S 2518 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUH,HNG.ELLIUrlUCAI. PERMIT NO.
BUILDING DIVISION APPLICATIONIERMIT r1.unJRlrvr..MECnANIGAL S 2518
BIBIJANG PROJECT IUI:N"1'I FIC.\TION
BGII.OINGADDRESS,. SANITARY NO. APVI.]CATION SUBMITTAL DATE
OW BfSNAMB: PHOS CONI RACTOR S Nn 1?'. LIC N2
��• C4'•R� �� W+h ` NIC CON'1'ItOLp
III d LI:R IAC NO: ADDkCtSS: �'�C ❑
La U. Rssu¢n�4 S
*0NUAC�Q�I ` ` PHONE: .1 BUILDING PERMIT INFO
�\wm\ U� �\ J� pt-5—f,7-74A 7-74 ❑ Consultant Fees Paid by Applicant(Initial) BLDG E111rel] PLUMIR MECH
V� KJ ll O I xl ` ❑ IL ❑ ❑
LICENSI!D CON'FRAUI OR'S DIhCiARA I ION QTY. HLGCTRICPHRMI'1'
I hereby affirm that 1 am licensed under provisions of Chapter 0(commencing - + J013 DESCRIPTION
"Z wilt Section 7(M)afDlvixioa3offle Businessland Is c,dnn,Codc,und my license is �� RF.SIDF.NTIAL:
WOO PERMIT ISSUANCE
W G in fall Enec and c0'w,, q. Of ❑SPDWI, ❑it[I'CHEN REMODIiL
LN
QUU License Cl sk_X_,,...1 Lic.p—�J_ 1 APPLIANCES-RESIDENT Al. []ADDITION ❑P[-UMBING RE-PIPE
FZ4! Dara 2• I k'1-1 Contrucmr
ARCI 111 EC'I"S UI!CLAItAT1UN - ❑MULThl1Nl"f []STRUCTURAL
ZONE Iundrn((and my plav,diall he,sed as pahlicusumds PANHI1S MODIFICATION
UP TO 210AKIPS
CZ—� [I INTERIOR 11 CHIMNEY REPAIR
F�FqW Lro,al,d Pmt casional 201-10S)AMPS IMPROVHMHNT 0 SWIMMING POOI,S
-1 OWNIJt-BUILDIR DECLARATION OVER ItXXIAMPS (I BATH RIiAfODI!IIkEPAIIt �DIiMULITION
C C-1 1 M1erchy affirm That 1 am exempt fmm the Contractors I.icense Law Battle
�ppP55.. W� follnxing rc t.X-it 9031,9,Busmcx and Noes nnx Coda Any city o county SIGNS ELCC'I RICAI, ❑On HER
t++LL oil
Q which scribes ra Permit na con,.d.after,improv..demulieh,or repair uny m uccule
^�N.] phor in itsalso y the ppli t for suchpetat to file a signed.mn cal SPECIAL CIRCIA UMOC. a
y
dan he is filluellip-11.11111 to II p m:of1he Contractor,Ticcr,d aw(Claphad
al—•0C (eon b ASee fDivot-ot 310 B .' can JI 1',: ar 'II'.
C) 1) LMMITER OR POLL INS1 r rQ COMMFR '
1.a e C That be is cxenra dicafrnn and he basis liar the alleged eacmpaoa.Any vuAatioo of ❑NEW BI.DG/ADDITION ❑DI3MOIJ I ION
xI Section 70315 by any applicam fur apemr, object,the up divanuo a civil penanyof POWER DEVICES
{y•-•N ❑TENANr ❑FOOD SERVICE
not nude man free hundred delhux(5500).
Z? IMPROVEMENT
Q El Lo the work, the pnrpeny,nr rnyemnnendes wino eyed fosaleir sole compensiness SWIMMING POOL ELIiC'I'kIC
' =O will Aothewon,and the I he C Itnal,U,cue oEemJ.....I e(Seu.,,an , on,oI ❑DTIIER
[A3
andProfession,whob Cndu:'1'hc Conb'aerro L and
dodoornutrk frsunownerur OIITLIiI'S—SWITCHI!S—FIX]'IIRHS
2 hil o
progeny who builds or imded ch t such i and who Joel such tints himself or through
lot own employees,e build al that such i bar
1h nal intended or nlr er,far NEW NIiSID1iN'I'IAI.ELI[(.TR SQ FI'.
sale.It.haw r,the Enildingu ntpm cat ix sdA within ono year of contplmiaq Nu SQ.PL FLOOR AREA $/SQ.En
ins cr-builder will have the burden of proving than he did nal build or improve for par-
Iwse ufmleJ.
❑ I,in r of the properly,sun wdrdsely emu a,lin,wish licensed armranms InOTA: O O
construct me project(See.Tal Pacific,vad Pro cssiaaa Cash:)'I he Com a,dar,Lr-
c e Law dates not apply to an owner of pmpeny who builds at improves thereon,and QT '. .PLUMBING PERMIT FEE
whn connote,fmsnch Pmjec(s with at rn,oh,l licemeJ pursumu e,the Cnraucous D
License Law. 4PGR "UANCE
❑ I an cxentpl under Sec. ,B&P C for this based yy��ppyy I1'.
ALTHk—D ENT—WA'r[R(CA) .FEB 1 1J��
owner nam
WORKER'S COMPENSATION DECLARATION BA . ,
O ,"- VICE
1 hereby affirm under penalty of pejnry ane of the following declaration.:
- baveaad willmfa
lioainmin uCcnllic.tenl Cnnxnu no self-insure r Wnrkere' Compco. DRAIN.—'k R,RO F,AIHIACOND. S'IT1k1ES 'I'YI iEDNS'I'RDGfIGN
,a .,as proked far by Section 3900 of the LaMar Cale,far the(wrfunnanee o(the
work far which mix permit is issued. FIXTURES-PER' A y
[:] I have and w111 maul In Worker's Cmn,vatinion Inca nmce,as rccpEral by Seenion
3700 of the Lmtn Cods.for the performnnce'}'� ark rar which lhispemti((is issued. GAS—I!A.SYS'I'I?M-1 INC.G )TLE'Is OCC.GROUT' AI'N
My Wer .. y(rgrxajq Instl�utlgcyticQaRlly No, number am
MyCurritrWe: /M'J�f II GG /—(/X`� hh llcy Nu,: GAS—I!A.SYSTEM-OVER 4(VA)
CERTIFICATE OF EX17MMON FROM WORKERS'
COMPENSAHON INSURANCE GREASMNDUSTRL M'ASTE IN'TERCF,I'OR
BUILDING DIVISION LEES
D'M1it section mcA nm he mnnplaalil the P:nnit is fin nne hnuJred dnlLrm BIIXB GIIFAIETRAP
m E,) PLANCHECK PEE
I cenifytha in the per6rmanceoflhe work for whish this penal is issued,I shelf SEWER—SANITARY—STORM EA
z .2U114.
non employ any Ishan in any mr,a
anner ss to become suhjes,to the Workers'Cbmpcn. ENERGY FHE
salt,,.L�wsof California.Date WATER BEATEN WIVIiNTll31.1!C'I'k
O Applicant GRADING FHE
z
Nal ICF TO APPLICANT Film,making this Ccdificamof Raenptinn,you should WATER SYSTEM/TREATINO
F"r become subject m me Worked,Compensation f the Laron Code,you mus(( SOILS PEE
j pcnsu pnrvlsionao
fonho ith comply with such provisions or this panni((shall he deemed a%akcd. WATER SERVICE
Q
CONSTRUCTION NhF,NDINGAGIicCY NEW ItIiSID1iN'1'IALI'LMN. SQ.ItIL PAID
U O Dae H cipt p
I hereM1y off muM1a((hem is a amarvaion lending agency far the performance of
((he work far which this permit is issued(See.TOO.Civ.C.)
aO H Lender's Name T(ylAl,:
U Lenders Address TOTAL: _
1 terrifythat I have aid his ppi nation antiitl I flat the aboveinformation BUILDING PEI:
N correct,1 agree to comply with all city and e....11,ordamenot,s and ,;an law,alln' .n. QT'Y. "MIiCHANICALPERMIT FEE
U z build'ng nmttmction,end M1eraM1y uumorin npnw.ntaavwtfmise((y nn encs upon me SEISMIC FEE
idir ennen((inncd property for InNeC6on Purposes- PERMIT ISSUANCE
(We)agree to save,Icr mify and keep hannle..s the City or Cupertino againxn ELECTRIC FEE
n
liahilitiw.judgtnents,costs and expenses which may in any wary accrue againd said City ALTER OR ADD TO MECH,
in eanscyuenceadmegroat •af this penult.In FEE
AlPLICANT' U'k5' :AND WILT,COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(1'0 10,0100CFM)
II
SOURCE Ef 11 Df Mr;CIIANICAI.IEIi
v1AIR HANDLING UNIT(OVER I0,000CFM) CONSTRUCT ION TAX
Sig: d p u moor tare EXHAUSTHOOD W/DUCT) HOUSING MI'IIGAI'ION FEE
ARDOUS MA'1'F.RIAES DISCLOSURE
Willlber"d um or fuuw building bell qu.nill rcon,handle hamMoua morin HEATING UNII'TO 100,000 BTU)
as defined by the Cupertino Mhampal Code,Chapter 9.12.and the health and Safety
Cale,Scullion 25532(a)? HEATING UNIT(OVER I W.gXI NTD)
Yat IINt,
YEN'I'I IATIONFAN(SINGIEFUlSID PAID Date Receipt Is
Will the applicant or future building occupant use equipment or devices which
`I haOnl.....air cnnlnTinuont i dA,wd by he Ray Arcv Air QmJity Management BOILER—COMP(3HP OR IW.000 BTU) _ T
. troch! 11,0/'/ BOILER—COMP(OVER 100,000 BT U)
Yes
I have rcvd the hmsrduur martial,regnircmenb under Chapter fi95 nr the Cal i- Alli CONDI TONER ISSUANCE DA H
fomka Health&Saba, NEW r Sminr¢25505,25531 and 25511.1 mulemand Lha if((hc NEW RESIDENTIAL MECH. SQ,FE 2
building it ((cur utcwnt.that i((is my twpamibil'nym nmify theoretical, ( f l
"ImC atl lie ma priarm iparmee ora eenireana nr iVpaacy. 1
11
Own r ge Dae 'TOTAL:11 ISSUED BY:
OFFICE
DATE JOB N0. -
Consulting-Engineers and Scientists • 3 9 99
425 ROLAND WAY q PRRO Ecr qq
OAKLAND, CA 94621 � / 4,4 /A-1//P_ry L-5, 1d7 /-
(510) 568-4001 LOCATION
TO t< �»✓I�d/� . NCV, / I P L� 5 CO/N1TRACTOR O//W/NNER////
A 14
Date 311,J C-/(wel).• WEATHER TEMP. tf r
_ / L gat �AM-
10
i. C l y F rY - to *at 7)o PM
Hours Charged To Project z Nuclear Density Tests f>- RRESENT AT SIT .
l//
Field,Task Number 'T yI Concrete Cylinders p/(� ///v v
THE FOLLOWING.WAS NOT/ED: / ���- �y`//a•.`/cr� A
3,f t/i 5/+ld ra 7 tlf ol(y'S tP y[rP T 7T nJifbP / % f n7il�n Pyl atN9/7 �5
"i nn�TT �- 9r/d✓ Ti7 4012Ct-af //�04u6ca..t.-o�..T
ICPze�T r,e,;.J SGLawedS �L�wP /X.Arn.venlel ,6CrGn Q/a�l r� -y�✓�`,a.�/.n�i ./�xcFf(�4i7>ar..i5
G yr.� r�nM J5 --d4 ✓n!e/ AJ5t✓k( 0 1/N S 4eo4-r/N r�nj L7 �r eni%
l,, / t J rr / V ,
61AI.,4/L1.'/A I- ofd 51 y
r i•e , -nti c 7D✓ I(InTi' � ✓a n 2.w vC�l rP �ic7�.Pf G,, �t ��o SP
wv+A->/Zarlr I f/I 5h^�l/f✓n I i?AFf /��L SeviC Conic MGra✓ yCv�-rol.•P w��iy�J✓ GAo�2d �^J
i< stfn/.l A l J�B.nn r n/f-£t r/� rn��A 2x/�Cvid✓ r,�ri -/B /
„ ntrun5 .3y15ertiKl i�J e�� ��i'An�cP i iJh CurrenlT O�iRn�S y1 5nec5. aod7-e" ;/v)c I
/ y
�P/��iy�coww c� �{ATIo�S- (nAx�eF? 6440444'tn.Y' 7AlIA4 4k !te >o/Gwi lrr�li'/ ve -/QAC/rkK�
COPIES TO /:i./A�,/ lln!/n l�l — Ka /�u �y (�W /i MELS D fi[E/ L)OW7
SIGNED
CLIEN,1/
POPA ENGINEERS Inc.
PC STRUCTURAL ENGINEERING CONSULTANTS
(217-Y Q7F CU �T�h(C7
Ae: : 1cpr oft V&} -Z-E f
7Ss c�,crPy�,eMs MY If-20"C04-L AOR T?tc— USS
17fEOILUYV/�c�L Ct d� 7rf7 L ,� T C��wrL.D
S If�f1 77/Z- -1,L Sr-eXt
. $%1 L 1-14�-ZIHG
. 4- —7ri'4ZRr- P� Yarood
U \\ILCIL,AfF70
JUL 21 1999
BLDG, INSPECTION DEPARTMENT pQ�,NPS'S/01
CITY OF CUPERTINO
CZ) No. 5
m
Ems. /01 a
JAI9 WL
�OF CAL1f04
GOLDEN VALLEY OFFICE CENTER
.` 2542 South Bascom Avenue • Suite 102 • Campbell, California 95008
Phone: (408) 559-4202 • FAX: (408) 559-3628