28035 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OE CUPERTINO -ELECTIUCAI. PERMIT NO.
APPLICATION/PERMIT PLUMBINO-MEDEN 11FICA 28035
IfUII,UING DIVISION I4UILUING PROIF:C1'LUEN'TIF'ICATION
BUILDING ADDRI3SS. 1rA1/ SANI'I'ARYNO. APPLICA'HON SUBMH'I'ALDATE
37 " va ,NIT* LOT S
1.?-11NAMf;: PHONE: O TOR'SNLIC NO: C J
NIC CON9'ROI.a
ARCIII ' JFW INEER: f� I.ICNO: ADDRESS ❑
K SOo Z3 /Z
CON]ACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRICRMIT FEE
18T PLUMB MECH
PERMIT ISSUANCE ❑
LICENSED CONTRACI OR'S DECLARATION APPLIANCES-RESIDENTIAL
JOB DESCRIPTION
❑yz I hereby affirm that l am licensed underprovisions of Chapters)(commencing with
WOO Section 7000)of Division 3.f the Bminess and Pmfessimts Code,and my license is in PANELS /�
F WF-. full force and L U
QFZtUy License Class YQ...x-�Y LIC.X ��� UP TO 2W AMPS ea�
ti=y Dwe Camrac W`�"L• 201-1000 AMPS SQ.FT.FLOOR AREA $/SQ.IT,
ZOyz AR 111 CTS BECLARATIO PL OVER Ilp0AMP5
OZ_❑ I and my plana all used public ticordx.
_Fm SIL. -6 r .1.�_(/�h SIGNS ELECTRICAL
,soca Lica at P�rnf-esu^nal OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
K O W U 1 hereby affirm Nm 1 atm exempt from the Convector's License Law for the
W 3 a H following aason.(Sutton 7031.5,Business and Professions Code:My city or county TEMP.METER OR POLE INST.
which requires a permit to Ormbse',ahcr,improve,demolisM1,or repair any structure
prior to its issuance,also requires the applicant fn
isuch permit to fileasigned statemrnt POWER DEVICES
Mm 0 that he islicensed pursuant to the provisions of the Contractors License Law(Chapter SWIMMING POOL ELECTRIC
deCL 9(commencing with Section 7")of Division 3 ofthe Business end Pmfessians Cade) VALUATION
Woim or that he is exempt therefrom and the basixfor the alleged exemption.Any violation of
Fa /O w
Z_attnalty Section 9031.5 by any for a permit subjects the uppllcano a civil peof OUTLETS-SWITCHES-FIXTURES
❑ Y
not more than Eve hundred dollars($500).
S .FT.
K�o ❑ I,asowncrof thepropeny,nrmyempinyenwith wages as theirsolecnmpensadon, NEWRESIDENTIALELEMR Q ORIFS 9'YPE CONSTRUCTION
c, will do the work,enddirmucture is.1 intended or offered for We(Sm.7044,Business
and Profesalons Cork:The Commetors License law does not apply to w owner of
property who builds or improves thereon,and who does such work himWfor through his
employees,pnwided that suchimprovCmeats urenm intended orofPorcJ for agile.Ir, OCC.GROUP RES.UNIT'S
however,the buildingor improvement is sold withinnne ycuofcompletion,theowner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
We.)' QTY. PLUMBING PERMIT FEE FLOODZONE APN
❑ I,as owneeafthe property,am exclusively contracting with ieemsed contractors to
naetmet the project(See.7(44,Business and Professions Code:)The Contractor's
License lawdoesnot apply to an nwnerofpropeny whobuilJaorimproves thereon,end PERM]PISSUANCE
whoc^ntracts forsuch Projects with acontfactor(s)limnmd pursuat ttothe Contnetor's
Licamc Law. ALTE0.-DRAIN&VENT-WATER(EA) FEC SUMMARY
❑ 1 am exempt under Scc. .B ffi P C far this reason BACK FLOW PROTECT.DEVICE
O TSIDE FRES
SANITARY Y N
Owner Dote DRAINS-BOON.ROOF.ARIA,COND. RECEIP`r#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
• .bcr1 hersbyafirm that l haveacentt
ificareofeansenoself-insum.m acertificaeof FIXTURES-PER TRAP RECEIPI'N
Worked Compensation Insurance or^cenilird copy there00
af(Sec.38 .Let,C.)which PARK FEE N
corsalleml drys il. RECEIPI'0
Policyp
p GAS-G.SYSTEM-1 INCA OUTLETS BUILDING DIVISION FEES
�Cenified copr is herehy fu 'shed. GAS-EA.SYSTEM-OVER 4(EA) PLANCHF.CK FEE
❑ Cenificd copy is riled with the City ins,re ion division. ORIEASFANDUSTRL WASTIE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' OREASETRAP SOILS ME
COMPENSATION INSURANCE
(Thiss«tinn need not he completed ifthe peons,is fortune hundred dollars(SIM) RY-SfDA !T. ENERGY IEE
m less.) -
ICertify that in the reconvene ofthe work for which thispermli,isrool,ishill WATER HEATER W/VENT(L'LECTR
not employ any person in anY moaner so ss to bCfDrtie {yet to the Wooten' PAID
C.mpcnsati n fCelifomia. t 5�Sa� WATER SYSTEM?REATING Dae RaeiptX
Z A licwtps o- "- Da
2 NO'ICIE TO APPLICANT:If,after making this Certificate of Exemption.you should EW RESIDENT IAL VLM B. SQ.FT. TOTAL:
1-" ) become anbjecno the Worker's Compensation provisions of the labor Code,you mus BUILDING PCE
forthwith comply with such Provisions or this permit abam
ll be excited revoked. 0 d+
a [) CONST RUCTION LENDING AGENCY E
SEISMIC FLEE� O.zI hereby affirm that them is aconsbuction lendingageney buthe performat¢ of dU the work for which this retort is'ssued a.jos)7,Civ.C) ELECTRIC FFEELenders Name J iPLUMBING FEE
U- r- Lenders Addrcas QTY. MECHANICAL PERMIT
0 U I Certify thin 1 have rend this application and sate that the shove inform tt to is MECHANICAL FEE
L21 comet.l agree to comply with all city and county ordinances and stare laws mist gto PERMIT ISSUANCE
F' N buildingcommuction.end herebyau0mriu representedveso(this city insurer. .the CONSTRUCTION TAX
Vz uMwc-mentioned property for inspection puryoxa, ALTER OR ADD TO MEC i.
(We)agree m save,indemnify u keep hartnlcss the City of Cii'mino s most
ilii^abbiilpi�lie{a.piu�/J_9g�m��e�mscnsls unit experts hichmayinamywayaccrueagmmstasi ity AIR HANDLING 1'0010.000 CFM)
-'--6'+�spthe grentinB Nis a i1 ._
AIR LNG UNIT(OV ER IBM CPM)
Sigt)aiurcaf Appl tC n star Pate EXIIAUSTHOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HHATING UNIT(TO 100,(X10 BTU) Date Receipt It p
Will the applicant or future building occupant sum or handle havrdous material HEATING UNIT(OVER IOlJ.f100 BTU) TOTAL: ( a
as derined by the Cupemino Municipal Castle,Chapter 9.12,and the Health and Safety
Cwle.Section 25532(u)'f V HN'I ILATION PAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE DATE
Will thea licantorfuture buildin uccu nt use tordevices whichemit BOILER-COMP(3HPOR IM.000BTV)
pp e he 9ui,Air
hart rJnus air contaminants as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100,000 RTU)
District'( P A ! p
❑Yea ❑No NEW RESIDENTIAL MECII. $Q.FT.
1 have read the havardous matmals"micmems under Chapter 6.95 of the IA11995
Calilnrnis Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that MA�/ 5
if the building does not currently have a tenant,that it is my responsibility to notify the
oceupam of the requirements which must be met prior to issuance of a Certificate of
Occupancy. CII r V rcMIINU `
Owner or authorised agent Date TOTAL: ISSUED BY.
OFFICE
�.......DATE-5J-Y-1 SUB7J^ECT.(epfCjl1L•,[/(¢/. -LC/K �.. Ps fir' SHEET NO.�.S...�/O�F.»Z�/ .._:.
CHKO. BY................DATE.................. __fi!ClGaLrL_..1Y�q C1.��.GY�o... •_.«.».. JOB NO.._w!_6_C•1 ...._..
............._..................................................__ ._.'a'_=.' - .�.-.�c-f- »l"�•__.:r::
KENNETH NELSON'
Registered Civil Engineer
ReEerences : (1) 199/ Ed. UBC 940 Saratoga Ave.
(408)247-2898 Suite 215
Design Load Assumptions : (psf) San Jose.California 95129
LL DL APPROVED
Roof ^fes 8 IN ACCORDANCE WITH THE CITY
CUPERTINO CODES AND ORDINAP' ES
Ceiling _/O ._ _ 7 DAT ' QR13FESS/04,
p 9
Sloped Cl'g. SIGNED ur•, ���N NF�� �F�
This set of ans and specifications M0.. �c� O ';'
V.'
1st Floor _jQ ..,.
be kept on the job at all times and it is L'
lawful to make any changes or al,. atior w No. 22023 9 7 m
12eGk _.___9_._-on-same without writton permis:i, n ii. n Lic. Exp. 9-30-93
2nd Floor 40....... /O._ -the building Dept., City of Cupertin . CN11,
Ext. Walls _= The stamping of this plan and spar, -•.i,,,, T a�\P
—1 - SHALL NOT be bald to permit or ! O 0 1 FOQ"
Int. Walls -- ? ' approval of the violation of any p . ILrr?�+
-'—" - any City Ordinance or State Lav
+\i
Party Walls. .. ..--_.. ... ... ..
D
• MAY 51955
Wind
BLDG. INSPECTION DEPARTI$IM
Seismic vs =__O.• ___W____ CITY OF CUPERTINQ
Timber Construction Design Criteria
With G'777^Zi .:'Lumber.`CradinK Rules
Use Grade f E x 106 f (repetitive use
Struct• Light
Framing (4 x 4) 02 1450 1.7 -
Strucc. Joists, O1 1500 1.8 1750
Planks t: Rafters Dene 02 1450 1.7 1700 1 .
02 12 1. 1
Light Framing b Std.
Studs (4 x 4) Grade 600 1.5
Beams 6 Stringers Dense Sel.
Struct. 1900 1.7
Beams 6 Stringers Sel. Struct. • 1600 1.6
Beams 6 Stringers Dense O1 1550 1. 7
• U1 1350 1.6
OMCEmbCOPY Dense U1 b 1400 1.7fb 1200 1.6
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