29549 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY- -
CITY OF CUPERTINO ' BUILDING-ELECTRICALI'HRMff NO, 29549
X g 5 4 9
BUILDING DIVISION APPLICATION/PFRMIT PLUMBING-MECHANICAL L
BUILDING PROJECT IDENTIFICATION ,
BUILDING ADDR17SS'. - SANITARY NO. APPLICATION SOB 11TTTAL DAT(
99c. -ti 9 3 7/z� 7
OWNER'SNAME: s I'HONF,: - CONTE TORISNAh ' LIC NO: r
r in 6 /R NIC CONTROL p
RCHI'fECTIENGINCER: LIC NO: ADDRESS: ❑
0s 6Y— —n1 �' C 6 - I
CONTACT: PHONE: - BUILDING PI7RMIT INFO
❑'Consultant Fees Paid by Applicant(Initial) .BLDG' ELECT PLUMB MECH
,LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT I>EE
I hereby aflinn deal Into Hcensed order pmvisimu.f Clwpa"9(annmeacing JOB DESCRIPTION
awZwith 5«tion 90W).fDivisionJnfNe Rosiness and Professions Cale,end my license is
WOO PERMITISSUANCE RESIDFNTIAL'T' '
F in full]lime and of lent.
`QUZV License,Cixss - Lic.p - ❑SI'DWh (�TCHEN REMODEL
y6S Uma Commdlu APPLIANCES-kESIDENi'IAL ADDITION L3 PLUMBING RE PIPE.
ARCHITECTS DECLARATION - ❑MUI.TI.UNIT ❑STRUCTURAL
ZCNz I undeneandnly plansshnil be usedles public records PANELS MODIFICATION
oz4c— - - - UPT0200AMPS - [1 INTERIOR t9�' �v,:A C�CHIMNEY kIiPAlli
F,� t.il1] Licensed Professional 201-1000AMPS IMPROVEMENT`
S, M 4 OWNER-BUILDERDECLARATION
pP(,0.'V46 1 herchy amnn that 1 vm exempt from the Commcmr's License Low for the OVER Iq%IAhll'S TH I/Rljl ❑DEMOLITION
Wilt LL U hollowing reason (Section 70315, d i f C J Any ry .numYt SIGNS ELECTRICAL OTHEyI(�
0.Oa1� which req res ape t t i t V improve,de I.h p ny'no mre
+tri.] priori a cc L requires the f r chp L 11 'g ed tamnmm SPCCIAI.CIRCUIT/MISC. LII Y Ur o
E�{y thethe bcensedpurso an no the provision,'If the CnntrvemYsLcenw Lim(Chap¢,9 - _
W..DO� (commencing with Sec,inn]IlfNpnf OivisionJof the Business and Pmfes.iiuns Cale)or TEMP.MI!fIiR OR POLE(NST CGMMERCIAL'
d 56�n eG that he is eumpt therefman ad the basis for the alleged exemptiun.'Any violation of El NEW BLDGIADDIT[ON -U DEMOLITION
fU Mm Section 7031.5 by any applicant for a permit subjects the applicanfto a civil penalty of POWER DEVICES
not more than Bvc hundraJ dolburs(SSW). ❑TF,NANT ❑FOOD SERVICE
FEZ gLcowncrofthe prop,rty,army, employees with wegesas theirs.].rompe¢smion, SWIMMING POOL ELECTRIC IMPROVEMENT '
G❑GE wHI dolhe work,mid thesuuemm is not immnded orofErell I.nule(Set.]Ig4,Buiiarc; - ❑OTHER
3 m and Professions Cale:The Contmetha s License Law Jens nm apply m an owner of GU'L'LETS-S ITCfBS-FIXTURES
pmpaty who builds or Improves'thereon,and who does such work himself or through his own employees,provided that such improvements ore not intended or offered for NEW 'PIAL ELECTR _ SQ Fr.
sale If,however the building or improvement is sold within one year orcompietio the' ^ SQ.FT.FLOOR AR• rS/SQ.PC
er boulder will have the burden of pincecir,that he did n t build.,mpnrve for
0' 1
f tb Pmpeny um eav]osov Iy t t y with licensed contracts t TOTAL: I !
nn t tha's p )ttl(Sec 9044.Business and professional Code)The Contractor_ L '
sx haw does nntrpply t.ao.wner of pmper hn hum ids nr mprrvesthcreon,and QT'Y P' IT FEB
who call jests withacunmaa s7 is dud pursuant to the Canuamor's -
Ua,cL - PENMI'C ISSUANCE
❑E' man ,Sec: ,B&PCfnnhis reason Y
AMER-DRAIN&VENT-WAT EA)"
f Owner Dm VALUATION
WORKER'S COMPF.NSA'I'ION DECLAkA'1'ION BACK FLOW PROTECT.DEVICE� /.� r0 060
Iheieb -(]lint under salt f (the follnwin tleclarmi.ns: ^'
ya pe yo perjury once g
❑ (have providi It;,bynection3 00 of Can senor Com.'sn, in, Wmkcfmserape.- DRAINS-FLOOR,ROOF AREA,COND. STORIES TYPE CONSTRUCTION
-satins,as hick this
kir by Ss issu 391X1.f the'L2M1nr Cale,for the pedomtonce of the
work hove and
illnormltis issued: FIXTURES-PER TRAP ,
I ❑Ihuve unJ will tnaintuio`i Worker's Cmnpensmion Insurance m r.yulrW by Section - - - s(
3900of the LaborQde.for the peformanct,of the work for which Nis peout isiaued, GAS-EA.SYSTEM-I INC.4 OUTLETS IAO OCC.GROUP AI'NT
• My Worker's Conopensuion lhxhmhec carrier and Policy.Untberwe: ' t
Carrier Policy N..: GAS-EA.SYSTEM-OVER 4(EA) ..
CERTIFICATE OF E%EMFI'ION FROM WORKERS' .. GRI?ASFJINDUSTRI.WAS'rl?INIf3RCEi"FOR
COMPENSATION INSURANCE -
lThissectionnecJnotbcarmplctMifrhepcnnitisforonuhundeadd.lari(Shflj HUILDIYY 11510 FIBS
or less.] " e GREASE TRAP , PLANCHECKFEB
!` (certify any
ofthuwoconne st1jechis permitmils'.)lpen- SEWER-SANITARY-STORM EA.2W FT. Q�
notmnp]oy unypersonin any mannerwaxmbean suhjecnnihe Worked Gsmpen �4f/'00 ENERGY PEE
satian Laws of C2lif.miu,Dae O O
z O Appli.unt nc _ WATER HF.ATTiR WNENT/IiLECTRt GRADING FEE
h NOTICE TO APPLICANT:IL after making this Certificate of F,%empti.n, ,,..should WATER SYSTEMaREATING
� J't hecanm object to t he Wom,ivCompensmiunprnvislonsnf he]allot C.Ac,Y.0 omit SOILS ME 'I7
fanhwithcamply wlthm`hpnsvisionsmthis perachdoll bedeemWrevokN. WATERSERVICE - V
CONSTRUCTIONLIiNDINGA(ENCY NEW RESIDENTIAL.PLMB, SQ.TT. PAID
U O l hereby affum that is a construction lending agency for the performance of R<ccip
the,ork for which this permit is issued(See.Nay,Civ.C.) NMECIIANICAL
Lender,Name - - ToTA0 Leadoes Address TOTAL: /.a. r 1cedify that 1 have read this application and stem that the.rove information is E
A conal.]agree a,romply with an city and county ordinances and sbnc lswv ovlmingm QTY, MECHANICAL PERMI'I' PEEbuilding consbuction,ondherebyaudiencererescausawuofthiscity,.enmrupe.dw ahoy-mentioned,r.peny for inspecdenpurposes..(We)same to save,indemnify and keep harmless the City of Cupertino again, PIiItMI'1'ISSUANCE E Iiahillties.Palgments,cost,and expenses which may in any way accrue agnimtmiJ City ALT ER OR ADD TO MECH EEin consequence of the granting of this permitAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI'('(TO IU,003 CFM)
SOURCE REGULATIONS. LAIR HANDLINGUNIT(OVER IO,000CFM( ION TA%
Signumreof ApplicaMC.nvac,orDate EXHAUST HOOD(W/DUCq HOUSING MITIGATION rE
HAZARDOUS MATERIALS DISCLOSURE '•
Will theapplimm carbonate buildingeceupam smmorhandle hevallous material HEATING UNI'r(TO 110,0)BTU)
as defined by the Cupertino Municipal Cale,Chapmr 912,and the Brainard and Safety
Calc,Section 255320V HEATING UNI'I'(OVER 110,110f)BTU) -
❑Yes ❑No -
. VENTILA'T'ION CAN(SINGLE RESID). PAID, Date Receiptp ^
Will the applicant orfuotre building occupant me equipmenter devices which BOILER-COM('(]IIP OR IW,OINI BTU)
mzait hasous air c.maminanta as defined by the Be,Area Air Quality Management TOTAL:
District, BOILER-COMP(OVER I flit"HTU)
' ❑Yes No _
I have read tic harurba,matcriuWrc nems under Chapter 6.95 of the Cali- AIR CONDITIONER _
)airs'' p ISSUANCE DATE
forma Health&Safely Cade,Sections 8505.25533 and 255]4.1 understood that if theNEW RESIDENTIAL MECH. SQ.IT. '
building does no,currently have a temmt.than it is Illy respnnsihTl Try to lunHy t ei rsee tpam
of the require encs which mu I,IIIb, i 1.issuancenfa CeniRee4mnf Occupancy. r -
Owneraruualmiredr,arn Dom TOTAL: a
ISSUED H
OFFICE
JODY T. TAI , P. E.
3214 WHIPPLE ROAD
UNION CITY, CA 94587
Oct. 23, 1996
To whom it may concern
Building Inspection Division
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
r
i
SUBJECT: Addition To The Pereira Residence
5998 Sutton Park Place
Cupertino, CA 95014
Bldg . Permit No. 29549
Dear Sir,
The undersigned has made special inspections for the
• installations of anchor bolts' ( ' drill' and epoxy into existing
footing ) for holdowns of thelabove subject project on October 23
1996. There are a total of ten holdowns anchor bolts for the
project that require special inspection. During my inspection ,
all ten of the anchor bolts for the holdown were installed per
the design plans and manufacturer' s specifications, ( epoxy of
5/8"diameter anchor bolts a minimum of 5" into existing concrete
footing with Simpson epoxy tie ET-22) . The embedment for all ten
of the anchor bolts is more than six inches.
Should you have any ques s-- ase call the undersigned .
Q�tOF E'SS/pv
P(/N�9lFv
Sincerely ,
CD rn
�.
No. C043045
Exp. 31,5110 0
JODY T. TAI , P.E.
J TT: j t t grFOF rvAAi
Copy to: 1 . Mr. 'Jim Per �tlOv
2:' Robert' Wider=
Rober't' Wilder Cbnstruction
1•