S 1914 (2) APPI5I1CANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Bt111.DING-ELECTRICAL I EDIT NO. 1914
BUILDING DIVISION APPLICATION/PERMIT I'LI91111NG-MECHANICAL
BUILDING PROTECT IDENTIVICNI]ON
-s BL LONG ADURHSS., SANITARY NO. APPLICATION SUBMITTAL DATE
� v l sg R�c� u%.D ?- e
OWryPJfS�'N 11?: M# ^��_42g�NF: / C( RACd�"Ill Ii: 61139-04)
13-0 NIC CONI ROIL
• ARC''IFFi11111TF.CTIENGINHER: 4 LIC NO: y ADDRESS: 1 ❑
CONTACT: PHONE. BUILDING PERMIT INFO
S Y 67 ❑ Consultant Fees Paid by Applicant(Initial) BOG FLI❑1CT PLUM MULCH
LICENSED CONTRACTORS DECLARATION Q'Ty ELECTRIC PERMIT FEE
1 hereby affirm that 1 am rearwal under provisions of Chapter 9(commenting JOB DF UPI ON
WOO with Section](XXpnf Division 3of Ne Basins..anJProfessions M dmylicenseiv
X00 wl PIiRMIT ISSUANCIi RESIDENTIAL:
x1-I-r n full force and effavt.5 � 6 693¢ ❑SFDWL al>❑KIT REMODEL
aUU LicenseC Loup Vain �/T` APPLIANCES-RESIDENTIAL ❑ADDITION BING RE-PIPE
yd1 Dera Compactor �a°—�5-•
Y AItCHITELT'S ULCI,AkAIION ❑MULTI-0NH' ❑S ODIF'I'AHO
1..7 y I'ANIihS
Z0.44
I ondervwntl Iny plans shall be uxul ns puhlicrecnrds MODIFICA'T'ION
O y O UP TO 200AMPR
Fa-I"Jm lacenwd Prnfcs.ional ❑IMPROVN ❑SWIMMING POOLS 2111-IfXXIAMT'S IMPROVEMENT SWIMMING POOLS
1' OwNF.k-BUILDIiR D13CLARATION
OVER I"AMPS ❑HATH REMODFUREPAIR I]DEMOLTI'ION
6 I hereby i ffimsemm tm
r that 1 am ep train the Conuse,License law for the
I x 3�U (allowing Larval.(Section 7031.5,Busincsv and Professions Code:Any cityor county SIGNS ELECTRICAL El OTHER
.I O which requires u Permit to w
eouscl,alter,improve,demolish,or repair tiny structure
prior to ts somince.alsoy the apitheart ananiu de a,i,n,d,oL1cnaan SPECIAL CIRCUI'fIMISC.
Ihtlh lx llllrvt It 0 p .tui I l L I lar• I (Claild"9
-0 (at 6 'Il Seel 7000)of Division 3 ft Ravines, dl I :.' tie CMe)or IEMP.METER OR I' .?INST. COMMERCIAL:
112 e C that he is exempt therefrom and the hams(nr the alleged emmptinn.Any violation of ❑NEW BLDGIADDITION ❑DEMO1.U'ION
_u•
Section 7031.5 by any applicant for a permit subjects the applicant o o civil penalty of POWER DEVIL . I
res not more than five hundred dollars 5500). ❑TENANT ❑FOOD SIiRVICE
F�>' IMPROVEMENT'
6 I,as owner of the property.or my employees with wages as their sole cipmpcmatinn, SWIMMI IXl01.ELECT I
Sp will do the wmk,and ihcsuuemrc is not imendedorotimil farxale(Sec.70 Bminevs ❑OTHER
a and Pm(eseions Cade:'The Gmlracmr's'Licenvn Law does not upply to an owner of OU 'TS-SWI ICHES-FIXTUREas .
pmpeny who huildx a Inpro r,iheraat,; 1 who Jaex such work hlnlsel(or Through
has own empinyeu,pmvldal that such oulanc clears are not intended nr(catered for EW RESIOHN'1'IAI.I:hf:CTR
sale.If.however.the building or improvement is salt within one year ofoompletion.the SQ.Irl'.PLfkl- k VSQ.ET.
tier-builder will have the burden of proving that he did not build or improve for par,
,),a of sale.).
❑1,as owner(If the property,am exclusively contracting with licensed unnmcmm to TOTAL: JUL 24 S'D
answct the project(Sec.TOO,Business and Professions Code:)Me Contractors Li-
seLow does nolapplyLoan wastrofproperty who builds orimproves thamon,and QTy. PLUMBING PERMIT FEE
,dolau Trams Ensuch trujeclswimrcanu'uclar(e)Iiwnsed pursuunnu Om Connxe...es01
CITY Ur I,�f-un IIVV
License Law. 1'LRMIT ISSUANCE
0 I am exempt inder3aa ,E3&PC hn this reason
ALTER-DRAIN&VENT-WATER(BA)
Owner Use Y&LUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW I'kOl'Iii;,T'.DEVICE IS,
1 hereby off rte under Penalty of pe jury one of the following declamliom:
❑ Those andwillmuinminuCeniOcnenfCnn.venae sell-insure G.r WorkersClimpen- DRAINS-FLOOR,ROOF.AREA,COAD, STORUJS IYI'H C( PION
nation,as pmvldcd for by Section 37N)n(the Uthor Code,Ra it,performance of he
work for whkh This permit U issued. FIXTURES-I'EIi'I'ItAPJIW
1 love and will rounnin Workers Cc ipcnsmion Insu,;.... us rcquiral by Seginn
3]00rD1v,Ia1b(c.Code.far the peri mmnccol Om walk far wdeh this penal is issued. GAS-F.A.SYSTEM-I INC.4 OUTLEB'S OCC.(Jtoup AI'N
My Woders Compensation Insurance carrier and Policy number arc:
Camer: Policy NO: GAS-EA.SYSTEM-OVER 4(FA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GRFASFANDUSTRI.WASTE INTERCUPI'OR
BUILDING DIVISION rifts
TThiervc0onncalien becempleted Nitta formulaeri,is formula fiaJJollurs($IW) GREASE'IRAP
or less.) PLANCIIIiCK Il?li
lecoify that 111 Thu parmarroceaf the wo,k fmwhich mivpermil is issued,l shall SEWER-SANITARY-STORM EA.200]IT
not employ any person in any m:mne� 5# �,I�ryypct m the Work...Carrier- 1:NERGY FEE
Z ration Laws of Culih '' 1) f l7 WATER HEATER WIVENDELECTR
O O Applicata GRADING FEIi
Z y NOTICE TO ADPL .il,after making this Cerific lm mExemption,you should WATER SYSTEMHREATING SOIIS FET:
abecome subject m T e Worker's Compensation provision,of the IyMn CMe,you must
W (onhwiln comply with Loch....isianxser this permit shall he deemedrevoked. WATER SERVICE
CGNSTRUCTIONic;a leading
NI?W RP.SIDP.NTIAL I'LMIt. HQ.PP PAID
I hcrchy nllirin this tlicrc isacnnxlmnion lending agency l'nr the Perannnanm of etc Receipt#
kU - The work far which lhix permit is Loved(See 3097,Ov.C.)
O Lender's Nana TOTAL
r W Lenders Address TOTAL:Yi541e�
I Certify this I have mad this application and state that the above information is BUILDING F..Ii
LF. Tail ln
correct.I agree to conlply with au city and county ordinances and slam laws reining to QTy, MECHANfCAI.PERMIT FEFEEUZ huilding eonsmtiu ,and hereby aulactim representatives minis city lo enter cpm the SEISMIC FEE
anovc mention l prnpany for ni,evimr pu...tw, ITIXMIT ISSUANCH
(We)agree el sane indmnnify and keep b:mnlevs he City as Cupertino ugoinsl ELECTRIC PEI7
liaddilies.judgrams,costs and expenses u'luchmay in any way acemetePinslsuil City ALTER OR A OUT,MECU
in asequence ofthe granting nfthis permit. PLUMBING FEE
APPLICANT UbliqRS17ANDS AND WILL COMPLY WI'1'11 ALL NON-POINT AIR HANDLING UNI'1'('10 10,000CFM)
MIiC11ANICAL ITE
SOUPf+ t ORS.
C� i? AIR HANDLING ON]'1'(OVER IfL(XX)CPM) CONSTRUMIONTAX
Sign reuf plicanVntra
Cocmr Dam EXHAUS'I'IIOGD(WIDUCD IIOUSING MI'I'IG At ION FEE
I IAZARDOUS MA'I'ERIA1S DISCLOSURE
IE
WIII the npplialm or furorehuilding uewppnm.vlorenr handle hlrnllJnue material BEATING UNIT(III ITX).00OBTU)
as defined by the Cupenln t Municipal CMe,Chapter 9.12.:md the I Icahh and Safety
Code,Section 2553260? HEATING UNI'I'(OVER 100,(X m)
❑Yes ON. VENTILATION PAN IS ERESID) PAID
• Date Receipt# O
Will he applicantotm Ins a building by the Btuseea AirQmor Management
BOILER-COMP( 'Ok I IN),(N10 BTU)
mit hazardous air cmnuminan¢as dclineJ by The Nay Area Air Qnullty MawgemenT T(YfAI,:
Dsoim9 BOILER-C P(OVIiR100(.)H1Ip
❑Yue E]No
I have real the hazardous materials requirements under Chapter 6,95 of the Cala- AIR C HTIONFR ISSUANCE DATE
fomin Health&Safely CMe,Sections 23505.25533 and 25534.1 understand that if Ne 'RESIDENTIAL MFCH. SQ.IT.
heAd�ina a hove um9iat.that it is my responsibility hp notifythe occupant
namew fine prof ap issuanceofa Cenifi.m If(Xcupancy.
' Iagcnl Dara 'I'OIAL: ISSUED BY:
OFFICE
EDWARD J. BAHAMIAN - CIVIL ENGINEER
10158 Richwood Drive
Cupertino, CA 95014
Phone/FAR (408) 257-8298
Feb. 3, 2000
Building Official
City of Cupertino
SUBJECT: 22056 Wallace Dr. , New Residence, Tract 801, Block
2, Lot 29
RE: Building Setbacks & Pad Elevation Certification
On this date, I visited this site, made the necessary measure-
ments and hereby certify that the following items are correct
and in accordance with the approved plans for this site:
1) All setbacks as measured to the outside of the perimeter
foundation forms.
2) The pad height elevations.
J All lot surveying and building staking were performed by me in
person.
Submitted by:
FOSIq;,4
J p4y'��ca
fdo. C13310 '7*
Exp: 3.31-Xee