S 3306A
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - KLECTNICIL °7v•'•�' 3 ^' J jo�
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL. J
11 trio noNO Pan INr-r InENTIFICATION I
PHONE: NT
- ^ CORACTOR'S NAMIi: LIC NO:
DONNE: a•f` ja
LIC NO: ADDRESS:
�f —t�Ors 1 202
i_
PHONE: ��/ BUILDING
1„Y1 CangaBairt Fees Paid by Applicant (Initial) 28 d BLDG (ELECT
9 ❑
LICENSED CONTRACTOR'S DECLARATION QTY.
m m
1 hereby affirthin 1 am licensed under provisions of Chapter 9 (romencing
with Section 70110) of Division 3 of the Business and Professions Code. and my license is
in full force and effect.
Lic'nrc Class Lit.#
Dam Contrvcon
ARCHITECT'S DECIARA'1'ION
1 understand on, plans shall he used as public merits
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affon that 1 um exmnpp from the Contractor's License law, far the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which mquires is permit ro c ... tmct, alter, improve, demolish, or repair any structure
prior m its issuance, also requires the applicant lin such pan on to f le a signed,moment
thn he Is license pursuant ,the provision, ofthe Contactors License Las, (Chapter 9
(commencing with Section 7") of Division 3 oftM Business and PromWons Code) or
that he is exempt foramens and the basis for Ibe alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit uncus the nppllcam m a civil penalty of
not more than live hundred dollars ($500).
Las owner of the property. m my employees with wages a their sole compenmtion,
will Jo the work. and the orectme is not intended m olliced 1m sale PSec. AD4, Has
and Professions Code: The Contractors License law does not apply m an o
property who builds or improves thereon, and who docs such work himself oit
hat
his own employees, provided that such improvements arc nal iron cd or of I'ereJ 1
sale. IL however, the building or improvement is cold within one year of completion, the
s nenbuilder of 11 have the burden of movl ng that he did not had W nr improve fur par.
po flat'.).
C7 six owner of the property, am exclusively contracting with licenmd contract 11.
Sous cl the pr.ject (Sea 7044. Business unit Protea.... Code :I The Comate is Li -
Law does not apply m an owner of property who builds or impmves thereon, and QTY,
who contracts hunch projects with a contranons) licensed pursuant the Contractors
License law.
1 am mem t under See. . B Af PC fonhis reason
O net Dane
WORKIBVSC( PENSM ION DECLARATION
the afirm, ander, panallyof perjury one of the following declarations
1 have and will maintain n Ceniftcate of Conlan to self -insure for Worker's Compen-
sation, as provided for by Section 37W of the Labor Cale, Tsar the performance of the
work for which this gamut is issued.
D I hive and will maintain Workers Compensopion Insurance, as required by Section
3700of the Labor Cale, for the p rf'mmnce of the work Ira which this permit is issued.
My Worker's Compensation Insurance Carver and Policy notmber are'
Cartier: Policy No.:
CERTIFICATE OF 17XEMM'ION FROM WORKERS'
COMPENSATION INSURANCE
(This s alien need mol be completed'd]he pemal is for nue hundred dollars ISI00)
or less.)
1 certify that in the performance ofthe work for which this Permit is issued, I shall
not employ any person in any manner so as to Wcome subject to the WorkersCompcn.
.lion laws of Calhoun, Data
Applicant I
NOTICE TO APPLICANT: If, after making this Ccriificme of Exemption, you should
hecome xuhjem to the Workers Compemarom provisions o1 the Iver Code, you must
forthwith comply with such provisions or this permit shall he deemed r'voked.
CONSTRUCTION LENDING AGENCY
1 hereby of. that hem is a constitution leading agency for the peifnr ininee of
the work far which this permh is issued ISce. 3097, Civ. C.)
Lender's Nene
LwWer's Address
1 certify that I have mad this application and state that the alsnvc infurn ati'n is
omit l agree to comply with all city and county ordinances and state laws Mining to QTY
building cmrvaactia., and hereby amhofsc representatives of this city menter upon the
clover -mentioned property for inspiration purposes.
(We) agree m save, indemnity sand kap harmless the Cary of Cnpcnino oguinxt
liahilities.jadgmenis, colas sand caucuses which may in any way accrue against said City
in no qucace of the granting of this Permit.
APPLICANT UNDERSTANDS AND ILP. COMPLY WITH ALI, NON -POINT
SOURCE REG 16ATIONS.
Signature of pliant(Compacmr Date
HAZARDO S MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hvanlmus material
as deli tied by the Cupertino Municipal Code, Chapter 9.12, unit the IIcahn and Safety
Colt. Section 25532(.)^
❑Yes [I No
Will the applicant or future Wilding oecupom use equipment or devices which
mil locations air contaminants as defined by the Buy Area Air Quality Management
•isbich
E] yes FI No
I have pard the harardnus materials reyuirements under Cbaper 695 of the Cah-
fo om Health A Safety Code. Sections 8505, 25533 and 25534. 1 understand that if the
building does net curemly have a tenant. Ibat if is my respmsihilily 10 notify one occupant
of the requirements which must W met prior to issuance of a Ceditican of Occupancy.
ELECTRIC PERMIT FEE
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
PANELS
UP TO 200 AMP'S
SIGNS ELECTRICAL.
T'IEMP.
SQ FT.
PLUMBING PERMIT
PERMIT ISSUANCE
ALTER - DRAIN A, VENT- WATER (FA)
BACK PLOW PROTECT. DEVICE
DRAINS - FLOOR, ROOF, AREA, COND.
FIXTURES - PIER TRAP
GAS - EA. SYSTEM -1 INC. 4 OUTLETS
GAS -EA. SYSTEM _7L JZI:'C—,
GREASE'TRAP ✓ II
S1iWlEN-SANI'fAR STON RAl2q)
WAT'IER IIEATEN W NT?LIECfR
WATER $YSTEM/t E�4i G
WATER SERVICE
NEW RESIDENTIAL PLMII. SQ. FT.
MECHANICAL PERMIT
PERMIT ISSUANCE
AL'1P.R OR ADD TO MECH.
AIR HANDLING UNIT (TO 10.00() CEM)
AIR HANDLING ONI'f (OVER IWEST CFM)
EXHAUST HOOD ONMUC )
HEATING UNIT IT 0 1010SO DTII)
HEATING UNIT (OVER 100.000 BTU(
VEND '11.A'1'[ON FAN (SINGLE RESIDI
BOILER - COMP LHP OR 100.000 FUL)
BOILER - COMP(OVER 100,0110 BTU)
AIR CONDITIONER
NEW RESIDENTIAL MECH. SQ. IT.
FI
FEE
FEE
2 -r-q
❑ ❑
JOB DESCRIPTION
RESIDENTIAL•
D SFDWL
D KITCHEN REMODEL
❑ADDITION
0PLUMBING RE -PIPIT
CMUITI-UNIT
DST'RUMURAL
MODIFICATION
D INTERIOR
DCHIMNEY REPAIR
IMPROVEMENT
0SWIMMING POOLS
D BATH REMODEUREPAIR D DEMOLITION
D NEW BLDG/ADDITION D DEMOLITION
0 TENANT DFOOD SERVICE
IMPROVEMfEN'f
D OTHER
AREA
StII V U Q
T(R
BUILDING DIVISION FEES
PLANCHECK FT:E
ENERGY FEE
GRADING FEfis
PAID
I RttciplN
I /n / TOTAL:I
ELEL C FEE
PLUMBIN' FEB
MECHANIC .FETE
CONSTRUCTION'1'AX
HOUSING MITIGATION FEE
S/SQ.
PAID --
Date Rtteip'n
ISSUANCE DATE
/ -:�- - ,,_'?9
- 7_ln7
..........'OAT2 .ySU EGT3 `' ll�t:C4J2—Aeax J��/�,r)c.A .SHEET �NyOp.. /._ORJC._..._..
2401041
. .'^ `.c,t N.. - /r,F-ice /�'�7�: �J��i• ..�.
KENNETH NELSON'
Registered.CM Engineer
Keferencess
Design Load•Assumptionsr.:(psf)
Use
Struct. tight
Frnming'(4 x 4)
Struct. .Joists,
Planks 6 'Rafters
Light Framing .6.
Studs (4.x 4)
Beams &'Stringers
Grade. f
(408) U7 -2W8
SQ Saratoga Ave.
Supe 215
San Jose. Callfomla 95129
APPROVED
IN ACCORDANCE WITH THE CITY 01
CUPERTINO CODES AND ORDINANCE-,
DATE___Z
SIGNED L-9—
me ab ns i,•
This set of pians
ll :^s ,nd it is'r
be kepton the j"•'.
lawful to r^a:;e o, a..c ag
on same y+'th:,u; r+.., n 1•- r =�i n
the building Dept.• G:IY of Cupc c.n,.
The stamping of this plan ; no ap u, z.i..nc
pi r0i be herd to pe,nzit Of to be ar'
- ,.. wise Jnr
ap �, ,.i it a W:, a• . t L'•i caY t"
106'", ` • f (repetitive use)
02 •
LL 'DL-.. '
Roof
....... U1
I" 7
1.7. 1950 '
42 .
875
Ceiling-,'•
Std.
Grade
55.0
Sloped Cl! g.
-Dense Sel.
1st 'Floor
Struct...
1900
2nd Floor,
Fact. Walls
it
Int. Walls
Party WalXs.L. . I .
Wind';
•
Seismic, ,.Vs
Use
Struct. tight
Frnming'(4 x 4)
Struct. .Joists,
Planks 6 'Rafters
Light Framing .6.
Studs (4.x 4)
Beams &'Stringers
Grade. f
(408) U7 -2W8
SQ Saratoga Ave.
Supe 215
San Jose. Callfomla 95129
APPROVED
IN ACCORDANCE WITH THE CITY 01
CUPERTINO CODES AND ORDINANCE-,
DATE___Z
SIGNED L-9—
me ab ns i,•
This set of pians
ll :^s ,nd it is'r
be kepton the j"•'.
lawful to r^a:;e o, a..c ag
on same y+'th:,u; r+.., n 1•- r =�i n
the building Dept.• G:IY of Cupc c.n,.
The stamping of this plan ; no ap u, z.i..nc
pi r0i be herd to pe,nzit Of to be ar'
- ,.. wise Jnr
ap �, ,.i it a W:, a• . t L'•i caY t"
106'", ` • f (repetitive use)
02 •
87tr
l.lv..
....... U1
.1400
1.7. 1950 '
42 .
875
1. to 1.005
Std.
Grade
55.0
-Dense Sel.
Struct...
1900
1.7
Beams &"Stringers.. Sel: Struct. ; 1600 1.6 r`I
Beams & Stringers. Dense O1: 1550 1.7 fitG1 1150.. 1.6 copy
• Pos,t & Timbers `Dense; U1.. fb 1400 • .1.7
1200' 1.6
h fb7.
KENNETH NELSON
Registered Civil Engineer
(408) 247.2898 940 Saratoga Ave. Ste. 215
Fax (4081 247.2898 $en Jose, CA 95129
JOB 9!A/26_; 9 dae,1
81-1E8T NO.-
CALCULATED
O. CALCULATED BY .�M DATE
CHECKED BY DATE
A/n.(aGLS
8.e0evol? urn//
�EKlat wo 0
+6 6t tChJov� J
Cross Sec fio.�
•.mD ri r_-rm,•�. •.... �W Nva
I
KENNETH NELSON
� Replslara0 Civil Enpinoar
JOB "30
-_0`
`
SHEET NO. -
OF
(408) 241.2898 940 Saratoga Ave. Slo. 215
CALCULATED BY
DATE
Fax (408) 247.2898 Sen Jobe, CA 95129
CHECKED BY
DATE
_ ..._ .h.-...,.. .......
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.....
11
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