28170 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 281
^yV( '.1 a O
APPLICATION/PERMIT PLUMBING-MECHANICAL L
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION L
• BUILDING ADDRESS: SANITARY NO, APPLICATION SUByMIITTTAL.DATE
V UNIT# LOT# -
OWNF,RSNAME: PHONE: CONTR OR'. NA LIC NO: \O JJ
CNn
NIC CONTROL#
ARCHITECTIENGINEER: LIC NO: ADDRESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG EL PLUMB q\QLD
LICENSED CONTRACTOR'SDEPERMIT ISSUANCE.CLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
gUCC Ihcreby affirm ofDivihm l 3 of
ied Business
isions ons Code,
(commencing with
Is10t0 full Section of Division3of the Bosinees and Pretensions Code,and my license is in PANELS
Fy UrJ
fullfumeCEdeffxt.
RR�yw License Class Lic.# UP TO 200 AMPS
y=y Dale Contractor 201-TOM AMPS
F'ooZ ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.FT.
CZZ=o I understand my plans shall be mad us pnblle records. OVER IOW AMPS 1 /s it
qI&
1--41; SIGNS ELECTRICAL / ynrN
Licensed Professional
al LLL V cni �.l V V
E'lQ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
O V I hereby affirm that 1 am exempt from the Contractor's License Law for the
3 vFi following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
which requires a permit to constrain,alter,improve,demolish,or repair any snuctare
Y� poorroitsissuanee,alsorequires the applicant!orsuch permit m rile asignW statement POWER DEVICES
p0 that he is licensed pursuaano the provisions of the Coatmcusee License Law(Chapter
W o�' 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
.,y or that he is exempt therefrom and the basis for the alleged exemption.Any violation of
h. a Sectio 703v15e byenyapplicant forapermitsubjems the applicant to a civil penalty of OUTLETS
a^S 0 not om than five huodrcd dollars($500). 1
refthepropenemas
y,manyploManwith wages theirsolecompensation, NEW RESIDENTIALBLECTR _SQ.Pf.
oSTORIES TYPE CONSTRUCTION
a20 it do the work,andthe structure is not inandedoroffered forsale(See.7044,Business -
e Professions Code:The Contractor's License law does not apply to an owner of
ropeny who builds orimproves theme.,and who does such work himselforthrough his
own employees,pmvided thatsuchimprovemers arenot immidedoroffered forsele.If, OCCGROUP RES.UNITS
however.the building or improvement is sold within oneyear mfcompletion,the owner- y
badder will have the burden of proving Char he did not build or improve for purpose of
a.).
❑ I,as ownerofthe properly,amexclusivelycontracting with licensed contractors to QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
construct the project(Sea 7044,Business and Professions Coda)no Contractor's
License Luwdoes nor applyman ownerofproperty who builds orimprovestharson,end PERMIT ISSUANCE
who contracts for such projects with acontracmr(s)licensed pursuanrmrhe Contractor's ALTER BA FEE SUMMARY
License Law. (' )
❑ 1 van exempt under Sec. B&P C for this reazon BACK FLOW PROTECT.DEVICE - OUTSIDE FEES
SANITARY Y N
Owner Data pRAINSFLOORROOF, CONE. RECEIPT#
- , , , .
0
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Thereby.M.tharlhaveawrtifleamofwnsennoself-Insure,eracertificateof FIXTIIRPS-PER TRAP RECEIPfp
Worker%Compensetion lnsutaneeoreeenlfiW wpy thermf(Sec.3800,Leb CJ which PARK FEE Y N
covers.11 employee's under this permit. GAS-FA.SYSTEM- INC.4 OUTLETS RECEIPT 4
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cenlfiodcopyishaebyfnmished.
[I Caddied copy is Bled with the city inspection division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This saakniteed not be completed ifthepermit is for one hundred dollar,($100) SEWER-SANITARY-STORM EA.200FT. ENERGYME 1 O
or les'.)
L
I certify that in the performance ofthe work for which this Permit is issued,l shall WATER HEATER W/VENT/ELECM
not employ any person m any manner so vs to become subject M, he Workers' PAID
Compensationt-awsof Califomia. Date WATER SYSTEM/I'REATING Dna Receipt#
7-+ Applicant
NOTICE TO APPLICANT:If,after makingrhis Cenifictur of Exemption,you should NEW RESIDENTIAL PLMB. SQ. TOTAL:
t~ OJ become subject to the Worker's Compensation provisions of the Labor Code,you must
1 forthwith comply with such provisions orchis permit shall be domed revoked. UILDING FEE
W Q CONSTRUCTION LENDING AGENCY SE IC FEE
z I hereby affirm ThatThem is a construction lending agency for the performance of
(� Q the work for which this permit is issued(Sec.3097,Civ,C) AL: EL E IC ME LA 01-,
Lender's Name
O H Lender's Address QTY. MECHAN Al.PERMIT FEE PLUMBI G FEE
V I certify that I have read this application and state that the above information is
'" correct.I agree m comply with all ciry and county ordinances and state laws relating to PERMITISSUANCE M HANK FEE
�+ building construction,and hereby authorize representatives of this city to enter upon the C NSTRUCTI TAX
L) 'Z above-mentioned properly for inspection purposes. ALTER OR ADD T MECH.
�--� (We)agree to save,indemnify and keep harmless the City of Cuperino against
Iinbilities,judgments,cons and expenses which may in any wayaccrue against said City AIRHANDLINGU IT(TOIO,000CFM)
to onsequence of the granting of this tmir.
6 AIR HANDLING U IT(OVER IO,000 CFM
$ignemre of Applicata/CmntOr I y Date EXHAUST HOOD( /DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO 00,000 BTU) Date Receipt#
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVE IW,O00 BTU) TOTAL:
Code,Section 25532(a)'1
❑Yes 12 No VENTILATION PAN(SIN ERBSID)
ISSUANCE DATE
WilHhea licanmrimure buildin yuipmen BOILER-COMP(311P OR IOD, BTU) ts�
azardous air contaminants az tlefine0 by the Bay Ares Air Quality Management BOI
LER-COMP(OVER 100,000B
R 100,000BDisWn9
❑Yes ❑No NEW RESIDENTIAL MECH. 09199
I have read the hazardous materials requirements under Chapter 6.95 of the f v�
5
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that I
if the building does not currently have a tenant,that it is my responsibility to notify the M�f Y LVN
occupant of the requirements which must be mel prior to issuance of a Ce tificate of
Occupancy.
Owner ,or authorized agate pate TO ISSUED BY: O/
OFFICE
05/22/1995 15153 FROM POPP ENGINEERS 5.E.C. TO 2570792 P.02
r
POPA ENGINEERS Inc.
.
=Pme
STRUCTURAL ENGINEERING CONSULTANTS
City of Cupertino 5-21-1995
Building Department
Re: Residence at 881 Lily Street
As requested, I visited the residence located at the above
referenced address. The scope of my visit was to inspect and
evaluate the condition . of the room added to the residence
without the benefit of a building permit . The entire residence
is an one story building. The roof consists of wood shakes
over skipped sheathing and supported by 2x6 dfir2 at 24" o.c.
rafters. Ceiling is supported by '2x6 ceiling joists at 16"o.c.
The maximum rafters span is 7'-6" and the maximum ceiling
Joist ' s span is 11 '-0" . Both or them are structurally
sufficient . The exterior walls are made of 2x4 studs at
16-o. c. and covered with 7/8" stucco over paper. The floor is
made of 2x6 df#2 floor joists over girders. The added space
is a study room. All it 's structural members match the
' preexisting members of. the house. There are no mechanical
fixture involved and the electrical outlets appear to conform
with the UBC requirements.
There were no signs of any distress in any part of the
addition or along the joint between the preexisting and the
addition.
The addition was done prior to 1969 when the actual owner
purchased the house.
This addition resisted several small to significant
earthquakes without any noticeable signs of weakness during
it ' s life. It is my opinion that this addition was built with
the same standard of care like the rest of the house.
Based on these facts, I recommend the approval of the final
inspection .
This is a professional opinion based on a visual inspection.
It was formulated in accordance with the generally accepted
principles and practices of the Civil Engineering profession .
No warranty is inferred or implied beyond what is expressly
written.
Should you have a ions regarding this letter, please do
not hesitate to10
�6�SipA
c p
John P. Pops ' cr" Nc•Co38 ECHWE
Qvill JUN- 91995
�gTFC%'C.4LiFC���
VALLEY OFFICE CENTEALDG. INSP�TION DEPARTMENT
2542 South Bascom Avenue • Suite 102 • Campbell, Chli k " 7500088
Phone: (408) 559-4202 • FAX: (408) 559-3628
05/22/1995 15:54 FROM POPR ENGINEERS S.E.C. TO 2570792 P-03
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TOTAL P.03
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RECIEHE
JUN -91995
RLR . INSPECTME14T
CITY P9I�E�ftid0 —