21911 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PIiRMIT NO.
Buili,ijing Address:
21911
Wnet9 RM77 one: APPLICAFIONSUBMIJ FAL D=
V RN-3 DV_%Z,GTI�� ca(.—J(t4L� CITY OF CUPERTINO-BUILDING DIVISION
Contractor's NamLm.No: APPLICATION / PERMIT
k_. eJ BUILDINGMl TRICAL-PLUMBING-MECHAMCAL CATEGORY CONTROL
Architect/Engleeen Lie.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address PERhRTI55UANCE I�il ❑ ❑ 1:1LICENSED CONTRACTOR'S DECLARATION
I herebyion7Othat lai licensed 3.ithunder provland Pe C.I.t.9dm,and APPLIANCESRF.SIDENTfAL JOB DFSCRB'7TON
11.e.hSedion 7000)ofd efelon3o(thegualneuandlarolndonaCade,and my
limnnelelA. force and c.a PANELS C� `
License Clan LIc.N - f` J\
Date Contractor UP TO 200AhLEq
It—j r�}�Jn
ARCHITECTS DECLARATION 2711000 AMPS tlf CJS QK
q�q�vu D❑❑❑O I understand my plans eha0 be used u public records OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT.
li Id Licensed Profemlmal SIGNSELECTRICAL
G kSLI, OWNER-BUILDER DECLARATION SPECIALCEKUfT/MISC
Z Iherebyafmnthatlam exempt fromthe Contrador4Llcerec Lawfeathe
following reason.(Section 70315,Butlnnstand Profeesions Code My tltyor
F F'� county which mqubeaa permit tomnstruct,alter,improve,demoBsh,orrepalr TEMP.MEfE40R POLE INST.
anyrtrudure prior tope leeuame,alaorcquiresthe applicant for uch permit to pp4ygB DEVICES
file a signed statement that he Is licensed pursuant to the provision Of the —— z z>C
3 u, Contractor's License law(Clop[er 9(commencing with Section 7000)of Divi.
SWIMMING POOL ELECTRIC
SOS sion3ofthe Budmmand Profeelom Code)mthathebesemptthemfmmand VALUATION
< the bash for the alleged exemption. Any violation of Se<bn 7031.5,by any OUTLETSSWITCHIS-FIXTURES
applicant for a permit subjects the applicant to a dull penalty of not mote than01
five hundred dollars($500).
�n ❑I,as owner of the pro", NEW RESIDENTIAL ELECTR_SQFT, STORIES TYPECONSTRUCTION
p perry,or esemployeewithwagesa their
compensation,Bmincthe work and ions) odure V not Intended or offered for
A sole(Sec appy to an ow and f property
Code:The Contractors License law
does$� who clo apply Asuch/ork owner wthrav h hiswho
nempoyees,provided that such
OCC.GROUP RES.UNITS
who nvese rats..kMmsended oroughedowne.If,ho ee, er,the d ihalsuch
improvementsarecut intended earofco (moor.theowevep tilderwdl have TOTAL;
Improvement bwld within oneyearofcompletbry theowner-bu0derw111l�ve
t e rrden o(pmving that he did not build orlmpmovefm purpose ofuorJ, QTY, PLUMBING PERMIT FEE FLODD ZONE APN
ate ow at
of the property,am exclusively contracting with licensed.
tradme to cons/rud the project(Sec.70p4,Busmen ami Rofeubns Code: PERMITISSUANCE
Contrecior.Lleem a law don not apply to an owner of Property who ALTER-DRAIN&VENT•WATER(EA)
Wild. or Improve thereon, and who contracts for such ppojeds with a
�'gR{Tadm(a)licensed pursuant to the Contrados.License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
LJ I am exempt under Sec. B k P C for this reawn FEES
Owner Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N_
RECF3PTN
WORKMAN COMPENSATION DECLARATION F0(NRpS,PER TRAP SCI{DOL TAX Y N
❑i hereby affirm that I have a certl0rate of consent to self-insurs,or a RECER'T N
rerti(Icab Of Worken'Compeioatlonlmurance oracertl(Iad copythereaf(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y— N
polis Lab C.) —
Pollry p DING Df N
GAS EA.SYSIiBd-OVER N(PA)
Com any - BUILDING Dt VISION F[ES
�ccrtiiea copy is heed with the city CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE
CertRled copy V filed with the city ImpMlon division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TFAtP PAID
COMPENSATION INSURANCE BEWER-SANITARY-STORM EA.200111'. Dale Reeel t#
(This section need not be completed If the perr dt or forone hundred dollars
($IMorlesd.) WATER HEATER w/vENT/Fd.ecrR ENERGY FEE Y N
I cerdfythat In the performance of the weak forwhlch this permit ie lumcl, —
I shall not employ any Ferment in any manner an As to become eubjed to the WATER SYSTEM/TREATING
Workere'Compensatlon laws of Calllornla.
Data PAID
O Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Recei t#
Z NOTICE TO APPLICANT:If,after making this Certificere of Exemption,you
should become subject to the Workma Compensation provi=0o(the Labor TOTAL:
IN Code,you at fart hwilh comply with such provisions or this permit shall be 1 D c.
W 7 deemed revoked.
CL 17 CONSTRUCTION LENDING AGENCY ' SEISMIC FEE
I hereby affirm that them is a construction lendingagency for the perforrry ELECTRIC FEE
M O ance of the work for which this permit islawed(Sec.3097,CIv.C.) TOTAL:
lander'.Name PLUMBING FEE
IL 1= Lender'.Addread . QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W m
Inlfythall have readthissppgcellon and gate thattheabove information
1 Ism rned.l agree to complywith all city and county ordinance and state laws PERMIT ISSUANCE FEES PAID:
W relating tobulldingconstruction,and hcrebyauthorlm repreertafiveeofthb
f Z city to enter upon the abovnmentloned props impectlon purposes. ALIMORADDTOMECH.
Date Recei t#
(We)agree to ve,I demnl n d ked armicu the City of Cupertino - P
V aga mt llabilltl , d me, saM expo hkh Troy inanywayacuue AIR HANDLING UNIT CFO Ig000CFM) SUBTOTAL:
against said t ceo(t grant ofthispmmit.
AIR HANDLING UNIT(OVER IO,000CFM) CONSTRUCTION TAX
igrutum of Applicant/Contractor Date EXHAUST HOOD(V✓/DIX;'D CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfuture building occupant store or handle heaardous HEATING UNIT(TO l0),0D0 BTU) Date Recei 1#
matedaI as defined by the Cupertino Municipal Code,Chapter 9.1$and the
I ealth and Safety Code SS,edlon 25534(a)I HEATING UNIT(OVER 100,000 BTU) TOTAL:
F1 Yea 1 I No
Will the applicant or rare building occupant use equipment or devices VENTILATION PAN(SINGLE BIRD) ho CE DATE
which emit haaardous air camsmlmnb as deBud by the Bay Area Air
Quality Management DisiddBOILER-COMP 7 DEEP OR 100,000 BTU)
Yes ❑No n
have read the harzNo..rtutvdals requirements under Chapter 6.95 of BOILER-CONP(OVER 100,000 BTU) MA
the California health k Safety Code,Sed ions 25505,75533 and 25534.1
and orstand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT R (aseBpyt:
respnesibilltyto norifytheoa pantofthemquiremenlswhich mustbemet SB17!-.i9+
prior la usuance of a Certlflcate of Occupancy.
Owneroraulhoriaed agent Data
TOTAL: ISSUED BY: " — -
OFFICE COPY
'1' 1 -I I'i'illi i i .. i :{• ' , .. .. rl.
.I% Y
pk
;. POPA - ,KIHLTHAU
STRUCTURAL ENGINEERING CONSULTANTS
Apri.1 8, 19'911
:' ony 'Vande stee'n'
'404011 Ph'arldp ,Drive RFEEC:esiVu; -1. '
up— n? ,,,,,CAI 95014 '
Re : Liv ing , Ro o Masonry Pi replaces Repair. CITY OF CUPERTINO
r:. BUILDING DEPT.
for Above,. Address , Cupertino
Aslper your 'request , 'I performed it review of the fireplaces,
refe'renced, above,I 'to recommend repairs of damage that had been caused
by th`1e 'Oc to,ber 11,761., 1.9891
,. ,large ,magnitude '( 7 . 1 Richter ) earthquake
found'Ireae'ritly', during , a roof repair .
The ex'tentrof :the damage found on- the fireplaces during th-is review
i.nLoated,'th'at these chimneys should be torn down to just below the
I :l:eve:1 ',ai d. repaired starting from that level . The repairsha.l.l
c'ons'ist ofi„rebu'i'llding ' the ,new chimney using standard masonryq'co'hstruu'ctign techniques with proper reinforcing, stirrups and ties to
the 'roof framing'.established, with - straps- to the rafter framing .. The
reilnforci.dg'. barsl,,Are' to 'be "gr,outed An place ( 24 ” minimum into th'e
base.,,masonry cavity) and the i•ebui..lding may proceed from that Dai.nt .
If"1 you,lh,ave.,any quest.i.ons regardinj� this. letter , please do not
hesi'tate,.to' cal'1 "
SOF ESS/
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RDQ E. ;40834i;hlthau '���y
1 4 No. C0408
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GLLIFN VALLEI,OFFICECENTER,
2542Southl Bascom Avnue' ' ,'.
„ e , Suil,. 102r Campbell, California 95008 '
Phone:,(408) 559=4202 . FAX: (408) 554-3628