29164APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE 13ALL POINT PEN ONLY
CITY OF CUPERTINO IIUILDING- ELECTRICAL.
BUILDING DIVISION APPIACATION/PF.RMIT PLUMBING -MECHANICAL,
BUILDING PROJECT IDENTIFICATION
PERMITNO. ^^a w a
2 9 11 L6 4
BUILDING ADDRESS:
0316 PLUM TREC- LN, CKPGRT10A, CA y,f-01q
SANITARY NO.
APPLIC ION SU MITTAL OATI
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O E IZE��� / I(jJE`� I
N 66 99 6
CON" CR)'SN LIC NO:
N/C
E3
///C���ONTROL#
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CRCHITEC VENGINLIC NO:
IW EER: W
AD ESS:
CONTACT: PHONE:
❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PHRMITINFO
B LDE ELECT LU B MEC ,
LICENSED CONTRACIOR;S DECLARATION'
I hereby affiim Nat I man licensed out, provisions rf Chapter 9 (cnmmencing
' with Smium7")of Division 3 ofthe Business and Pmfcssiort Code, and my license is
> Uo full fora and effect.
t
License Class Count,....
jD
1 mc Camrunnr
QTY ELECTRIC PERMIT FF.E
Pasais
JOB DESCRIPTION
RF_SIDENTIAL:
05FDWL 11 KITCHEN REM EL
DITTO O PLUMBING RE -PIPE
1:1 MU - NIT 0STRUCTURAL
MODIFICATION
❑ INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
O BATH REMODELIREPAIR 0 DEMOLITION
(—]OTHER
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
j ARcinrECFS DECLARATION
I understand my plans shall he used ns public records
1
PANELS
UPT02MAMPS
I Licensed Rvfcssinnal
II OWNER-BUILDERexempt
D the Connote o for the
I hereby .affirm(Sna that 1 I S exempt from the Contrncmrs License city
1isturbfoll.wingreasitPemit 703 tocommon,thei+and Professions Cdrdc:Any ciy warfare
whor, its IRSae..1llmCOres thealter,Imprrsu.h n omit,Me. sigany tWrtnre
prionnits Esstaxedpalsoat to th. provisions
visionso for sucContrurmivaicense gnedemtemem
that lifeeaeJ pursuanno the pro visions of the eBusin so License Luo (Chapter9
(commencing.1heisempth Senfixtra it of Divisionfor of the Businessandon.limitations,i1michCoilt) or
that he is exempt dhcrtfmm and the basis far Ne alleged exemption. Any virlmion of
Section 703 l S by any applicant for a permit subjects the applicant to a civil penalty of
not .are than five hundred dolls. ($500y
01, us owner the property, or my employees with wages as their sole conitormation,
will do the work, and dare structure is not intended proffered for sale (Sm. 7144, Business
and Professions Code: The Contractor. License law does not apply m an owner of
property who builds or improves thereon, and who does such work himself or through
his own employees, provided that such improvements aro not intended or offered for
sale. If, however. (lie building or improvement is sold within one year ofaompletion,the
rwncrvbuifder will have the burden of forcing that he did not build or improve for put.
pose of sale.).
0 1, as owner of the property, am exclusively contracting with licensed contractors to
conoractthe projem(Sea l044, Business and l'nffesaimvx CndeO The CnnOvcmrs Li-
cense Law does not apply m an owner of property who builds or improves thereon, and
who contmenfersuch projects with a ommatims) licensed pursuant to the Cor mush 's
License Law.
O l am exempt tinder Sec. ,H&P C for this reason
201-I000AMPS
OVER I"AMPS
SIGNS ELECTRICAL
SPIiCIAL CIRCUIT/M15C.
TEMP. METER OR POLE INST
COMMERCIAL:
NEW BIDG/ADDITION ❑ DEMOLITION
❑TENANT ❑ FOOD SERVICE
IMP EMENT
'R
POWER DEVICES
SWI MM ING POOL ELECTRIC %
OUTLETS—SWITCHES—FIXTURES
NEW RESIDENTIAL. CLECTR SQ 14.
SQ. FII FF$OOpRR AREA
JAN 251996
Re/
V Y �F VUftfT III>O
$/SQ. FT..
X 8803
O L
Q TY PLUMBING PERMIT FEE
PERMIT ISSUANCE,
ALTER —DRAIN & VENT— WATER (BA)
Owns Dare
VALUATION
6 3 z9
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one cifflue low
e foling declarations:
,] I have and will maintain a Certificate ofConsenrto self-insurc fur Worker's Compete
cation, as provided for by Secdon 9700 of the I mor Code, Sir the perfornwnce of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance, as required by Section
379)of the Labor Code, for the performance of the work for which this permit is EssrW.
My Worker,Cnmpemmion Insurance carrier and Policy at lunare:
Cartier: Polity Nu:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section rad not be completed ifthe permit is furore hundred dollen ($1 W)
ar less) Tythminthe performano,atom work for which his is issued.
not employ my person in my mannerso as to hcomsubject o the Wnken' Counter-
talion Laws of California. Date
Applicant
BACK FLOW PROTECL DEVICE
DRAINS— FLOOR, ROOF, ARRA, COND.
STORIES
TYPE CONSTRUCTION
-
HC URES — PER TRAP
GAS — FA. SYSTEM -I INC. 4 OUTLETS
OCC.GROUP
APN
GAS— EA. SYSTEM -OVER 4(HA) '
GREASHANDUSTRLWASTE INTERCEPTOR
BUILDING DIVISION WITS
GREASETRAP
I,[ NCHECK FEE
SEWER—SANITARY—STORM EA. 200 Fr.
ENCRGY FEE
WATER HEATER W/VENT/ELECTR
GRADING FEE
NOTICE TO APPLICANT If, after making this Cenificnm of Exemplinn, you should
become subject m the Workers Compensation provisions of the Labor Code, you mull
forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1herebyafium that there is a amsuvaion lending agency for the pemlLmame of
the work for which this permit is issued (Sec. 3097, Co.). C
Lender. Name
WATER SYSTIiMlfltliAf]NG
SOILS FEE
WATER SERVICE
PAID / 6 �
etc Rcceip S
NEW RESIDENTIAL PLMB. SQ, FT.
TOTAL:
Lenders Address
T f
I ratify that l have rami this application and state that the above information is
correct. l agree to comply with all city and county ordinances and state laws relating to
building construction. umd hereby vuthoris repreaentalives mf this city to animation the
move-mendoned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Beni lines.judgmena, costs and as parses wblelunay in any way aarue against said City
in nnameance of the granting of this pnmid.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
r�
BUILDING FEF Its
SEISMIC FEE
QTY. MECHANICALPERMIT FEE
PERMIT ISSUANCE
EL
PL 81 RIE
MECHANICAL FE
AUIDIe(3RADDTOMECH.
AIR HANDLING UNIT (TO Ination CFM)
AIR HANDLING UNIT (OVER 10,0(10CFM)
CONSTRUCTIO AX
Signamreof ApplicanVContractor Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building accepted store or handle hazan/nux material
as defined by the Criterion Municipal Code, Chapter 9.12, and the Health and Safety
Coda, Section 25532(a)'t
O Yes CNo
Wel the applicant or aura building mcueause equipment limy Ma as which
mit
ehorurdrus air cnnmDay as defined by the Nay Area Air Quality Management
IDistrict7
❑Yes ON.
I have oW the humrdous materials requirements under Chapter 6.95 of the Cali
from, Health & Safety Code, Sections 255(15, 25573 wd 25534. 1 understand that if the
bmilJing Joel nm cumrently have u mntn0 that it is my respomsihiloy to notify the occupant
of the trgoiremena which muss be ran priono issuena of a CmiGcae of IXcupency.
EXHAUST HOOD(W/DUCT)
HOUSING MITI ATION FEE
HEATING UNIT (TO 100,008 BTU)
HEATING UNIT (OVER 100,000 BTU)
PAID
Da.. Reexim
- -
VF.M'ILATION FAN (SINGLE RESID)
BOILER -COMP QHP OR I00,ODfl BTU)
BOILCR- COMY(OVF.R IIX),IIIyI BTU)
AIR CONDITIONER
ISSU ATE
'
ISSUED BY:40,
NEW RESIDEM'[A]. MECH SQ til'.
Owner, or i mhodnd agent Data
O
OFFICE L v V
Is
KENNETH NELSON
Registered Civil Engineer
940 Saratoga Ave. Suite 215
San Jose, California 95129
(408) 247-2898
March 15, 1996
Job No. 956123
Building Inspection Department
City of Cupertino
10300 Torre Ave.
Cupertino, CA 95014
Subject: Foundation recommendations for a One Story residence
addition at 30326 -Plum Tree Ln.,Cupertino,Ca.
Gentlemen:
At the request of the Owner, Mr. Chin -Te Chen, the subject
property was inspected by the undersigned on March 15, 1996.
The inspection verified that the soil conditions observed were as
per my recommendations of December 27, 1995. I therefore approve
the foundation excavations and construction.
If there are any questions regarding this subject, please contact
my office.
Very truly yours, QapFESS10414
aEt H NFA �FZ
Kenn th Nelson_
Registered Civil Engineer #22023 " r z
c No.22023
KN/kn
Lie. Exp. 930.97
�' �
cc: Mr. Chin -Te Chen