25404 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
FRICAL
p CITY OF CUPERTINO PLUMBING-MECHANICAL PERMIT NO. 0
BUILDING DIVISION APPLICATION/PERMIT
BUILDING PROJECT'IDENTIF'ICAI'ION
BUILDING ADDRESS:
W/'CII.1/IYI.I � " ./�2r�Q�! SANITARY NO. APPLICATION S,UBpMITTAL DATE
Mr7�/ �II�NM/ �✓ UNIT0 OM LOO/Tg
O ERS NA C� /�L/� �O PHONE: _ O CONTRACfOR'S NAME: LIC NO: L
IrJ 8 5 NIC CONTROL Is
RCHIIECT/ENGINEER: LIC NO: ADDRESS: ❑
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT' PLUMB MEC}{
PERMIT ISSUANCE ITf�C_II 117p�t IY¢�-
LICENSED CONTRACfOR'SDECLARATION APPLIANCES-RESIDENTIAL TOB DESCRIPTION
psZ I hereby affirm that l am licensed underprovisionsof0apter9(commencingwith
WCC Scram 7000)of Division3oflhe Busines,mc!Prof ns ions Code.and my license is in PANELS s
p4z full I.iccnrceaml effect. 1
Qt-Zd License Came Lic.p UP TO 200 AMPS
rn G N Dace Contract 201-11100 AMPS
Z O rNn Z ARCHITECTS DECLARATION SQ.FT.FLOOR AREA S/SQ.FT.
I understand my plans shall be used as public recmda. OVER ELL AMPS
rot SIGNS ELECTRICAL y (J1 A `or
6K-' Liceroed Prom,ximad / _
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT MISF.
UyU 1 hereby affirm thin I am exempt from the Coarcts License Law for the
0.y following mason.(Section 7031.5,Business and Professions Code:My city or county TEMP.METE O E INST. ® 1
�fh ON¢ which requires a Permit to conswct.her,improve,demolish,or repair any st.cons
o, prior to its ismance,aIN
AL
Ho requth
ireseapplicam far such parrrdno Am a sigrmdsuument POWER DE 1 I N
{y C pC that he is licensed pursuant to the provisions of the Contractors License Law(Chapter V
a eLL F-
9(commencing with Section 7")of Division 3 oflhe Business and Professions Code) WI POOLE 1 A UA O
p r^N on dual he is exempt therefrom and the back I.the alleged exemption.Any vinlmian of - S-SWITC UR'
�Za Section 7031.5 by any applicant for spermit subjects theapplicanno acivil pemBy of
g$ nor more that five hundrcdd.11. 150). N RESIDENTIAL E SQ.FT.
Q. ❑ hmnwncrnf Beprnpeny,ormyemployeeawith wageeaetheireolecompemmio S NS 'ION
p, will do thework.and the smetureisnot immndedorofferM forsde(Sm.]044,Business
and Professions Code:The Convenors License Law does not apply to an owner of
progeny whobuildsorimproves themon,and whodms such workhimselforrhrough Ns OCC.GROUP RES.UNITS
own employees,prov ided that such improvements are not i ntendm or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner
builder will have the bu dam of proving that he did not build or improve for purpose of TOTAL:
W1e')' elyarmor. QTY. UMBING PERMIT FEE FLOOD ZONE APN
❑ Iuct a e protect
(See.fropny,1,Business
and Professions
with licensed:)The onmmor's �� V
License the uesnot(Sec T ono Business and whol ild Cada:)The Comraamis PERMIT ISBUANCE
who uLawdues not applymanownerofproperty whosedIdsorimprovesthereon,mm
whocmmaw.for such projecb wiB.conOacmr(s)liamed pursuant mthe Commerors ALTER-DRAIN&VENT-WATER(HA) FEE SUMMARY
License Law.
❑ I am exempt under Sec. B&P C for thio meson BACK FLOW PROTECT.DEVICE SANITARY Y LS N
Owner Dam RECEIPTp
DRAINS-FLOOR,ROOF.AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOL.TAX Y_N
❑ I have a or a certified
ecanastaul(Smuram aanifrcmiof ftECEIPTp
FIXTURES-PER TRAP
Wurkers'Compensmion Insurance or ecertifed copy Beuof(Sm.3900,Lab CJ which PARK FEE Y N
oven all employee's under this p.ir. GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIPT In
Policy Is BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Certifiedcopyisherebyfomished.
❑ Certified copy is tiled with the city impaction division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING IEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not be,completed iflhe permit is for one hundred dollars($100) SEWER-SANITARY-STORM EA.200FT. ENERGYME
or less.)
I certify But in the performance of the work for which this permit is issued,l shall WATER HEATER W/VENT/ELECIR
am employ any person in any manner an as to Impose subject to the Workers PAID
Compenmtim Law.of Califomia. Data WATER SYSTEMMEATING Data Receipt 11
O Z Applicant
Z0 NOTICE TO APPLICANT:If,after making'his Certificate of Exemption,you should NEW RESIDENTIAL PL,yIF SQ.FT. TOTAL:
rV] become subject the Worker'a Compensation provisions of the Labor Code,you must
. '4 forthwith comply with such provisions ,,his permitahall be deemed invoked. - BUILDING FEE •OO
a rn-
CONSTRUCTION LENDING AGENCY SEISMIC FEE
Irk far which
t Bn them is i sued(S construction lending97, iv.gemcy for Be pesfnnrmnce of
U O TOTAL: ELECTRIC FEE
the work for which this pemmit is issued(Sec.3W],Civ.CJ
Ledex Name[^ Lender's Addrcsa QTY. MECHANICAL PERMIT FEE PLUMBING FEE
Gkl1 certify thmaIE
Bad I have mad this application and state Bar the above information is MECHANICAL E
0. rest l agree an comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE
buildingconavuctioo,and hereby authorim representatives ofthiscity menter upon the CONSTRUC ION TAX
U above-mentioned property,for inspection purposes. ALTER OR ADDTO MECIL
(Wc)agree m are,indemnify and keep harmless the City of Cupertino against
It.bilities,judgmrna,cosas andespenuswhichmay in anyway sante against said City AIR HANDLING UNIT(TO HE,"CFM)
I nsc uenceofthe gra ingaP ipemth. AIR HANDLING UNIT(OVER 10,OW CFM)
ignalum I' VC.nmmtm ^ am E%IIAUST I{OOU(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dam ReceiptM
Will the applicant or future building occupant store or handle Interactions material HEATING UNIT(OVER 100,000 BTU) TOTAL: 10
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Code,Sermon 255324G? VENTILATION FAN(SINGLE RESHE
❑Yes ❑No
ISSUANCE DATE
Will the applicant or future building acupat use equipmem m devices which emit
BOILER-COMP DHP OR 100,000 BTU)
hazardous air contaminants as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100)010 BTU)
DlltdCl? 1 H
❑Yea ❑No NEW RESIDENTIAL MECII. SQ.FT. Q
1 have read the hamrdoua materials regoiremema under Chapter 6.95 of the AUG ^a 1993
California Health&Safety Code,Sections 25505,25533 and 25534.1 udersandat
ntB
if the building does not currently have.tenant.that it is my me tsou,adbly to notify the
occupantorthe requirements which must be mer prior to issuence m of a Canificaof Ci 11, J`I CUt'eH I INV a
Occupancy,
V♦
Owner or audooriud agent Dam TOTAL: ISSUED BY: I ✓t O UC
.o.t+J.u._e.s,ui.v..�.YL 2' Sf M1 G 'h..i�. � .�i,rrY'^'` "•.a�..,.:iJ.S'.�L 'u':i.za'l..:n:..-...
KENNETH NEL.SC7N
Registered Civil Engineer
940 Saratoga Ave. Suite 216
Son Jose, California 96128
(408) 247-2888
July 23, 1993
Job No. 938094
� y
AUG ,: 1993 i
Building Inspection Department
City of Cupertino BLDG. INSPECTION DEPARTMENT
10300 Torre Ave. CITY OF CUPERTINO
Cupertino, CA 96014
Subject: Residence addition to the residence at 10734
Martinwood way, Cupertino, Ca. APN 384-36-031
Gentlemen:
At the request of the owner, Mrs. Peggy Phillips, an inspection
of the subject property was made by the undersigned. The
inspection was made on July 1 , 1993 to examine the construction
of a 626 Sq. Ft. addition to the subject residence. The
existing one story residence was built approximately 31 years
ago and appears to be in excellernt condition. The addition was
y. built in 1979 and, in my opinion, was constructed in accordance
with the Uniform Building Code and all other applicaole City
ordinances in affect at that time.
I therefore approve the addition as built, and recommend the
issuance of a permit and final approval.
My services consist of professional opinions, conclusions, and
recommendations made in accordance with generally accepted
Engineering prn "ciples and practices. I have made reasonable
efforts to ensure that this report is accurate, however I cannot
assume any liability for damages which might result from it or
for any oonJitions which this report might fail to disclose.
n. If there are any questions regarding this subject , please
r? contact my office. -
�,P.�.;.�.,gip,✓
Very truly yours, QUO y�t.N P/c� q�F
�—
( Kenneth Nelson
Registered Civil Engineer ¢22023 +Cr ^`
KN/kn lie. :E.A.P. 9-30.93 .
> cc: Mrs Peggy Phillipa
OFFICE COPY � oFCA�rr��
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