25377APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
APPLICATION /PERMIT PLUMBING - MECHANICAL.
[irl), ITY OF CUPF.RTINO MILDING-EMUTRIC'AlI
BUII,DINf. DIVISION INILDINC. PROJFICf ]DENT F'ICA'1'[ON
PERMIT NO.
GAI}DRESSO
ZUNIT# LOTp
SANITARY NO.
AI'PWCA'I'[ON SUBMITTAL DATE
N AME: PHONE:
CONTRACroRa= N;Mli:_� LIC ND: `RI•V�`GL
N/C
CONTROL,x
kINIERS
ECT/RNGINEER: LI�`O:
RESS:
a
QTY.
ELECTRIC PERMIT
FEE
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
PERMIT ISSUANCE
fG ❑ ❑ ❑
Gi
LICENSED CONT'RACTOR'S DECLARATION
I hereby affirm that am licensed underprovisionsof Chepmr9 (commeacingwith
APPLIANCES - RESIDENTIAL
JOB DI?,SCRIPI'ION
PANELS
UP 200 AMPS
Section 7")of Division 3 oftbe Business and Professions Cade, and my license is in
full Toaffect.
Licen
/ s m e Che,i Class Lie #
i Dam Carbonate,
y�_ �• R
1�Q C• •Y�` —,
201 - 1000 AMPS
ARCHITECTS DECLARATION
1 undersmnd my plans shall be used m public rocoMS.
OVER IOW AMPS -
SQ. IT, FLOOR AREA
$ /SQ. FT.
SIGNS F.LECfRICAL
I
Licensed l'mfcasinnnl
OWNER-BUILDER DECLARATION
I hereby n the Commune License Lew for the
that I an exempt from the Codions
SPECIAL CBtCUIT/MISC.
TEMP. METER OR POLE INST.
(Se Ce
following reason. (Section 7031.5, Business and Professions Code: Any city or county
I which requi«e a Permit or construct. elmq improve, demolish, or repair any mrumum
p stmemwt
tit tb petmR3oLicese
POWER DEVICES'
thinnoslicensedparmardt
j that here t,insed pursuam to the provisions of the Connotation's License Prom law (Chapter
rovisins ofore Co La
f 9 then he nciseratu emcfam and me.11ciedr.rsro� Professions Cade)
orthoheie 1.5 by almirmm�nd the basis subjects i1.. civil permydf
Section ] 031.5 by any epplicmtforn permit subjuts the applicantmecivil penalty of
SWIMMING POOL ELECTRIC
VALUATION
OUTLETS - SWITCHES - FIXTURES
1 t mthunfve hundroddollers S5 W).
crofthepropertY, ormyempinyeeswithwagesastheirsolecompemation,
NP.W RESIDENTIAL ELBL -IR S .PT.
Q
STORIES
TYPECONSPIiUCTION
w Jmhe work, mJtheswaure isnotintended proffered Tortola (Sec.]OW,BUSiness
a . Professions Cale: The Contractor's License Lew does not apply to an owner of
propmny who builds or improves thereon, and whe dace such work himself or Through his
on employees, provided that ere such improvements not intendedurofferW Beside. If,
OCC. GROUP
RPS. UNIT'S
however, the building or impmvemcat is sold within one year ofctrmpletion, the owner-
builder will have the burden of proving that he did not build or improve for purpose of
TOTAL:
QTY.
PLUMBING PERMIT
FEE
sale.).
❑ Las mnend'thepropeny,om excursively codtraming with teemed cano-actorste,
W,OOD'LONE
APN
crammer the project (Sec. 7044, Business and Professions Cade:) The Crom star's
License Lowden not apply to an ownerofpropeny whobuildsor improves thereon , and
PERMIT ISSUANCE
whorommets for such projects with a connotations) licensed pursuant India Contractor's s, law.
Lice n
ALTER- DRAIN &VFN W
tE_
FE E SUMMARY
❑ 1 em exempt under Sea 8 & P C for this «assn
BACK MOW I'ROTECI'. DF:V 'E
�"
I ()Of SIDE :LS
Owner Uate
DRAINS - FLOOR, ROOF,AR A, D.
t
ANTI
R
Y N
RHCEIPIM
WORKMAN COMPENSATION DECLARATION
❑. Ihe«byaffirm that l haveacenificme ofcomanuoaelf- insure, oraceniecateof
'Wokers 'Compensation Insurance ora candied copy thenem(Sec. 38M, Lm CJ which
covers all employee's under this permit.
Policy p
SC f1CI.
Y N
RECEIPI'N
-
IIXTUR[S -PIiR TRAP
C Y N
RECEIPT#
GAS -EA. SYSTEM-II
CA OU'f
BIJ .DING DIVISION IFlFS
Campnny
GAS - EA. SYSTEM -OVER 4 (EA)
PLANCHECK FEE
❑ Certified copy is hereby famished.
❑ Certified copy is filed with the city inspection division.
GREASIVINDUSTRL WASTE INTERCEPTOR
GRADING ME '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GRPASETRAP
SOILS FEE
SIiWER- SAN] TARY -SFORM HA. 2BOFT.
ENERGY PER
(This section need not hecompleted ifthepemtit is for one hundred dollum(SIM)
or Is..)
WATER HEATER W/VENT/F.LECTR
I reality that in the perfncmnce of the work fm which this permit is issued, l shall
not employ any person in any manner so as to become subject to the Workers
Compensation Lawsof Califami.. Date
Applicant
WATER SYSTEINUREATING
PAID
Date Receiptp -
NOTICE 1'0 APPLICANT: IL afmr making this Cmificme of Exemption, you should
become subject to the Workers Comperwtion provisi en of the Labor Code, you must
NEW RESIDF.N'1'IAL PLMIL SQ. PT.
TOTAL:
forthwith comply with such previsions . „his Femtit shill be deemed revoked.
BUILDING ITE
�a
CONSTRUCTION LENDING AGENCY
SEISMIC FEE.
1 hereby affirm that them is a construction lending agency for the performance of
TOTAL:
F.LECI'RIC FEE
the work for which this permit is issued (Sm. 3097, Civ. C.)
Lender's Nome
Under's Address
QTY.
MECHANICAL PERMIT
FEE
PLUMBING FEE
I certify that 1 have real this application and state that the above information is
PERMIT ISSUANCE
MECHANICAL FEE
neat Iagrec mcomply with all airy mdcrunty aNimncee mdstnte Iowa relmingm
building construction, and hereby authorize representatives refunds city to euterepro te,
aMVe- mentio perry for inspec,.a pu
ALTER OR AUI3 TO MECH.
CONSTRUCTION'1'AX
ree
(We) , indemnify and P p ha floss me City of Cupertino against
liahiliti ms, seta mdexpe iV hicl, ay in my wayaceme against said City
AIR HANDLING UNIT ITO IB,000 CFM)
ins N n of gtmtingof tit” 't! a
AIR HANDLING UNIT(OVF.R IO,OW CFM)
.ignatere of applicant/Contmcor Dam
EXHAUST HOOD(W /DUCO
PAID
HEATING UNIT TO l(R,WO BTU)
Date Rcreiptu
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Caere, Chapter 9.12, add the Health and Safety
BEATING UNIT(OVER IW,IIlY1 BTU)
'1'
VENTILATION PAN (SINGLE RF.SID)
Cede, Section M532(a)1
❑Yes 11 No
Will the applicamor futerebuildingsccupeat useequipment orderats whichemit
BOILER - COMP(3HP OR IW,0008TU)
ISSUANCE DATE
hazardous air comaminoms . defined by the Buy Ara Air Quality Management
District]
BOILER -COMP OVER IOO,fMX
(OVER I BTU
A
e ❑Yes ❑ No
N
NEW RESIDENTIAL MECH. SQ. IT.
1 have read the hazardous materials requirements under Chapter 6.95 of the
'JUL
Culifnmin l leulth N Safety Cade, Snaiom 25505, 25533 and 25534. I und.onead @at
�I (yf(1�
�
if the building does not currently have a tenant, that it is my responsibility to reify the
oaupant of the requi«menu which must be met prim m issuance of a Certificate of
^T
O,marat y.
YI1� ur
1 (#
ISSUED BY:
Owncrorivulam zed....I Dam
TOTAL:
UrrlUt .
6217,1:5-1
7
10
i
v
N
K E N N E T H N E L S O N
oga Ave. SaniJose, California Suite
(408) 247 -2898
July 27, 1993
Job No. 936091
EmuD
D
JUL 29 1993
Building Inspection Department BLDG. INSPECTION DEPARTMEXT
City of Cupertino CITY OF CUPERTINO
10300 Torre Ave.
Cupertino, CA 95014
Subject: Enclosed Patio room addition to the residence at 10876
Alderbrook Lane, Cupertino, Ca. APN 369 -20 -034
Gentlemen:
At the request of the owner, Mrs. Barbara Lindsey, an inspection
of the subject property was made by the undersigned. The
inspection was made on July 22, 1993 to examine the construction
of a 120 Sq. Ft, addition to the subject residence. The
existing one story residence was built approximately 38 years
ago and appears to be in excellent condition. The addition was
built in 1979 and, in my opinion, was constructed in accordance
with the Uniform Building Code and all other applicable City
ordinances in affect at that time. No set back encroachments
were noted.
I therefore approve the addition as built, and recommend the
issuance of .a permit and final approval.
My services consist of professional opinions, conclusions, and
recommendations made in accordance with generally :accepted
Engineering principles and practices. I have made reasonable
efforts to ensure that this report is accurate, however I cannot
assume any liability for damages which might result from it or
for any conditions which this report might fail to disclose.
If there are any questions regarding this .subject, please
contact my office.
Very truly yours,
Ken et�on '
Registered Civil Engineer #22023
KN /kn
cc: Mrs Barbara Lindsey
/RpFESS /0\
w No.22023 m
a- Lic. Exp. 9 -30 -93
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