28160 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 6WLUING-ELECTRICAL PERMIT NO. LteaSI!!^ LV.^ O
BUILDING DIVISION APPLICATION/PERMIT PLUMIIING-MECHANICAL
BUILDING 1'RO.IECT IDFIN'I'IF'ICAI'ION
H.DING ADDRESS: G} SANITARY NO. APPLICATION SUBMITTAL DATE
20 99 f��1c; c�4 cQr; C cz ,
UNI'I'IT#p LOl'p
O NEHSN MF;: " WO RIONF7�I_�� C NT1y2t�1,QR'9 AN MF::� LIC NO: N/C COM ROLA
RCIII'TF,CT/ENGINEER: LIC NO: s� ADDRESS El❑
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
ELECT PLUMB ME.CH
PERMI'1'ISlUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL )py
OCZ Iherebyieffirat m li
that lacensed under pmvisionsof0apter9(commencing with
�00 Section]pIXO of Division lof the Business and Pr.fesions Code.and mylianse is in
PANELS ��
F�,W License Clad Lica UP T0Tilt AMPS
mF-7N Date Contractor 201-1000 AMPS _—
7,8`az ARCHITECTS DECLARATION OVER 10(11)AMPS SQ.FT.FLOOR AREA 5/SQ.FT.
O i_O I undcrsumd my plane shall he used e,public oaroM,.
FhF W SIGNS I:LIiCIRICAL
Licensed Pmfcasional
og OWNER-BUILDER DECLARATION SPECIAL CIRCULDMISC.
KOaO I hereby affirm that I am exempt from the Cummcmrs License Law fur the
W'3LLy hollowingreason(Section 71315,Bi,innssunJ Profe,si e,Code Any city.!county TEMP.MEIT,R OR POLE INST.
which reenters a permit to carentuct,alter,improve,demolish,or repeal,any evucmrc
do,to its issmme.also ompires theapplicumforsach permit to file.signed statement POWER DEVICES
WC p that he is licensed purmanun the Provisions of the Commctor.License Law(Chapter
LL e Fti 9lwmmcasciagwhh Section 7000)of Divisian3ofthe Ruxincssand Professions Cale) SWIMMING POOL ELECTRIC VALUATION
Warm or that he is exempt herefrom undthe bask lin the al lege)exemption.Any violation of
F-Z.Q Section 7031.5 by any applicant for a permit subjects(be applicant to a civil penalty OUTLETS-SWITCIIES-
of 19XTURES
FSp not more than five hundred dollars P$50% NEW RESIDENTIAL ELECIit SQFT.
o❑'�� ElI.asownernOM1epmperty.ormyemployeeswidhwagesasdheirsolecompensation, . STORIES TYPE CONSTRUCTION
m3. will do the wod.,and the structure is not intended or.flcred for sale(Sce.70e,L Business
and Professions Code:The Conlmct.eLicense Law does not apply m an owner of
pmpeny who but Ids or i mprov ea thereon,and who dors such work hi mself or through his
OCC.GROUP RES.UNITS
wnempl.yees,provided thatsuchimprovements arenor erarof dmoffertd fo...les r-
M1nwevegillhathe v l the
buries ofpmentiunt he didnone t build or improve for the purpose of T ��
builder will M1uve tM1c burden of pnrving thw M1c Jid not build or improve for purpose of
iv1c')' QTY. PLUMBING PERMIT FEE FLOODZONE APN
❑ I,mownerofdhepmpeny,mnexclusivelycontractingwhhllcemedcontmed.rsto
convincer the pntject(Seo.7044,Business and Professions Code:)The Comment's
License Law J.esnot apelymtmnwnernfprapmy who huildsor Improves thereon,and PERMIT ISSUANCE
who contracts for such projects with a contrecluds)licensed puamentehe Commemra se Law.
License
gL'fP.R-DRAIN&VENT-WA'IllR(FA) FEE SUMMARY
❑ l am exempt under Sec. ,B&P C far this.n BACK FLOW PROTECT.DEVICE OUTSIDE FlJ:S
SANITARY YN
Owner Data DRAINS-FLOOR,ROOF.AREA,GONG. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTA% Y N
❑ I herehyaffirm Mat l have.certifrcme d ameeat to self-meare..fa«nifiv.'c ofFl%TllRFS-PER TRAP RECEIP #
Workers Compcnution lnmmnceor.certified c.pytcasaf(Sco.3X0(1,Lab C.)which PARK FEE Y N
over,all ands cc's under this permit. GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIFI'a
NT
Policy a BUILDING DIVISIOES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Certified copy is hereby famished. Sal �9
❑ Cenified copy is fled with the city inspection division. GREASG/INDUSTRLWASTE av,
RCEPTOR GRADING FEE
CERTIFICA'IT.OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(Thix section need not be completed if the permit is!aeons hnrMred dollars(5100) SEWER-SANITARY siTOR P.200FT. ENERGY FEE
I cenifyN:n in the perl.rmance of the work!nr which this pcnnit is issued,lshot] 'R IIIiATEW/VJN'1'/EhIiC'I'R
not employ any person in any moaner to as to become subject to the Winker: PAID
Compcnsatinnlaw,of C.lifom6. Date YS RATING Date Run ipta
0 0 Applicant ;W REST E LPLMB. SQ.FT. TOTAL:
z 0 NOT ICE TO M'PLICAN'I.11,der mukingdo,CenBleme of Exempuoo,youahould
(A hamre subject the Workers Compensation provisions of...-Labn Code.you man
W7 fonhwid,empty with such provislo.,or this permit shall ber deemed invoked. BUILDING FT:13
UJ Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
Lai
0. Thereby turner hanbcrc is ameramnion lendmgagcncy partite of
z pcmti 'I'OIAL: IiI.ECTRIC FIJI
V C) the work far wM1lchthis d is issued(Sea.3097.Civ.C.)
Larder,Name PLUMBING HE
U- F lander',Address QTY. MECHANICAL PERMIT FEE
0 t.1 1 certify that 1 have read this appliaaion and son that the above infommu t is MECHANICAL FEE
1" correct.I agree to comply with all city and county ordinances and state laws relating toPERMITISSUANCE
building construction.and hereby authorize .Th
representativesis city toenter alien the CONSTRUCTION TAX
U Z elnvc-memioncd property for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,in i n fy it keep harmless the City of Cupenian agam,t
EA.Ip terns,cos and grvr,a,whirhamyi.. y entail City AIRIIANDI.INGIINIT(TO10,(XX)CFM)
lase nse (IheB y�eucu �
' AIR HANDLING UNIT(OVER IO.00D CFM)
S' nature fApplicanUConlrnemr Dute EXHAUST HOOD(WMUCT) PAID
tIAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Datta Retained a
Will the applicant or future building occupant store or handle havmdous merial HEATING UNIT(OVER I ho"BTU) TOTAL
us defined by the Cupcninn Municipal Code,Chapter 9.12,and the Ilealth adSatafety
C..I,Section 2553200? VEN'1'ILA'I'ION FAN(SINGLE RBSID)
❑Yes ❑No
ISSUANCE DATE,
Will theapplicantorp.tum building occupant useegm'pmen ordevices whichemit BOILER-COMP(311POR IOO.00BIU)
Duumi air mnnminunt,it,detinet by the Bay Arca Air Quality Management BOILER.COMP(OVER 100,00O BTU) .Q A
klrim7 /r`Y p
Cl yes ❑No NEW RESIDENTIAL MECH. SQ.Pf.
1 have read the hw.amors materials requirements under Chapter 6.95 of the
1 p 7 'g9
Culifnmia I Ic.hh&Safcdy Crdc,Snnimtx 25505,25533 naso 255)4. undcrstund that
ifdhc building does not curren0y have a tenant.thin it is my responsibility to notify the b
occupant of the requirements which must be met prior to issuance of a Certificate of
ccupancy. I'lllryV
Owners authorized ahem Data ISSUED BY`�+/
OFFICE
May 29 , 1995
To: City of Cupertino
Building Inspection Department
The property located at 20199 Pacifica Ave has several features
build without permit:
1. Spa in the backyard. .
2. New heater located near master bedroom at the first floor.
3 . Enlargement of master bathroom at the first floor master
bedroom.
As a registered Civil Engineer I conducted inspection to
determine that work done as per item 3 listed above did not
compromise structural integrity of the building.
Master bedroom and its master bathroom are located at one
story portion of the building. The roof above consists of roof
trusses which span within exterior walls and do not have any
intermediate supports. During construction the interior only
walls were relocated and as such did not effect structural
stability of the roof or lateral stability of the building.
In my opinion the work of relocating walls is done satisfactory
and complies with 1991 UBC requirements.
If you have any questions do not hesitate to call me at
408/942-2351 .
---- /� Sincerel
oQROfESSlpyRl ;!'tiG.Q-r j "ZL>C ? �'�
Leon S yman,
Civil Engineer, No. 35441
No.35441
C1 JV
Q'OF CA0��
PLOT PLANS
B
EKE® $ o [ O LSC
DATE � D
OFFICI COPY PLANNING DEPT, JUN - 71995
DATE _qe BLDG. INSPECTION DEPARTMENTI
_ CITY OF CUPERTINO,
BLDG. DEPT. a
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June 7, 1995
To: City of Cupertino
Building Inspection Department.
I, Leon Sheyman homeowner designated Efim Rivkin to obtained building
permits for the property located at 20199 Pacifica Ave., Cupertino on my behave.
Sincerely
Leon Sheyman
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