26541 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITfY OF CEPERTINO rERMITNo. f�
BUILDING DIVISION APPLICATION/PERMIT PLUMBfNG-MF.CNANICAI. G
. ItI11L_DINO PROJECDIDENI'IFICA'IT(IN
BUILDIN ADDRESS: ��4SANITARY NO. A�PPLyIC//ATIONSUBMITTALDATE
/IN12,71 UNIT# LOT
P PPIIONE: I NAM LIC NO: l
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RCHITECTIE'NGINEER: LIC NO: ADDRESS: ❑ ,/ J, r Ixl
CONTACT: 17 PHONE: ' ' -w
QTY,. EI;PCTRIC PERMIT FEE. ''BUILDING PERMIT INFO
PERMIT ISSUANCE BL ELP. PLUhf� MECH
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL Qom[\J\
I hereM1 ffrm shut l amlicemadmider visionsof Cha tag a mmemd. JOB DESCRIPTION
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Fq 00 Section a And of Division 3 of the Business and Rofessions Code,and my lean.is in PANELS 1
full(Tree lid effex�`� ly1/
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Li��y,Class Za0 S
Licp UP AMPS
yQa DuCo..., IDI.1000 AMPS
Z Ori` zARCHITECTS DECIA TION OVER 1000 AMPS Q.Ff..FLOOR AREA VSQ.FT.
O Z—A I understand my plans Mall M used as public records. _ .Y � ' D
F= SIGNS ELECTRICAL
Licensed ProPovsionel OWNER-BUILD ER DECLARATION SPECIAL CIRCU ���
O a F I hereby r.Se that I'an exempt from the Commcs Co License Law for the
�3C` frllowintl reason(Section]031.3,Business and Professions Code:Any ,city ognrwty TEMP.METE a
�yyw1 which rcyuirese PermitmconswcLalter,improve,demolish,or repair any etrvaure I
a� prior to its issuance,also requires the applicam forsuch permit file a signed statement POWERDEV /sI1 y ur
p that be is licensed pursuant to the provisions ofthe Contractors License Law(CI V IN UY
a Cc� 9(commcncin with oration]000)of Division3of theBmineu and Profeaeionv Code SWIMMINGPO C
VALUATIO
❑y
in that he is exempt therefrom and the basis for thealleged exemption.Any violation of OUTLETS-SWITC -PIXIVRPS
F Q Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
� O not more than five hundred dollars(1500). 'NEW RPSIDFNTIAL ELECfR S .PT.
W
m ❑ I,asowneroftheprolsmsy,ormyemployae withwegu astheirwlecompemation, Q STORIES TYPECONSTRUCTION
will do the work,andtheswcwreisnot intended reoffered forsNe(Sec.70a4,Basimess
and Professions Code:The Contractor's License Law dare not apply in an owner of
propenywhobuildsorimpeoves Nertmr surdwhodoessuch wrrkhimxlfwtbruughhis
ownemployces,providedthatsuch impmvememsame not intended oroffesed Beside.U. OCC.GROUP E�N
however,the Indianan,improvement iasold within one yearofcompledior,theowner- T TAL:
builder will have the burden of proving that he did not build m improve for propose of
sale]. QTY'. PLUMBING PERMIT FEE FLOOD ONE'
❑ Las the prrfthepee 704 , usiha ivelycomreProtean.withlde)The Com roam
Lacersc.mml the oes not(Sec.]044,Business and ywhobrns ormp The Contractors
License Lawdarsuch ppjects ithacofpropeny whobdpursumproves thereon,and �� PERMIT ISSUANCE
whocnmraasforsuch projects wiutecontremor(q licensed pureuansmNe Conductors ALTER-DRAIN&VENT-WATER PA
License how.
❑ 1 em exempt under Sec. ,B&P C for this reason
BACK FLOW PROTECT,DEVICE SANITARY _N
Owner Dam ECE1P1'p
DRAINS-Fl.00R.ROOF,AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOL TAX, Y—N-
FIXTURES
N
❑ Thereby affirm thviheveaartife,•^ofconxnnoxlf-insurt,ae anifiate of FIXTURES-PER TRAP RECEIPfN
Wvrker.'CnmDenvtion lnsunmcem aceni0ed ropy thertrf(Sa.lg010.Lab CJ which PARK FEF. If/ Y N
rovers etlemployee's uncle,this oernt#i 7G �//���� GAS-EA.SYSTEM-IINC.4OUf1.EfS RECEIPT#
Policy Is L�(/7_T U DING DIVISION FEES
Company— �4 — GAS-EA.SYSTEM-OVER4(EA) PLAN FE
❑ Certife p a ere ytumts
OR Cenifedwpyisfiledwith ciry,sWtiondivieion. GREASEENDUSTRL WASTE INTERCEPTOR GRA NG FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOI C
COMPENSATION INSURANCE
(This section need not be completed ifthe permit is forone hundred dollars(SIM) SEWER-SANITARY-STORM EA.200P17. ENE
rrlessJ
I certify that in the perfonrtnmrf Ne work far which this permit is issued,i shall WATER HEATER W/VBNT/ELECTR
not employ any person in any manner w u to become subjas to the Workers' PAID
Compensationlawsof Califomis. Data WATER SYSTEMiTKEATING Data Receipt#
0 z Applicant
Z NOTICE.TO APPLICANT:If,after making this Certificate of Exemption,you mould NEW RESIDENTIAL PLMB. SQ.ff. TOTAL:
E" (/] became subject to Ore Worker.Compensation provisions of she Labor Code.you must
forthwith comply with such provisions"is permit shell be demand revoked. BUILD GFEE
la, CONSTRUCTION LENDING AGENCY SEIS C ME
Vz I hereby effortthat them is v construction leading agency for the performance of TOTAL: ELE IC FEE
O the work for which this permit is issued(Sec.3097,Civ,C.)
D-i Lender.Name -
I Lenders Address zMECI1ANICAh PERMIT ;FEE PLU GING FEF.
1 certify that 1 have red this application and state that the above information to
0.1 c<mca.la inem I with all cit and count ordinances andstate laws heading t - ME 1ANICAL FEE
gree empty y y g PERMIT ISSUANCE
CA building construetion,and hereby authorize repmsenmGves ofthiscity t animation the CON TRUCf10N TAX
U uMve-mentioned property for inspection jamboxs. ALTERORADDTOMECH.
(We)agree to save,indemnify and kap harmless the City of Cupertino against
liabilities,judgments,cormandexprenswhich may in any wayacauesgnivuaid City AIR HANDLING UNIT(TO 10,0001 CFM/
in conxquence of the granting of this permit.
AIR HANDLING UNIT(OVER 10,0110 CFM)
Signature of ApplicenUConrrater Data EXHAUST HOOD(WR)UCD PNE
HAZARDOUS MAT pIALS DISCLOSURE, BEATING UNIT(TO 100,"BTU) 4DATE
Will the applicant m future building mcupent store m handle harardous material
u defined by the Cupertino Municipal Code,Chapter 9.12,and the l leahh and Safety HEATING UNIT(OVER 100,0100 BTU)
Code,Section 25532(e)1 ,J VENTILATION FAN(SINGLE RESID)
❑Yes pNo
Will the applicantor f oma building occupant me equipment ordevices which emit
9
BOILER-COMP(3HPOR103d)(0ITTU)
Inamilous air wmmmments as defined by the Bey Area Air Quality Management BOILER-COMP(OVER 100.000 BTU) '
Dinsrin't �/
❑Yes ' No NEW RESIDENTIAL MECH. SQ.Ff.
1 have mad she Safety
Code,
materials 3505,cmau under Chapter understand
nd the V
California Hearth&SeRty Cde,material ,at 25533 and 25534.1 understand Net
if the building dal nos variant,have a taint,that it is my responsibility m notify dm
acupam of the xquimments which muss be met prim to/iu�BBaonce of a Certificate of
Occupancy. /
Ow t mized agent �^ Data TOTAL: ISSUED BN77
OFFICE
/ a
Inspection Query for a Specfic Permit 5/23/97
[PERIIAITr_ IT�.S SITiUS SiTiRE.ET ot# INSDE9CRIP� In8�T1 ftliE_DESIRE U_a_eUone
6541 10352 MIRA VISTA PREGUNITE 5/20/97 5/20/97
6541 10382 MIRA VISTA PREGUNITE 5/22/97 5/21/97
26541 10382 MIRA VISTA PRE-GUNITE HV EN 5/23/97 5/23/97
Inspection Query for a Specfic Permit 5/23/97
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Page 2 '
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PIS, '
,(t 19 May 1997
William M. McMorrow,
CE, GE
Consulting Mr . Ray Whitford
Geotechnical c/o Lifetime Pools , Inc .
Engineer 910 San Antonio Road
Palo Alto, CA 94303
SUBJECT: Observation of Pool and Spa
Specializing in Excavation and Steel
Failures, Reinforcement
Rehabilitation, Mike & Carol Stanek
and Forensic 10382 Mira Vista
Engineering Cupertino, California
Dear Mr. Whitford:
�15 4930114 During the construction of the swimming pool and
. spa, I have visited the Stanek Residence to ob-
960 San Antonio Road serve the swimming pool and spa excavation and
Suite40l placement of steel . The purpose of my visit was
Palo Alto, California
94303 to determine whether the exposed soils in the ex-
cavation were as anticipated and will provide
stable support for the pool as well as determining
whether or not the steel pool and spa reinforce-
ment was placed in accordaance with the approved
plans .
My observations indicate that the soils exposed in
the excavation will provide stable support for the
19 May 1997
pool and spa, and the steel reinforcement meets
the requirements of the approved drawings .
Zn summary, I believe that the requirements of
the approved drawings have been accomplished by
your firm in a professional manner and the pool .
construction should proceed..
Very truly yours ,
Ir
✓TF GF�A4,F
WILLIAM M . MC MORROW, CE, GE
•
i 11IT
CITY OF CUPERTINO
10300rroffe Avenue Telephone 777-3228
INSPECTION NOTICE
BUILDING DIVISION
JOB DATE
ADDRESS ZO I F2 1'e-1114 TIME
DAILY REPORT 0 CORRECTION NOTICE C3 VIOLATION 0
TYPEINSP_ BLDG.0 ELEC. 0 PLBG.[3 MECH. 0
• WEATHER INSP.,-
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CARD TO REMAIN ON JOB-SITE