26538 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
C'.TVOF VUPERTINO BUILDING-E '1'R1 AL PERMITNO.
BUILDING41/VISION APPLICATION/PERMIT PLUMBING-MECHANICAL 26538
_ BUILDING PROJECT IDEN'1'IFICAT'IGN
BUILDING ADDR/ESSS�: �}' ./f `ry' /1 35qz � ,.UJ 2 — SANITARY NO. APPLICATION SUBMITTALDATE
I.V a'5./�/ UNIT# /T LOT#
OINRFRIPAME:
PHONE
191h. A CI ITEE/EINF.GR: LICxO:Z' CDDRFSS:�IfS NAME: LIC NO Z NIC ONTROL#
�] s
CONTACT: PHONE: �+ ❑
..1, � '` QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
WN1 8 ,2Q^ Z^'13 PERMIT ISSUANCE DG ELECT PLU 'C
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
nwz Umreby affirm shall am licensed underprovlslonso(Chapter9(commencingwllh
0C Section 1000)of Divided 3 of the Business and Professions Code,and my license is in PANELS
W F full ford.and effect.
UU V �t , � s
FZ� License Class sy' �Cmuom� .(f UP 70200 AMPS !.'�/� �J6�
mGG]ro ,Date 11-1� Comradar /lTj._p0 201-IOfq AMPS / / •L
Zpy-K ARCHITECTS DECLARATION OVER I"AMPS
SQ.FI'.FLOOR AREA S/SQ.PT.
OZ-0 I understand my plans shall be used as public records.
_ W SIGNS ELECTRICAL
rn .]
J Licensed Professional -
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
�W?yU I hereby affirm that 1 am exempt from the Contractors License Law for the `\
W 30co following renson.(Section7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE IN ST. '
�yJ which requires a perm m construct,alter,improve,demolish,or repair any swmurd
at i+;� prior to its issuance,also reymres the applicant for such permit to file a signed statement POWER DEVICES
pl�'
GC, that he is licensed pursuant to the provisions of the Contramors License Law(Chapter 's
LO,O ' 9(commencing with Section 7")of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC l \ VALUATION
_y orthatheNexempftherefrom and the basis for@c alleged exemption.Anyviolation of
F ¢ Section 1o3L5'y any applicant forapermiJ subjenaJhe npplicannoacivil penalty of OUTLETS-SWITC r -FIXTURES
normo,'Iban five hundred dollars($500). 'I !~ ^7
a ❑ 1,asowneroftheproperty,ormyemployeeswithwagesustheirsolecompensation, NEW RESTIAL BL SQ.
FT. STORIES TYPE CONSTRUCTION
will do the work,and thestmcture B real neendedoroffered for sale(Sec.104,Business
and Professions Code:The Connector's License Law does not apply to an owner of
property whobuildsnrimproves thereon,andwM1odoessuch work himselforthr.uga hie OCG GROUP RES.UNITS
ownemployees,providedtbatsuchimprovementsarenotintendedorofferedformle.If,
however,the building orimpowement is sold within one year of completion,the owner- 'TOT
builder will have the burden of proving that he did not build or improve far purpose of
stet.
❑ I,as owner of the prolnny,um exclusively contracting with licensed contractors to QTY, PLUMBI P. IT FEF. FLOOD ZONE APN
construct the project(Sec.1044,Business ant Professions CoJeJ TTe Connemnr's
License L.wdees notapply Joan ownerofpropenywho builds.,improves thereacter PERMIT ISSUANCE �•
whodontracts for such projects with a contractors)licensed pursuant to the Contractors ALTER-DRAIN&VLNT WATER(P.A) FEE SUMMARY
License Law.
❑ 1 am exempt under Sec. ,B&P C for this reason OUTSIDE.FEES
J BACK FLOW PROTECT.DEVICE SANITARY Y N
Owner W Date - 1BC1HT1
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF.AREA,COND. SCHOOLTAX Y N
• /�sa, Iherebyaffirm that l have.cenificateof consent toself-insure,ora cedifiGad of PIXTURGS-PER TRAP RECEIPT
Workers'Compensation Insurance or acertiRcopy thereof(Sec.3800,Lab C.)which PARK FEE Y N
allSYSTEM-]INC.4UTLETS emplpy ,Wtler ll�rs pe GAS-EA.SYSTOn RECEI #
coverelicy# -S-TJ1600.S BUILD IV ION FEES
Comturry i GAS-GA,SYSTEM-OVER 4(P.A) PLANCHF.CK PER
I&
Certified copy is hereby famished. -
I& Certified copy is filed with the city inspection division. GREAS MNDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP
COMPENSATION INSURANCE SOILS FEE
AV
or les(This section need notbe completed ifthe permit is fours,hundred dollars SEWER-SANITARY-STORM EA.20017. ENERGYF - `
Iceady that in the Performance ofthe work for which this permit is issued,l shall WATER HEATER W/VENT/ELF.CTR
not employ any person in any manner so as to become subject to the WorkersPAID
Compereatiou Laws.f Califomia. Date WATER SYSTENINREATING c Receipt#
0 Z Applicer,
- Z. C NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMIL SQ,Fr. TOTAL:
In become subject to the Workers Compensation provisions of the Labor Code,you must
forthwith comply with such provisions or this permit shall be deemed revoked BUILDING FEE r
W z CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there is amnorroon lending agency for Jhe performance of L. ELECTRIC FE.
V O the work for which Jhis permit is issued(Sec.3091,Civ.C.)
w Lender's Name PLUMBING FLE
0 U Lender's Address QTY. MECHANICAL PERMIT FEE
I certify that I have read this application and state that the above information is
correct.l agree to comply with nil city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANIC .FEE
y buildingconstruction.and hereby authorize representatives ofthis city to enterupon the
CONSTRU ION TAX
U 7 ahove-mentioned property for inspemion proposes. ALTER OR ADD TO MECII.
r� (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
in conseyuence of the granting of this Permit.
`�� AIR HANDLING UNIT(OVER 10,000 CFM)
Slgnnmre of Applicant Contractor Dam EXHAUST HOOD(W/DUCf) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt#
Will the applicant or future building occupant store or handle hazardous material If EATING UNIT(OVER 100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Coda,Section 25532(ap
11 Yes ❑No VENTILATION FAN(SINGLE REBID)
Will the applicant orfuturobuildingxcvpantuseeyuipment.,devices whichemit BOILER-COME OHP OR 100,000 BTU) ISSUA A DAT
hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) ��.• �� ��
1.,iatrdf, `'DVI 95
❑Yes ❑No NRW RESIDENTIAL MGCH. SQ.FT.
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533 end 25534. l understand bou II Y V1.Wit t
if the building does not currently have a tenant,that it is my responsibility nmify the
cupam of the requirements which must be me,prior to issuance of a Certificate of
Occupancy.
Own,comahorize tigent Date T ISSUED BY:
OFFICE
of 16 August 1995
AUG N i 1995
�• B6Y Ut CUPERIINU
oul.
BUILDI;fi UTyT.
William M. McMorrow,
CE, GE
Y Whitford
Mr. Ra
Consulting ,
Geotechnical c/o Lifetime Pools , Inc .
Engineer 910 San Antonio Road
Palo Alto, CA 94303
SUBJECT: Observation of Pool and Spa Excavation
Specializing in and Steel Reinforcement
Failures, Mike and Sheri Hess
Rehabilitation, 1013 westlynn way
and Forensic Cupertino, California
Engineering
Dear Mr. Whitford:
4930114 During the construction of the swimming pool"and
spa, I have visited the Hess Residence to observe
the swimming pool and spa excavation and placement
960 San Antonio Road
Suitel of steel . The purpose of my visit was to determine
Palo Alto, California
94303 whether the exposed soils in the excavation were as
anticipated and will provide 'stable 'support for the
pool as well as determining whether .or not the steel
pool and spa reinforcement was placed in accordance
with the approved plans .
My observations indicate that the soils exposed in
the excavation will provide stable support for the
pool and spa, and the steel reinforcement meets the
•
,f
16 August 1995
• In summary, I believe that the requirements of the
approved drawings have been accomplished by your
firm in a professional manner and the pool con-
struction should proceed.
Very truly yours ,
a ' H0.00972 si
EXP. y{
4rP OF CFS\40.
WILLIAM M. MC MORROW, CE, GE
•
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