S 2291O z
z
h
fy
1, z
UO
�U
a
N
UZa
40
/\
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO
IIUILDING DIVISION APPLICATION/PERMIT
RUILI)LN-EILEC'I'RICAL
PLUM IIIGNG-MF.CIIANI
IDIFICFICATION
BUILDINGBUILDING 1'RO1El; I'P,MI'
PERMIT NO,
S 2291
BULI.DIN(?—DDIRISS:
SANITARY NU.
APPLICATION SUBMITTAL DAI'T
^�
• -Z'U k& S'G v rii L'i D
I Z—
%Q'S-Y�
NER'S NAME: PHONE:
eTroi..i I
/
�CHDLicT/t?NGINF.fiR:
CONI'RACTf]R:S NAME: LIC NO:
�x
NIC
CONTROL#
LIC NO:
A Il 5S: 1❑
CON'T'ACT: PHONE:
❑UILIJINC PERMIT' INFO
/(` ,
❑Consultant
Fees Paid by Applicant (Initial)
BI-DGr— ELECT rLEl II MO 1
S��
LICENSED CON "I RAC'I'OR:S OFCI.ARATION
hereby affirm that 1 ant licensed notice powbinn., of Output, 9 (commenemg
QTY.
IiLEC'PkIC PERMIT
FEE,;
JOB DESCRIPTION
PERMIT ISSUANCIi %
nll'ull fora nn1lfc Divisinn3nflhcHminess unJ l'mfexsinnx Ede. unA mylicense is
RESIDENTIAL,
❑SFIIWI. ❑KI TCHEN REMfIDIiI.
APPLIANCES - RESIDEN [AL
PANELS
UPT0200AMPS
License Class Lic.#
Dmc Cnuwmor
A CHITEC'1'S DECLARATION
lu c ypl s c public recurs"
r an s't m
❑ADDITION ❑PLUMBING RI -PIPE
0 MEUN-UNIT ❑ S'MUCTURAL
MODIFICATION
❑INTIiRIOR ❑ CHIMNEY REPAIR
IMPROVBMI?NT SWIMMING POOLS
ceased tufa Scone
201-10N)AMPS
WNER-BUIL IiR DECCARAI'ION
1 hereby affirm) hm 1 am exempt from the Contractors I.iceme Law In, ate
following reason. (Section 7031.5. Business and P..R ssi ins CMe: Any city or county
❑HA'fl{kEMODEUREPAIR C3 DEMOLITION
❑ OTHER
OVER I(XHIAMPS
.
SIGNS ELECTRICAL
which mynircs n punnit u, eansmiet, aIle, improve, dro n idi, nr repair any structure
SPECIAL CWCUIT/MISC
n'•
priorto its i"suance.also requires the applicant l insuchpamil m file a."ignes xDmment
,bar he is IicenseJ pursuam to the provisions of the Cmdearb i" License Law (Chapter 9
(cvmowncingwit h Section]0N))olON was 3of,heBu-na.,t„ I Prue,ionx Code)-
that he is exempt therefrom and the basis for the alleged exemption. Any vitiation of
TEM n MET Ii R OR IY) ?INST.
❑ NEW BLDG/ADDITION ❑ DEMOIA PION
Section 70315 by any applicant lir a permit subjects the applicant to a civil penalty of
POWER DEVICES
❑TC:NANT C3 FOOD SERVICE
of more Ihun live hundred dalbrtx 1&5IN#.-
❑ I, ns owner of lM1e pmpeny, nr my employees wish wage. an their sole rompcnsmion,
will do the work, and the nmeturu is not intended nr offered for sale (See, ](D4, Rumness
I I'ItOVIiMIiNT
I:R
SWIMMING LIi1.EC1'RIC
OUTLETSI I CA his - FIX (ORES
ant] Professions Code 'I Contractor License Low does not apply to an owner m'
NEW RF DENTIAI, ELEC!R SQ Ff.
#coped who build.., or improves thereon, and who does such work himself or though
his own employ,,, provided Nat such improvement, ate nal intend,,] nr Whieed f r
mle.If, however, the buildnNor improvement ismld within one year of completion,the
SQ. Cr FLOOR AREA
5/SQ. Ff.
e -builder, will have the burden of proving that burial not build or improve for put.
❑,in,onVursale.).
L m owner of the pmpeny, am exclusively contracting with licensed contractors In
e
f(YIAL:
ruse a the project (Sec. 9(414, and The O's
bei Code
oxs
Law does applytoan owner property who improves then nd
wbehnimsnrto[
QTY.
PLUMBING PERMIT
FF.F.
wac
Commenod
ithacol'propeny
ho contracts for such pmjecu with a asmmaortsl IicenuJ punuam to the Comractols
PERMIT ISSUANCE
Liana, Law.
1 am exempt under Sec . It & P C for this reason
Dale
WORKER'S COMI'1?NSATION DECLARATION
Fereby nffmn under pentilty of perjuryone of the following
ALTHR - DRAIN & VFNT- WATER (EA)
VALUATION
V
/�00 V
('
BACK PLOW PROI'IiCf. DEVICE
ir,tum Woke,doulard, C,n
ion. as andwieforll b inetion 370f)of theConsabrCode, for the Wnrkmance of the
",,tion, as provides for by Section JTp of the ItuMr Code, for the perlirmance d the
work is issued
DRAINS - IIAOIt, ROOF, AREA, WNU'
STOIRIF.S 'I'YPEC[1N5'fRI1C'fION
FIX '1'URES-1'ER'fRAP-
have wills antai
❑ I have and will maintain Worker's eoteCompensation workh his Pert t i Semina
for which
J700of the LuMa Cuxle, for the perfnmmnce ofthc work for which this #,null is issued
GAS -Ed SYSTEM-] INCAO .EfS
OCC GROUT'
APN
My Won ke"Ct onsminn Insurance carriertins Policy nuedmrem,
Canna Policy No.:
/J
GAS -EA. SYSTEM-OVII (EA)
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSA'T'ION INSURANCE.
GRI?ASFIINDUS'1'I< 11-S I'H]NT HRCIFMR
BUILDING DIVISION Igi13S
('This ,,salon need not he completed ifthc #,orbit is Tenor, hundred dollars 181001
or Icsx.l
GRIiASE'IRAP
-
PLANCHECK FLIT
_
I ccnify that in the performance nl' the work for which this pemhitis seined, l ehull
nal employ any person m any manner sex as m hcsunw wliput ht the Workers' Compen.
SEWER -, NITARY-STORM EA. LX)IT.
IiNF.RGY FET?
WN[E HI!A'IERW/VLNrNITR.CAR
codon lauwnof CcIll 'naDma
Applicant
GRADING Flit?
NOTICE DO APPI.ICAN'C IL after..taking this Certificate of Exemption, you should
tuunte .bjec, rube Worker's Compensminn prnvWaa,of the Labor Code, yon mux]
WATER SYSTEM/TREATING
SOILS FEE
WATER SERVICE
forthwith comply with such pswisionsor this permit shall be- residual revoked
CONSTRUCTION LENDING AGENCY
I hereby affront that is a construction lending agency for the permonmenee of
NEW RI?SIDENNAL PLM R. SQ. PI'.
PAID
Dom (Receipt#
the w ... k for whirl, diis...rust i., Is"treJ (Sec 3099. Clv. CJ
Lenders Name
TOI'AI:
Lender's Acidic,"
TOTAL:
-
BUILDING FEE
.77 -on
I certify tum 1 have rend this applicant aria tore Nat the meso mro, u pion lx
QTY.
MECHANICAL PERMIT
FEE
_
correct. I agree mccmply with all city and county ordinances and state laws relating to
building comhor,,mq:cod hereby andarize representatives of this cay at enter upon the
.
PERMIT ISSUANCI?
nMrvmmmntioned property for inspection pu,pnxs'
(We) agree m save, indemnify and keep hmmlcss the City of Cupertino against
?LEC'I'RIC P131i
AM 11 R Oil ADD' IO MEC[ I.
PLUMBING FEE
hatudinni,judgmon... costa tod cxwo", whiuhney in tiny way a:znmti'au ,said City
in consequence of the graining of this perand.
AIR HANDLING UNIT (TO 10,(X10 CF
ML ll
IA WE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
SOURCE RFI' '. fl0
ADR HANDLING UNIT (OVER I C11M)
CONSTRUCTION' %
Signatureif ApplicanVCoultucmr
HA9ARDOUS MATERIALS DISCLOSURE
EXHAUST HOOD(WIDUC
TIO '� 1'I'IGA'1 i?I?
Will lhcappllenm or future buildingna'npanlatore or handle hatardouxmmerial
HEATINGUNITf101 000BUD
us define) by the Cupeninn Municipal Csde, Cbap¢r 9.12, and the Iluahh and Sulity
Code. Section 2.5532(al'/
[Dyes 0 N
1 HEATING UNIT (/ER Rp,f)(XI (ITU)
��--���/
PAID 462-
Uete Receipt 4
VLN'TILAI I( TAN(SINGLE RESID)
OMPORP IIIIII
Will the nppliu:mt or tinurc building ha:cupam use eyuipr Qu nr devices which
emit huurdoas air eommninants as defined by the (lay A. Air Quality Management
TOTAL:
77t�0
f O1DER-CONI. OVF.RMILE
(XPI BTU)
DBmmr
❑Yes DNn
AIR CONDITIONER
I have read Nc h under Chapter h95 of rhe Cali
ISSUANCE DATE
NEW RESIDI3N'1'IAL MECIL SQ. PI'.
ode, Se tion2materials 5, 25533 an
fomie Ilul &Safely Code, Scaimu 25505, 2553) and 255,,1, I n mmiynt] ,hut if the
building dceano cu Ally M1avcamnan6 Nor it is my mspnnsibilitywnmify the uecupom
Qa
J'3
olthercyui ext s Ic me nuisauancc oin Ccnificmcof Occa,waq.
-
ISSUI:DB11-70e
TOTAL:
Dwner amhnrive a cot Date
OFFICE
4677 Archcove
1012 .98
San Jose, Ca 95111-1726
City of Cupertino
10300 Torre Avenue!
cuportino, CA 95019
Att: Uuiloing official
Rn: House A(7[(ition h Remndel
20105 Scofield Driv(
Cupertino, CA
Gor,ti emen:
(408)161-8718, FoX.(408) 226-9427
Undersigned was i.ndoed involved with the house addition design
in the polio( of 19 9-1990 at the captioned site.
My personal exporiance rolat:r,d with this project was mainly
Muer tho Structuial jesign consisting of plans G calculations,
• which wore .in compliance wivh 1989 uniform OuIldtng code.
orefore it is my opinior, that the strrctural interity and
sarelty of this nddition havo boon both maintained.
Should you have quesnions regarding this matter please fool
f.row to Contact- this nffice.
Truly yours,
w W
Wendy Hsieh, S.E.
cc; Steve 'fang, Property Owner
OCT 5 1998
INSPEBLDG.CITV OFT ION DCPAR uv,cJv (
CUPCRTINO