28215 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDING-ELEC I RICA L PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL. 28215
HULLOING DIVISION BUILDING PROJECT IDEN'FIF'IC.ATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
(.- NUNIT# LOT#
ERS NAME: PHONE: C RACTOR'SNAME: LIC NO:
J s• NIC CONTHOL#ARCHITF:CGENGINIiL'R: t 1 LIC NO: AD F,£� § ) L, IL-- �` '� ❑
CONTACT: PHONE: `C] r V BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
B GLECT PLUMB MECH
PERMIT ISSUANCE I�TI/l_`.
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESMEM'IAL LOB DESCRIPTION
Metz I hereby offmuhat l am licensed underprommomofChupter9(commencing with � },/��
x0100 Section 700(1 Divisors3ofthe Businessand Professions Code.and my license is in PANELS �"��
I,ns�toCt,, full forcemd effect. h ♦ S��
h<ZW License Class Lic.# UPT020GAMPS IM_�_lO
may Date Comractm 201-111(7 AMPS �\(�
Z UyARCHITECTS DECLARATION OVER 101%1 AMPS SQ.Ff.FLUOR AREA $/SQ.FT.
O z'—'M I understand my plans shall he used as public records.
P:4C; SIGNS ELECTRICAL
s Licensed Professional
Cyee6 OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC.
NOp,F 1 hereby affirm that I am exempt from the Contractor's License Law for the
13 w following reason.(Section 7031.5,Business and Professions Code:Any citynr county TEMP.MEI ER OR POLE INST.
f�m j which requires a femur 10 construct,alter,improve,demolish,or repair any smictum
Y� prior m its issourta,ls0 requires the applicant for such Permit to file a signed statement POWER DEVICES
W 9O that he is licensed pursuant to the provisions of the Contmcmr a License Law(Chap...
uu � 9(commencing with Section 7")of Division 3 of the Business and Profession.Cade) SWIMMING POOL ELECTRIC VALUATION
W—.m ort hat he is exempuberefrom and the basis fmnbeallegW exemption.Any violmion of OUTLETS SWITCHES-FIXTURES
t:K. Section 701 IS by any appmi
licemfar o Faced,subjects the applicant to a civil penalty of
Cpnot..ort than five hundred dollen($50o). NEW RESIDENTIAL ELECIR 5 FT.
❑ Lmownerofthcproperty,ormy<mployceswi,h wagesastheirsolecompemeton, Q' STORIES TYPECONSTRUCI'ION
willdo the work,and the smactom is not intendedor offered forsale(Sec.7044,Business
end Professions Codc:The Commetor's License Law does not apply to an owner of
propeny who builds or improves thereon,and who does such work himselfor through his
ownernmol,tox,provkhad urenot intendedmofferelfmssle.If. OCC.GROUP RES.UNITS
however,the buildingor improvement is sold within one yearofcompletion,the owner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
Bale.).El QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
the project(Sec ]044Business and Professions Cw1eJ This Co 's
Lbomme Lapplyoanneofmeny whsarim Nearn.mad
PERMIT ISSUANCE
whums for such projects with aconuacmr(a)icearealpmuunt tothe Contractor's
Licence Law. ALTER
ENT-WATE (CA
) FEE SUMMARY
❑ 1 um exempt under Sec. ,B&P C for this ruson BACK FLOW PROTECT.DEVICE OUTSIDE FEES
SANITARY Y N
Owner Dam RECEIPT#
• DRAINS-FLOOR.ROOF,AREA,COND.
WORKMAN COMPENSATION ofem DECLARATION SCHOOLTAX Y N
❑Workers
reby Compenrmthatlhave a rance ora sande copythereof(sent to ec.38,or Lab C.)which
RECF.IPfp
FIXTURES�PER TRAP
Workc,i Compensation lnsumnceorucereified copy Hereof(Sec.3gW,Leb CJ which PARK FEB Y N
rs all employee's under this permit GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIPT p
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cenieed copy is hereby famished.
❑ Certified copy is fled with,he city inspection division. GREASEIINDUSTRL WASTE,INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(For section need not he completed ifthe permit is fnesue hundred dollars Pi 100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or less.)
Icmifytha,in the perfonnanceofthe work for which this permit is issued,].hall WATER HEATER W/VENT/P,LECI'R
me employ any,person in any manner so as in become subject an the Workers' PAID
Camommuonlswsof Cilifarrou Data WATER SYSTENUTREATING Data Receipt It
Q Z Applicant
z � NOTICE TO APPLICANT:IL after making this Ceni,icate of Exemption.you should NEW RESIDENTIAL PLMR. SQ.FT. TOTAL:
!— p] bestramo ocem the Worker's Compensation provisions of the Labor Code.you must BUILDING
5: forthwith comply with such provisions or this proadishill be deemed revoked.
Z
CONSTRUCTION LENDING AGENCY SEISMIC FEE
'I hereby affirm that there is acnnstrmtion lendingagency for the perfirmunce of
U O ,he work for which this permit is issued(Sec.3097.Civ.C.) TOTAL: ELECTRIC FEE its
Lender's Name PLUMBING FEE
W U launders Address QTY. MECHANICAL iRMIT FE
I certify that I have read this application and state that she above information is MECf1ANICA FEE
0. comet.Iagree mromply with all city and county ordinances and state laws relating to PERMIT ISSUANCE
building construction,and hereby authorize representatives ofthis city[center upoods, CONS NT
U ,Z above-mentioned property for inspection purposes. ALTER OR ADD TO MECH.
(We)agate to save,indemnify and keep harmless Ne City of Cupertino sgt i ist
liabilities.judgments,casts and expenses which may in any way accrue against said City AIR HANDLING UNIT(TO 10. CFM) Is
inconsequence ofihe granting ofthis permit.
( �#26 AI ANDLING UNIT(OVER 10,
Signature of Agpli,an/Corarman Date EXHAUST HOOD(W/DUCO
f{gZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO 100.0th BTU) D e Receipt#
Will the applicant or future building occupant store or made huvtrdous mmeriul HGTING UNIT(OVER 100'"BTU) TOTAL:
as defined by,he Canaria.Municipal Code.Chapter 9.12,and,he Health end Safe,y
Code,Section 25532007 VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE T'
Will thea licuntor future huildin cu w,nsfe mi tordevices which emit BOILER-COMP(3HP OR Ifp,1100 B'IL) pp��
hazardnas air conmminums as defined by,he Bay Ares Air Quality Management BOILER-COMP(OVER 100,000 BTU) � ' !f
Disbar,?
❑Yes ❑No NEW RESIDfINT1AL MECH.—SQ. �"M 28
1 have read the hazardous materials requirements under Chapter 6.95 of the 19��
Cnlifnmia I,sari&Safery Code,Sections 25505.25533 end 25534. 1 understand,hat I Y
if,he building does not currently have o mount,that it is my responsibility,to notify the
occupant of the requirements which must be mit prior to issuance of a Certificate of Ur UUf Lj�
Occupancy.
Owner or anthmizeJ agent - Date TOTAL: ISSUED BY:
OFFICE
SEVILLE PROPERTIES INC TEL No . X108 257 0792 Jun 09 .95 13 :52 P .03
86/89/1993 12143 PKUm PUrH FHO1N68m3 S.B.G. TO 23T8T92 P.01
POPA ENGINEERS Inc.
' pmMew STRUCTURAL ENGINEERING CONSULTANTS
dL�
JUND13 1995
BLDG. INSPECTION DEPARTMENT 8-2t-legs
city of Cupertino
Building Department CITY OF CUPERTINO
Re! Residence at 881 Lily Street
As requested, I visited the residence located at the above
referenced address. The scope of my visit was t0 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 2x8 dfs2 at 24" o.c.
rafters. Ceiling is supported by 2x8 ceiling joists at 16"o.c_
The maximum rafters span is 7'-8" and the maximum ceiling
jcist 's span is 111-0". 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 2x8 dfN2 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 alsctrical outlets 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 sighs of weakness during;
it 's life. It is my opinion that this addition was built with
the same standard of care like the root of the house.
Based on these faets; .1 recommend the approval of the final
inspeotion•
This is a professional opinion based on a visual inspection.
It was formulated in accordance with the principles and
practices of the- Civil Engineering profession.
N y is inferred or implied beyond what is expressly
as+oy�
o$e P v
�d a any questions regarding this letter, pleaco do
c o heait , o contact me.
I No.COM40
. .I * Exp. 3l31fp "
Crvll
Ar6 GOLDEN VALLEY OFFICE CENTER
aacom Avenue • Suite 102 • Campbell, California 95008
Phone: (408) 459-4202 " FAX: (408) 559-3628
1
TOTAL P.61