28430 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERNU I N0. 2 8 4 3 0
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.-MECHANICAL LJ{
BUILDING PROJECT IDKN'I1PICA'I'ION
BUILDiNGGjA�DDRLSS: , / p�♦ SANITARY NO. AP/P/LLICATTIIO�N SUBMITTAL DATE
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UNIT p LOT X
OWNS N1Me: P F: CONTRfCOR'S NA
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A H BLT/ENGIN"R:h0q1 0AJ U ADORI:SSOAAIM : ❑ ` l�V r
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CONTACT: PHONE: `
QTY. ELIiLTRIC PERMIT FEE BUILDING PERMIT INFO
BLDLfF PLUMB MCCII
PERMIT ISSUANCE MECH
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL /•
p pA Z, I herebyuffirm Nat l am iicenuduaderprovisionsol'Clupter9(commencing with Se
Y100E Swoo1.0of Division Softhe Business and Professions Code,andmy license is in PANELS
�zU full"force and affect. I
Q License Class hic.p UPT02W AMPS
yr Q y Dam Cmarsee m 201-I"AMPS
Z Oy ler. ARCI I ITECI'S DECIARAE'ION OVER IOW AMPS SQ.FT.FLUOR AREA S/SQ.Fr.
OZ-0 lundersmnd my pleas shall he used as public records.
r"�nd�w LiccnuA Pmlessionnl SIGNS ELECTRICAL /r`11g1.7X1
c,yckQ OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC.
XOaF 1 hereby u1Hnn that 1 am exempt from the Contractor's License Law in,,the
Q': imQ following reasnm(Secti�n]031.5,Bminess wJ Professions Cale:Any city or county TEMP.METF.RORPOLCINST.
1.'�' J whirM1 requites n permit re constmd alcor,improve,demolish m ea signed
any ewnurt
'a }� thinnoitsissuance.
censed pursuant to es the he proisiormntfor such the Carnation's
Licese La statement 1'OWL•0.DEVICES
til QOm 9(c he is licensedp Section Neprovisions of the me Business Licenuessi (Chanter
LLKpoLL 9(commencing with Section]IXIO)ofDivision l of Ne Busincasund Professions Code) SWIMMING POOL ELECTRIC ^ VALUATION
onhat he is axempnberefrom and the basis fnr thcallegcd exemption.Anyviolaion of OUTLETS-SWITCHES-PI%TURES
L44 Section 7031.5 by any suffered for a pumit subjects the appllwnuoa civil penalty of
not more than live hundred dollars($500).
eZOp ❑ I,nsownerofthegrope Y.n ormYemp Y loceswiihwa6esasibeirsolcann,cowries, INEW RESIDENTAL ELF.CIR _SQ.FI'. STORIPS TYPECONSTRUCTION
W
a3— will Aothe wod.ander he Caramelinot ze.
License Leoertdfornd e(Seeapply 1.an owner
and Prty,who builds
Code:The Cmttmnon,Licenu Law does not hicas to an owner of
pociownenywyces,pmvidcdprnvesthereon.and ements notihwdr oroffcmdthrough sme,his DEC,GROUP RFS.UNITS
howemplthe oyeesilding rimpr improvement
sold ithino ayear ofcompffated thea ner-
haweveaillhavltheburimpmmmentishathethinoneyemofcomplotion,theownw- 'T ��
builder will Love the burden fol proving that he did not build or improve for purpose of
1 j' QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
`�
I.
asownerofthe pmpeny,um rXelusivelycontraaing with licensed auntmcmmto
�duct the project(Sec.7044,Business ane4Professions Code:)The Contractor'spg0.MIT ISSUANCE.
License Law de cs not apply to an owner of pr epeuy w ho bailds ar i mprovn th<mon,and
whncmumas for such projects with a coronations)licensed pursuant o the Contractor's ALTER Licenve Law. WA I ER HLC FEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C for th6 rtuson BACK FLOW PROTECT,DEVICE oUffi—DETT=
SANITARY Y_N
Owner DataDRAINS-FLOOR,ROOF,AREA,COND. RFCFIPTN
WORKMAN COMPENSATION DECLARATION SCUOOLTAX Y N
❑ Thereby off nn Nm lhaveecenificme of nmsem mself-insure,onr cenificnm of pl%TURKS-PP.R TRAP i+ RBCHIP1'N
Wnrkem'Compenasdon Insurance ora wniEM copy Nuwf(Sw.3flW,Lah CJ whioh PARK FEE Y N
covers all employee's under this permit. GAS-RA.SYSTEM-1 INC.4 OUTLET'S RECHIPf p
PnliryX r BUILDING DIVISION1017,13
y
El Canifedcopy is hereby fumishal. GAS-EA.SYSTEMAVER 4(F PLANCI II7CK FEC Z
❑ Ce
❑ Carib..cony is lilcd with Om city inspeetinn division. GREASWINDUSTRL WASTE INE': 'iI'TOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASHTRAP SOILS FEE
r COMPENSATION INSURANCE
(This action need not bennnplc¢dif Nepemril ie(Drone hurMmd dollars(5100) SEWER-SANITARY-S R .2WPT. ENERGY FEE
or Icss.)
I certify that in the performance of Ne work for which this permit is issued,l shall WATER II L i ECfR
not employ any person in any manner so as to become subject to the Workers' PAID
Z
Cnmpercramnw
l.asof CNlifomia. Data WATER SY 'M EATm ING RccimN
Applicant
Z NOTICETOAPPLICANT:If,after making this Certificate of Exemption,you should NL'WRESIDFRTIALPLMB. SQ.Ff. 161 TOTALo
r+ V] becrnnesubjecnnthe Wnrkefs Cumpensatiun provisions of the Labor Cnde,you must
�i
forthwith comply with such provisions for this permit stroll he deemed revoked. $BUIDIN FOCONSTRUCTION LENDING AGENCY MIC FEE1 hereby affirm th:a there is a construction lending agency for the performance of
Ne work for which this permir i.s issued(See 309],Civ.C.) T CTRIC FEELender's NamcMBING FCClender:Address QTY. MECIIANICAI.Pf:RMIT PE �`
V I certify that 1 have mad this application and nate that Ne abve information isa correct/ la mclomar I thullen Iconnt fdinafocesandsunelnwsrefinc m lPERMIT ISSUANCE HANICAL FI:8 nd`e ram yn gu7j .1savengeofosnardlemafod her by far impee carfamereuntmives ofNis city mmmrupon the
(„) uhnv(We)agree 1. are. uderarby and keepolae AUIER OR ADD TO MECII, STRUCTION AX
�i (Wo)agree al save,isunds.fy and keep hmmless Na City
of Cupenino against
linbilitin,'udgment,cams and eapensea which may many way accrue against said City AIR HANDLING UNIT(TO IB,BfIfI CFM)
in confthegmming ofthispermit. big
AIR HANDLING UNIT(OVP.R 111,000 CIrND
m
'ignawof AppliedifiCentracmr 9 Date A EXDAUSTHOOD(W/DUM 1
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(T'0100,000 BTU) Receipt
Will the applicant or future building occupant store or handle hazardous material HI3ATIN0IINIT(OVE•ItIW,01q BTU)
m defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25512(a)'1 VENTILATION FAN(SINGLE RUSID)
❑Yes ❑No
BOILER-COME(3HP OR 100,000 BTU) ISSUA E TE
Will theapplicant orfumre buildingacwpanwxequipmem nrdeviceswhich emit � n B
hazardat air contaminants as defined by the Buy Arca Air Quality Management BOILER-COMP(OVER 100,000 BTU) (�
Aistri<t1 Jut
❑Yes 0 N NCW RESIDENTIAL MI3Cf1. SQ.ET. / F!'/Vtl
1 have reud the hazardous materials requirement under Chapter 6.95 of the y//Y Uh ® ,A
California Health&Safety Cade,Sections 25505,25533 and 25534. 1 understand that ` J
if the building does font currently have u mmmt,that it is my responsibility to notify the (�N.
cupant of the reyuiremwt which must he met prim m Issuance of a Cenifiam of _
Occupancy.
Owner or authorized agent Data 7144 ISSUED BY:
;TZ�
OFFICE
•
October 4,1995
Cupertino Building Department -
10300 Torre Avenue
Cupertino,CA 95014
Re:Kitchen/Entry Remodeling
:10370-Mira Vista Road
Cupertino,CA
Permit No.28430
To Whom' It May Concern:
1)All plywood sheathing should be 1/2"CDX. (The 5/8"'shown on the drawing A3 was a
misprint.),
.,2)Plywood sheathing was not shown on the south wall of the family room addition because it was,'
assumed.to already have plywood(rather than the insulation board which was discovered to have.,
been used). The area between the holdowns on each side of the french door will be upgraded
• with plywood.
-:Please:give me a call if you have any,questions.,
Siice'el l `
,71
Richard Morrison,AIA
cc:,Owner,Contractor
RICHARD. M'OR'RI'SON,. AIA
A. R C . .:H ' I ` T E :C. T'
TEL:(415)321=3729 FA(X:(415)321-0190^'
.: '1150 UNIVERSITY DRIVE, SUITE 103 MENLO PARK, CA 94025 ,.