AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX Signdure of ApplicanUCantacmr. Done, EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building eccepant tare or handle bazmdous damrlal HEATING UNIT(TO 100,000 BTU) as defined by the Cupenum Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532nd? HEATING UNIT(OVER 100,003 BTU) DYs - _1 No VENTILATION FAN(SINGLE RESID) PAID Date ReceiptN Will the applicant or future building occupant use equipment or devices which emit havrdons air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP CHP OR 100,00X1 B'TU) District? - - I TOTAL: DYes C]No 'BOILER-COMP(EVER 100,010f)BTU) harzrdous materials 'AIR CONDITIONER I have read the requirements soder Chapter 6.95 of the Cali- ISSUANCE DA fomia Health As Safety Code,Sections 25505,25533 and 25534.I understand Nat if the NEW RESIDENTIAL MECH. SQ.CE " building ds net currently have a tenant,that it is my responsibility to notify the mention ooe f the requirements which most od met prior to issuance of a Cenifieme of Occupancy. Owner or authorined agent Data - TOTAL: ISSUED BY: _. (lpplCp. - • RESIDENTIAL PROJECT COVER SHEET: Ctty of ' Cupertino Assessors Parcel Number: �7S –X39— D as� % c Name of owner. ,rDtn 6 / `�LGr2Z�1 � 1ti Project address. Contact person. / l Phone02 rl6 Fax. Net square footage of lot. Existing e Square footage: First floor: !�$ �aProopos 6O S ! Second floor: — Garage: 4 O0AMC Are there at least two 10 foot by 20 foot clear spaces inside the garage? o N • �L6'� On what floor(s) is work being done? � - Brief description of work. _LL Q L (Sln Code editions: 1994 UBC (Y-N)1994 UFC (Y-N)1994 UMC (Y-N) 1994 UPC (Y-N)1993 NEC (Y -N) PLOT PLAINS CHECKED-BY, PLANNING DEPT, ©ATE / /Si BLD6e DEPT. o �NSp I/051g96 D c/ry Fo pF9r4 ff 9ryFNr o F IPY Plan Review Process Work Book Page-7- 4 Front Yard Street 917 Brookgrove Lane Brookgrove Lane Built area including garage = 1680 square feet Added area = 60 ss mare feet Land area (118 X 59) = 8990 square feet �41/ New built area to land area ratio = 25% • • Back Yard H use o tline I • I Current I Location of Front I Roof Line Added Living Door I Area= I I I I I I Garage Lot Line Proposed Location of the front door . Scale 1" = 10' Front Yard W_ � � 7 _ . i O• -a - O ° -,9C;7 m �o 3 1 e LAN ' ter vL 1 s i n� S I s s