25758 I; APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 'I
HII.H O-K CRICAL PERMITNO.
APPLICATION/PERMIT - PI.MJIIING-MECIIANICAI, f� C C p
BUILDING DIVISION BUILDING PROJECDENTIFICATION ^r• t J J O
BUILDING ADDRESS: SANITARY NO. APPLICATION SUI{MMAL DATE
IILOg ST4oFFeP— L.,P`NG IsUNI114 LOT# — ����
OWNERS NAME: PHONE: CO CTOR' N LIC NO:
� OJIS "�csN CIO 7-5db'S47U N/C CONTROL#
RIHITECI'/EIJ INFER: LIC NO: ADDRESS:
r CIG $-el,'pGk� ❑
EONTACT: PHONE:
QTY. 'ELECTRIC PERMIT FEE BUII.DINC PIiRM19'INPO
4 )<f/S
3Zl- 96-77 Bk ELECT' PLUMB MECH
PERMIT ISSUANCE 2�� -91s— 'A# 11.
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
q 02 I hereby affirm thvl l oto lice Business
n ss and inions is Chap te,lad my Brame wish
LL10O failsectionmrra mid)of Division3of the Business end Professions Cala and my license is in PANELS
IIy'WI';. full force anJ effeq. UP TO 200 AMPS
<Zµ License Class Lic.#
in Qo- Dale Contactor - 201.1000A7PS
hv 7 ARCHITECTS DECLARATION SQ.FI'.FLOON A EA $/SQ.Fr.
'ZOm'� OVER IfKK1AMP5
O21z q 1 understand my plans shall he used as public rtcords.
PmFt4 SIGNS ELECI'RICAI.
x , Liccn.ed Professional 2Y'I.pZ
w� OWNER-GUILDER DECLARATION. SPECIAL CIRCUIT/k11SC. r
OaU 1 hereby alarm than 1 em exempt Instant the Contractors License Law for the
W 3 4 h following remain(Section 7031.5,Business and Pafessimis Code:Any city or county TEMP.METER OR POLE INST. p �2
1=1�:0which rapares a Permit to construct,alter,improve,demolish,or repair any structure L q� i Jq
ce;¢]aT� prion0ia issuance,vlsoayuirtslhe applicant farsuchpnmiuofileasignedstvtemem POWER DEVICES e
1y L2 q O 'but he is licensed pursuant to the provisions of the Contractor's License Law(Chapter
a o.o�' 9(commencing with Section 7000)of Division 3 ofthe Business and Professions Code) SWIMMING 1'001,ELECTRIC VALIIA'110N
^y orthathe isexemptaherefmm and thebacisfonheallegedexemption.Any violationof OUTLETS-SWITCfIfS-FIXTURES
Q Section 9131.5 by any applicant for a pamat subjects the applicant to a civil penalty of L .I
_ 10
no,tome than five hundred dollars($50B. . . 9
� $ Q I.asowneroftheprnpcny.ormyemployeeswithwagesasibeirsolecampcnsation, NEW NESII]IiNT1A1.ELECTSQFI' 3(�I is ) IWFECONSTRUCTION
a will do the work,unit the structure is not intended or offered for sale(Sec]044,Business
and Pmfessiuns Cuda:T4 Contractor's Liana Law does not apply m on owner of
propeny who builds or improves thereon,and who does such work himselfor through his
ownemployees,provided that such impmvemerds manor intendeduroffered forsele.If, 10 OCC,GROUT' RIS.UNITS
however,the building oriropmecmce is sold withinone yearofcompleiion,tbee owner- 1
builder will have the burden of proving that he did not build or improve for purpose of
n..1 .. QTY. PLUMBING PERMIT IEE FLOOD2ONE APN
rotthe pmpemy,ton endusivdyconrtaning withlicensedt Counmato
ic nuc[the project(See.9044,Business end ywhobions Cod J'0u Co,n.,.'e
Lie ase Lnwdoesnotapply manownerofpmpcny whobuilds or improves 0ereon,entl PERMIT ISSUANCIi
why controea for such projects with acontachrom licensed punuam to the Contractor's
License l.ew. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ I am exempt under sec. 7 b 14 ,B&P C Ruda,reason 11T51
BACK MOW PROTECT.DEVICE SANITARY YN
Owns T'LJ1G R. T/_JfRCI D 1 k7 RECHIPI'N
WORKMAN COMPENSATION DECLARATIO DRAINS-FLOOR.ROOF,AREA,COND. SCHOOLTAX Y N
❑ Iheraby alfum that l have u ceniricntc of consent to self-insure,or a certi fcate of RF,CF.IVp#
orken compensation lnsunnecoracenifiedcopythereaf(Sec.3900,1nb CJ which FIXTURES-PER TRAP PARK FEE Y N
nvcrs all employee's under this permit. GAS-EA.SYSTEM I INC.4 OUTLETSRECEIPT#
Policyp BUILDING DIV ION ME
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE J
❑ Cirri lied copy is hereby fum4aheJ, r7
CI copy is riled with Be city inspection division. GREASE/INDUSTRI.WASTE INTERCEPTOR GRADING ME �s00
CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS ME
COMPENSATION (I
COMPENSATION INSURANCE. �� '
(TaNsectionneed not becompleredifthe pormillnfor One hundred dollars($100) SEWER-SANITARY-STORM PA.203M ENERGY FlIf ��
or less)
I cavity that in the performance of the work forwhich this permit is issued.Ishort WATER HEATER W/VENT/ELECfR
urn employ any person In may manner so as on become subject m the Workers' PAID
Cnlnpelsouionl-awsof California. Dan WATER SYSTEM.TRF.ATING Dote Receipt
0z Applicant p
z0. NOTICHI0 APPLICANT:If,after making this Ceruficule of Exemption,you should NEW RESIDENTIALPLMB. OsT3 SQ.FT. 3161 PA TOAL: p� 173
Ly become subject o the Worker's Compensation provisions of the labor Code,you must
� ; fonhwith comply with such provisionamns permit shall be deemed revoked. BUILDING FEE 2S0
a [� CONSTRUCTION LENDING AGENCY SEISMIC FEL? Oas
1 hereby affirm than there is a construction lending agency for the performance of
U O Ne work for which this permit is issued(Sec.31197,Civ.C.) 'I' 1' h: ELECTRIC PI?Ii ,
Lender's Name
c F Lender's Address QTY.'i' iMFCIIANICAI.PF.RMIT FEE
PLUMBING P
U 1 family that 1 have read this application and state that the above information is °
06
IFcirca. l agrea to comply with all city still county ordinances and sum laws relating to PERMIT ISSUANCE ��tij MECHANICA
Coybuilding construction,and hereby amhoriae representatives of this city to enter upon the ��VV
-V 7above-mentioned property far inspection porpoises esALTER OR ADD TO MECI ICONSIAUC' (1
I Z
C (We)agree to save,indemnify and keep to It ray c'ICUruel Inst
liabilitice,judgmena,cosa andexpenses whichm y itte art AIR HANDLING UNIT(TO 10.000 CFM) sas
n consequence of thegnnting of this rmit.
AIR HANDLING UNIT(OVER 10,010CPM)
nowren Applicunt/Contncnr Duce EXHAUST f100D(W/DUCI') PAID
HAZARDOUS Agoccu occupant
HEATING UNIT(TO 100,000 BTU) Dam � t
Will the applicant or foam bur Aing occupant store or honAlehaeardous material HEATING UNIT(OV&d 100,000 BTU) TOTA.:'
as defined by the Cupertino Municipal Code,Chvpnr 9.13,and the Hwlth enJ Safety
Calle,Section 25532(e)9
You No VENTILATION PAN(SINGLE RfSID)
❑
ATE
W it I the applicanum future hnilding accupam use eyuipmm o
erdevicee which emit
BOILER-COMP(3HPOR 100,000BU)TISSUAN Es,s'
h mous an eotm
nniniaa as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000BTU) [k
)rain? AUG O �g94
❑Yus ONc NEW RESIDENTIAL MECH. ` SQ.FT. 3 OTC
I have read he h tardoue maBrials ourirernena under Chapter 6.95 of the CITY Ur
California Health&Safety Cuda,Sections 25505,25533 and 25534. I understand that VV Cf II
ifthebuildingdosnotolards yhavea't e,nthato is to responsibilitymamity the
o c u am of the require vena Which ust be met p� or m issuance of a Catarina of
Occupancy.
Owner or uuthu izcd agcm me T ISSUED B .
OFFICE
TR'4t
SANTA CLARA COUNTY
CENTRAL FIRE PROTECTION DISTRICT
• � G
14700 WINCHESTER BLVD.
LOS GATOS,CA 95030-1818 (408)378-4010
SERVICE X110 SINCE 1947 FAX(408)378-9342
To: Christy, City of Cupertino
Building Department 0
S �2
From: Fire Prevention Buureau��jj
The building located at / �20 // /4� Has been FINALED.
The building permit number is:
Date:
Signed: Radio Number x �J
MELVIN R. HILL, INC.
R.C.E. 19704
142 KENNEDY AVENUE.
CAMPBELL, CA 95008
(408) 866-1546
FAX 866-1375
94654
j 15 September 1994
(Dea
is Ignacio
09 Stauff Lane
ertino A 95014
This report presents the results of the field density tests
carried out by our firm for the subject development located at
11209 Stauffer Lane in Cupertino, California.
• The purpose of this testing and observation services was to con-
trol the earthwork operation at the site for their proper place-
ment and compaction.
The site was stripped off of all organic and contaminated
material to the depth below where debris and organic material
were found. At this point the soil was properly moisture condi-
tioned and then compacted to 95 percent relative compaction (ASTM
D1557-78) . Additional fill then was placed at the site in lifts
of 8 inches and was compacted to 95 percent relative compaction.
i
Field density. tests taken at the subject site revealed that
proper compaction (approximately 95 percent relative compaction)
was achieved during the fill placement. It is therefore con-
cluded herein that the site is in proper condition and ready to
receive further improvements.
Summary of all field density tests are presn ed in Table I of
this report. 6/J� /� (n1�0
QPpFESSI() EGE§
Yours tr �xvW R. y�l/F2� OEC
���u -- }� l 6199
UJ ! 704 m B�N� INSPECTIO
m Exp.Sep.30, 1997 .cin Os FDpe��P,,a...Rrm�
• Melvin Hill * LVQ ,
R. C. E. 3 CIVIL
qp�F GAQi 4