28918 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO' BUILDING-ELECTRICAL. PLRMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. -
BUILDING PROJECT IDENTIFICATION 28918
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
05;71P Soong Lvcr-A
OWNERSAM PHONE:
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.4RCHITE /F.NGINHHR: . LIC NO, "Up S ❑
War-1,r-(, i LtGS 13 ,7�i�Sa 6d/)NGHf�lilt BVA SAN��3��5
CONTACT: PHONE:: BUILDING PERMIT INFO
}POUT. WpfLKM 10)V ?/ Consultant Fees Paid 6y Applicant(Initial) BLpG B PI,uMB MO t
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE L^J ItAbll
1 heathy affirm thin I am Bcensed miner provisions or chnpmr 9(c unuenaisg JOB DESCRIPTION
IOIyWZ with Section]OOI)ofDivision3efthe Business and Professions Cook,laid my license is RESIDENTIAL,
FOO ' full force ande n. PERMITISSUANCP. �•
aW .C77 ❑ADWL ❑PLUMBINREMODEI.
QUW Data eClass � -�3 IamN
MGG Date ���jg ��Conm aur APPLIANCES-RESIDENTIAL ❑ADDRION ❑PLUMBING RE-PIPE
n
ARCHITECT"SDllcl.A p'1'IO ❑MULTI-UNIT ❑STRUCTURAL
ZO Z FundemanJ my plans shall he usrd as public records PANELS MODIFICATION
�.4�M Licensed Professional UPTU 2W AMPS ❑INTERIOR El CHIMNEY REPAIR
pp 201-119X)AMPS IMPROVEMENT OWNER-BUILDER DECLARATION -
GGp, a 1 hereby affirm Int1 nm exempt from the Comramors License law Topic OVER["AMPS ❑BATH REMODEURF.PAIR DEMOLITION
x 3 d U following reazon.(Section]031.5.Business and Professions Core:Any city or county SIGNS ELECTRICAL. �QT'HEk , .I] S/�dJT'ljpl)A,1/-
rYl1l O which requires a pcmm to comwn,alter,improve,demolish,or mpair any swctum Pen.. S� •-7
prior tells issumum,also requires the applicant lot such permit to file a signed emollient SPECIAL CIRCUIT/MISC.
ythat he is licensed pursuant to the provisions of the Commcmr's License Law(Chapters,
G£O (commencing with Section 70(111)of Division 3 ofthe Husinessand Professions Code)nr TEMP.METER OR POLE INST. COMMERCIAL:
tl6 that he is caempt therefrom and the buds for the alleged esemptinn.Any violation of ❑NEW BLIJG/ADDITION ❑DEMOLITION
X�+en en Section]031.5 by any applicant for v permit subjects the applicant to a civil pcwhy of POWER DEVICES
F. > not more(ban live handout dollars($5110).• ❑TENANT ❑FOODSERVICE
O ❑ I,as owner of the property.or my employees with wagesu their sole compensation, SWIMMIN POOL ELECTRIC IMPROVEMENT
will do the work,and the structure is not intended moffered for sale(See.](114,Business ❑OTHER
6 3$ and Professions Code:The Contmemes License Law docs not apply to an owner of OUTLL'TS-. IT LIES-FIXTURES
propcny who builds or improves damon,and who docs such work himself or through
his own employers,provided that such improvements are nm intended or offered On NEW REST :NTL ,E .CT'R SQ Fr.
sale.IL however,the building or improvement is sold within one yen ofconipletion,the SQ.FT.FLOOR AREA $/SQ.Pr.
ownervhuilder will have the burden of proving that he did not build or improve for pur-
01,mowncrofthe properly,am exclusively rnmrncting wish licensed contractors'. TL:' yQU 3s
nmmet the project(Sec.7044,Business and Note...ma CoruO The Contractor's Li-
cense law does not apply to an owner of progeny who builds or impmvcs thereon,and QTY. PL B RMI FEE {{// r 24
who contracts for such projects with a contranoos)licensed pursuant to tee Commences 1985
License Low. f, PERMIT ISSUANCE Wf�'
p lam exempt under Sec. ,B&PC for this reason Y
�r
ALTER-GRAIN&VENT- (CA) "VALUA'1',ON
Owner Dam
WORKER'SCOMPENSATIONDECLARATION ' BACK FLOW PROTECT.DHVICF aO UQQ
I herehy affirm unJbr penalty of perjury one nl'Ne following declvmtione /
❑I have and will maintain a Ceni6catc ofConscnt to self-insure forWerkeA Compcn- DRAINS-MOOR,ROOF,AREA.COND. STORIES TYPE CONSTRUCTION
sides,On,provided for by Section 3700 of the Labor CMe,for the perrortnonce of the
work for which this permit is island. FIXTURES-PERI'RAP 3
1 have and will maintain Worker's Compensation Insurance,as required by Section - -
3](X)ofthe UberCode,for the,crl'mmm.a of the work for which this pe�n((ie issued � GAS-I!A.SYSTEM-I INC.401H LETS �A OCC GROUP APN
My Workees Cnm ymionlns��yrt���epp er end PolicynW1J�j,yee
Cntriee 5�°l$aTTIC FIaT✓� I'Nic,Nn: -I GAS-EA.SYSTEM OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS `
COMPENSATION INSURANCE GREASE/INDUSTRL WASTE.INTERCEPTOR II DING D 1 1
(Phis section need not becompleted it'the permit is fortune hundred dollms($100)
qlall
m less.) GREASE TRAP
PLANER FE!
Loy anythininthe performanymanceo ion,workas
which Ons the W rkersued,I'Compeshall SEWER-SANITARY-STORM EA.200 IT.
not empty any person in any manner so as rte become subject m the Workers Compel- ENERGY
Z Anion Laws of Culifomin.Data
Z O Applicant - - WATER HEATER WNENT/F.LECTR ,GRADING PEE '
tr N NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEMI TREATING
abecome subject to the Worker's Compensation provisions of the Labor COLIC,yen mum SOILS
W forthwith comply with such provisions or this permit shall ler:deemed revoked. WATER SERVICE
Q
CON
tthem UC cIONLENDINGnGENCY NEW ItGSIUIiNTIAI,PLMIf. SQ.Ff. PAID
C.) Ih nwhichthi thanhere issue (See i0lending agency fonhe performvnm of ate Receipt g
Ir she work Por which this permit is issued(Sec.309],Civ.CJ
1-� Fender's Name TOTAL:
LUkI Lender's Address
y hovercnJ this upplic:nion anJ site that the vM1uve inlonnmiun is BUILDING FEE
iF V] correct.l Mere to comply with all city and county ordinances and state laws telming m QTY. MECHANICAL PERMIT FEE
C building construction,and hereby amnion,represenmtivesofthisclty to enterupon the SEISMIC IEE
aMsve-mentioned pmpcny for inspection purposes. Ir
'(We)vgrcem save,indemnify and keep harmless the City of CuNnino against A PERMITISSUANCE ELECTRIC FE
Iimilities,jud,ounts,costs and expenses which may in any way accrueuguimt said City' ALTER OR ADD DO ME41.
in consequence ofthe gmmin,of Nis permit, PLUMBING F E
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,(910 CFM)
SOURCE REGULATIONS. MECHANICA FEB
I&�y,�w/ AIR HANDLING UNIT(OVER Ht"CTM) CONSTRUCTI NTAX
Signature of ApplaaMConvactor�r - Daln J— EXHAUST HOOD(W/DUCT) HOUSING MRIGATIO
HAZARDOUS MATERIALS DISCLOSURE
Wdl the epplicent or fwure building occopenlsmre nr handle hezeNtuus memriel HHATFNGUNIT(TO 10 (m91BTU)
as defined by the Captain Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(0)'1 HEATING UNIT(OVER 100,000 BTU)
❑Yes ON. VENTILATION FAN(SINGLE RESID) PAID
Dam ecend"
e
Will Ne affliction or future building occupant use cyuipmcnl or Acvices which BOILER-COMP(3IIP OR 100,(1(10 BTU)
emit hazardous air contaminants as defid Management by the Bay Arca Air Quality Manement TOTAL
DlstrimY
❑Yes ON. BOILER-COMP(OVER IOO.W()BTU)
I have read the hazardous materials reyuiremcnta under Chapter 6.95 of the Cali- AIR CONDITIONER - - ISSUANCE DATE
fomia Health&Safety Code,Sections 25505,25533 and 25534:1 undersand thin if the NEW RF.SI ENDAL MECfi. SQ.IT.
building dins nom
t currently have a nonk thin it is my responsibility In roti ry Ole occupant
of the nequiremenn which as.
be met prior m issuance of a Cenificum of Ccragrancy.
Owner or authorized agent 'Date ^ - ISS URD BY:
OFFICE
RICHARD FOUST& ASSOCIATES
P.O. BOX 720862 San Jose, CA. 95172
Phone (408) 193-2465, (4081993-9341, Fax(408) 293-2465
to
95145
Nov 1, 1995.
Building Department
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Dear Sir:
We have inspected the swimming pool excavation for the Lau residence
at 10570 Santa Lucia in Cupertino, California. We found the swimming
pool excavation and the steel reinforcement to be substantially in
accordance with the plans and with acceptable pool construction.
If you have any questions, please call us at our office.
Yours truly,
AR
C.
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�F CSA-r��\
Richard Foust
1cLt7 `�Di�-�Fir/kC-u 4kfk/k
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