26174 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE SALL POINT PEN ONLY
. - C+fPY OF CUPERTINO UI�DI ,-E,E R A, PPAMI'TNO.
BUILDING DIVISION APPLICATION/PERMIT )IN(IPINGZI']DANICAI. X174
III111,DING PROdCCI'IOF.NI'IF'IC.ATION v (�
BUILI]ING ADDRESg: //�� ( ` SANITARY NO. APPLICAATIION�SUBM11TTAALDATE
2 Oil CU # LOT# fr� T
OWNERS NA � PNONF.: CONTRALIE: LIC NO:
G '1 _ NIC CONTROL#
as se,
ARCI IIT17M_/ENO NEER: LIC NO: ADDRESS: ❑ 1 y�
CONTACT: �PHO�N'aE: BU61 ILDING PCRMIT INFO
4 ,,,,,C6��6 QTY. ELECTRIC PERMIT' FEP"
I _{ pLDG F.CI' PLUM LCf
e�e Lae PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION gPpL1ANCPS-RPSIDENTIAI. ION DPSC ION
�CZ Ihereby affirm that lam licenuAundapmvisione of Chapter9(commeneiagwith
s OO Seann7")of Division]of the Bmimas and Professions Code,and my license is in PANELS
full fire.and effect. �^_7
<'Z License Class Lic.N UPTO200AMPS • , � D
sOo Date Cement, r 201-1000 AMPS
SOD. ARCHI'IECI"S DECLARATION OVER IIXOAMPS SQ.FT.FLOOR AREA SISQ.FT.
�Z� 1 understand my plans shall h used as public records. Z 0�{ //ss
y SIGNS ELECTRICAL
� � Licensed Professional b
OWNER-BUILDER DECLARATION SPCCIALCIRCUIT/MISC.
�OyU 1 hereby affirm that I am exempt from the Convector's License Law for the
following reason.(Section 7031.5,Business and Professions Code:Any city or county TrMP.METER OR POLE INST.
gwhich requires a protons to convect,alter,improve,demolish,or repair any structure
z`!(Y� prior to its issuance,also requires the applicant forsuch Permit o file a signed summed, POWER DEVICES
��aMOthat he is licensed puauamtothe provisions of te hComraemex License Law(Chapter SWIMMING POOL ELECTRIC
a.0 LL 9(conunencing with Smtion]Oo0)of Division 3of the Business and Professinm Code) VALUATION
��rn nnhni he is exempuherelrnm and Ne basis fonhe alleged ex.mp,ion.Any violation of UTIFTS-SWITCHES-FI%TURES
Za Sextum703 L5 by anyapplicantfor apc.it aubjecutheapplicanudacisit penalry of L
I than five hundretl Dollars($500). .W RESIDENTIAL ELEM _SQ.PT.
y p m.wnernfthepmperty,ormyemployces with wagesu Mei,mlecuri,a ntim, STORIES P,CONSTRUCUON
y Oe willdo rk,mdtahesuucmmisnmimmndedoreffcredforule(Sm.] an Ik4,Businmsp� f�
and Professions Code The Contractor's License Law does not apply to owner of
propertywhobundserimprovesthercon,anlwhodoes such work drawelfonbrough his R UP RFy,UNITS
own employees,provide) arc that such improvementsnot intended or offered formic.If. n\O(�C.G
O L V J uI I�
however,ihebeilding or improvement is sold within one ymr ofcempledon,the aware. J
builder,will have the burden of proving that he did not build or improve fee purpose of �+
nolo.).
❑ I,mownerofihepdrprny,amcxciusivelyconvectingwithlicenmdmmmmorsro QTY. PLUMBING PERMIT FEE ATE FLDG APN
oixtruet the project(Sec.7044,Business and Professions Code)The Contracmra �.
License Law dnexnnt apply to un ownernf prnPeny whohuildsmimpmves thereon,end PERMITISSUANCE
whoctrntmeasfarsachprnjectswith.conwemrB)licensed pursuannothe Cnnveaors ER VENT-
License Law. ALTWATER IRA) FEE SUMMARY
❑ 1 em exempt anderScc. B&PC for this reason BACK FLOW PROTECT.DEVICE SANITARY Y_N
Owner Data RECEIPTN
DRAINS-MOOR,ROOP,AREA,COND.
WORKMAN COMPEcamofoNDECIABATION SCHOOLTAX Y N
❑ Ihereurnitu d.Ithat lbavea m.ceateofconsentmsif(Suure,0.Lm C.)Whichtrof FIXTURES-PER TRAP RFC: p
Wmkcri Compcnsmiun Insurance orecenifedenpy thercof(Sec.JBW,IabCJ which PARK HE Y N
covers all employm's under this permit, GAS-EA.SYSTEM-1 INC.4 OUTLETS .I PT#
Policy# B^DVG PIVISION FEES
Company GAS-CA,SYSTEM-OVER4(EA) PLANCHECK
❑ Craifiedctspyiaherebyfomishil.
❑ Certified copy is filed with the city inspection division. ORGSPONDUSTRL WASTE INTERCEPTOR GRADING
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOII,S
COMPENSATION INSURANCE
(Thisareionneal maincrompletedifthepermit isformebundrMdollms($100) SEWER-SANITARY-STORM EA.2(on, PNC OY FEL:
or less.)
Icenify,hot in he perfmmnnce of be work for wbich0is permit is issued,l shall WATER HEATER WNENT/ELECIR
not employ any prawn in any manner so u in become subject to the Worker% PAID
Z Cnmpensatinnl.uwsof California. Date WATER SYSTEMILREATING Data Receipt#
Applicant
Z 0 NOTICE T'O APPLICANT:If,after making this Cenifcatcof Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
become subject m the Worker's Compensation provisions ofthe Labor Cale,you must
forthwith comply with such Provisions or Nis Permit shall be dmmed oikM. BUILDING FEE r"a
[� CONSTRUCTION LENDING AGENCY SEISMIC PER k
Z I herchy affirm that them I,.construction lending agency for the perfmmence of ELECTRIC FEE
O the work for which this permit is issued(Sec.3097,Civ.C.)
Luders Name
0PLUMBING FEF.
Landale Address ' QT'Y. MECHANICAL PERMIT FEE
w 1 certify that I have rood this application and state m
e that the above inforation is MIiCHANICAL FEE
onmet.l agree m comply with all city and county ordinances and state laws mining to PERMITISSUANCE ��
�+ buildialUam ortim,end herebyauloure repreeenmtiveso(,his city mrnter upon Ne CONSTRUCTION'fAX
V above-memioned property for inspection proposes. ACTI:R OR ADD TO MECIi.
(We)agree an move,indemnify and kap harmless the City of Cupertino against
limilities,judgmems,casts and expenses which may in any way accrue against mid City AIR HANDLING UNIT(TO 10,"CFM)
in c
quence of the gaming of this pemtit. AIR HANDLING UNIT(OVER 10,000 CFM)
igrama. Applicarr/Contrictor Dam EXHAUSTHOOD(WIDUCI')
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IM."BTU) Uatc Receipt#
Will the applicant in future building Occupant mare or handle himadous material IIEATMG UNIT(OVER 1fH1A10 BI U) TOTAL:
m defined by be C,wnino Municipal Code,Chapter 9.12,and the Health and Safety
Cala Section 25532(el?
Yes ❑No VENTILATION PAN(SINGLE RFSLD)
❑
Will Ne applicant or future building occupant uw equipmentmdevica which emit
BOILER-COMP(3HP OR 100,0011 PTU) ISSUANCE DATE
,amadou.air contaminants as defined by the Bay Arca Ah Quality Management BOILER-COMP(OVER 100,000 BTU)
Nstdct? pq
❑Yes ❑No NEW RESIDENTIAL MECH. - SQ.FI'. fl' A B RT
I have read the hazardous materials requirements trade,Chapter 6.95 of the tl.i'
H building does Safety Cody have ons sim,that
it I, and responsibility
l understood to ru nd,hm /li ]
CaliforniaCIf thernaHatfircsn afetyCdehaveetenant,,hathisand my 255M.1l undersoifyod the % 1
meupern of the arquiremenu which must bn
e met prior issuance into CcniOcme of ````�
Occupancy. Dole
Owner or outhori¢ed agent Date O' L: ISSUED Bri Au
OFFICE
K E N N E T H N E L S O N
Registered Civil Engineer
940 Saratoga Ave . Suite 215
San Jose, California 95129
(408) 247-2898
June 1 , 1994
Job No. 946010
Building Inspection Department
City of Cupertino
10300 Torre Ave.
Cupertino, CA 95014
Re : Foundation recommendations for a building addition to the
, residence at 22100 Wallace Dr. Cupertino, Ca.
Gentlemen
At the request of the Owner, Mr Gene Lee , the subject property
• was inspected by the undersigned on June 1 , 1994.
The inspection verified that the foundation excavations and
construction were in accordance with my recommendations of
March 10, 1993. I therefore approve the foundation construction .
If there are any questions regarding this subject , please
contact my office.
Very truly yours , o99.0FESSIp�
Kennet Nelson 2
Registered Civil Engineer #22023 No.22023
Lk% Exp.9-30-97
KN/J
'rr4f CIVIL
c r. G a Lee , F
Of CAl1E0�
19,9
��y9� JOB copy
• °
TF14t RAN SHALL REMAIN ON
F Ji$ AT ALL TIMES DURING
CONSTRUCTION.