26353 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOPERMIT NO.
APPLICATION/PERMIT PLUMBING.MECHANICAL26353
BUILDING DIVISION gU1LDING PROJECT IDENTIF'ICAT'ION
BUILDING ADDRESS: O D r SANITARY NO. APPLICATION SUBMITTAL DATE
VIA &&&7—
UNIT It M
OW E: A , HO C R'S E: LIC NO: 777F
CONTROL#
RC DTECUENGI EER: LIC NO: DDBESS:
CONTACT: HONE/ EC
QTY. TRIC PERMIT FEE BUILDING PERMIT INFO
AlLDGU MF.
PERMITISSUANCE JK
LICENSED CONTRACfORSDE L ON pppL1ANCFS-RESIDENTIAL J ION
IOmz Ihereby7")ofrmthaO 3 ofth Business nd Professions
Chapter sand my homse with �O
�i401al0 Semon]ped)of Division 3 of the Business and Rofcssions Code,aM my licene is in ppNglS
qd full force and effect.
F<F.z License Cleo Lo.is UPT0200AMPS s�
tn6y Dere Contrectm 201.1000AMPS
z OyaARCHITECTS DECLARATION OVER 1000 MM'S SQ.Ft.FLOOR AREA EISQ,FT.
O z--p I understand re plans shall be used m public records.
F .4 SIGNS ELECTRICAL
6Lined Professional
CY d cs6 OWNER-BUILDER DECLARATION SPECIAL CIECUITIMISC.
iyyiS5OyiU 1 hereby affirm that 1 am exempt from the Cantracrofs License Law for the
tLLO y following ousson.(Section 1031,5,Business end Profession Code:Any city m county TEMP.METIER OR POLE INST.
C ES E,.3 which requires a permit to construct,after,improve,demolish,or repair any structure
F Y� Four ro its iuusam.also requires theapplicaot fmsuch pemm mfileavilnedstetemem POWER DEVICESea. \
eat pC that he is licensed pursuant m the Provisions of the Ce Business
License Lew as Codm
so 9 thin he
e is exempt therefrom
iromandthe basis
Sof the Business end Professions Code) SWIMMING POOL ELECTRIC VALUATION
y or thin heia tempt Wercfrum and the berms(mthe alleged exemption.Myl panion of OUTLEfS.SWlTCHES.F
Section 7011.5 by any applicant for$Permit subjects dte applicant m a civil penalty of
na mom than Ove hundred Jollan($500).
tatuu $ ❑ I,unwork,auds,story,ormyemtendeeswiNwegeseade(Solecompemavoa, NEW RESIDENTIAL �' STORIES TYPE CONSTRUCTION
y3— will dorhework,enda:IT.Coreisnot is Lim.
a..apply
I.sa,Busi..f
and Rofessions Cade:The Contractors License Isw d«s not apPIY to en owner of
p..plhubuildsorimprovesthimprvmcnts «notch wofkhimselforthmug.hie OCC.GROUP RES.UNITS
ownemployees,provided Natouchent is sold
wit erenot intended mot&red farsale.If,
builder will
building or improvement is hold a didnoneyeu or improve for the owner
builder will hove the burden of proving that he did not build m improve for purpose of
side.)
0
e❑
, QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
convect w project(Sec.oano Business par Profusions Cade:)The Cher acmns
cLicenseontra Lewd«snot apply rokol.Business
rtywho builds Code:)
Ciercun,end PERMIT ISSUANCE
whocontractsforsuch project with acrmractods)licensed payment to the Contractors ALTER DRAIN&VFM-WATFA(EA) FEE SUMMARY
License Law.
❑ I am exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVIC IS, TY D N
Owner Date DRAWS-FL RCCEIPfp
WORKMAN COMPENSATION DECLARATION SCHOOI.TAX YN
❑ lhembyaffimthatlheveacertifcumofemsemmaelf-insum,oramrifimteof RECF.IPfp
Worken'Compitaimnlnsumnre ora cmilied copy,thereof(Sec.38M.Lab C.)which FIXTURES-PEARK FEE
T Y
covennll employee'sunder this permit. GAS-EA.SYSTI9M-1 INC.60UTLF"" • RECEIPT
Policy If ppAA �g BUIL DIVI51 ES
Company GAS-EA SYSTEMDA ��
❑ Cm ifiedcopy i.lumaby fundshM. PLA HECK FEE
❑ Certified copy is Bled with the city inspection division. GREASFJINOUSML WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(Thin sectionneednm be cumplmad ifthe permit is for ane htnduddo1lms(5100) SEWER SANITARY-STORM EA.200FT. ENF.RG
or leu.)
IcadFY thatin Ne performance of the work fmwhicM1 this permit isissued,lshall WATER HEATER WIVENTIELECIR
not employ any person in any manner
no e,in ecm
become subject to she Workeri P D
Comsonsatimtl-awsof Celifrmin. DureWATER SYSTEMTREATTNG pat Receipt#
O NOTICE APPLICANT:If,after matin Nis Cettifiwc of Exemption, AL:
z g p ion,you should NEW RESIDENTIAL PLMB.—SQ,FT.
f-� f/] becomeh comp to the such Pr Compensationorcs provisionof the Labor Code,you must
5'
forthwith comply with such Provisions or this pemdt shall be d«rued revoked. BUII.DINH
Q+ Q
CONSTRUCTION LENDING AGENCY SEISMI FTSE
Vz I hereby affirm that hem is a construction lending agency for the performance of
Q the work for which this permit is issued(Sm.309],Co.C.) TOTAL: ELE IC FEE
Lender's Nem,
I,,
Lenders Address QTY. MECHANICAL PERMIT FEE PLUMB ME r�
I,citify that 1 have reed this applicmion and state that she above information is
acorrect T agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANIC FEE
VJ buildingconsuuctiun,and hereby authorise rtpseamutives ofthis city roamer upon the CONSTRUCI'10 TA%
V 4 above-mentioned propmy for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and kap Initial.[be City of Cupertino agaimt
liabilities,judgmrms,cros ties saw hi6paymm,wa�eagyingsaid City AIR HANDLING UNIT(TO IT"CFM)
con of'
rusting oft I
AIR HANDLING UNIT(OVER 10,000 CFM)
Signiture of ApplicanUContractor EXHAUST HOOD(W/DUCT,
y ,/p-y PAID
HAZARDOUS MA'
RIALS
'SUM
HEATING UNIT(TO IOTW BTU) Dau mript#
Will the apolicant or forum building occupants ore or handle haean us normal ❑EATING UNIT(OVER 100,000 BTU) TOTAL:
ss defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cuda,Section 25592(#)9
0Yes 11 No VENTILATION PAN(SINGLE RESID)
Will thc$pplicanmrfuwrt buildingmcupent umequipmemordevices whichemit
BOILER-COMP(3HP ORB0,000 BTU) ISSUANCE Ir
ezmdom it connotations sa defined by the Boy Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
orcin]
C1 Yea El No
No NEW RESIDENTIAL MECH.—SQ,FT. P A O D
1 have read the Safety
Code,
materials requirements undo Chapter understood
of the Pi
if the uil Ninth&Safety Code,Sections 25505,t it
and 25534. 1 undo malt thm MAY 0 6
if the building a re not currently have a tenant that it is my nuance biliry a notify the 1994
occupant of the reyuiremenu which must or nut prim m issuance of a C,rtifica¢of a7s7
Occupancy.
Owner«authorlsedegem Date TOTAL: IS UEDB ter rU H )
I
• CitH of Cirperti»o
10300 Torre Avenue
Cupertino, California 95014
Telephone (408) 252-4505
DEPARTMENT OF PLANNING AND DEVELOPMENT
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May 25, 1994
TO WHOM IT MAY CONCERN:
RE: 10211 Hillcrest
• I was asked to inspect the property at the referenced address, and conducted that inspection this morning.
The addition appears to have been done in 1979, and,on visual inspection,appears to cont ply with
required codes effective at that time.
The building is finished, no rough frame, electrical, plumbing, mechanical or foundation inspections have
been performed.
CITY OF CUPERTINO
1
Jim Jones, Inspector
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JJ/cda
cc: file
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