28927 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL 28927
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: - - _ SANITARY NO. APPLICATION SUBMITTAL DATE
o bso S'CWc, Aa,0` If u
OW BISNA 'IjOiyECO .l R'S NAME: LIC NO:
7 77NIC CONTROL p
RCHITECT/FNGINEER: LIC NO: ADDRESS: ❑
-ONIACT: - PHONE: BUILDING PERMIT INFO
a ❑ Consultant Fees Paid by Applicant(Initial) LILDGlp ELECT PLUMB MECH
lissi ❑ ❑ ❑'
LICENSED CONTRAC'TOR'S DECLARATIONQTY. ELECTRIC PERMIT FEE
1 hereby affirm That Turn licensed under provisions of Chapter 9(cm
omencing JOB DESCRIPTION '
OB'Z with Sectior700i)of Division Jof the Business and Potassium,Gsdeand my license is RESIDENTIAL:
00 in full force and effect. PERMIT ISSUANCE
ayUZ Uceme Class Licp - S ❑
FOWL - [I KITCHEN REMODEL
fnQ Date Contractor ES
ctor APPLIANC -RESIDENTIAL ADDITION PLUMBINGRE-PIPE
y ARCOTI ECf'S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL.
Z O J Z 1 understood my plans shall he used us public records PANELS MODIFICATION
OZ6PTO200AMPS ❑INTERIOR El CHIMNEY REPAIR
r 14 LLW Licen.ved Professional 2111-loon AMPS "' IMPROVEMENT
ej4 OWNER-BUILDER DECLARATION OVER IUO AMPS El BATH RF.M IJREPAI N
CC CC 6 I hereby off rte thus 1 am exempt from the Contractor's License Law for the QQ��--__
ap5s O y U following rectum.(Section 7031.5,Business and Professions Cede:Any city or county SIGNS ELECTRICAL ❑OTHER �
W 3 LL Iv¢-rr which requires a permit to emstmcm,alter,improve,demolish,or repair any structure //�kaa�h77
.2 pHill o its Issuance.also requires the applicant for such pepon m File usignedsmammem SpIiGIAh CIRCIII"1'IMISC.
ythat M1e is licemed pursuannahe provisions of the Convector's License Law(Chapter9
00 (commencing wiTh Section]000)af Uivision3of rhe Business antl Pmfessions Cude)u, TFMP.METER OR POLE INST. COMMERCIAL
dpx�:2
T� that he is cxcmpt therefrom and the basis for the nllegcd exemption.Any vinildin i or - C1 NEW BLDG/ADDITION' ❑DF,MOLITION
�m Section]OI LS by any epplicvmforapemtit xubject,nhe applicant toe civil penally of POWER DEVICES []TENANT ❑FOOD SERVICE
not more Than Eve hundred dollars($500)( IMPROVEMENT
ZO I]1,as owner ofthe property,or my employees with wages as their vole compensation,mpenson, SWIMMIhUPOOLELECEI
' C
yy willdompwork,andthestru tun is not intended oroffered forcale(Sec.]0L1,Business ❑OTHER
W�3 and Isrufessiom Cede:The Commcnir's License Law dues not apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,and who docs such work himself or through
his own employees,provided that such improvements are not intended or offered for NEW BESIDENTIAL ELECTR SQ FT.
sale.If,hnwemi,the huilding it,improvement issold wimmone yemofcmtpletion,the SQ.FT.FLOOR AREA VSQ,ET,
owner-builder will have the burden of proving that he did not build ar improve for pur-
pose of sale,),
I,us owner of the pniperty,vm cxolnxi rely commotio, ,,in totaled clmtmemra m TOTAL:
convect The Project(See 7014,Business and Professions CmfeO The Committees Li-
release Law duesour applymair cr of property who With or irriamesthercm,and QTY, PLUMBING PERMIT /E
whncommetsfmxuchprojecu, tithe arab (e)Ikensed pursuant m the Con¢tern, s
Liceme Law. PERMIT ISSUANCE
❑ lam emmptu er ,B&PC iambic ancon
ALTER-DRAIN&VENT-WATER(HA) a VALUATION
net Dare J
KEN OM iNSAI'IONDECLARATION BACK FLOW PRO I'F.CT,DEVICE
Ihercby amr penaltyo perjury one of The following declarations:
V (have and will mai InaCert tem ofComenuu self insum for Workers Compcn- DRAINS-FLOOR.ROOF.AREA,COND.
atlnn,asprork Iforb '•aionJ] of the Labor Code,for theperfonnunce,ofthe STORIES TYPE CONSTRUCTION
work far which this I courn a r FIXTURES-PER TRAP
I]1 have and will maintain Workers Compensation Insurance,as required by Section
3]101 nftbe lapr Cnde.bra the perfmmanm of thgwnrk[ar wM1lch thio permit is issued. CAS-BA.SYSTIiM-I INC.40UTLBTS OCC.ONOUI' APN
T My Worker's Compensators Insurance carrier and Policy number arc:
Carrier: Policy No,: GAS-EA,SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPT[ON FROM WORKERS'
11
COMPENSATION INSURANCE GREASE IINDUSTRL WASTE INTERCEPTOR s
(This section need an,he completed if els,puttµis for nne hundred dollars($1(N)) BUILDING DIVISION FEES
or less. GREASP,'I'RAP
I'LANCHECK PEE
Joy any That,,,,a
in air,performanceaide
as
for which this permitieisland.Cadma - SEWER-SANITARY-STORM F.A.2W IT.
not employ nny penton in any manner so ax to became subject to the Workers'Gimpen- [NERDY HE
Z ration laws of California.Dam
WATER HFATF.µWNLM/ELGCTR
O Applicant GRADING FEE
V) NOTICE'DO APPLICANT:If,aper making This Cenilicale of Exemption,you should WATER SYSTEMOREA'1'ING
F-' 7 become subj.,m the Workers Compensation provisions of the Lapr Cede,you most SOILS FEE
WQ forthwith comply with such provisions or This permit shall he deemed revoked. WATER SERVICE
� Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.IT. PAID
U 01 hereby affirm that hem is a constmction lending agency for the performance of. Date ReceiptN
Us the work for which this permit is issued(See.3097,Co,C.)
O F-' Lenders Name TOT L.
U Lendcr's Address - TOTAL:
G1 oci ify that I have rend this application and state dim the alcove information is BUILDING
r.a to correct.I agree to comply with all city and county ordinances andsene laws relamingm QTY. MECHANICAL PERMIT FEE
U � buildingconstmetinn,andhareby uuthoriurepresenmtives'ol thlscilymootderupnothe SEISMICFEE
above-mentimeA Triplicity for inspection purposes. PERMIT ISSUANCE
(We)vgroe ni save,indem iry unJ keep hunnlesn the City of Cupertino egvbam ELECTRIC FEE
liabilities,judgments,costs andel s which may inany way acemeagoind said City ACIER OR ADD TO SECT I. PLUMBING FT:C
inconsequence of tp granting of tl s milt.
APPLICANT'UNDERSTANDS A, D WILE.COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IB,fNNI CFM) MF:CHANICALPEE
SOURCE' EG ON
ens10 AIR HANDLING UNIT(OVER 10,000 CFM)
CONSI'RUCfION TAX
ignamearfA Tics Caii Data E.XHAUSTHOOD(W/DUCT) HOUSING MITIGATION FEF.
ZARDOUS M TERIALS DISCLOSURE
Wiflmeappllc, for WturehIng....pant xoom nr handle hnzanlous marndal HEATPU UNIT TO 100.100 B U) "
in refined by the Cuperm Tpal Cek,Chapter 9.12,and The Health and Safety
Cale,Section 25532(a)? HEATING UNIT(OVER 100,000,BTU)
❑Yes E]No
VENTILATION PAN(SINGLE RGSID) PAID -
Date �) Receipt It
Will the applicant or furore building occupant use equipment or devices which z.
( plinar, us yr rnmaminanms as lefinW by the Boy Area Air Quality Management BOILEk-GDMP(3HP OR IW.INO BTU) . .
Dinriet> - TOTAL:
. ❑Yes El No BOILER-COME(OVER I00,IXI0 BTU) ��
I have teed the hazmdous materialsrtuirements under Chapter 6.95 of doe Cali- AIR CONDITIONER
9 p M ISSUANCES A
tope Heralfirgdoes,&Safety Cape,Sections 25505,25533 and 25534.1 understand Thai rpritt z y
buildingdar not aurtndy hmxanamed,merit is my rtspmsibilirymnmify the wcupant NEW RF.SIUENI'IAL MUCH. SQ.FT. 4f
of the requirements which must ba no prior ai issuvnmofu Cenificamof Occimmcy. to Ifs(
Owner or authorized agent Data TOTAL: ISSUED BY:
OFFICE
L. WADE HAMMOND
Land Surveyor
6310 THORNTON AVENUE
NEWARK�CA 94560
September 6, 1995 Tel: 510-796-26?.4 r FAX 510.790-2650
City of Cupertino
Building Department
c/o Marc McGee ✓
10190 Pasadena Ave. #1
Cupertino, CA 95014
Subject: 10250 Scenic Blvd.
Building department:
I have staked the foundation for the above project. The foundation as staked is
correct per plan and does not encroach upon the setback lines. I have placed a mark at
the finish floor height that is 117' above the street centerline.
Very truly,
U
c�SI LAND
LO
ve LOUIS wtkDE
HAMMOND L. Wade Hammon
PLS
it EXP. 3-31-98 C
s N° 6163 \P
Tq� OF CAS\E���
McGee
L. WADE HAMMOND pµI"we tire*
Land Surveyor
6310 THORNTON AVENUE
NEWARK, CA 94560
Tel: 510-796-2624 FAX 510-790-2650
November 7, 1995
City of Cupertino
Building Department
10300 Torre Ave.
Cupertino, CA 95014 "' ,� •,
Subject: 10250 Scenic Blvd. - McGee Residence (: f
Building department:
I have completed a pad elevation survey at the above site. The pad elevation is
correct per the approved plans.
Very truly, .
= L. Wade Hammond
PLS
cc Owner: Marc McGee 10190 Pasadena Ave. #1 Cupertino, CA 95014
Contractor:Terry Brown 10230 Scenic Blvd. Cupertino, CA 95014
Inspection Query for a Specfic Permit 1/16/97
PERMIT# SITUS ST SITUS STREET Lot# INSDESCRIPT InsT a DATEDESIRED DateDone
28927 10250 SCENIC BLVD ROOF FRAME 10/27/95 10/27/95
28927 10250 SCENIC BLVD FOUNDATION/POU 11/15/95 11/15/95
28927 10250 SCENIC BLVD GARAGE SLAB 11/21/95 11/21/95
28927 10250 SCENIC BLVD INSULATION 12/21/95 12/21/95
28927 10250 SCENIC BLVD ELECT-R 5/3/96 5/3/96
28927 10250 SCENIC BLVD FRAME 5/3/96 5/3/96
2892710250 SCENIC BLVD MECH-R 5/3/96 5/3/96
28927 10250 SCENIC BLVD PLBG-R 5/3/96 5/3/96
28927 10250 SCENIC BLVD INSUL 5/6/96 5/6/96
28927 110260 SCENIC BLVD MECH R 5/6/96 5/6/96
•
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• Inspection Query for a Specfic Permit 1/16197
Inspector Unita Peas/Fail Code
AD 2P
AD 2P
AD 2P
AD 2P
CC 2 P
CC 2 P
CC 2F
CC 2P
CC 2P
CC 2P
1
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