24557 APPLICANT TO FILL IN INFO IITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 1I111l1l M ILDI C- .LF.LTRICAL PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 24557
BUILDING DIVISION BUILDING PROJECTIDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATIOIN�SUBMIIIT/IA�LDATIi
rr Z19Z5 •'I�V �`V♦ UNIT# LOT# ��/✓•La'/
OWNE S PNF.: .} PHONE' CONT "BLM
CR V CONTROL#
�ARCHITLCT/ENGINEER: LIC NO: A ESS:
CONTACT: PHONE: ILDING PERMIT INFO
Q7-Y. ELECTR
ELECT PLUMB MECH
PERMIT ISSUANCE ❑ ❑LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDpyZ I hereby affirm Beat l am licensed under,mvisionsofChapher9(cnmmencingwidtJOB DESCRIPTION,s100 SellfocM�lofDivision 3.f the usiwss and Professions Code.soil my Bireme is in PANELSlr� 1 pN�T
FuL Z cc Lic. UP Tp 2W AMPS
y=y alts ` 201-Iqq AMPS
1-'rnZ RCH[ ECLARA'TION SQ.FT.FLOOR AREA $1SQ.Cr.
p0-m.0 I undemnnd my plans shall as publicretools. OVER INS)AMPS
P=n F m SIGNS ELECTRICAL
Qy2j LicensM Profeasinnal
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
OaO 1 hereby affirm that 1 am exempt from the Contraam's License Law for the
W3LLy following maum(Seetion 9031.5.Business and Professions Code:Any City rr county 'ILMP.METER OR POLE INST.
which requires a permit to Construct,alter,improve,demolish,or mpair any sanctum
'W}7 Prior,,it'"tance,also relm.,meapphenal forsuch per.it file.signedna¢mem POWER DEVICES
,=<O that he is licensed pursuant to the provisions of the Contmcmr.s License Law(Chapter
a XOLL 9(commencing with Section ACKBOf Divismn 3Ofthe Business and Professions Codd SWIMMING POOL ELECTRIC VALUATION
m—In ,,ohm he is exempt therefrom the basis for Inc alleged eaemptinn.Any violation of A 1 OO O 1
p-Za Section 7031.5 hyany applicant for a permit subjectslhe applicant to a civil penalty of OUTLETS-SWITCHES-FIXTURES V
nm more than f vc hundred dollars(SSq)).
e: ❑ I,asownerofthepmpeny,mmyemployeeswithwagesastheirsolecompensmion, NEW RP.SIDENTIALELF.CTR _SQ.FL STORIES TYPECONSTRUCTION
will do thewmk,and the stmcture is not irendedoroffered f.rsale(SCe.7014,Business
and Professinns Cole:The Commemrs License[.aw does not apply m an Owner of
progeny who builds or improves thereon,and who does such work himeelfonhrough his
ownemployces,pravided that such improvements smart intended oroffcred for sale.If, OCCCROUP RM,UNITS
however,the building or improvement is sold within one year of completion,theowner- TOTAL
builder will have the burden of proving flet he did not build or improve for purpose Of
OR.).
CI1.issuance.Dm
he properly.aexclusively contracting with licensed contractors m QTY. PLUMBING PERMIT FEE ------FLOODZONE APN
comma the pmjmt(Sec.7(344,Business and Professions Coal The Contract.-
LicenseLaw doesnot apply toanowner of properly who builds or improves thereon,and PERMIT ISSUANCE
who Contracts for such projects with a commelo(s)licensed pursuant to the Contractor's ALTER Law. WATER(EA) FEE SUMMARY
❑ 1 am exempt under Sec. B&P C fm Bhis reason BACK FLOW PROTECT.DEVICE OVTSI E FEES
SANITARY Y—N—
DRAINS
Owner Dam DRAINS-FLOOR,ROOF,AR G,GOND. RF,C APT#
IO
WORKMAN COMPENSATION DECLARATN SCHOOLTAX Y N
❑ l hereby affirm that[have acerifcale ofconum teself-insure10XTURFS-PER TRAP oracenificmeof RECEIPTIt
Wodcts'Compenammn Insurance.,ucenified c.pythCmaDSec.3WM.Lab C.)which PARK FEE y ry
oven all employ..ander,his permit GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIPT'p
1 obey#
Company BUILDING DIVISION FEES
GAS-EA.SYSTEM OVER 4 UTA)
❑ Ccnificd copy is hereby famished. PLANCIIECK FEE
❑ Certified copy is filed with she City inspection division. GREASEVINDUSTRL WASTE INTERCEPTOR GRADING ITE,
CERTIFICATE OF 122XEMMON FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
('this union need not be Completed Ube#remit is fmone hundred d.11.(SIM) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
ar less)
Ice ' IrxT pert coffl workfor, thisperrojejunon,Tshall WATER HEATER WNENT/ELECTR
1.nm e y rs s subject t.the Workers' PAID
' n lawsnfC ifomia WATER SYSTGM/1'REA'rING Dale Receipt##lien �
zQ NOTICETOAPPLICANT:ILaRcfmakin i nificnc of Exemption,youshould NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
F (q become subject no the Worker's Compensa )) sons efthe Lubar Code,you moa
� � forthwith comply with such pr.vixi.nso ix jleanillshallbedeemcdoevoked. BUILDING FEE 2 ,�.
Q CONST RUCTION LENDING AGENCY SEISMIC IT17
z I herehy affirm thanhere is a conswai.n lending agency I 'he performance of
V 0 the work for which this pemtit is issued(Sec.3097,Civ.CJ TOTAL: ELECTRIC FEE
Lender's Name
U1<naers Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
�'s C1J Chance
I certify that 1 have read this application and ,are that the uhnve inforimelinn is 0.. urrca. Ingrec to comply with all city and county ordinances and state laws relating m PERMIT ISSUANCE MECHANICAL FEE
UZ Mono,-gumsvuctinn,nnd Far hyvummiee rovoc,netives.fLeiscigl.cnter upon the
L) z above-mentioned property for inspection purpose' ALTER OR ADDTO MECH.
CONSTRUCTION TAX
(We)agree armless the City of Cup'n 'ain't
liabilities ' n sex which ayinanyw acemeagainstmid City A IR HANDLING UNIT(TO 10,M0 CFM)
Co ftheg. this p.
AIR HANDLING UNIT(OVER ILOW CFM)
ngnanrcof AMlichaV omracmr Date EXHAUST HOOD(WNUCn
PAID
HAZARDOUS MATER AIS ISCLOSURE HEATING UNI T('1'O I iLOW BTU) Date TJ
W ill the appli not or furore building necapant store or handle hartmims material
as defined by flu Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100.000 BTU) TOTAL:
Code.Section 25532(.)7
❑Yes ❑No VENTILATION FAN(SINGLE RL'SID)
Will theapplicaut Or future building,,ccupam teeequipmernordevices whichemit BOILER-COMP EBIP OR 100.000 BTU) ISSUANCE DATE
hate
Distinct, BOILER
air contaminants as defined by the Bay Area Ab Quality Marege..t BOILER-COMP(OVF,R I W.IXq BTU) p{k
❑Yes C3 No pY
ID
NEW RESIUEM'IAL MECH. SQ.FT.
1 have read the hmadous materials requirements under Chapter 695 of the - • 1992
California Health&Safety Gude,Sections 25505,25533 and 25534. I understand that it'the building does not currently have a termnt,that it is my responsibility to notify the ecupant,,f the mr,ma mems which must be mn prior Bo issuance ofa CenifcaleofaC.paney. U�—OwnennamhmiCd agent Date TOTAL: ELDEC
OFFICE
.��
V MELVIN R. HILL, INC.
R.C.E. 19704
142 KENNEDY AVENUE
CAMPBELL, CA 95008
408-866-1546
FAX 866-1375
92090
9 December 1992
Building Department
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Dear Sir:
We have inspected the chimney being repaired by Ernest Ruffo
Masonry Company at 21925 Hyannisport in Cupertino, California.
• Two rebar were installed with the construction of the brick
fireplace and chimney. Two additional 1/2 inch rebar will be
installed adjacent to the flue liner. This will be done by
using epoxy. The chimney has a metal strap around the rebar
and is tied to the rafter with two 1/2 inch bolts.
I have approved the construction to continue, subject, of
course , to your approval . If you have any questions, please
feel free to call me at my office.
Q�pFESSIpH{
Yours truly, O N R, A <e`
,7aa 9i
" Exp. Sep. 30, 1993
Melvin R. Hill
R. C. E. 19704LJCLI*
EDE# FE
. 0 1s9� D
BLDG. INSPECTION DEpA
ort OE OPQNQTMEn
DEC - 1 2 - 9 2 s - 1 3 1 2 P . 02
rvf�
NEwbta ice: «
FVZ
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V. EPca�
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• rLU6 ^j
B4
1 1992
BLDG. INSPECTION DEPARTMENT
CITY OF CUPERTINO
SECTION A - A.`
l�� `� •lam �rn1.1, w No. 19,104 '7l'
Exp. Soo. 30, 1993
c� si�aP 3�a x x iB; P 332 2440
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