S 2973(IPPUCANTTO-FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
C19•Y OF CUPERTINO RUIL01N(;-nLMIMit.Ar.
AIIILDINc DIVISION APPLICATION/PERMIT PLUMBING.-MECHANICAL.S
It U I L.DING PRO.I ECT II ENT1 PI CATION-
•"•,.," ..,.
2973
BUILDIN U�DyDRESlti: •
LA 6 fA-1 IAA. %O 1 Z3
SANITARY NO.
APPLICATION SUBMI'ITpA1. DAIL
oho C' C
0µNf�{;y NpMB; �� IRIONE:
"4V�'(T\r G
�iC111TECDENGINEER LIC NO'.
CON RACR)k'NAME.. I.IC NO:
Aj]I)I2ESS: �`
NIC
❑
CONTROLp
Q C
i V l
CON'EAC7E iPHO/IN ',,
9 `tel r� (5
❑ CnnSUI[nnf FCCM PAlfl by A(11)IIC311f (initial)
' EUILDINC PERMIT INFO
NLOG ELECT PLUME — NAME
ILK 1�1—SII 1^•L/ L^Q/
I,ICEN51iD CONTRACTOR'S DI~i(;\6AItAT10N
I nenhy uhrm this I am han.ed ender.......outs of Chapwr 9 eunmencing
Q'PY ' ELECTRIC PERMIT r FEE
t .
JOB DESCRIPTION
r P17RMMISSEJANCE 3
with Section 700(0 of NO son, 3 of the Business and Potassium, Cale. and my license is
in full farce un I +�/ �( /�
RESIDENTIAL:
❑SFUWI. ❑KI'ICHf:N REMODEL
APPLIANCES - RHSIDENI IAL
License'/('.lu.s� Lit,# •��-1Z
D.n— Commcmr
ARCH II' ECT'S DI!CLARAI ON
1 understand my plan. shall he used as public mond..
C1 ADDITION ❑PLUMBING RE -PIPE.
❑MUI:TI-UNIT El STRUCTURAL
C1
❑INTPRIOR ❑CHIMNEY REPAIR
IMPNH4FMHNT` WIMMdN(1 POOLS
PANELS
Oil TO 200 AMPS
Licensed Podcssioe"I
2061000AMP$
OWNER DECLARATION
1 herchy affirm that I am exempt from the Carlocmrt's License Law, for the
following reason. (Smninn 7031S. Rusinen, and Pmdessor v Code: Airy city m' munty
TII BE ItIiI'Alk DI?M'NT N
� 1
j - LER f''-
OVI-,R IXaEAMPS
ELECTRICAL O
SIGNS—
whice reyuites a mm�n u)amnme. alma improve, demalivh, or repair any smucture
prier to to i.suuncu,uh) reasons,dic."ieunl burster nmtino file r signwlstumnxm
SPI?GIAI. CIRCUII'IMISC. /
that he is licensed pursuant rte the provisions of the Connano'p License Law (Clusters
(commencing with Scnion 11N0)mf Division Jofmcllmincx unJ l'ndessions Codd or
TEMP. MIGTR LIR POLE INST.
1:�
than he is exantpl thercfroon and the basis for the alleged exentpdun, Any violation est
❑ NEW BLDG/ADDIT[ON ❑ DI?MOLT"T[ON
Section 11131.5 by any applieael for. crout,emeat, the applicum ma 1;111 pmm1lynf
not more lean live nundred dellen (5500).
❑Laxowuen,l the prnpany, ornryuntpinyaswinhwagm ns lheirnnle caltmarentinn,
will do the work,andnhueucnre isnot intended ur ol1'cred In, In(See .➢)id, B.,intss
POWER DEVICES
❑TENANT ❑]Too])SI? VICE
IMPROVEMENT
3Oil YI?k-"
SWIMMING POOL ELECT RIC O
and Professions C:xle: The Common/. License Law does not apply m an owner of
OUTLETS- SWITCHES - FIX ORES
sensory wen build. or Improve. mcreon, and whu dose such work housell in through
fustian employees, provided that .an imPmrvcments arc nal intended nr offend for
solo. If hnwcvmJhe huilding orintpmvemum ismld within one year of nmtpletinn,the
NEW RES'IAL
ELECT, SQ ITT
SQ. PT. FLOOR AREA
$/SQ. Irl..
er-huildcr will have tee hmden of proving the he did not build ur impm.a fin
"Ori
)
El I fThe p my ly cambactic, withl d c ancou,m
V. P
acm I t fee protect (S 7(44 E '. d Prol Ostia,< 1 ) I he Cunft u Li -
acme 1 d t psny 1 b IL p c : nand
QTY Pl,l)TQ�IjdG EMIT' FEEwlunnrsufo
C
�LIt hpr lk'ls with . nel rf )I'eaul anmx Gann ors
,I at n pr u
PERMIT ISSUANCE
s�
Incurs, law.
E] I am exempt under Sec. ,B& P C for this re:uon
IJ O
AER - DRAIN & VENT'- WATER (IiA)
Owner IJalc
VNAAI'ION
BACK FI.OW PROTECT. DEVICE
WORKERS COMPENSATION DECLARATION
I hereby and en.....a"tracally of p.Unry one of the lldlowing Aalamlionv.
/�
DRAINS- FLOOR, ROOF, AREA. COND. •—
Ihase and x'ill mainmin aCenlfira¢ol Cunsenna selGinsure for Worker'. Centpva-
potion, as provided for by Searom 9100 of the Labor Coda, for the Performance of the
StFORIES
TYPE CONS IRUM ]ON
sunt A fine which do, recruit is i¢ued.
FIXTURES -PER TRAP
❑ 1 have and will maintain Wmaa, Contp:tnmlian Inmrana, as required by Section
3710cfmc Luhnr Code, fnnhe • forma cc nfthe wnrkfor which this serol, is issued.
GAS - PA. SYS "I I:M-I INC. J OUTLETS
OCC. GROUT'
AEN
My Workr Is C I s.r Ice and 1'nI{ey nunmcr urq
Cartier. Policy No.:IIJM fa)
GAS -FLA. SYS'I'IiM-OVlika(P.A)
LATE OF USE. RON IROM WORKERS'
CERTIFICATE
COMPENSATION INSURANCE
GREASGHNU,SrI Rl' WASTE IN'ITRCIiPTOR
BUILDING DIVISION FPF_S
[Itis section need not lse completed tithe Tama is income hundred dollars (SITE)
nr lws)
GREASE I RAP
-_ -- '
PLANCIII?CK PEG 7�
Icrnifythm in meperfurmance oftbexnrk li+rwhkh nhispermitis issurA,l.hall
not employ any person in any manner so as to beanie subject to the Worker; Crouton-
SI?WER-SANITARY-STORM IiA. ^_INEPT.
IiNERGY Illi
WATER UHATCR WN17N'I'd?L FCIR
radion Law, of Cabi..n+io. Date
Applicant
GRADING ELI?
NOTICE 10 APPLLCANI': If, attar making this Certificate of Exemption, you ,hold
become su19'ecl h+nhc W+nker's Compcomatinn p... cons of the Labor Code, you mfrs,
WATER SYSTE.mrTREATING
SOILS PCE
foahwith comply wilesuch provisions oT this permit shall le deemed mvnked.
CONSTRUCTION LENDING AGENCY
I famwallimt lhinlmre is ammmtnion lending agency tormeperomtanmof
WATER SERVICE
p�
UnaeRcctpt#
NI7W RESIDENTIAL PI.MII. SQ. lel'.
the work fir which this use m.it is ivsuad (Sm.300V. Clv. C.)
Lender's Name
TOTAL:
Landers Address
D
BUILDING
I cculfy that 1 have read this epplication and stale That be uhme ink nnnotion is
meet. I agree a, comply 'ith all dry and county nrdini acs and sine )aw, mining w
building ammtectinn,am reny:mthrrim mpresannivesnfthis city to miser elan tee
QTY. MSCI IANICAL PERMIT . • FELE
(�
SEISMIC E
ISSUANCE -
PERMIT ISSUANCE
ELI? -I? .
cbnv�n+emion „per nn.pucn a puq+osea'
(Wc) a ee In �' ¢• Indemnify and AecP hmniles the City of Cupcmno against
Iiabilitics, juJ menu, and exnnu. which may in any way uccme against sail Cily
' nseyucn Bol the .ming old Bruin.
APPLIG&N UPiD1= AND IVILL COMPLY NON -POINT
it; :I it U T - s
ANTER OR AUDIO MIiCII.
- Q 0
PL.UMHIN 1:1? f a
AIR HANDLING UNIT ('ID IU,IMXI CFM)
!�
MHCH ICA,ITiE v
AIR HANDLING UNI 'I'(OVER 10,004) CI+M)
CONS'rlt NIIfEN TAX
L l
Signa plicunULt vsr oc
HALA MA'TIiRIALS DISCLOSURE
Will meapplicant or future building occupant store or handle lnzardotu mawrlal
GXHAUS'THOOD(WMUCT)
HOUSING MI'T'IGATION FEE
BEATING UNIT. (To 1X1.100 BT1J) L D
nav defined by be Cnpeninn Municipal Cuda Chapmr 9.12, end the Hued@ and Safety
Cesk. Section 2551(x)?�/'`
❑Ye. )CM,
T"
Willthe applicamor inure huilding occupant use... point or dainces wbich
tit bi7acdons air eomentinnntx as defined by the BU Area Air Quality Managetncat
);'dried?
Yee(�
I IFNI'IN(! UNI ]'(OVER 110,000 BTU)
PAID
Dam Rraci Pled
VI?NTILA'TIONI'AN(SINGLE RES ID)
.OILER - COME OHP OR W.XO RTI])
TOTAL:
a�
IfOILER- COMI'(OVEIt IIN),04kE B'TU)
I
n
I err In haruldeue'suria"a"Boremcn¢under Chapmrl95 of the Cal i-
firm, 1h & 'a . C:xlc, Sections 25515, 25513 and 25534, 1 understand ran if the
hal m t' oftam,menti. nyre.pmuihility to notify due reatpaof
Alit CONDL'1'IONIik
ISSUANC: DA'Pf3
^ Q
'T
NEW RESIDENTIAL MECH. SQ, L -r
11 lust be met pdnr n, i..aana oft Certificneof Occupznry.
U Date
ISSUED BY:
(YI'AI
OFFICE
05/20/1999 07:51 714-630-6114 POOL ENG RON LACHER PAGE 01
PWI
engineering
inc.
.=31� FAX Cover Sheet —=
Date: May 20, 1999
Time: 8:32 AM S2cS
To: Mr. Dave Scannell
Building Inspector
City of Cupertino
Voice: (408) 777-3200
Fax: (408) 777-3333
From: Pool Engineering, Inc.
Sent by: Ron Lacher, P.E.
Pages (including this cover sheet) _
Re: Swimming Pool Under construction at The Sunset 1999 Idea House
At Lot D, Hammond Way, by Creative Environments
Comments:
Please be advised that I have reviewed the reinforcing steel installation in the referenced
project. It is my opinion that the reinforcing steel is installed In conformance with the approved
structural plans.
N you require any additional information or if I can be of any further assistance, please call me
at (714) 630-8100.
Thank Youl
Ron Lacher, P.E.
1201 N. Tuatln Avenue, Anaheim, California 92807 Fax: (714) 630$114 Phone: (714) 630$100