27249 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO nun. PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL. /I (�
BUILDING DIVISION - BUILDING PROJECT'IDENTIFICATION - 4 J
UILDING ADDRESS: SANITARY NO. APPLICATIONSUBMITPALDATE
Q SUNIT, .. 11.�k
# LOT IT I I-1.
OWNERS NAME PHONE: O ACTOR'S NAME: LIC NO: N/C CONTROLAdk>R #
r./G�9&E xi�L%frios 6"63
CHITS T/ENGINEEIL LIC NO: DDRESS: ❑
N .S r
CONTACT: r�� ,f ayyA(f(fjT'Z PHONe: "d d• T ' Z--` �. a h'' `F BUIEDING PERMIT INFO
(� ELECT RIC PE RM IT;.,4 4 %p; 'iFEE
',�•/���TF/�. ^? 'al &s9YrbkAw:4'v.xL!I ILJ\ PLUMB MECH
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL B
cmz I hereby affirm that l am licensed under provisions ofChapwr 9(commencing with '
FtOC Sediofull rrowelaf Division 3of the Rosiness and Professions Cade,and my licence is in PANELS
F<U, LiclaraChisla feet UP TO 200 AMPS
<z License Clvss Curt
m<N Dam Comraztor 201-1000 AMPS
Z8yK ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
O m- M I understand my plans shall be used as public records.
q' Licenced Pmfesslonal
SIGNS ELECTRICAL
,��JJ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
OyF I hereby affirm that I am exempt from the Contractor's License Law for the
3 m
I'J Om following reason.(Section 9031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST,
y; which requires a permit to construct,alter,improve,demolish,or repair any structure
Nr;� prior to its issuance,also requires the applicant for such p conotto file asigned statement POWER DEVICES
Op that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter
2p, ,FL 9(commencing with Section 7")of Division 3 ofthe Business and Professions Code) SWIMMING POOLELECTRIC VALUATION
W!2 to or that he is exempttherefmen and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES •'� 1 l cod
QSection]031.5 by any epplicenl for a permh subjects the applicant to a civil penalty of 1
not more than Eve hundred dollars What). NEW RESIDENTIAL ELECTR S .FT.
❑ l,asownerafthc properly.ormy empinyeeswith wagesesthei...lecampensatlon, STORIES TYPE CONSTRUCTION
L
.2 will dome work,and mostmtsure is out inlendedoraffered forsale(Sea.]0FI,Business
and Professions Code:The Contraawla License Law does not apply to an owner of
propanywho buildsorimprovesthereon,a ndwhodoessuchwerk himselforthroughhis OCCGROUP RES.UNITS
n the
hpmvior i Nsetouch improvementsarenot year
ofi loroffered forests. rL
however,theave[lie orimprovement issoldwithinoneyear ofimmolation,thepose ofIce
builder will have the buNan of that he Nd not build or improve f L
Forcing paw purposes
sa❑le) 3i , x) "
1 as owneroflhepproperty, exclusively contracting contractors Q"Te :
'FEE FLOOZONEMHMIT- APN
construct the prajeal(Seo.7044,Business and Professions Code:)The Conlruamr's
License Law does not applyto an ownerofpropery whuhuilds or improves thereon,and PERMIT ISSUANCE
who contracts far such projects with a comractor(s)licensed pw.uantto the Convector's
License Law. ALTER-DRAIN&VENT-WATER EA) a i FEE SUMMARY-
❑ 1 am exempt under Sec. ,B&P C fo reason BACK FLOW PROTECT.DEVICE _ OUTSIDE FEES
SANITARY Y N
Owner pINS-FLOORROOF,AREA,COND. RECEIPT#
,
WORKMAN COMPENSATION ARATION SCHOOLTAX Y
I❑ Iherebyaffirmthallheveacenlficama sent ea self-insure,or a aenificalcof n URES-PERTRAP RECEIPT#
Work co"Cona'asation lmoranceor ied copy thereof(See.3800 Leb CJwhich PARK FEE Y N
covers all employee's undert ' mi[. CA -EA.SYSTEM-I INC.40UTLETSRECEIPT#
Policy# A BUILDING DIVISIO ,FS
Company GAS EA.SYSTEM-OVER 4(EA) PLANCHECK PEE
❑ Certified copy i ereby fmaiahed.
❑ Cenifed copy is fi with the city inspersion div` OREA INDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICA OFEXETTON FROM GRIiASL RAP SOILS FEE
CO ENC
(This section need notbe co ppe one hundrN oilers($100) SEWER- ITARY-STORM EA.2WF1'. ENERGY
or lase.)
I certify that in the pertmananc rk for whic thispe .let. osh ATER HEATER W/VENT/ELECfR
not employ any person in any ms to beco eobj t an' pp
CompensationLawsofCalifomie. AW ER SYSTEMUREATING ate Receipt p
0 CR NOTICETO APPLICANT:If,aftermaki this Certiflaam of Exemption, -SQ.FT.p'on,you should RESIDENTIAL PLMB. S TOTAL:
z (q become suhjed to The Workers Compeneetl provisions of the Labor Code,you most
forthwith comply with such provision.or Ni it shall be deemed revoked. BUILDING FE
W z CONSTRUCTION LEN G AGENCY SEISMIC FEE
rrC--11 1 hereby ofPom that is a construction le ing agency for I acted
the work for which This permit is issued(Sec.3097, .C.) ELECTRIC IE O
L) lantlera Nemah" 77
, 77 ,
F Lenders AddAdd., �- as + 'MECHANICAL PERMIT v FEE`PERMIT FEE
" '
U 1 certify that 1 have read this application and show that In above mfnrme[i m s
acorrect Iagree to comply with all city and county ordntances and state laws wlating to PERMIT ISSUANCES MECHANI AT,FEF,
f" building construction,andhereby authorise representatives of Nis city venter upon the CONSTRU TION TAX
L) y idnn property for inspce[ion proposes. ALTER OR ADD TO MECH.
G (We)agree to save,indemnify and keep harnliew the City of Cupertino against
liubilit ,judgments,costs and expenses which may In any way acerueagainm said City AIR HANDLING UNIT CTO 10,000 CFM)
con c enee of the granting of th' permit.
d AIR HANDLING UNIT(OVER BLOW CFM)
re of Applicvnt/Convacmr Gulf EXHAUST HOOD(W/DUCT
PAID
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO 100,0010 BTU) Data Re ' t#
Will the applicant or future building occupant store or beadle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100,000 BTU) AL:
Cade.Section 532(e)R
12 Yes El No VENTILATION PAN(SINGLE RESID)
Y
Will theapplicanmrfuwrebuildingmcupam ueeequipmenmrdeviceswhich ami[ NOVILER-COWU11P OR IW,DITO BTU) 1$S E TE
hazardous air contmmucho.as defined by the Bay Area Air Quality Management BOILER-COW(OVER 100,000 BTU) t\ ra
Iris,? - ! 1994
J ❑yes ❑No NEW REWWNT1AL MECH.-SQ.FI'. City
1 have read the haswdous materials requirements under Chapter 6.95 of the VII f Vl' Vuf•tn I VAC
Calilo have
Health&Safety Code,Sections notai,25533and25534.1understand Nat
if the building does not currently have a tenant,that it is my responsibility to notify the
occupant of the rem
qulromes which must N met prior to Issuance of a Certificate of
Occupancy.
Owner or amounted agent - Date ISSUED BY:
OFFICE
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P , , NbV 11994 D
LDGI, INSPECTION DEPARTMEO
I Z _1Alr w Aiwa 6VLt ,Nr CITY OE CUPERTINO
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0 0 ,II AC ORD.3',9:4N!ITH THE CITY OB
o�\ R IND CODES IM ORDINANCES
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' I 1�ecJicaIi ns MUST.
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OVEN be pt 1 n the';!,', 3t!3 I times and it is un
r lawf I to make ;any c•;,;es or aiterafionE
on c ime wnucc :t n pa:m•ssion front
Home Owner. Bill and Mary Kolbeck Contractor. Showcase Kitchees,Inc the uild 1C GF pi. Cdy I Cupeaino.
Address:729 Stendhal Lane 12333 Saratoga-Sunnyvale Road The •tom �irr c, ,I,S r ,i and specitica(onk
SHA .L N R 6 be „e d pa.mit er to * ad,
•
OFFItE City:Cupertino - Zip:95014 Sarotaoga, CA. 95070 approval A the vicilliCn of any protionf)
Project: Kitchen Remodel California Contractors License#665395-B ?t any CJy 0,dmanee or State Lai,
Copy ;-
Remove and replace cabinetry,new
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skylight,appliances and counters. j
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