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28918 (2) 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: ? ti ,MEry ` tICO1)2 0 - C INOLK .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. G �F CSA-r��\ Richard Foust 1cLt7 `�Di�-�Fir/kC-u 4kfk/k C P�gz.�ktrf Sia ) rail c Sof W fr�f, C. A