28454 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-,USE BALL POINT PEN ONLY -
CITYOF.CUPP.RTINO //ffj� ' RUH.DING-ELECTRICAL. PERMITNO.
BUILDING III "7 APPLICATIONJPERMIT PIA !RING-n1ECHANICAL 4"'. 2845A
ll ll / ', BUILDING PROJECTIDRNTIF'ICAT'ION
BUILDIN ✓V _ �_ W" ✓ + - , SAN!PARY NO APPLICATION SUBMITTAL DATE
' OWNER'S IAAME `PHONH C(NI'RACI OR'S NA N11 LIC NO, t v~•����
L f'a ��, NIC CONTROL#
ARCHITECf/ENGINF.F.R: m LIC NO I/ AUDRIi55: a' ❑
PHONE �yI
CONTACT MIT
INFO-
// (�/ 2'! v ❑ Consultant Fees Paid by Applicant(Initial) I BLOCi, ELECT PLUMB MF.CH
�f LICENSED CONTRACT'OR'S DECLARATION � DC Ib
QT'Y F;LECTRIC PERMIT FEE I`ION J'°r
I hereby affirm flit.I am licensed under provisions of Chapter v Immmemmng I � LOB DESCRIPTION
woowtmsahan]IX)0)ar Dl�n.nan3anne Business and Prareammmercle,an�han.enm 1 rugn11T 1ssuANC1:
FwF n full force and effete •� /� .-K)S, WL ❑KITCHEN REMODEL
FU H license C %s — Con p l7 i "
yQI" Date Lic.41 tar XXLtJ n APPLIANCES-RESIDENTIAL. ❑ADDITION ❑PLUMBING RE-PIPE
[g... ARCHITECI-SDECIARAT'IOP - � PANELS ❑MULTLUNIT ❑STRUCTURAL
i Z O 5 Z 1 understand my p1,tp.m dIdit oad m PuhbSrccord, I - MODIFICATION
OZ-'n - /Q ('_/_. _ '/` UI'TO 2IKIAMPS ❑INTERIOR ❑CHIMNEY REPAIR
F4t:@ Licensed Professional I, 201-100 AMPS I- IMPROVEMENT
Cd' 1 hertb firm mm�amBmDERnmEthe Cnneec rr Licenx I�w Ter the OVER 1000 AMPS 0 BATH REMODEUREPAIR El DEMOLITION
6 hereby exempt
x6x0LU fgimunng ma (Saint..70315,Bianesend Profaa...Code:Any any uT county SIGNS ELECTRICAL ❑OTHER v
W 3 LL g' which tectonics a partial(a construct,alter,nmpmve,demolish,ur rtpair any structure
� pnononta rssmnce.also regmresthe epPhemt for such petmino Rlea mgnedsmmmem SPECIALCIRCUI'OMISC
HoKppK }
that he n licensed pursuant to the pmnsons of the Contractors license Um"Chapmr9
00 (commencing wnh section 7001)ofDivision 3 of the Business and Profnsmas Qde).T TEMP.MITER OR POLE INST CGMM1IERCIAL'
a 6 e that hens emmpt merchant and the brans for the alleged exemption Any vmlmi.n of - ❑NEW BLDWADDTUON ❑DEMOLITION
y Section 70315 by any applicant fur a Permit subjects the epphcnnn ni a civil Frothy of POWER DEVICES ❑TENANT [I FOOD SERVICE
FZ} not more Nan five hundred dollars(SSW) IMPROVEMENT
�=� I]Lns owner of the Propcny,or myemployces wnh wagesmtheirade cnmpensaion, SWIMMING POOL ELECTRIC
ad L: wildcats,wnd.aniline suucwrens not mtendeduroffetialfbrs.[a(Se,70,14,Blourc, ❑OTHER
W end Professons Code The Connors License 1xw does not apply to an owner of OUTLET'S-SWITCHES-FIXTURES
6 3^ pmpeny who builds or nmprovev dot.a,and who arcs wch work himself or through
his own employees,provided thin such mpmvements um ma ounnubd or offend for NEW RP_SMENTTAL ELECT Ro =t . - - _
sale If.howevmthe budding mtmpovemcnis sold within one year of completion the s..a SO FT FLOORAREA ,LSQ ET.
owner-budder will have the burden of proving that he did not build or improve for put-
pose of ale.).
I]1,as owner of the propeny,amexcldnvely convecting with licensed Contractors to
consumer the pradat(SCC.7040,Huai..nod Profesaons Cade:)The(Canowturs fa-
came Law does not apply to an owner of properly who builds or improves ancreon.and IQTY. PLUMBING PERMIT I FEE
- who contracts for such prnyects with a commands)licensed pumatnuonhe Contmaor. .�
License law PERMIT ISSUANCE' Ep-
❑IamexemptunderSec. ,B A,P C far thom.mn A
ALTER-DIUONS,VFNT- ATE ) �ON 1Z��
Own-• � Da'- - I b!J}'I VALUATION sf
WORKER'S COMPENSATION DECLARATION BACK ROW PROTECT.DIX' I f//��■•/�. CJ,Jr
I hereby affirm under penalty of penury one of the following d¢larvpon.. //�� aW9 Pact itNQ
•I]I traversal will mainmma Canlficnteof Camara milt-Ill.umfor Worker'Cnmpcn. DRAINS-FLUOR.HOUR ARRA,MIAt-
aatinn,as provided for by Section 3]00 of the Labor Code,far the performance of III I STORIES TYPE CONSTRUCTION
work for whmh thu Fa ars...It • ' ITTI'URES-PERTRAP �1 '
E]I have and will mammon Worker's Compensaion Insomnia,as,,.,,ad by Section
377 of the Labor Code.far the yPyrerarrformnce of the work for whalnhis peonl is lswed GAS-EA.SYSTIiM-IINC40MI.F.'IS � ', DEC GROUP APN
•' Carden {mince can Print dcy Nny numbererc GAS-EA SYSTEM-OVER 4(fA) s f4 �7f
CF.RTIFI A F110__I EXEbIIvFON FROM OR E S'
COMPENSATION INSURANCE, GREASPJINDI15TR1.WASTE INTP.RCEPT6[k I BUIIAING IVI$IQN RHI?S
(Ths section need not barompleted ifanepernit to foronchundmldalls,ISHII1 GRhASIi TItAI' � �.,
.,less i n PLANCHECK FF,E �.,
I certify an.,in'an,Fclmmanc,of the work for which this Fennnuuwed,IMmll
notemploy any penonmanymonncrso us In hccomm�nhla't lnlhe Wnrken'Connpatn- SEWER-SANITARY-STORM' 4W N
ENERGY FEE '
z ,z smom Lewsnf Caffornm.Data WA'1'I7R I IEA'I'ER WIVIiN'1'BiLEC'r\\
APDlicnm ' -- _ GRADINGF -
NOTICE TO APPLICANT II,nRennlking I...Cerolicar al l?xentpio...yon should WA'1'I?RSVS'I'1?MIIREKIING
[^ became subject the Worker'm Compenwmn pnwi.ion.III the Labor Cute,yon amt ` SOILS FEE-
G
Lathwith comply wahsuch pmmmana or this permit shall be dcencd rc.olard WATIeR$ERVICIi O-\
z - CONSTRUCTIONLENDINGAGENCY NEWRFSIDEN'I'IAI,PLMIL SQ,FE \�+�.' !PAID -
C.) p I herebydfithi that them msued(SeeiO97,leading agency lot the perfnmuncenl s Receipt# 3'
O'H Leaders for what ilia Permit is issued(See 100],Cnv.C)
U Lenders Nam° +4—I
�s Lenders Addr-v - AI 7 '
�a y I carols than 1 have road this application and ame that the ahova minrmatiun iv 1— P BUILDING FEE , ` 6,r'
F4.W7 correct.lattice mmmply.x nh ill city and county onhroancestndstme Inwn mlmmgm IQTY. M ECHANICAL PERMIT FEE
U G budding cunsmonam,mal hembyaatbmva mpm..aativasofthixuny ,I e.mrup.me SEISMIC FEE ' Vq above-mendoned properly for Inspection pure ses. PERMIT ISSUANCEi(We1 agree to save,indemnity and keep harmless the City of Capcnmo against I ELECTRIC FEE liabilnies,juagmems.cstsand expenses which may in my way cantraagaimt slid City AITER OR ADD TO MECII. -
nwquerce of the grminng of lhn Fenno !PLUMBING FE1.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) MECHANICA FE SOURCE REGLLATIONS AIR HANDLING UNIT(OVIiR 10,fN111CI'M) CONSTRUCTI NTAX Signature of AppllcanCOntmnor Dam c EXHAUST HOOD(W/DUCf)I HAZARDOUS MATERIALS DISCLOSURE !HOUSING MI GATION FEB
Will me applicant or future huddog occupant more or handle ha,crdom material HEATING UNIT 00 I W."BTU) ,
az defined by the Cupertino Municipal Code.Chapter 9 12,and the Health and Safety -
Code,Secl m 25532(x)+ HEATING UNIT(OVER 100,010 BTU) !
C:]Y., F1 No VEM'RAT'ION CAN IS INGLE RESID) (PAID Dane F tp
r Will the applicant or future building occupant ux equipment Or devices which
1 ion hamNaus air contaminants as defined by the Huy Area Air Quality Management I BOILER-COMA CHIP OR 100,000 BTU)
Dunn.? TAE'
❑Yes FIN. I (BOILER-COME(OVER 100,000 BUD
• I AIR CONDITIONER ISSUANCE DATE
1 have rtd the hernrdom nmenals negwrtmenu under'Chapter fi 95 of the Cdn� - 1
• foam Health Sa Safety Cade,Sections 25505.]5533 and 25534.1 understand that of the I NEW RMIDENI•IAL MFCIL - SQ ET.
building aces nit currently have a moans.that it is my responsibility to notify the necupmt
of the attainments which must be met prior to issuance of a CemOCme of Occupancy. -
Owner at mthonzea agent Data I - _L' ` ISSUEDB
OFFICE
OCT-16-95 MON 09 :54 AM P. 04
,• �■ ■■,
C =� MARVIN D. KIRxEBY
2397 FOREST AVENUE
SAN JOSE, CA 95128
(408) 984-0331
Job No. 91025
October 12, 1995
Building Department
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Re: 22539 Alcade Rd.
Gentlemen;
Per Section 7014 of the Uniform Building Code, we have inspected the rough grading for
the subject lot and hereby state that it is in substantial conformity with the approved
grading plan. Finished building pad was measured to be within 0.2 feet, plus or minus, of
the approved design grades.
• If further information is required please contact the undersigned.
s
Yours truly, nr � �FESStoHq
Marvin D. Kirkeby
Registered Civil Engineer
i
V e�DO; OCT 171995
D�pfCTION DfPgRT
OF, cuatRTlNp.MEdf�
OCT-16..-95 MON 09 :53 AM P. 03
• \� 0% MARVIN D. KIRKEBY
2397 FOREST AVENUE
SAN JOSE, CA 95128
(408)984-0331
Job No. 91025
October 12, 1995
Building Department
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Re: 22539 Alcalde Road
Gentlemen;
Please be advised that the foundation forms for the subject house have been inspected for
compliance with building setbacks as shown on the approved plans. I hereby state that
the forms are as shown on the approved plans.
• If further information is required please contact the undersigned.
Yours truly, QT0Fessroti
i
Marvin D. Kirkeby 1P g < y
Registered Civil Engineer
1p
I
•