22243APPLICANT TO FILL IN'INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY 3 (D
. Bullden Project Identification '"
0WI In Address: -•
LO rav/�r4 / DOtly. .
PERMITNO.
22243
rs name ^ LPhone:APPLICklION
CITY OF CUPERTINO-BUILDING DIVISION'
APPLICATION / PERMIT
BUILDING-ELECTRICALPLUMBINGMECIIAMCAL
SUKMI1 IAL DAM
/
— —�(
c cror'sNaep: 'M c. No:
v""lS'&
CATEGORY
CONTROL#/s-3
Archuect/Engineer. - Lk. No:
/��,t �. ,�.�
Addre q .-rTa.L.L//V A/c—,5L NA'yl�hE
QTY ELECTRIC PERMIT
BUILDING PERMIT INFO
I
r�FEE
PERMIT ISSUANCE 4 (r�
• LICE NSEDCONTRACTOR'SDECLARATION
I hereby affirm that l am L'emsed under provisions of Chapter9(rommenc.
ingwith Section 7000)of Division ofthe Business and ProfecealonsCode, and my
limens Is In full form and effeci.:
License Cess Lke
Date Contractor
ARCHITECPS DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
OWNER -BUILDER DECLARATION
Iherebyaffirenthat I am exempt from the Contractors License Law for the
following reason. (Section 7011.5, Business and Professions Code: Any city or
countywhirhrequtmsaper wmmtmc%alterimprove,demolbh,orrepalr."1-
anysWctureprlortoitsissuance, also requireslheapplicantfornuch perrrdtto
file a signed statement that he is licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9(commencing with Section 7000) of Divi-
sion3 of the Business and Professions Code) orthat he is exempt therefrom and
the basis for the alleged exemption. Any violation civi o(Secten no m re any
appgcantfor a perMtaubjecta the appticaM toacivli penalty of no morethan
five
five Nunn owner hepr($509.,
❑ I; as owner l the property, or my employees with wages r their sok
compen
�tende
.1. (Sec.
sae(Sec. pply to inowend opetyCode: The or hearts, hemeLaw
B..i .....d Professions aedthe s Code: The Contractor o kens eLaw
does not apply to in owner of property who builds orimproves thereon,and
who dcesauchworkhimself mthrough hisownemploym provided thatwch
Improvements are not Intended or offered far sae. If, however, the building or
Improvement is sold within oeeyearcifcompletion, the owner-bullderwill have
tIgIlurden of proving that he did not build or Improve for purpose of sale.).
II 4 as owner of the property, am exclusively contracting with licensed
Code.
contractors to is LWct the project (Sec. appy Business and of property
License Law does not apply to an owner of property who
The Coor unproven
builds or Improves Nereus, and who contracts (w such p(ojech with a
cgtSlattor(sexempte under Sntrothe Contractor's License Law,
L� I am exempt under See. B & P C for this mason
APPLIANCES-RESIDENTIAL
JOB DESCRIPTION
P U-44
PANELS C I� a �Iq, '
F- N t'
201-1000 PT
OVER 1000
SQ. FT. FLOOR AREA
t Lt' 321
/ r ra �VYtO
l
e
SIGNS
SPECIALCIRCUIT/MISC
TEMP.METER OR POLE [NSC
TOWER DEVICES
SWIMMING 1200L ELECTRIC
_
/ ` OUTLETS-SWITCHESFIXTURES I �
VALUATION
.2—v v
NEW RESIDENTIAL ELECTR SQ.FT,
57DRIF5
TYPECONSTRUCTION
TOTAL:
LT IT,
QTY. PLUMBING PERMIT FEE
OCC.GROUP
RIES. UNITS
PERMIT ISSUANCE
ALTER -DRAIN & VENT- WATER (EA)
Ff.00D 7ANE
APN
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, CONTI. -
'.
PER •TRAP
SANITARY Y_ N—
RECEPT#
Owner Date
°'-EWORKMAN COMPENSATION DECLARATION
E]WOR
hereby affirm that I have a certificate of consent to self -ince, or aTU�`
certificate ofWOrkee ComperwHoninsuranon oracertifeed ropy thereof(Sec
380D,Lhb C.) -
Policy #
SCHOOL TAX Y— N_
RECEll'1'M
-
GAS EA. 5YSTEM-1 INCAOUTLETS
PARKFEE Y_ N_
RECEIPT a
GAS EA. SYSTEM-OVER4(EA)
Com an
,_.P Y
BUILDING DIVISION FEES -
[]Certified copy is herebyfurnished.city
❑Certified copy a filed with the city Irapettlon division,
CERTIFICATEOMPE IXEMPNI NSFROM ANGE. ERS'
COMPENSATION INSURANCE
(TNssettionneed na becompleted If the perMt bear onehundred dollar
(StpO)arfy that
Isnot employ an person erformance the work an as tobco eesubjecrmit Rothessued,
I
I shake not employ any person in any manner at u ro become subject m the
Worked Compensation Laws of California.
ia. Date
Applicant
NOTICEExemption, you
co esubjettothe after making this
sationCertificate
provisions
Code,shoulyou =at forth ith co ply with such promo n proWis per it s Labbe
deemed re roket forthwith comply with such provisions orchis permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
IherebyaM thattheree s ch. mictlonfendingagency for the perform
once of the workfor which thin permit is batted (Sec. 309x, Clv. C.)
Lender's Name
Lenoer'e Address
1 cedifythatl have read thisapplicationand statethattheaboveinfo rhation
b correct,I agree ro complywith all cityand ountyordinances andante laws
relating to building construction, and hereby authodza representatives of this
city to enter upon the above-mentioned property for Inspection purposes.
a (We) agree to save, Indemnify an d keep harmless the City of Cupertino
against liabilities, judgments,ous"od expenms which may enanywayaccroe
.gal t said Inc equence oft granting of this P et
�/
GREASEANDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
`D
PAID .
Date Recti t#
GREASE TRA['
SEINER-SAMTARY-STORM EA 200FT
WATER HEATER W/VENT/ELECTR
ENERGYFEE Y N—
y"
PAID
Date Recti t#
ATER SYSTEM/TREATING
NEWRESIDENTIALPLMB. FT.
'
TOTAL:
BUILDING FEE , d 0
,2,
SEISMIC FEE x
TOTAL:rq—
ELECTRIC FEE
QTY, MECHANICAL PERMIT FEE
PLUMBING FEE aC9'J
MECHANICAL FEE
PERmrr ISSUANCE tZa�
FEES PAID:
Dale Receipt#
ALTERORADDTOMECH.
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL:
AIR HANDLING UNIT(OVER 101000 CFM)
CONSTRUCTION TAX
s hm,of.^Ihxtht/C Date
HAZARD ATERIALS DISCLOSURE
Will the applicant orfuture building occupant store or handle hazardous"
material as defined by the Cupertino Municipal Code, Chapter 9,12, and the
Health and Safety Code Section 25532(.)?
❑ Yes M No applicant orfuture building occupant use equipment or devices
Will the aor
which emit hazardous an contaminants as defined by the Bay Area Air
Qiality Management District?
4Yes f�No
have read the haza'3oua materials requirements uederChapter6.95 of
the Gllfernia Health & SafetyCode, Secthms 25505, 25533 and 25534. I
understand that if the building does not atmently have a tenant, that it is my
responsibility to not lfy the occupant of the requirements which must be met
prior to issuan of ificatem c$ipa
//
611
EXHAUST HOOD IW/DUCT)
CONSTRUCTION TAX PAID:
Date Retei t#
HEATING UMT(TO 100,000 BTU)
HEATING UNIT (OVER 100,000 BTU)
, y
TOTAL: 3 —(,
VENTILATION FAN (SINGLE RESID)
'
ISSUANCE DATE
Ap
PAID
JUL M ,y p H ����
ISSUEDB�
BOILER -COMP OHP OR 100,000 3TU)
BOILER-OONIP(OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQFr
Oor aul zed agent Date
TOTAL: ♦m
OFFICE COPY
J
I�
!, The Structural
Consulting Engineers
18590 Avon Lane
Saratoga, CA 95070
f /
-71
,119
JULY 31, 1991
RE: 10850 BROOKWELL DR.
CUPERTINO, CALIF.
FOLLOWING CLARIFICATIONS ARE HEREBY MADE TO THE APPROVED SET
OF PLANS FOR NEW ADDITION :
1. ROOF RAFTERS ARE 2X8 DF. NO. 2 OR BETTER @ 24" O.C.
WITH MAX. SPAN OF 14'-611.
2. FLOOR JOISTS ARE 2X10 DF. NO. 2 OR BETTER @ 16" O.C.
WITH MAX. SPAN OF 13'-011, PROVIDE 2X10 BLOCKING BETWEEN
JOISTS AT FLOOR PLYWOOD EDGES. `
TRULY YOURS //D r , VC E jCA c) e 7'1/
� TK Cl Y'L'IWDO� �
,/SHAHRIAR t
REGISTERED
, q,vy
(Q ac-SriOAJ S
C6NF 2 A-44 oN
FtuL
SIONAL ENGINEER
��c-C--ASF Cqu- C-Nc.,NEE2
phone (408) 395-9236
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ASST :'^y
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