30964APPLICANTTO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING -ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUM
11 BUILDING PROJECY IDENTIFICATION
O ^ /N ag
PERMITNO, IFV964
3BING-MECHANICAL
.JWILDINGADDRESN
I032s Pum Tp -se LN
SANITARY NO,
APPLICATION SUBMI'PIAL DATE
I -
HERS NAME PHONE:)-
PKF MM 1-675.4
CONTRACfOR'SNAME: LIC NO:
N/C
❑
CONTROL#
ARCHITECM..NGINEF.R: LIC NO:
ADDRESS:
= i'ACI% PHONE:
SR 44� 63t< <w)
aa -v39 I.
❑ Consaltanl Fors Paid by Applicant (Initial)
BUILDING PERMIT INFO
BDG ELECT PLUMB MECH
E] 1:1 ED
LICENSED CONTRACTOR'S DECLARATION
1 hemby affon that 1 am licensed under provisions of Chapter 9 (commencing
ision3ofthe Business and Professions Code, and my license is
1 with forceand
tnfullfomeand effect.
License Class Cma
1 Dam Conwcmr
j ARCHITECTS DECLARATION
1 understand my plans shall te used as public records
Licensed Professional
Oat I am exempt fr m Ce Cort ON
� I hereby affirm that 1 um exempt !cont the Comracror's License Law for the
following ream.. (Section 9131.5. Business trod Professions Code: Any city or county
which requites a permir to construct, alcor, improve, demolish, or repair any structure
prior o its issuance, also requires the applicant for such permit to file u signed statement
I
that he is licensed pursuant to the provisions of the Contractor's License law (Chapter9
(commencing with Section 7") cf Division 3 of the Business and Professions Code).1
that he is exempt therefrom want he bait for the alleged exemption. Any striation of
Section 01131.5 by any applicant for a permit nrhjretstheopplicarem a civil penalty of
n mom than Five hundred dollars (5500).
❑I, as owner oflhe propeny, or my employees with wages as their sole compensation,
will dathe work, and the stmctuce ix nn, intended uroffered for tele (Sec. JD41, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon, and who does such work himself or through
his own employees, provided unit such improvements arc nm intended m offered forNEW
sale.fiLhowevcq the butldingor improvement is sold within cneycarrdo
fcomplen,theQ.
ilde
owner -bur will have the harden of proving that he did not build or improve Im pur-
pseolmilde
1, as owner of the pmpt em exclusively contriving with licensed Contractors 1.
consumer the project (Sec. IOW, Business and Professions Cars., h. Coaaactor'a ti-
c re
se Lawdsnotapplytoanownerofpropertywhobundsrrtripr..vesrbcreon.and
who contracts for such projects with o commemr(s) licensed pursuant m the Contrsecors
License Law.
I am exempt under Sec. , B A, P C for thisrcusen
WE h
' i ---�W�O—RKEER''S COMPENSATION DIX A ION--I-���-T�-
I hereby affirm under penalty of perjury one oldie following declamations:
I❑ I have and will maintain a Certificate ofConscm at.self-insum for Worker's Camped-
'tattoo, as provided for by Section 37M of the Labor Code, fm the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, an; required by Section
3900 of the LaborCode,fe,the pcfc,..e..f,hc work for which an, pe.it is issued.
My Workers Compensation Insurance coricr and Policy number art:
Curricn Policy N.,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
flbivectionnad not be completed if Ne permit is tonne hundrcddollars(5100)
or less)
for subjech tt to the ad Workers
not employ any pecten in any manner so us m become subject m the Workers' Compen-
Toy any thatinu in any mannct,ro ine as om,,B
serum Laws of California. Data
Applicant
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL:
❑SFDWL ❑ KITCHEN REMODEL
❑ADDITION O PLUMBING RE -PIPE
❑MULTI -UNIT ❑STRUCTURAL
MODIFICATION
❑INTERIOR [I CHIMNEY REPAIR
IMPROVEMENT
0 BATH REMODE EPAIR ❑ DEMOLITION
❑ OTHER SV�hlld=
PERMIT ISSUANCE
APPLIANCES - RFSIDENTIAL
PANELS -
UPIC 3W AMPS
201-1000AMPS
OVER IIXNIAMPS
SIGNS ELECTRICAL
SPECIAL CIRCUIT/M ISC.
1 EMIR METER OR POLE INST.
COMMERCIAL'
[D NEW BLDG/ADDITION ❑ DEMOLITION
❑TENANT ❑ FOOD SERVICE
IMPROVEMENT
[]OTHER
POWER DEVICES
SWIMMING POOL ELECTRIC
OUTLETS - SWITCHES - FIXTURES
RESIDENI'IAl. ELEC'I'R
PT. FLOOR AREA
f,� p
if I D
��� 2 RECD
CITY Ur CUPER
$/SQ. PT.
e
TOTAL:
QTY. PLUMBING PERMIT FEE,
PERMIT ISSUANCE
ALTER - DRAIN ,4 VENT -WATER (CA)
VALUATION
BACK FLOW PROTECT. DEVICE
DRAINS- FLOOR, ROOF, AREA, COND.
STORIES
OCC. GROUP
TYPE CONSTRUCTION
APN
FIXTURES - PER TRAP
GAS- IA. SYSTEM I INC. J OUTLETS
GAS - HA. SYSTEM -OVER S (EA)
GRHASIWNDUSI'RL WASTE INTERCEPTOR
BUILDING DIVISION FRES
GREASE TRAP
PLANCHECK FEB
SEWER -SANITARY -STORM EA.2IX01'r.
ENERGY FEE
WATER HF.ATHR W/VENT/CLECI'R
GRADING FEE
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
hecome smelter to the Worker's Compensation provisions of the Tabor Code, you must
frhwirh comply with such Provisions or this pemtir shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I Ihrohy affirm ohm there iso combustion l,ndingrigeney forthe perfomtmttof
work or which this pximm is issued (Sec. 3097, Civ. C.)
Name
WATER S YSTEM/TREAI'INC
WATER SERVICE
SOILS FEE
PAID
NEW RESIDEWIAL PLMB. SQ. PT.
Dole Receip,N
TOTAL:
r.nder's
Lender'sAddress
TOTAL:
1 entity than I have reu1 this application wont swan that the starve infnmratinn is
cermet l agate texturally with all city and county mdinancas andsrme laws relating to
building construction. and hereby amhorim repmscntanves ofthis city to enter upon the
above-mentirned properly for inspaction purposes,
(We) agree to save, indernnify and keep hurt the City of Cuperlion against
liahilines,judgments,mm,and awines which may inany way stem¢ against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1, NON.POINT
SOURCI GULATIONS.
2/1?/
I.V9
Signammof Applicant/ meverm f1i Date
HA BRDOUS MARIAIS DISCLOSURE.
Wll,hart,licant or future bmIdiagwcupmr store or handle hazardous mmct.1
as defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
CWc, Section 8533(0)? -
E] Yes WN.
` Will Ne aircontont tionsa building exception by Air cmlity or Managemch
/ it hmardous air ammminants as defined by the Bay Arca Air Quality Manugnnmt
Area ent
Oixrria?
�. ❑Yes No
I have read the hurardmtis materials rcquircmems tinder Cbopmr 6.95 of the Cab.
fomes Health is, Safety Cole, Sections 8505, 8533 and 53x.1 understand Out S the
builJingd urn currently have a tenant, that it is my responsibility to nobly theoccupant
a ntz which mmtMmct pdormiuvurce ofa Certificmeo
F the Owner or
Owner euthonxW ager I i)aTc'�
QTY. MECHANICAL PERMIT FEE
BUILDING FEE
SEISMIC FEE
X
PERMIT ISSUANCE
ELECTRIC FEE
ACIER OR ADD TO MECIL
PLUMBING FEE
AIR HANDLING UNIT (TO 10.0a) CPM)
MECHANICAL FEE
AIR HANDLING UNIT (OVER 10.000CFM)
CONSTRUCIONTAX
EXIIAUSTHOOD(WMUCT7
HOUSING MITIGATION FEE
HEATING UNIT (TO 100.000 BTU)
PAID
Dme R¢ciptX
HEATING UNIT (OVER 100,000 BTU)
VENTILATION PAN (SINGLE NF.SID)
BOILER- COMP OR 100,000 BTU)
TOTAL:
BOILER - COMP(OVER IW.UfNI BTU)
AIR CONDITIONER
ISSUANCE DATE
ISSUED BY:
NEW RESIDENTIAL MECH. SQ. FT,
TOTAL:
OFFICE
RCD
ECESVED
FEB 13 1997
610G. INSPECTION DEP
CITyOFCUPFanA TiHENT
STRUCTURAL CALCULATIONS
PREM KuMAR RESIDENCE'
Limited lateral calculations
10325 Plum Tree Lane
Cupertino California
JOB NUMBER =
THIS ENGINEERING DESIGN IS FOR THE AREA OF ADDITIONS SHOWN, ONLY.
NO WARRANTY AS TO THE QUALITY OR THE STRUCTURAL INTEGRITY OF THE EXISTING
HOUSE IS INFERRED OR IMPLIED BEYOND WHAT IS EXPRESSLY WRITTEN IN THE
CALCULATIONS AND ON THE PLANS. BY ACCEPTING THIS WORK, THE OWNER
ACNOWLEDGES THIS ENGINEER"S LIMITED LIABILITY.
C POPA ENGINEERS
GOLDEN VALLEY OFFICE CENTER
2542 South Bascom Avenue • Suite 102 • Campbell, California 95008
Phone: (408) 559.4202 FAX: (408) 559.3628
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Golden Valley Office Cenwr • 2542 S. Bascom Ave. " Campbell, CA 95008
Phone: (408) 559-4202 * Suite 102 Fax: (408) 559-3828
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Job No.
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Golden Valley Office Center • 2542 S. Bascom Ave. • Campbell, CA 95008
Phone: (408) 5594202 EX: 1 Suite 102 Fax: (408) 5593620
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Golden Valley Office Center • 2542 S. Bascom Ave. • Campbell, CA 95008
Phone: (408) 5594202 EX: i Suite 102 Fax: (40B) 5599628
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10325 Plum Tree Lane C 1 1
Cupertino, CA 95014
Ph: 408-777-9037
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Exp. 3/ /97
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