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21831 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY building Protect Identification PFIMIT NO. Building Address: 21831 ic4a 10� ~' nere NarrP: one: APPLjCAMWM9MrrATn= --,LVL-J S /1/ 2-S CITY CITY OF CUPERTINO-BUILDING DIVISION G CeeraN•ne: LI;.Ne: APPLICATION / PERMIT XX �'^ -�- BUILDING-FIECTRICAIPLUMBINGMECHAMCAL CATEGORY CONTROL# Architect/Engineer. Lie No: s— QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: PERMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S pr DECLARATION I hthSeMoby fn7=)tlamncen3ofthe under usinemsionso(Chapter9(cemmmc MPLIANCESRF.SIDENTIAL JOB DESCRE'TION InlicenseI in I7W0)of Dlvifon3o(lheeuslnessandPro(essionefbde,and my LJccn bin Ifo d Lie. /_ PANELS Dat Claey Liu.# 3 leas Dat 11 Contractor ARCHITECTS DECLARATION 201-1000 AMPS O 1 understand my platyshall W used a public mounds. OVER1000AMPS SQ.FT.FLOOR AREA 5/SQ.FT. qty C r— SIGNSELECTRICAL k (/ Licensed Professional ' t Lu OWNER-BUILDER DECLARATION SPEC AL CIRCU T/MLSC Iherebyaf rmthatlamexempt from the Contractors Llnnse Law for the following reason.(Section 70315,Buslnea and Profeabne Code:Any city ar O i=. TRMP.METERORPOLEINSf. I county which requima pertN1 m i.cxx .dPmIhMMm demolish,ycJtyor anystmcture prior toles Issuance,also requlrestheappllam forsuch permit to ROWER DEVICES file a signed statement that he b licensed pursuant to the provblom of the 3µ1n+ Contractor.License law(Chapter 9(commencing with Section 7000)of Divi. SWIMMING POOL ELECTRIC SOS eon 3 of the Business and Profealia Code)or that he Is exempt therefronowd VALUATION yd the basis for the alleged exemption. Any violation of Section 7031.5 by any <5 applicant fora permit subjects the applicant to a civil nal of not rometion OUTLETSSWITCHESRXTURES PP of I PP penalty ZZ OO .CxI five hundred dollars($500). NEW RESIDENTIAL ELECTR �n ❑l,as owner o(the property,or my employees with wages as their sole SQ RIES TYPE CONSTRUCTION zR compensation,will do the work,and the stmcb re is not Intended or offered for FM sale(Sce.7044,Business and Professions Code:The Contractors License Law E r�$ does not apply to an owner of property who builds or improves t hereon,and �CGROIIP RE£IRJITS E: whodaessuch workhbrwel(orthrough hlsownemplgen,provided that such Improvement arc not Intended orolfcred(orale.((however,thebullding or TOTAL: improvement asoldwithinoneyearorcompletlon,theowner-b Hderwdlhave tF)Lqurden of proving that he did net bund or Improve for purpose o(ale.). QTY. PLUMBING PERMIT FEEFLOOD7ANE APN u L as owner of the property,•m exclusively contracting with licensed PERMIT ISSUANCE - contractors to meat ori the project(Sec.7094,Business and Promaxime Code: The Contr ctor's Limm a Law does not apply to an owner of property who ALTER-DRAW kVENT-WATER(FA) Wilds or Improves thereon, and who contracts for such pioject with a tt[aetr(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY U I un exempt under Sec. B k P C for this reason BACK FLOW PROTECT.DEVICE OUTSID DRAINS FLOOR ROOF,AREA,GOND. SAMTARY Y N_ Owner Date RECEIPT# • WORKMAN COMPENSATION DECLARATION FIXTURES-PERTRAP SCHOOLTAX Y N �[hereby.(firm that I have•certificate uranc of concent to opytneure,ora RECEIPT# 3800,abofWorken'Compeaatlenlaurance ora certified mpythereof(Sec. GAS EA.SYSTEM-1 INCA 380Ic Iris C.) PARK FEE Y_ N Policy# RECDING Df X Com any ; GAS-EA.SYSITM.OVERd(FA) BUILDING DIVISION FEES nCertltedcoythere mlehe nCertUed ropytriled with the dry Wpecnon awl.Inn. CREASE/INDUSfAL WASTE INTERCEPTOR PLANCI-IECK FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Date RCCeI tM Rhlseection need not be completed Rthe pemat t far one hundred dollars ($100)orlcssJ WATER HEATER W/VENT/ELECTR ENERGYFEE Y N ]mortify that In the performance of Ja the for this permit is wed, — Ishall not employ any person In any manner n a to become subject to the WATER SYSTEM/TREATING Workers'Compensatlon Laws of Callfomla.Date PAID O Z Applicant Z D NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you NLS'RESIDENTIAL PLMB. SQFf. Date Remi tit H should become subject to the Workro Workers'Compensation provtioof the Labor TOTAL: CC 0 Code,you mostforthwith—ply with such provisions or this permit Mall be deeed revoked. BU FE m LUCONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirm that there Is a coatmctlon lending agency for the perform ELECTRIC FEE 7 Z ance of the work for which this permit t Lswed(Sec.3097,Civ.C.) TOTAL: co Lender'.N. PLUMBING-FEE 1L F Lenders Add. QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W I mrtitythat l have read thisappilat!omni statethat theabove information correct.I agreeto complywith all cttyand muntyordinances and state laws PERMIT ISSUANCE FEESPAID: �. 4 relating to building construction,and hereby authorize representatives oflht 2 city to enter upon the abovcmentbned property for Inspection purposes. ALTERORADDTOMECH. (We)agree to ave,indemnify an d keep h ass the City of Cupertlso Date ReCel tic O against liabilities,judg rats,costof ex o hlchmayinanywaywerue AIR HANDLING UNIT RO 10,000CFM) SUBTOTAL: sgeiataid a enc of the U ofthll permit{{ w ls.� pt/ AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX Sig a Ap est/cont er ��/Date l ExHAUBTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAl RDOUS MATERIALS DISCLOSURE Will the applla est or future building occupant store or handle hazardous HEATING UNIT(TO 103,000 BTU) rnDate RecCl tff aterUI as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code Section 25532(a)7 HEATING UNIT(OVER I(0,000 BTU) TOTAL: ❑Yes - Willtheapplicantor hTw m building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) F65UANQT DATE which emit hazardous air contaminants as defined by the Bay Area Air Cl��►' Quality Management District? BOILER-COMP OI N OR 100,000 BTU) Ph Ya GI No PP�4•yy qq everead leap&he a fee materials Sections t5533 and 25534. of ROILCR-COMP(OVIR 100,000 BTU) the understand t Resile building Safety Code,Sections 75505,ve a t and 25534.I G'C understand that Rohetheodoe not of eroquir haves which#that It met NEW RESIDENTIAL MECl I. SQ.FT responsprior to bility Issuance saltytheacteof ccupanequlrcmente which moat be rrct oft ft01 prior to Issuance ofaCertificate of Occupancy. Owner or authoomd agent Oale TOTAL: ISSUED BY: OFFICE COPY 1 4 , January 21 , 1991 • John Wistron 20711 Scofield Drive Cupertino, CA 95014 Re : Living Room and 'Nook Barbecue Masonry Fireplace Repairs for Above Address, Cupertino As per your request, I performed a review of the fireplaces referenced above to recommend repairs of damage that had been caused by the October 17th , 1989, large magnitude ( 7 . 1 Richter) earthquake found recently during a , chimney sweeping . The extent of the damage found on the fireplaces during this review indicated that these chimneys should be torn down to the upper shoulder, just below the ,roof levels and repaired starting from that level . The repair shall consist of rebuilding the new chimney using standard masonry construction techniques with proper reinforcing and ties to the roof framing established with straps to the rafter framing. The reinforcing bars are to be epoxied in place ( 6" minimum into the base masonry) and the rebuilding may proceed from that point. If you have any questions regarding this letter , please do not • hesitate to call �o V%of ESS/0N,` Timothy M. Kihlthau R.C.E. 40834 Jj C V � AlFOF CAUF�� GOLDEN VALLEY OFFICE CENTER 2542 South Bascom Avenue • Suite 102 • Campbell, California 95008 Phone: (408) 559-4202 FAX: (408) 559-3628 OFFICECOPY.- .