28473APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
OFFICE
CITY OF CUPERTINO BUILDING - XLECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING. mF:cnpmcAL
PERMIT NO.
28473
BUILDING PROJECT IDENTIFICATION
NUILMNG ADDRESS:
SANITARY NO.
APPLICATION SUBMITTAL DATE
I o�t Lit-. GA g So ly
OWNER'S NAME.: lP,H.O4NE:
`ia. _ - rC LL baa V pfd` eL�f p`
1'lb L•G
COhURACTOR'h NAME: LIC NO:
NIC
CONTROL#
s RCH�ITECT/ENGINEER: LIC NO:
ADDRESS:
CONTACT: PHONE:
BUILDING PERMIT INFO
El Consultant Fce9 Paid by Applicant (Initial)
B ELECT PLUMP IJECH.
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LICENSED CONTRACTOR'S DECLARATION
1 hereby amrm the I aro licensed under pmvishms of chapter 9 (nommencing
with Semi.n 7000)6( Divisimnl ofthe Busineu and Pr.fcssions Code, and mylicenu is
in full from and effort.
License Class Lic. p
Dote Contractor
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL:
❑SFDWL 0 TCHEN REMODEL.
❑gDOITION LUMBING RE -PIPE
\r�`r
❑MULTLUNIT ❑STRUCTURAL
MODIFICATION
s1 _
PERMITISSUANCI3
APPLIANCES-RLSIDENTIAL
ARCHITECT'S DECLARATION
1 understand my plans shall the used as public records
-
PANELS
.Z.
Jh
UP TO 200 AMPS
RIOR ❑CHIMNEY REPAIR
Licensed P,fnsi.nnl
Iam exempt lfr m the Com IONOVER
hereby affims o nt I em esemnl from the Contractors Liccnu law for NeON
following ,earn. ISecti.n 7011.5, Rosiness and Professions Code: Any city or county
which rt, six a permit to mans theL,dic impmvq demolish, laid, ,pair any swore
#,,coloitscense Trnsort tote lhovisiosartheation such pencilLcense awJshaptert
thmheislicensedpursuamtoNeprovistanmTtheConwcmr,Liccnul�w(Chepter9
(commencing with Section 7000) of Division 3oflhe Business and Professions Calelmr
that he is exempt therefor and the basis for the alleged exem tion. An mlittion of
P g P yv
Sati.n703L56yanyapplicant for a s"permit subjects the applicant scivil pcnnhy of
re than five hundred dollars ($500).
sowner of Ne pmpeny.rmy employees with wages as their ante compenutinn,
!Ildewnrk, send thesweturc is nm intended or nlfereJ for,le (Sec. 71}00, Business
d Pm ssinnx CWe: The Commn.rs License Low does not apply to an owner m
perty ho builds or improves them -on, and who does such work himself or through
20LI(KKIAMPS
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3p3
7pN.
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pa
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VEMENTOat
REMODEI/RF.P IR ❑DEMOLITI1
krTH�E
I000AMP5
SIGNS P.LECfRICAI.'�
SPF:CIAh CIRCUITIMIgC.
TEMP. METER OR POLE INSY
COMMERCIAL:
❑NENANT ADDRION ❑DEMOLITION
❑TENANT ❑ FOOD SERVICE
IMPROVEMENT
❑OTHER
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLET'S -SWITCHES-FIX'NRE.S
his own employees, provided that such improvements a, not intended or offered for
NEW RESIDENTIAL ELECTR SQ ET.
SQ. FT. FLOOR AREA
$/SQ. FT.
aide.If, however, the building or intproventenl is sold within one year ofcorepletion, the
owner builder will have the burden of proving that he did not build or improve for pur-
• '
#nee of sole.).
❑has owner of the property, em exclusively contracting with licensed cmm,n.rs to
cambial the land. (Sea.7044,Business aad ProficWtn, Code, The Co..me... a LI.
OCT 13
T
N
cense Law does not apply to an owneraf#,perry who builds or improves thereon, and
QTY, PLUMBING PERMIT FEE
199,E
who coramits firsuch projects with a contmetor(.$) licensed pmsnantto the Conlrnetors
License w.PERMIT
❑ exempt uncle B& P C for this usson
rill 7 A,J( Vvm'L:fu 6k
./
ISSUANCE
ALTER - DRAIN & VEW- WATER (HA)
Own, te
VALUATION
1
• al�yA'�
• &6
WORKER'S COMPENSATION DECLARA
Ihereby amrtn under penahy of perjury ohm of the following recensions:
BACK FLOW PROTECT. DEVICE
DRAINS- FLOOR. ROOF, AREA, COND.
I have and will maintain s Certificate ofConsenuo sel Ginsure for Worker'a Compcn-
tion, n provided for by Section 3700 of the Labor Code, for the perf.runce of the
wrkfrwhich this permit is issued t
STORIES
TYPE CONSTRUCTION
FIXTURES - PER TRAP �-
LA
❑ I have .ad will maintain Workers Compensation Insurance, es required by Sation
3700mfthe Labor Gale, for the perf�rm�nce.f the work for which Nis pemdt is issued.
My Workers Compensation it artier and Policy number ere:
1
` GAS-EA.SYSTEM�IINC.40UTLET$ r'
OCC. GROUP
APN
Cartier: Policy No.:
GAS - EA. SYSTEM -OVER 4 (EA)
CERTIFICATE. OF EXEMPTION FROM WORKERS'
COM PENSA'I'(ON INSURANCE
(This section need not he completed if the pemtit is format hundred drs
olla(S Italy
m Ices)
GRPASFJINDUSTRL WASTE IN'T'ERCEPTOR
BUILDING DIVISION FEES
GREASE TRAP
PLANCHECK PER
SEWER-SANITARYSTORM F.A.200 FT.
-
z
0
I ccul'y that in the performance ofthe work for which this permit is issued, i shall
nm employ any person in any manner so as to become subject to the Workers' Co dden-
sation Laws of Califoran. Data
-
Applicant
ENERGY FEE
WATER HEATER WNENT/ELECTR
GRADING FEE
SOILS FEE
NOTICETO APPLICANT: If. after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions.,this permit that 6e deemed revoked
WATER SYSTEM/fRLATING
WATER SERVICE
Q
jz
2
CONSTRUCTION LENDING AGENCY
I hereby affirm that hem is a contraction lending agency for the performance of
PAID
Datee t
NEW RESIDENTIAL PLMR. SQ. PE
L Fthe
work for which this permit is issued (See. 30th], Civ. C.)
Lenders Name -
-
TOTAL:
Lenders Address
a
(y
N
BUILDING
SEISMIC ��em
1 certify that 1 have read this application and state that the above information is
correct. Ias= to comply with all city and county ordinances and state laws Mating to
building construction. and herebymthoriet repssentatives muds city to enter upon the
QTY, MECHANICAL PERMIT FEE
above -m intioaal properly for inspection purposes.
(We) agree to ave, indemnify and kap harmleu she caytty pc t t
PERMIT ISSUANCE
HLECMIC FEE �
Iiahilitics,judgintram costaund expenses which may many wr�ecc ea inst Cit
in consequence of the granting of this permit.
A OR ADD TO MECH.
PLUMBING FEE
APPLI 11NDERSTANDS AND WILI COME. 'N Ti NOt 1
SOURC (EG . TIO
Rf NDLINGUNU(TO 10,000CFM)
MECHANICAL
AIR HANDLING UNIT 10,000CFM)
CONSTRULTIO TA%
rmanedf ApplicaMCom,dor Oat
HAZARDOUS MATERIALS DISCLOSURE
EXHAUST IIOOU(W/DUCT)
HOUSING MIT ATION FEE
IBEATING UNIT CTO 100,0011 BTU)
Will the applicant or future building occupant score at handle mountains material
as defined by the Caption. Municipal CWe, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)7
HEATING UNIT (OVER 100,0110 BTU)
❑Yes 0 N
Will the applicant or ants, building occupant use equipment or devices which
emit hcontaminantsallova air contaminants as defined by the Boy Arca Air Quality Management
rim^
Fl Yet ON. -
PAID
Dam Recet t#
VENTILATION IAN (SINGLE R&SID)
— ,
BOILER COMP (3HP OR 100000 BTU)
A
`
BOILER — COME (OVER 1110,00) BTU)
AIR CONDITIONER
I have read the heaardsms matemits rmqui,mems under Chapter 6.95 of the Cali-
ISSUANCE DATE;
NEW RESIDENTIAL MECH. SQ. FT.
(oris Health & Safery Code, Sections 8.505, 25533 and 25534. 1 understand that if the
building does but currently have. t t. that it is my respotuihiliry torridly the occupant
u
I re men, which a innoissuance.fu Ce iflate of Ocau'uncy.
,
,
rmnmharbad .,an Date
TOTAL: -
ISSUED BY:
OFFICE
KIER q WRIGHT
Civil Engineers Surveyors, Inc.
Mr. Brian Kelly
Kelly Gordon elopment Corporation
550 Sout inchester Boulevard, Suite 502
San Jos , CA 95128
Re: Lot 8, Tract No. 8332
19948 Price Avenue, Cupertino
December 13, 1994
Job No. 89143-10
We have ed the buildding-eorners for this residence. We have staked the corners in
accordance wit t to setback dimensions shown on the site plan prepared by Progresssve
Design Associates dated September 1994.
We have also checked the as -built elevation of the building pad and found that it was
constructed to elevation 205.5.
If you have any questions, please give me a call.
JDW/kc
OFFEE cap Y
3350 Scott Boulevard, Building 22 • Santa Clara, California 95054 • (408) 727-6665 • FAX (408) 727-5641
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