Loading...
05010162 CIT_Y0 FLUPERTIN BUILDING DIVISION PERAW 14Oi�ITROTOR_INFORM�ON BUILDING ADDRESS: PERMITNO05010162 NER'S NAME: PERMIT ISSUE DATE OW IGNATIUS & JQSEHINF. DING n1 1971/200c; lop NE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u00 LICENSED CONTRACTOR'S DECLARATION Job Description F I hereby affi,m Nal 1 am licensed under provisions of Chapter 9(commencing aw with Section 7013)of Division 3 critic Business and Professions Code,and my license is Atg infullTac'' REP �CK/ADD STAIRS/TERMITE REPAIR j = LiOW Class Lk.N LF,O Ddle enntfaelof ARCHITECTS DECLARATION se u 1 undersand my plans shall W tried as public records ;0 Licensed Professional NUb f9' 2005 S OWNER-BUILDER DECLARATION I thereby affirm that 1 am exempt from the Con manor's License Law for the p o fallowing reason.(Section 7031.5,Business and Ptnf"sinor Code:Any city or county m which requires a Permit to construct,alma improve,demolish,or repair any snucturc f-Za prior to its issuance.also requires the applicant for such Permit to rile a signed uld car Nat he is licensed pubacam to the provisions of NeConuMClur's Lummi,taw(Chapter 9 Valuation WFo (commencing with Section 71)(0)of Division 3 of the Business and Professions Core)a, i that he is exempt Ncrcfrom and We basis for We alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects We applicant to a civil penalty of 3 4A 74aQ3$IberO 0 Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the propmy,or my employees with wages as Nei,salt compensation, will do Nc work and the swan¢is not intended or offered for side(See.7044,Business and Pmmssions Code:The Contractor's License law docs nor apply to an owner of Required Inspections property who builds or improv"Narcan,and who docasuch work himself Or through his own employees.provided Nat such improvements are not intended ormRered forsale.If. howcvxn We building or improvemem is sold within one year of completion.We owner builder will have dm burden of proving Nat he did not Wild or improve for purpose of sale.). 0 I,as Owner of the property,am exclusively contracting with licensed contractors to construct We project(Sec.7044.Business and Professions Code:)Tht Contractor"Li- cense,Law dors not apply to an owner of propeny who Wiles or impro es Merton,and who contacts for such projects with a contractors)licensed pursuam to We Canmmors License law. I dm exempt under Sec .B&P C for Ni rcuan Owm" AkJ.ti `f I�IyJ� Dam tLir WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury ane of Was following declaations: 1 have and will maintain it Cenificale of Consent to self-insure for Workers Compere ration,as provided for by Section 3700 of We labor Code,for We performance of We work for which this pct rd,is issued. I]1 have and will maintain Workers Compensation Insurance,as required by Section 37W of dm Labor Code,for We performance of We work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Cartier: Policy NO.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need nor becompleted if the p.it Is fair.hundred dollars($100) ardess) I ecnifv then in We performance of We work for which this permit is issued,1 shall not employ any person inany beco docrou sp as to embj"vo the Workers Compensation Laws of Cilifo a.Date {ice I 'am^"o Applicant t/-(JtATa cr rN NOTICE TO APPLICANT:If,after making Nis Cedificale of Exemption,you should became subject to We Worker's Compensation provisions of We Libor Code,you must .JO fonhwi N comply with such provisions Or Nis Permit shall he dcemcd mvaked. Z'"' CONSTRUCTION LENDING AGENCY Ihereby aMo.Nat them is a cman"eirm lending agnsy In,We perfurmance of fYi Ne work for which this permit is issued(See.3097,Civ.C.) fA Q Lender's Name Leaches Add. U C) I cenify Nat 1 have read this application and sure Nat We above informmfun is (lJ/ 0 U coiled I agree m comply with all city and county ordinancesvc,;of and circ laws totaling pt to pU abovengeotioned construction.and herebyauthorizepie rtpr"enuNes of this city menter anon the W above-mentioned a m Interiorlysave for OSKCindemnify Purposes. gy (We)agree to costs indemnify and keep harmines We City scenic Cupertino against h in f Wecastsang of thisexpereas which may in any way accrvc agaimtsaid City U z in consequence of UNDERSTANDS of this permit. '—' APPLI ANT UNDERSTANDS AND WILL COMPLY WIT ALLON-POINT Issued by: Dale / SOUR REG NOyS. f u, `1 � zoo Re-roofs Signature of pplicanUCantmero 'Dale HAZARDO MATERIA DISCLOSURE Type of Roof by porfirr(Mur palCode,ding Chaptstorco,handle Heal th and Safety az defined by the Cupertino Municipal Code,Chapter 9.@,and Nc HcaIN and Safety Code.Section 25532(a)? / All roofs shall be inspected prior to any roofing material being installed. - ❑Yes K. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove iii hevardaus air contaminant u defined by We Bay Area Air Quality Management all new materials for inspection. Jisriel? ❑Yes ©No I have mad the hazardous materials requirement under Chip.,695 of the Calirm. .is Health&Safety Cole,Scninns 25505,25533 and 25534.1 undcrsund that if the Wilding does n currently hmc terrain.unit Nit is my rcspansibility 0 nudfy the Meupant of We require rat nlrlutsit met poor to issuance urn Cenirientcof Occup y.V ; Signature of Applicant Dale v All roof coverings to be Class"B" or better Owncror au oriscd agent t bent '1' �I pts a r i �fi n A5 c.�+ `k` u ar ..r ''. Sal.�" .�{3� �•} 4'i ..L �n .3'( k REStq I° E "T3IA'LPR � C 'COVE�R.SH' aETr . CUPEI�TINO . ...5 : ,I Assessor's Parcel Number: '274 Name of owner. ti ^� e, Project address. _0?4 TA a e J Ca n e L ^ ^ Contact person. Phone. (Lto �� 44 C.. ^ Z` i1 Fax. ( cro ice\ y-e'-F (o + fp4 \ Net square footage of lot. �- Existin Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? N • Is privacy protection planting required for the project? Y On what floor(s) is work being done? Brief description of work.`` .QR J�e L ° A 1 fn 0 F--x G Code editions:2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC (Y-N) 2001 CPC (Y - N)2001 NEC (Y -N) Effective 11/1/02 RECEIVED 2 7 2005 i Plan Review Process Work Book Page-8-Revised 4/28/04 r \t" • I`a •z T O l ,� O O jqCD on n O 'b. 14 77 CD .Vyi rn R• ib 17-N 1 cr .D a = 4y �- N=:m n CL M w to G N /07 Ji` 160 f' .. � - vrr n \ ' -► IVED 1 (� Y ! �° 2 7 2005 r I = EIVED 2 7 2005 v d tLiu .. It ls•-fin'; i. -:.,,'�� � � N � � i e_— RECEIVED � 2 7 2005 x: �t r� - •CITY OF CUPERTIN• CITY OF PERMIT APPLICATION FORM CUPERTINO dh APN # 3542 0 el Date: T Y-J Y' 1 /7,7 'aov S� Building Address: Mailing Address (if different from building address): Gv3 �}✓en��� Z4*1,0_ o Owner's Name: Phone #: Cont ctor: V License#: Contact: Phone: Cupertino Business License#: Fax: Building Permit Into: Z—x LLk:'�Y oL�c 11 Bldg [�� Elect ❑ Plumb ❑ ech U Job Description: v I Residential p- Z-4 o �rl��z�z -e d«- Commercial ❑ Sq.Ft. Floor Area: ZZ $/Sq.Ft.: oa 3 ¢ d Cost of Project: Occupancy roup: t.#:;-7/Awz�' Type of Construction: 1 /^ Please check this box if the project is a second-story addition: El Project Size: Standard Ek" Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax -Resi/Mobile BUILDING BELECI000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of3 / /�/ 6 0 Yan '> an Chew 34966 Silverlock Ct. Fremont, CA 94555 (510) 794-4276 Phone (4 15) 558-6686 Fay Building Department 10300 Torre Avenue Cupertino, CA 95014 Tel: 408.77 7.3228, Fax; 408.777.3333 This is to certify that I have examined the construction as specified in the revised design for the replacement concrete retaining wall at 10397 Avenida Lane, Cupertino, CA .9501.4.3946. lam satisfied with this installation as stipulated in the change request for the design that was approved by your department on October 7, 2005, including all rebar re-enforcements as the ASE has noted during the permit review/approval process as well as Otl; additional tie beams to connect the retaining wall to the existing structure of the house. Please let me brow if you should have any questions. 'Thank you. Truly Yours, -Yan Yapi Ciew Registered Structure Engineer �,c�_ 7 ��- Lic*S 2 2<L<lF iSS1�N"� ZVI W "rRuclaRt`� �. �raTF pi\toa`\� S�er�t• 8 : ELAN CHECK; 558 3686; Oct 7-05 4:57P;A; Pace 1 ;'1 • Yan Yan Chew 34966 Silverlock Ct. Fremont, CA 94555 (510) 794-1276 Phone (415) 558-6686 Fax Building Department 10300 Torre Avenue Dipertino, CA 95014 Tel; 408.777.3228, Fax: 408.777.3333 ,'Ttti, is to certify that I have examined the construction as specified in the revised t design for:the replacement concrete retaining wall at 10397 Avenida Lane, Cupertino, CA „t . 9501.4-3946.. I aim satisfied with this installation as stipulated in the change request for the design that was approvM by your department on October 7, 2005, including all rebar re-'enforcamcnts as the A:SE`his noted daring the permit review/approval process as well as the additional de'beams to connect the retaining wall to the existing structure of the house. Mcrae let me know if you should'have any questions. Thank you. Truly Yours, -Yan Yan Cl"iew Registered Structure Engineer �Ycf .7 Z, �- Lie* S 2 �d2R4F�SSr�jH�(�, aTF F N)�\t4�` s (� u �j yt Av- CLT {} � 2UG5 r. � clopy . .NIS PLAN :SHALL REMAIN . N sHE :JOB AT:ALL.TIMES LAJ.RINC- CONSTRUCT1ON r y INTERDEPARTMENTAL COMMUNICATION GMSC P 0 6 2 8 9 8 To: Contract Distribution Dept: 27-32 Bldg: 182 Plant: 1 Date: 08/16/93 From: G. G. Hurlbert Dept: 80-10 Bldg: 154 Plant: 1 Ext: 2-5146 Subj: CONTRACT N00030-91-G-0054, SP BOA ORDER KH971A The purposes of this modification are to (1) modify Section B, identify as a service effort, (2) Section E, clarify inspection and acceptance and (3) Section F, extend delivery date. NOTE: A copy of all contractual completion documentation/evidence (i.e. letter of completion, Certificate of Conformance, report transmittal, DD250, etc.) must be submitted by the cognizant/ responsible organization to MSD Contract Controls, Orgn. 80-10, BIdg.154, ATTENTION: K. M. SNODGRASS. • G. G. Hurlbert MSD Contracts GGH/vrg Attachment: (1) Subject Document (LMSC/P062898). •