23759 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMITN
A°lidtoo"g AO.
Acidness:
23759
nets ante: one:
D CITY OF CUPERTINO-BUILDING DIVISION / n
etre ;°Mane, Lic.N.: APPLICATION /PERMIT (p L.
/ BUILDINGELECTRICALPLUMBINGMFLF3AMCAL CATEGORY CONTROL N
Art ItM/Eng[ Ic No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: PESMITISSUANCE T ❑ ❑ ❑
LICE. CONTRACTOR'S DEC ATION
Iherebyafflrmt I am licensed under provhianaofChapwr 9(coomenc APPLIANCESRFS7DENTIAL JOB DESCRR'CION
Ing with Section 7000)of Division qoft�he Businneasand ProfesslonsC°de,and my
Liceneaclaml Cc N!_Contractor
/ / �Z 1 PANELS G
ARCHITECPS DECLARATION 201-1(100 AMPS -
aZq l understand my place shall be used as public record& OVER1000AMPS SQ.FT.FLOOR AREA
(/ Licensed Professional SIGNSELECTRICAL
res FLi7 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MLSC 9 N A L E D IN
Z' 4 (hereby affirm that Iam exempt fromthe Contractors License Law fm the
following reason.(Section 7031.5,Business and Professions Code:Any city or
�4'Q cou my which requires a permit W cocetruat,alter,improve,demolish,or repair TEMP.METER OR POLE INS(. O [�Id'n
a any streetom prior to its Luna our,Alan requires the applicant for such permit to
F V POWER DEVICES
firea signed statement that he h Herneed pursuant to the provisions of the
3p� C°ntram's Lice.Law(Chapter9(comnencingwith Section 7000)of Divi- DATE VAIIIA�nh,!
ECIRIC
F„ sion3ofthe Buslnenand Profembr Code)orthal hebexemerem
ptthfroand
E5 S the bash for the alleged exemption. Any violation of Section 70315 by any
< ovn.E sWTtr _ 'a
applh mired apermitaubfecta the applkanl toativil penaltyo(nat morcthan / ll
(Iw�M1undreddoWrshepro NEW R D:*A4 ELFG EFS TYPECONSTRUCTTON'
�n
as owner li the property,or my employers with wages es there dote x
umpeneatlon,wllldolhe work and thestructure h not Intended or offered for
oI.(Sec.7614,Buslnem and Professions Code:The Contractah Liansn Law,
$$ does not apply to an owner of property who Wilda orimproves thereon,and LJA 3t
t1 sss�> I OCC.CROUP RE£I1NR5
whodoes such work himself or through his own employees,provided thatuch
Improvements am not intended moffered for sale.If,however,lhebulldlng m TOTAL: _
Improvement 'am wdlhinoneyearofcompletion,the owner-bullderwlll have
lla,tptrdeo of proving that he did nm build or improve for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
u L as mvner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
conlraclon to construct the prefect(Sec.7044,Business and I'mfemioru Code:
The Conte'dor's License Law dont not apply to an owner of property who ALTER-DRAIN A VENT-WATER MM
Wilda or improves thereoM and who contracts for such p(ojens with a FEE SUMMARY
cgp(�acootie)licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE
I_J I am exempt under Sec. w
B k P C far this rean
OUTSIDE rFroc
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
Owner Date RECEIVE N
WORKMAN COMPENSATION DECLARATION FIX.fIJRFS PER TRAP SCHOOL TAX Y N
Of hereby Affimt that I have a certificate of consent to eeB-Inure,ora RpOEPi N
certificate o(Worken'Compewtton lrnumeceora credited mpy thereof Bac. GAS EA SYSTEM(INCA O[fT1-EI5 PARK FEE Y N
3800.Lab C.) RECEIPT N
Policy N
Com try GAS F.A.SYSTEM.OVER d(EA) BUILDING DIVISION FEESSTR
CertlOed copy Is hereby tumished. CREASE/INDUL WASTE INTERCEPTOR PLANCHECK FEE
Candied copy,is fired with the city Inspection division.
CERTIFICATE.OF EXEMPTION FROM WORKERS' GRF-ASETRAP PAID
COMPENSATION INSURANCE SEWER-SANTIARY-STORM EA.200FT, DRIB RCCeI IN
(This section need not Le complmed lithe permit hfor one hundred dollars
(S100)orlmm.7 WATER HEATER W/VENT./ELECTR ENERGY FEE Y N
]contil11 cm thatinunp in the perfomunce of tha work fo as to b this permit a Wend,
I shall not employ any person In any manner m es to become subject to the WATER SYSTEM/TREATING
Worlicant mpewtlmn Lawn of GllfomW. Date PAID
O Z Applicant NEW RESID=AL PLMB. SQ.FT. Date ReceI t#
Z O bruldNOTIb TOAPPLICANT:R,after making Workers'
Compensation provisions
Exemption,you
CCCode, ou=st forth ithto co Workers'Competuationprovhloruofit the s Lab be TOTAL:
� N deemed renwet(onhwlth comply withsuch provisions orthhpermit shall be BUILDING E �s
W deemed revoked. _
CL C CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirmthat there is a conshuction lending agency for the perform, ELECTRIC FEE
D Z ansa of the woIs
rk(or which this permit is Issued(Sec.3097,Civ.C.) TOTAL:
U O Lenders Name PLUMBING FEE
LL I— Lendces Address OTY. MECHANICAL PERMIT PEE MECHANICAL FEE
W re
O I nlye
lhatl hevreadthhappliati nd
onastatethattheabovelnformatlon
S honretl.I agmeto comply with act tltyand county ordinances and state lawn PERMIT ISSUANCE FEES PAID:
>. relating to building construction,and herebyauthorlxerepreeentativamfthh
W
H U) city to enter upon the above-mentioned property fm Wpectlanpurposa. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep harmless the City of Cupertino Date Receipt#
V against liabilities,judgments,metsand expenses which my In anyway accrue AIR HANDLING UNIT(10 10,000 CFM) SUBTOTAL'
1 Incen Granting of this permit.
1 AIR HANDLING UNIT(OVER 10,"CFM) CONSTRUCTION TAX
Signsnere of Applicant/Contractor Data EXHAUST HOOD(W/DTJCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE _
Wllltheapplicunt orfuturebuilding [MATING ATING UMT(TO100,WOBTU) Date Receipt#
material as defined by the Cupertino Municipal Code,Chapter 911 and the
Health❑ and Safeny Cedr,Sectimon 25532(a)7 HEATING UNIT(OVER 100,000 BTIJ) .R,'TsO,TAL
Wlllthe zppllcant cr❑future building ompant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUey dE FATE
which emit haeardous air contaminants as defined by the Bay Arca Air
Quality Ma regemcnt District? BOILER-COMP Ohm OR 100,000 BTM
YeB N° 'JUN -1 1992
have read the h.Wous materials requirements under Chapter 6,95 of BOILER-COMP 100,000 BTU)
the Glifornia Ilealth k Safety Code,Sections 75505,25533 and 2:534.1
underesponsibility
that Rtify the the ing emupon of t emqulyhave aments tenant,that it mets my NEW RESIDENTIAL MECH. SQ.Ff CMI IPI\
responslbiltyto trolly the oateorfloflherequlrcmenb which rtwstWand CITY Ur Ger
prior to Issuance of a GnlOate o(Omrpanry. \'/��y/{/✓��^
Owner or aulM1orlud°gem Data TOTAL: ISSUED BY:— l
OFFICE COPY
POPA - KIHLTHAU
p STRUCTURAL ENGINEERING CONSULTANTS
June 8 , 1992
Dr. and Mrs . Dale Compton
10131 Pharlap Drive
Cupertino , CA 95014
Re : Family Room Masonry Fireplace Chimney
Repair Recommendations for Above Address , Cupertino
As per your request , I performed a visual review of the fireplace
chimney referenced above to recommend repairs of damages observed
during the chimney sweep inspection of this house .
The extent; of the damage found on the fireplace during this review
indicated that this chimney should be repaired starting from the
observed torn down condition . The repair shall consist of rebuilding
the new chimney using standard masonry construction techniques by
wire brushing the removed and exposed portion of the embedded #4
•
reinforcing bars to remove all rust and mill scale , then grouting in
place the removed bars with Custom 'Pour. Stone' grout in the wire
brushed and vacuumed holes in the existing chimney mortar. The
required FHA strap ties were observed to be in place , therefore the
rebuilding of the top 5 . 5 ' of chimney can proceed as described with
no additional tear down necessary.
If you have any questions regarding this letter, please do not
hesitate to call .
�oQaess�Q,yae
I i fig. 684 83 G
Timot y Kihlthau
R.C. E. 40834
GOLDEN VALLEY OFFICE CENTER
2542 South Bascom Avenue • Suite 102 • Campbell, California 95008
Phone: (408) 559-4202 FAX: (408) 559-3628