S 0305F
a
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.. ELEC'PRICAL I PERM]I NO.
IJU11.DING DIVISION APPLICATIONIPERMIT rINGPRNJ. T IDENTIFICATION
S 0305
1 NIIILDING. PROJECT IDENTIFICATION
Mu
M
rf Hiteye
PHONE:
❑ Consultant Fees Paid by Applicant (Initial)
I hereby offrm that 1 am licensed under provisions of Chapter 9 (commencing
4�jOZ
with Section 7(1 Division 3of the Bminescund Pmfeesions Ctde.imdmy license is
yLLI in full force and effect.
QUU I.iccnsc Clan Lich
C G Da¢ Comma...
ARCHITECTS DECLARATION
0;.o, Z 1 u manJ mY Plan sh IIx used a public records
Z—
N Lice. 'anal
y J OWNER UILDER DECLARATION
C w Q I hervhy affiml that 1 an, exempt from the Count .... o', License Law fm The
6 U following reason. (Section 1031.5. Business and Professions Cod: Any city or county
O ya aelhch acquires a permit to cnmwct, abet, immense, di,r iah, or o puff any nommou
prior to ns issuance atm reqs m, the mppl cent for such pennll m file t s ned walcmem
�y J thin hes licensed puauanit) the poo son.vofthe ContraunsLicense Law (Chapter 9
aQi (commcncng with Sedom 70(lbof Do Ivan Sof the Busucssond Profession, GdC)or
X o C thug he is exempt therefrom and the basis for the alleged exemption. Any violation of
'—i4 Section 103 L5 by any applicant for a permit suhjmb n
1.6
the applicant ) a civil penalty of
not more Than five hundred doikes ($500).
ESQ
E] 1, as owner of the propenyl or my employees with wages as Their sole nonpensauon,
will do the work, and the ochre is not intended or offered for sale (Sec. AW. Business
a3 and Prnlc.siomt Code: 'Phe Conwaor'u hleen,C Law does nor apply to all owner of
property who builds or improves thereon, and who dsxs such work himself or through
his own employees, provided that such improvcu¢nfs are not intended or offered for
vale. If. however, the budding or impmvemem is sold within one yea orcompleaon, the
owner-buimer will have the harden of proving that he did not build or Improve for put -
pose oracle.).
1, as owner of the property, am exclusively contracting with licensed Contrast to
on meet he pr,j o (See 70 1,1. Bn,..C,, ane professions C ulc:) The Common lis Li-
cense Law does not apply to an owner of property who builds or improves themon, and
who enlrecn for such pmiccn with a contractors) licensed pursuant To the Contractor's
License Law.
1 um exempt under Sec. . B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decelerations:
I have and will maintain a Certificate of Consent to wlf-insure for Worker's Compact.
.motion m przwiJed for by seainn J1W of the L id ur Gdc for the performance of the
work for which this permit is issued.
❑ 1 nave and will mainmm Workers Confirmation Insurance, as required by Section
391X1 of the Latour Cock, for the perl'ormmrcc ofthe work for which This pernto is issued.
My Wnror .,a, 1 1 u and Policy nut
Cant ',you„- rV5/LA9—
CERTIFICATE OI :MFTION FROM WORKERS'
COMPENSATION INSURANCE
IThissection eyed uni bennnplac l if me amanit is forone hundred dollars(SI(X))
or less.)
I eerily that in the perfnrmmnce of the work fir which this permit is issued. I shall
not employ any person in any manner so avis become subject e, be Worker.: Compeer.
O z cation Laws ofcalimr,iu. Dur
Z 0 rippueam
fn NOTICE TO APPLICANT: It, afix, making this Cenilicate of Exemption, you snutild
a? become mbject to the Workers Compensation provisions of the Labor Code, you must
W forthwith comply with such provisions or this permit shall be deanM revoked.
a
7Z CONSTRUCTION LENDINGAGENCY
UO 1 hereby amthi innmea iss ed(Sec. 30 Cis. agency fnr The perli,rmunce nl'
F Leworkfor which this permit is issued (sec. 3091. Civ. C.)
O U Lender's Nave
L<ndcr s Address
dI ttnee that I have read This application y ordinances able mm me starve information ,,
N cording I ante res comply with roll city rand coumry aives and state laws relining e QTY.
mooingcnnslmdiunLand hereby Pp C,. Lives of this city benmrupon the
aM,vc (We) it property fnr emnif an keepfic.
(We)agreeu, save, indemnifyandhich bay in
wCityof Commit s against
incoitieracroc fthecostsand expenses which may in any way uttme against said City
Aconsequence NDERSFA g StrisD WILL
APPLICANT UNDERSTANDS AND WILL C(IMPLY WITH ALL NON -POINT
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle counties material
m dcfimcd by the Cupertino Municipal Code. Chapmt 9,12, and The Health and Safety
Code. Section 25592fa)^
[3Yea E3No
Wil The applicant ur fable holism, ,,.Paul use egnipmcm or device, which
Emit haurduas air contaminants as defined by the Bay Arca Air Quality Management
Dia"icl^
l7 Yet, No
1 have rcud the h .... I is materials mquircments under Chapan6.95of'TheCali-
under Health K Safety Code. Sections '3505. 3533 end 3534. I understand Than if the
building does not cumntly have a mount. That it is my responsibility Io nosily the mcupwl
of The fcep6manems which most be met no, it issuance of a Cenifimbe of Occupancy.
Owner or Committed agent Date
ELECTRIC PERMIT
PERMIT ISSUANCE
APPLIANCES - RISIDIiNTIAL
PANELS
UP TO 200 AMPS
201-I000AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUI P/MISC.
TF,MP, METFi�.
POWER DEVICES
SWIMMING POOI, ELECTRIC
OU'TLEI:S - SWI I Ci - FIX1
NEW RESIDENTIAL F,LECI'R
PLUMBING PERMIT
PERMIT ISSUANCE
ALTER -DRAIN h VENT- WAI'FR (EA)
BACK FLOW PROTECT DEVICE
DRAINS- FLOOR. ROOF, AREA, CON D,
I'IX'I'URIiS - P13R'1'RAP
GAS - lib SYS 'I EM -I INC.4 OUTLETS
GAS -EA. SYSTEM -OVER 4 (EA)
GREASEANDUSTRL WASTE INTERCEPTOR
GREASE TRAP
SEWER - SANITARY -STORM F.A. 200 FT.
WATER HEATER WNE;NTAR.ECTR
WATER SYSTEMUREATING
WATER S12RVICE
NEW RESIDENTIAL PLMH. SQ, FV
MECHANICAL PERMIT
PERMIT ISSUANCE:
ALTBR OR ADD TO MECH.
AIR 14ANDLING UNIT (TO IBM) CFM)
AIR HANDLING UNIT (OVER I0.W(1 CFM)
EXHAUST HOOD OVWUC )
HEATING UNIT (TO 100.100 BTU)
HEATING UNIT (OVER 20CLOID BTU)
VENTILATION PAN (SINGLE RESID)
BOILER - COMP (3HPOR 100,0110 BTU)
BOILER - COMP (OVER IM fibb RPU)
AIR CONDITIONER
NEN' RESIDENTIAL MECH. SQ. FT.
ICE
FEF,
0
BUILDING PERMIT INFO
HLUG ELECT PLUMB MF,CH
❑ ❑ ❑
Gi — JOB DLSCKII'IIi
RESIDENTIAL
❑SFDWL
❑ KI' I'CHEN REMOOF
❑AUDITION
❑ PLUMBING RE -PIPE
❑MULTI -UNIT
❑STRUCTURAL
MODIFICATION
❑INTERIOR
C1 CHIMNEY REPAIR
IMPROVEMENT
E3SWIMMING POOLS
❑ BATH REMODEL,'REPAIR
❑ Diiiiom 1D w
❑OTHER
a(�
❑NF,WBLDCVADDITION
❑DEMOLI'T'ION
❑TENANT
❑ FOOD SERVICE
IMPROVEMENT
❑OTHER
!4 S FLOORFT. FLIR
is
U,
r �UNEftD
FEE ki•INU
l re
STORIES 11 TYPE(
BUILDING DIVISION FEES
PIANCHECK FEE
ENERGY FEE
OR hili
SOILS 19?E
PAID
TOTAL:
BUILDING FEE V
FEE
SEISMIC FF.Ii
ELECTRIC FEE
PLUMBING PEE
MECHANICAL. FEI
CONSTRUCTION TAX
HOl1SING MITIGATION
PAID
Ore Reedpt w
ISSUED BY:
ISSUANCE DATE
IJ
• KENNETH NELSON
Registered Civil Engineer
940 Saratoga Ave. Suite 215
San Jose, California 95129
(408) 247-2898
July 10, 1997
Job No. 976049
Building Inspection Department "'ECF0 �
City of Cupertino JUL 151997
10300 Torre Ave.
Cupertino, CA 95014
Attn: Mr. Dave Scannell BLDG. INSPECTION DEPARTMENT
CITY OF CUPERTINO
Subject: Residence remodel at 1121 Stafford Dr. Cupertino,
Ca. ( New window in Family rm.)
Gentlemen:
At the request of the owner, Mr. Pong & Chieh-Yin Hsu, an -
inspection of the subject residence was made by the undersigned
on June 18, 1997 the observe the proposed location of a new 4'-6"
• wide x 4'-0" sliding glass window in the Family room. Data
regarding the dimensions of the house and construction materials
was also documented.
Based upon my inspection and subsequent check of the lateral
resistance of the remaining exterior wall, I have determined that
the proposed window construction can safely be allowed.
I therefore approve the proposed window size and location.
If there are any questions regarding this subject, please contact
my office.
Very truly yours,
ee neo.'
Registered Civil Engineer #22023
KN/kn
cc: Pong Hsu
S&J Windows
r � �
9
�Frs l ��
O
`,', I No. 22023 J m
CC \Lic. Exp. 9-30-93/ ---0
\�T CNiL �Q-
\ OF CA\Y(,j��