S 3331 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL - IT PE` NO -
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL 3331
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS; SANTT IARY NO. APPLICATION SUBMITTAL DATE!
OW 'S NAME: PH�ORF'J &q CONTRACTOR'S NAME LIC NO:,AI N/C CONTROL#
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CHITECT/ENGINEE&. LIC NO'. ADga ESS: ❑
7 SO _kjap Sr,,-
7CONTACT. PHONE. BUILDING PERMIT INFO
_V&a_ �...�r /���� ❑ Consultant Fees Paid by Applicant(Initial) - LDG ELECT PLUMB MECH
LICENSED CON'TRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
I herehy aBirm that 1 am licenced under provisions of Chapter 9(commencing JOB DESCRIPTION
qZZ with Section]000)of Division 3 aRhc Business and Pnd'ea inns Code,and nryhcenmis
k�00full PERMIT ISSUANCE s' .fO RESIDENTIAL:
IyF
re and el]ec 5 ❑SFOWL ❑KITCHEN REMODEL
�U Licensa Clara Let.
Nate) Date - ContractL--� APPLIANCES-RESIDENTIAL TION ❑PLUMBING RE-PIPE
ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z O v 7a 1 understand my plans shall be used as public records /I MODIFICATION
OZ.`°-Q UP T0200AMP5 ZZ Z4I El INTERIOR L1 CHIMNEY REPAIR
F4EC' Licensed Professional 201-IOMAMPS IMPROVEMENT
W 2,�,...II OWNER-BUILDER DECLARATION e E]SWIMMING POOLS
1 hereby affirm that 1 ora exempt Lambe Commomr's m ase Law for the OVER IMOAMPS ❑BATH REMODFUREPAIR ❑DEMOLITION
aU fidllowing feasor.(Section 7031.5,Business and Profession tla:Any city or county pvrUpia
SIGNS LLECTRICAL
[..WON whleh requires a permit to construct niteq hnprove dmno c nr repan any stractur,
,�j y< once,aL y tit pplicam fa...ch mu fl o.gn d'I mmem SPECIAL CIRCUUMISC.
2 Y thath 1 Jpurs n rh p one a[theC fauns L' rnaf (Chaptu9
uL.00a (co 'ng ith Sam, u 000)ofDim,on3oft luau,sand Prorecciom Code)or TEMP.METER OR POLE INST. pM
I
m titer he iv exempt therefrom and the basis for I alleged exemption.Any violation of E BIIS� AbD T O 1 �{ O
„r N Settinn'l0315 by any appllcam[or a permit hjects the appllcanuo a civil penelry of POWER DEVICES NAN �V ��OOD C8
50 rn more than 17ve hundred dalton(5500) PROVEMENT
❑Lasownerofthepropeny,nrmye ogees with wages as their sole compensation, SWIMMING POOL ELECTRIC
C F. wit l do the work,and mit .. ureic intended or offered far sele(Sec.]IW4,Bucinesr OTHER
1x13 and Profession,Code The Conn for's License Law does not apply to an owner of OUTLETS-SWITCHES-PIXTURBSBy
W property who huilJ.c or improv Iherc and who docs.tach work himself ar Ihmugh
his awn employees,provide that such improvemenu are not imended or offered for NEW RESIDENTIAL ELECTR SQ FT.
snle.lf,howevarmcbuil ' g or improvement is sold within one yaref'eompleimn.the SQ.FT FLOOR AREA $/SQ.Cr
par
will has aburden ofproving that hedid not build orimprove for put-
pee of sale).
❑ 1,as owner of a property,am exclusively commcting with licensed exoracmrs n TOTAL
meuct the p lee((Sec.]B4q Business and Puur..ior,Cold:)The Comment's Li- I'
se Law s not apply n an owner ofpcepeny who builds or improves
therms,and QTY. P UM GPERMIT FEE
whoeont etafor such pmjuls with eeomraemr(s)Iieemsod pursuvm to IM1e Contmcmr's
Licari,
❑ in exempt under See. ,B&PCfer[hisressmn PERMIT ISS.
ALTER-D NHECTI E EA7 VALUATION
owner Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROI'EC NTTI
1 hereby affirm under penalty of per)ory one of We following deelarminne
I haveand will maintain aCetificateafConsent Conseno self-inanre for Workar'a Com ,AA,pen- DRAINS-FLOOR COND. SORIES UCI 10N
at
as provided far by Section 30(10 of the Labor Code for the pa fnmmnce of the V
k or which this permit is issued. FIXTURES-PER TRAP I
war JJ
j 700 of a and will ode,maintain Workers Compensmion Insurance,h required by Section
3]1x1 of the Labor Code,for performance of the work for which this permit is issued. GAS-EA.SYSTEM-]INC.40UTL.TS OCC CROUP APE
My Work"[,�Co�mpens I Insurona art ier and Policy Ur qi� ; II
Carrier:_L'q�C<�p[I+�'� Policy No.:k�Ttr7�lO`r�43� GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATIONINSURANCE GRF.ASEJINDUSTRI.WASTE INTERCEPTOR
(This section need not be completed ifthe permit lcf mndreddellms($IW) BUILDING DIVISION I+BI?5
or less.) GREASE TRAP PLANCHECK FEE
I certify[balm the performance of t r forwhich this permit ix issued,Ishall SEWER-SANITARY-STORM EA.200 FT.
no[employ any person in any man as m become subject to the Workers'Cmmpen- ENERGY FEE -
Z ,anon Lawx of California.
Z WATER HEATER WNENT/ELECTR
Z 2 'Applicant GRADING FEE
Ir ti NOTICE TO (CANT:jr,after making this Certificate of Exemption,you should WATER SYSTEMaREATING
E"t hecom feat m be Worker',Compensation provisions of the Labor Cade yma mus[ SOILS FEE
W f
it comply with such provisions orchis Permit shall be deemed revoked. WATER SERVICE
CONSTRUCTION LENDING AG NEW RESIDENTIAL PLMB. SQ.FT. PAID
U 0 I hereby affirm that there isnanswctio ng agency for the performance of ae Receipt#
E~- the work for which this Permit is issue (19],Cie C.)
Q U Lender's Name TOTAL:
Lenders Address TOTAL:44o.W
con' r 1 have rend dlis application and state that the above information is BUILDING FEE
L�t V1 c r but.comply withal]city and county ordinances and sum laws relating to QTY. MECHANICAL PERMIT FEE
U uilJing ttmFWe[ion,and hereby authorize representatives ofthis city contention the SEISMIC FEE OQ
whose-mentioned property fat inspection purposes PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless the Clry of Cupertino against )� ELECTRIC PEC07
lishlli[ies,judgments,wets and expenses which may in any way acerae against said City ALTER OR ADD TO MECH. �wh /.�� 6
in consequence of the gmnfmg of tbia permit PLUMBING FEE V V
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10/000 CI7M) -
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signetumcf AppliantsCobere[ar Date ' EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO I00,003 BTU)
a,defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
Cade,Section 25532m)° HEATING UNIT(OVER 100,000 B'TU)
❑Yw VENTILATION FAN(SINGLE RESID) PAID
Will thea I'mant or future hu Id' occupant use equipment or devices which Data Receipt#
pp pen Area
BOILER-COMP(3HPOR 100,000BTU)
it havardous air mmaminants n: Med by the Bay Area Air Quality Management .PO9.AL:
clod?
❑Yea No BOILER-COMP(OVER 100.000 BTU)
I have rad the hamrdam mmelnl,raqulro mus made,Chance 6,95 of the Cali- AIR CONDITIONER ISSUANCE DATE
forma Banks&Safety Code,Secdanc25511A 25533 and 25534.1 understand that if the NEW RESIDENTIAL MI CH. SQ.Fp.
building does not currently have a tenant that it is my respnmihiiity to notify the earcernl
of the requirement_which mast Isparta niasnanm
e pdoo of o Cmrifrean of Occupansecy,
Ownermruthur dd,get Date TOTAL: ISSUoD BY'
OFFICE
�o�-- ---------
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• ADDITION
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LOT AREA•1500 SOFT,
b
2.155 SOFT.EXISTING LOT COVERAGE•31%
O " ADDITION SOFT.•II 50,FT,
1 (N)TOTAL 60.FT.LOT COVERAGE•2366 SQFT,•31%
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PLOT PLAINS j
CHECKED By,, i
APN: 326-43-03I DATE-J.2
MFM
; PLr;NN,,INGpDEPT,
J LCF
���I; JI DATE _/ !/0 ��
)EC 0 819- 9 _�
j = PT.--1
EILDU. INS'ECTION DEF F\RI nntiv f j
CIT(OF CUPERI NO
10610 CASTINE AVE,
PLOT PI AN: N T S
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• 16 W243 W2436 W3018 W2436 SCW2436-R
. . . . . . . . . . . . . . . . .
B ISP46-L ❑ ❑ BCSOSP48 .
95 n �` X1S'T : 3DB
36- 36 36
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182 ,��
1:Wood cap on half wall 9
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2:Tip-down front
3:Double cutlery
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4:Spice insert
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All dimensions size deslgnellom This b an ori Inal desl o�®B Design: 06/1 MO
D.9no.
9'�en are mDIKI to veda411on on g On end mual MOON Scale:matlmum Dale 09/ISNB
job ate end adjustment la At job nol De released or copletl uMess CATHERINE MOON
conmtions. applicable lee has been geld or lob 10870 CASTINE AVE
order placed. 10670CCUPERTINO.CA AVON Designer
NM ___ __.__..._... ....._._ .._._.. .
127
16 W2436 g W2436� W3018 2436 SCW243 R
BCSOSP48-L ❑ ❑ BCSOSP48-
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FHD9: N
-R s
4�-u3
3D83 ,' 366
5 D :2
70
110
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W. F R/1V3618
9 178
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79170 1
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6 71
181 36
CAY4 L 24 —t
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GI.I� p¢oJlq�—p nt� � �. r•l „t E�
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All dimenslons 8 size designations moonall Desio"
: 06/1698 Dsp no
p Tltla Is an original design end must Scale:1/Z'.t' 0
jobare dsubject to varlao lit jo on not M released or wpleo unless Date : 09/15/98
fob sue and adluslmenl to ret Jab applicable lee has been Paid ar Job DATHERINE MOON
conditions. order placed. CUPS TINO, SAVE Designer
CUPERTINO.CA 95014
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