28878 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL ItO PEN ONLY '
CITY OF CUPERTINO .. "BUILDING-ELECTRICAL. PHRMIT NO, ^a�a ass .a^
•BLALDING DIVISION APPLICATION/PERMIT PLUMBING.-MECHANICAL � L VX 8 1/ VX
BUILDING PROJECT IDENTIFICATION '
BUILDINGADDRISS: SANI'1'ARYNO. .. APPLICATIONSUBMITTALDATF
.j!4 1, �. U-0 c7,16 D G°endilk r�,ri Sri l�a�ktNC [G
NAME: t a L Al9NIZ, - CONS'ItA"'S NAME;�y ♦- LIC NO:
9 !w/ /`ii+/`G./n(Y� I - C NIC- ^/ �/C,Ip'L�N'180L[\p�
•ARCHR[Cf/ENGINI:IiR: I.IC NO'. Atlilk15�7/'TC��J�1'�'E /TV � J1 �-1�. ❑ /' � l J
C�OIN�TACT. fI PHONE: _ BUILDING PERMIT INFO
❑'Consultant Fees Paid by Applicant(Initial) a BLDG LEC PLUMB MECH
aw
- * LICENSIiD CONTRACTOR'$IIECLARATION ❑
I hereby affirm Not I am licensed under provisions of Chapter 9(cmntncndn g QTY ELECTRIC PERMIT FEE JOB DESCRIPTION
a ,
p
yg00 with Sedian]tx10)ofnivision3oRhb Business and Nnfes:ion:code,vndmyhcenmiss RESIDENTIAL
F 'in full Pone end efPoet.�,.�} 'PIiRMI'f ISSUANCE
�UV License Cless_5.�.. Lic.p—fP-`t._8—(- f - ❑SFDWL - E3 KITCHEN REMODEL
F W Dale / ��x Contra s•(xGU/Q( APPLIANCES L'Rfi51DIiNT1AL ❑AUDITION El PLUMBING RE-PIPE
w Q' ARCHITLQ"S D[CLARATION [IMULTI-UNITO STRUCTURAL
Fly9• PANELS'
ROP1 rj
1 d t dayir,plagsibrill bemeed bl ds d, MODIFICATION
02:2q s Ill'1 O 200 AMPS.- ❑INTHE)R s [3 CHIMNEY klil'Alk
YF�
Licensed pFie.: nal 211-I000AM1'S IMPROVEMCNT
e�+k�dd OWNER BUILDERDECLARATION
y O W 6 1 hereby affirm tbat 1 am exempt from the CnmranorY License 1.vw for to OVER 1000AMPS ❑BATH RF.MODEVREI'AIR DEMOLITION
3 a V following odur n.(Section 7031.5,Busirs and Prnfcssam,Cade:Any city or county SIGNS ELECTRICAL ❑OTHER
a. which requires a permit to construct,alter,improve,demolish,or repair any structure
}� prior it)its issuance,also requires the applicantfor such Permit o file a signed statement SPECIAL CIRCUIT/MISE.
shot he is licensed pursuant to the provisions of the Conescmrs License Law(Chapter 9
C) (commencing with Section 7WE of Division Sof the Bus!lees and Prdession..Code)nr 'I EMP,METER OR POLL INST, COMMERCIAL:
cW
that he is exempt temfrnnt'anJ Ne nasi,I'nr the alleged exemption.Any vitlainn of O NEW.BLDG/ADDITION O DEMOLITION
N Section 7031.5 by any applicant for a pemtit subjects the applicant m a civil}ounhy of POWER DEVICES
t^6
net more than Five hundred dollars($5000). OTENAN1' ❑FOOD SERVICE
Las uwnernf the norm Io ees with wo pcnse IMPROVEMENT
q ❑ pmpce Yemp y genesalei(Sec.nsm tion. SWIMMING POOL ELECTRIC
well dothewon,andthese COmisnotintended Use
it for sale(Sec.'/11W, tuner of ❑OTHER
W and Professions builds
o imp oyes themrs License Law does not apply ns if owner of OlTT1.EfS-SIVITCHPS-PI%TUREg
. 6 3 property who builds or improves thereon, pr who does such work
te himself of through
aid own employees.e provided that such improvements w are not intended or olleruf for NEW RESIDENTIAL F.L[:C'I'R. SQ Ff.
s�le. bujldeventheve7lingoren ofprovin ideal he ithinonoyeurnfemnpa,finpr- SQ.FT.Fl.00RARRA' 8/SQ.I'T.
er"builder will l'ry, burden ofpmving ihm he did not build nr intpmvt for Pur- ( 0 A
nose of sown a 11e
❑1,as owner of the pmperiy,and exclusively contracting with licensed comment,to T -
construct he project(Sre.9044,Business and Professions Ccdc:)The Common's Li-, OCT
cense Law does not apply toanowncrof property wbn builds or improv,thereon.and QTY, PLUMBI PERMIT FEE . a
who contracts for such projects wit a corntnnnos)licensed pursuant to the Commctoes li
License Law. ' PERMIT ISS NCP -
❑IamexemptunderSec. ,B&PCfnr Inkmaeon -
- - AUI iR'-DRA1 ` WA'I'HR'(EA)..
Owner - I]or
WORKER S COMPENSATION DECLARATION - BACK FLOW R TECT DL
I hereby affirm under penalty of perj ry o e offfin,full.,
g J I t 7
•O l have and will maintain a Centficam ofConscra inIf'nso fini-Workees Compel.. DRAINS-FLOOR;RO RPA. 1,7
cation,as tied far b Section 3700 of the Labor Code,for the STORIES J'YPE CONSTRUCTION
phich y, per[nrmence of N<
work have
this pemtit is issued FlXTURFS-PER'S
have and will maintain Worker's ComeInstance, required by Section -
37W of the Labor Gale,for the performhnce of nl'thework
work fm which
Nis penni0 is issued, CAS-HA.SYSTEM-I INC.JOU
- My Worker's Coiitpensann l nsurarrrYYYrLe cuyy'ei iron policy number am: OCC.GROUP APN
Callen/•sssfLVMaM�/raaraa J>Pnllcy No,: - GAS-LA.SYSTBM-OVlik4 HA) j
CL'RIIFICATE OF EXE II'LON FROM WORKERS' GRHASFIINDUSTRL WASTEINTERCEPTOR
COMPENSATION INSURANCE
(Misivisbimneednutbecompined iftbe pemtit is fmonehundreddullars($100) BUI 1 DI\'S10N FEES
or less.) - GREASP.TRAP
I'LANCHF,CK FE
Icenify Net in the peRotmance oRhe work for which tis permit is issueJ,lxhall SEWER-SANITARY-STORM EA.200 FT.
nut employ any peann in any manner so.,in he.con suhjen m he Worker(Compel" ENERGY FEE
Z .sadun Law.of Ca1R..Io..Dora
2 Applicant- - WA'1'lik IIfATEk WIVEN'1'112LF.CTR GRADING _
NOTICE TOAPPLICANT
[.,he Wdrk If,afteCia making t!e vi,i icon of Lampilnn,you should WATTIR,SYSTEM/1'REATINGsecanSOILS FEE
a , famustur copy the WorkersCompensation provisions be
Lnbm Coked. most
� funhwiN comply with such provisions or this permit shall be deemed r<mkW. WATER SERVICE.
0
UO CONSTRUCTION LENDING AGENCY - NIiW RESIDENTIAL PIIMB, SQ.ET. PAID
(hereby affirm that hem is a construction lending agency for performance of ^ Data Receiptp
ft. r•t, the work(a,which this permit is issued(See.9007,Ci v.C.)
D U Tondo's Name _
TOTAL:
Isndu's Address -
0. I certify that 1 Lacs read this epplicutitn and slate that Ne shove infortnution is BUILDING FE .::
N correct.1 agree to comply with ell city and county ordinances and statelaws relating to QTY. MECHANICAL PERMIT FEE
C.1 ,7J building conswetion.and hereby authorize nprescmetives ofthis city to cn¢rupon the SEISMIC FEE
above-mentioned propery for inspection purposes. _
%RMIT ISSDANCE
(Wagree to save,indemnify and keep harmless the CityofCupertino at /
F.LECIRIC C
Iiibilities,jad ems,costs andexpenses which tray in any way ac meagainst said City ALTER OR ADD TO MECH.
Le
in consega ceo ranting of Nis Pe 't. PLUMBING[HE
APPL MUNI . DS AND V ,L r MPL WI ALL NON-POINT, AIR HANDLING UNIT(To Iporto cnich MECIIANI AL FEF.
s SOL` C RI GUL, U. S '
AIR HANDLING UNIT(OVER UL"CFM) CONSTRU . ONTAX
gnaure o'Applicant/Contmcmr Date EXHAUST HOOD(W/DUCO- - HOUSING MR ATION PIiE
"HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle Incurdnus ntmerial HEATING UNIT(TO 100,0(1(1 BTU)
Us defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety - ,
Codb.Scent.25532(u)'1 s I., HHATING UNIT(OVER 100.000 BTU) -
❑Yes' ❑N - 's .
(It ' VEN'III.A'I'10NFAN(SINCI.BRESID) PAID
-
W'IIN - Date zeeciptH
air costa f t building occupant use Air Quality an gement BOILER-COMP(3HP OR 100,000 BTU)
.Dist ict'hazardousair contaminants defined b the Bu Area An Quality Management - TOTAL:
District' BOILER-COMP(OVER 100.000 BTU)
OYes C]No
I have mad the hactiolms materials nsquimmrm,under Chapter 6.95 of to Cali- AIR CONDITIONER ISSUANCE DATE
farm.HoUlth&Safety Cad Sections 15505 25533 add 25534 1 understand got ifflan NF RESIDENTIAL.MECII.- ,SQ.1"t. �/�//.•/�
of the gdce t chm t of poor t: y :p bltyt 0f Occupancy
[);to
0psnt Y
'
of req ncnte tub Jtm must lPrinrt cola Centylo nof(8wpn u - t
Owner or auNorisd ogcm - Dam TOTal. ISSUED BY:
OFFICE
RICHARD FOUST 8 ASSOCIATES
P.O. BOX 720862 San Jose, CA. 95172
Phone (408) 193-1465, (408) 993-9341, Fax(408) 293-2465
95142
Nov 29, 1995.
Building Department
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Dear Sir:
We have inspected the swimming pool excavation at 19905 Bay Wood
Drive 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.
CP,���°
Richard Foust