24377 .,AP-PiACANT TO FILL IN INFORMATION WITHIN RFD LINES — USE BALL POINT PEN ONLY
B 2Building Project Identification PERMIT NO.
me.A0rs Y0aame:o �kwsamr 24377
one:
CITY OF CUPERTINO-BUILDING DIV SION /O�1��
C crux.Name: L LIc.Ncx APPLICATION f P l
1 ^a BULLDING-ELECTRICAL.PLUMBI EAMCAL CATEGORY CO
N
A to is neer. Lio No:
QTY ELECTRIC RM FEE BUILDING PERMIT INFO
Add $` Vg% PEtMITISUANCE ��� ❑ ❑
LICENSED CONTRACTOR'S DCIARATION
me
I hereby afflrmthat hem homed under provisions of Chapter9(mmmmc- APPLIANCES L � w JOB DFSCREsTION
IngwithenseI In
to.and ision
the Buelne,eand ProfessioneCode,and my Y 1s"�D���
Llano ie hi s form and c.1 YY
LicenseCbss LI.M h
Date Cordrador
ARCHITECTS DECLARATION Ai
q�q�uu aO Zp I understand my plans shall be used as public records. V AMPS 'SQ.Fr.FLOOR AREA S/SQ.FT.
FL �j Licensed Professional 4kNSE 7RI tiiC 2 �/.
fn 6 kldu OWNER-BUILDER DECLARATION SI'ECUL (n U J CJ
ZL, 7� Iherebyaf@m that l am exempt fromthe Contradora License law fm the
o following reason.(Sectim 70715,Business and Professions Code:My ctty or
F000nlywhldrrequ4 apemdttommtmMaltn,lmpmve,demolleh,mrepalr TEMP.M RI'OLE $T.
E < anystmc mprior Witebwance,alwrequlreslheapphantforeuchpert ttu POWERCES
V file a signed statement that he Is licensed pursuant to the provisions of the
Contractor's License law(Chapter9(comnendng with Section 7000)af Divi- gwA{hBNC LELECTRIC - VALUATIO,yssasa
�0 3oftheBusinessandPodenlonsCode)orthatheIsexempttherefmmand
the Lash for the alleged exemption. Any violation of Section 7071.5 by any 1 e'
G appli..tfor.per tsubJ,UtheappOc..tt..dvllpenahy f.amerethan �'�' ICHESEXTIIR7S `
flue hundred dollars(550 . NEW RESIDENTIAL ELECTR
nI,as owner.f the property,or my employees with wages as thelrsola c-Q'FI. SIl7Rl[S TYPE CONSTRUCTION
compensation,will do the work,and the structure Is not intended or offend for
O .le(Sec.70M,Bushes ad Professions Code:The Contractors License Law
s$ does not apply to an owner of property who builds or Improves thereon,and OCC.CROUP RFS.AMTS
who does suchwork himseltor through his own employees,provided that such
improvements arena Intended oraffemd fm,ale.It,howeveq thebulldingor T
improvement Iswldwthinoneyearofcomphe Wb thewvner-buMerwill7 ve
snotprovingthM he did nabuildcrlmprovetmpurpose.f.b.). QTy, PLUMBING PERMIT FEE FLOOD TONE APN
h as owner of the property,am exclusively contracting with licensed
onto mruwa the project(So.7064 Buchem and Professions Code: PERMIT ISSUANCE
C.Mdor's License law doe,not apply to an owner of property who
Ilds or Improve theorem,and who contracts for such proJem with a ALTER-DRAIN&VENT-WATER
cqaqador(a)licensed pursuant to the Contractor's License Law. FEE SUMMARY
LJ I am exempt under Sep B &P C for this reason BACK FLOW PROTECT.DEVICEOUTSIDE FEES
DRAINS FLOOR ACOP,ARCA,COND. SANITARY Y N
Owner Date RECEIPT N
WORKMAN COMMSATIONDECLARATION FDCrURE.S PER TRAP SCI{COL TAX Y N
C31 hereby affirm that I have a mdifiate of consent to selfdnuare,m. RECEIPT46 N
ttAiflmtea(Workers'Compen timlmuranmoramrtified mpythereof(SM. GAS EA.SYSTEM-1 INC./OUTLETSder PARKFEE Y N
3800,lab C.) RECEIPT N
Policy N
Com ny GAS EA.SYSTEM-OVER6(EA) BUILDING DIVI ION FEES
1 0C,mBI,d copy is herebyfurnished. CREASE/INDUSTRL WASTE INTE2CE'TR PLANCHECKFEE ..11
❑CertRied ropy b(Bed with the city Inspection division.
E
CERTIFICATE OF IXQa1PTION FROM WORKERS' CREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Date Recti t#
(Thissection need not be completed If the permit is forces hundred dollars
(f10Wotifyth in WATFRHEATERW/VENT/E.ECTR ENERGY FE Y N
(certify thatothe person
In oftheworksorwMshthispermsIc issued,
Isbell not employ any perwa f any manner so u to become abject to the WATER SYSTEM/TREATING
worker:campen,anen Law.of California.Date PAID
O Z Applicant NEW RESIDExnALPLMB. SQ.Fr. ate Recei t#
Z 2 NOIICETO APPLICANT:B,after making this CertlTWte of Exemption,you
should become subFaT to the Workers'Compensation provisions of the Labor TOTA '
CCy Code,you neat forthwith comply with such provisions orthb permit shallbe
W C deemed revoked. '
a CONSTRUCTION LENDING AGENCY I$ IC FEE
I hereby affirm that there b a mmsbudlon lending agency forthe perftm, ELE RIC FE
M Z anm of the work forwhlch this permit is issued(Sec.3097,CIv.C.) TOTAL
II
00 Leaders Name PLUMBINGF E
LL F- Lender's Address QTY. MECHANICAL PERMIT FEE MECHANI L FEB
OW I mrtifythatl have read thisapplimtlonand statethattheebove information
1 bmrmd.I agreeto complywilh all city and county ordinances and slate laws PERMIT ISSUANCE FEES PAID:
relating to building construction,and hereby wthmfu representatives of this
I" Z dtytoenter upon the above-mentlooudproperty forWpectionpurposa. ALTERORADDTMECH. Dale Recti t#
(We)agree to save,)ndemNfy an d keep harmless the City of Cupertino
L) agalnstl WUm,jad n ,cora expenses which may in anywayamue AIR HANDLING UNIT(f010,000 CFM) � � SUBTOTAL:
agal e d In e f the granting of this t.
AIR HANDLING IRgH'(OVER 10,030 CFM) CONSTRU NTAX
SI tore of Applicant/Contrador Dat EXHAUST HOOD(W/DUCT) CON$TRUCTI NTAX PAID:
11 HAZARDOUS MATERIALS DISCLOSURE j 7A
Will the applicant or future building omvpant stare er handle haurcious HEATING UNIT(TO 100,000 B'IU) Date RCCCI [#
material as deflacd by the Cupertino Municipal Cade,Chapter 9.17,and the -
IleaithaadSatetyCode Section 29533(a)7 HEATING UNIT(OVER 100,000 BTU) T A
❑Yen No VENTILATION FAN(SINGLE REBID)
Will the applicant' tum building occupant use equipment or devices ISSUA CE DATE
which emit haaardous air wntaMrants as defined by the Bay Area Air
Quality Management District? BOLLFR-COMP OHPOR 100,000 BTU)
Yes ❑No
4haveres
dthe hazvdousmaterials requirements under Chapter 6.95of BOILER-COMP(OVER 100,000BTU)
the California Health&Safety Code,Sections 75505,75533 and 25536.1
understand that if the building does not currently have a tenant that it b my NEW RESIDENTIAL MECH. SQFT p's p
responsibility to notify the occupant of the requirements which must be met P PO I
prior to Issuance of a Certificate of Occvpa ncy.
Owner or authors da agent Date OCT 21 1992
B TOTAL: ISSUED BY:
,jilt VrvUrrniniv
OFFICE COPY
CUPERTINO SANITARY DISTRICT
SANTA CLARA COUNTY
DISTRICT MANAGER-ENGINEER 20088 STEVENS CREEK BOULEVARD. BLDG.C BOARD OF DIRECTORS
• MARK THOMAS B CO. INC. CUPERTINO, CA 08014 RICHARD A.FELLOWS,.nm
ROY M.RUSHTON.s ,
DISTRICT COUNSEL PHONE(408)253-7071 FAX(408)233.5173 WENDELL H.KERR.JR.
PHILIP D. ASSAF OF CURTIS B.HARRISON
STURGIS, NESS. BRUNSELL B DR.JOSEPH F.BROWN
SPERRY
October 22 , 1992
File: CuSD - MOP
Building Department
(Cupertino)
Mr. Jerry Brager
Building Department
City of Cupertino
P.O. Box 580
Cupertino, CA 95015
Re: Addition/Residence, 10200
Hillcrest Road, Cupertino
Control #7119 Permit #24377
(APN 326-16-007)
• Dear Mr. Brager:
Based on the proposed improvements, as shown on the plan
submitted to this office on October 22, 1992 , no additional
fees or permits are required by the Cupertino Sanitary
District.
Yours very truly,
MARK THOMAS & CO. INC.
District Manager-Engineer
by William E. McBee
WEMc: lw
•
SUPPLYING SANITARY SEWERAGE SERVICES FOR:
CITY OF CUPERTINO, PORTIONS OF THE CITIES OF SARATOGA. SUNNYVALE AND LOS ALTOS
AND SURROUNDING UNINCORPORATED AREAS