29093 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES:-USE BALL POINT PEN ONLY
f CITY QF CUPERTINO BUILDING-ELEL-fRICAL PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL �C� o Jn
BUILDING PROJECT IDENTIFICATION J
0 ILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
diN Pik. _ - � I �T� i -tq-q�•
NE N ME: PHONE: _CONTRACTOR NAM is IC NO,
NIC CONTROLA
40
RC IITELT/ENGINEE LIC NO: . D
�$ 3RP S:
el 7A
CONTACT: PIE BUILDING PERMIT INFO
ej)C/k 64V67
-Q Consultant Fees Paid by Appllcan[(Initial) BLDG ELECTPLUMBMEECCH
LICE CONTRACnDECL N QTY ELECTRIC PERMIT' FF,P,
I hereby anirm mm I ata licensed nodalder provisions of Chapter 9(enmmencints JOB DESCRIPTION
az with Section 700IDof Divisi 3ofibe Butommasand Pr essmom Ctd ad� yhcemi
W- in full to.and effect. q /_ PERMITISSUANCE �NTIAI
�U License Cl L10.M V VVV FDWI- ❑KITCHC:N REMODEL
Dam Contraror APPLIANCES-RESIDhNTIAL ❑ADDITION ❑PLUMBING R&PIPE
A L ECTS DECLA • PANELS ❑MULTI-UNIT []STRUCTURAL
2:02Z y 1 undersand nay plans shall be used as public recnNs - MODIFICATION
pZp UPTo 200AMPS 0INTERIOR ❑CHIMNEY REPAIR
��E'W Licensed Professional - 201-HM0AMPS IMPROVEMENT
r<� ....II OWNER-BUILDER DECLARATION RS
LaL C�6 I hereby affirm th:n 1 mil exempt from the Cnmacmts License Luw for the OVER 11110 AMT'S [I BATH REMOUEDRF.PAIR�(]�DEMOLITION
pd O L U following reason.(Sermon 1031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
YYJJ 4 Oa which requires a amdt to construct.alter.improve,demolish,or repair any structure -
.] primnoits issuance,also regwres hbe applicant for such permiuo tilcu aigneA xtmement SPECIAL CIRCUIT/MISC. n
;!{} thrheislicensed m&anuothepmvisinmoftheCnntacmr..Licer,LuwlChapler9 1��r
a00 (commencing with Satman 7"ha'Division 3ofthe Busmnessand Prefession.CWe)nr TEMP.METER OR POLL'INST. COMMERCIAL:
d e o�C that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDC/13 (TION, Q,,ii DEMOLITION
4. 9ectlon not mots,than five hrrdmd dollars($500).90315 by any applicant for a permil subjects the applicant to a civil penalty ul' POWI?R DEVICES � r t11
..y ❑TENANT LIF0'8NS:RVICE
FZQ I,as owner ofthepropertyorm loees with woes as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
❑ YetnP Y B pens.
II do the work,and the strucam is not IntendedoroffwW fill sale(Sas 1144,Business ❑OTHER
Gand Prof ddons Code:no Conuarors License Law does not apply to an owner of OUTI-ETS-SWITCHES-MIXTURES
property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements ore not intended or offered far NEW RESIDENTIAL HLECTR SQ PT.
sale.If,however,the building or impnmement is sold withinoneywrafrnmpletiun"fin SQ.FT.FLOOR AREA $/SQ.n..
wheat-builder will have the buNen of proving that he did net build or imprnve for par- ` E Q 1
pose.,sale.). - 24-1 tO3
[:1 1,as owner ol'the prnlwny,vn exclusively ennvaaing wllh licensed nmhucnns In I e a.�—�'{{��.•
construct the project(See.1044,Business and Professions Cod,'Ibe Cnntrenor's Li- -22
cense Law does not apply tb an owner ofpmNby who builds or improves thereon,and. QTY. PLUMBING PERMIT FEE �K 1
whheounba,for such It ja7s tithe comactortx)licensed parsuunt to the Contractor's
Licsnsc law. PERA11'1'ISSUANCE
I amexempt under Sec. •H&PCfor Nis«mvn
Owner
ALTHR-DRAIN&VF WATEiR CA) VALUATION
Dam
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECkP540413
I hereby affirm under penally of perjury one of the following declaredons:
I have and will maintein a Cedilicate of Consent to xal6insme for Worker'.Compel DRAINS'-PLGOR.ROOF, ,CON
action,as providW for by Section 3700 of the Labor CsWe,for be performance of the STORIES TYPE CONSTRUCTION
.,it for which this permit is issued. FIXTURES-PCR TRAP
❑I have and will nmtlntain Worker's Compensation hournce,ss required by Section
37M fdab labor Code,fnnhe performance ofthe work for which this Permit is issued. GAS-HA.SYSTEM-]INC.4O 'L OCC.GROUP APN
My Workets Cnmpe atir cc tamer end Policy mbar are:
Carrier: s Policy Na.: GAS-EA.SYSTEM-OVER 4(EA)
CIA F13XEMPfIDN FRO 0401 1? S'
COMPENSATION INSURANCE GREASMNDUSTRL WASTE INTERCEPTOR
(This section need not hecomplcmd Ifhhe North is formic hundred dollars($Hp) BUILDING DIVISION F111
GREASETRAP `_,. I�� �=
nr less.) - PLANCIIIiCK PEP.`l --
sm
IoyanypetinlinanynrmemceoOstobecmehe work far wubjectiotheWokersuCont,cll SEWI3R-SANITARY-STORM EA.200 FIE.
not employ any person in any twiner so as m become subject m the Workers'Compcn- ENERGY FE �
,7, sation laws of Califorms Dam e 1 2
Q - WATT?H HEATER W/VENT/EhCCIR 27
rZ.. GRADING FE
NOTICE
F.
afte
fificate
y become;TO APPLICANT:IT Cormakingthis Cmodsof the
Exemption,Cnl youshould
mind WATIiR SYSTC:MfTNF.A'I'ING
a became subject, the Workers Compensation provisions of the nalxn Code,you most 50145 ME
forthwith tom 1 with such ions or his tshull he Deemed revoked.
� Q pywi prolix palmi WA'1'Hk SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT PAID I
ClO l hereby affirm that there is it construction lending agency tar the perfoorrooeof D. Receipt
IL F the work far which this permit ms issued(Sts.3097.Ci,C.)
O U Lenders Name
TOTAL:
06 1 LemicAddrexx 1—Ifte IS
Q. I eenify that I have read Nis application and rale that tbd above infnnnetinn is BUILDING F '
rA correct.T agree to comply with all city and countyordmnonces and slate laws relating m QTY. MECHANICAL PERMIT FEE
U z. building construction,and hereby arbounie representatives ofthis city to enter upon the SEISMIC E
r� abnvememiomed property for inspersion purptxses.
(We).,.a to save.indemnify and keep moue xs the City of Cupenino.,amnet PERMIT ISSUANCE ELECfR F.
liabilities,judgmants,costsvndexpenseswhichnwyin.nyw.ytmcmeoguinsisamd City ALTER OR A01l TO MECH.
msequence of the gaming of this pit ;1. PLUMBIN .H
A c LICANT UNDERSTANDS AND WILT.COMPLY WITH ALL NON-POINT
AIR IIANDhING UNIT(TO 10,,11 CFM)
SO' ' EGULATIONS, MEC14ANICAL F1H milk
ynz J AIR HANDLING UNI'f(OVER 11,000 CPM) CONSTRUCTIO f
at pylic ue EXHAUST HOOD(W/DUCO HOUSING MITIGATIO HE HAZARDOUS MATERIALS ISCLOSURE
Will Ihe.,licwt nr future huildingaccupantstnreorhandle membloua material HEM ING UNH(TO 100,000 BTU)
as defncd by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 2.5532or? HEATING UNIT(OVER 1011000 BTU)
❑Yes ❑No
� VENTILATION PAN(SINGLE ktSID) PAID '
Data Receipt X
Will the air c mot or foam(formedldni,occupant use equipment it Management
which BOILER-COMP UHP OR 100,11111 BTU)
:mit huzarJoux air conaminana as AcfineJ by the Bay Arca Air Quality Munegwnem . . 'TOTAL:
oistdnY BOILER-COMP(OVER Iisif BTU)
❑Yes ❑No T
I have nevi the heamdnus taledals numdivmemsunder Chapter 6.95 of the C.H. AIR CONDITIONER ISSUANCE DATE
farm.Health&Safety Cade,Seddon,M505,25533 wJ 25534.1 undersand that if the NEW RESIDENTIAL MECH. SQ.Ff. -
building does nut currently have.a aunt,that it is my respnnihilig m notify me wcupmt
ofthe requirements ismob must he met prior to msmanceor.Ccmificme of Occupancy.
Owner or authorimJ agent DateV 40 ISSUED BY:
OFFICE
EDWARD J. HAHAMIAN
CIVIL ENGINEER
1211 PARK AVENUE #212
SAN JOSE, CALIFORNIA 95126
(408) 279.2954
March 27, 1996
PERMIT N
9093. !,
ADDR 21131 Rainbow Dr.
Trac 8352,
Contra Const. OWNER: Grace Lin
Attention: Chuck RECEIVED:
Building Official MAR 271996
City hall, Cupertino, Ca. CITY of CUPWINO
BuiLUSN6 WT.
RE: SETBACK & FAD VERIFICAMON
This letter supercedes and clarifies my letter dated March 18,
1996 for this site.
On March 18, 1996, I made the appropriate measurements and
hereby certify that the elevatiln and height of the house
and garage pad was graded in accordance with the approved planes;
that based on measurements to the outside of the perimeter forms,
the setbacks are correct as per approved plans.
Submitted by:
4 QJ•
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' No.C13310
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