25852 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITX OF CLIPERTINO BUl.1.11NirIl1.CFRICAL PERMIT NO,
APPLICATION/PERMIT PLUMBING MECHANICAL. 25852 C O 5/�
BUILDING DIVISION BUILDING PNOJECI'IDENTIFICATION J Q J L
BUILDING ADDRESSSMARY NO.
Orl OF -C APflJGTIOfT SfIBh1I1TA1.DATE
UNITN LOT I
OWNERS NAME_' PHONE CONHiACIOOR'S NAME .i IC NO:
G a Guzk 11L1 �7vildt� Vol) WC CONTROL#
RCHI'JECfANGINFER: LIC NO: ADDRESS: ❑
ONTACI': PHONE
QTY. ELECTRIC PERMIT FEE BUILDING PCRMIT INFO
BL ELECT PLUMB MECII
PERMTI ISSUANCE ❑ 11
LICENSED CONTRACTOR'S DECLARATION AppLIANCC•S-RESIDENTIAL /� TOB DESCRIPTION
Clea? I hereby affirm that I am lieumi undni-Mvialant afCha,e 9(mmm�eneingwitb
1+100 Susi IO and
I Division 3.f the Pusinns and Pmfusiom Code,aM rtry licmae u in pAN
full Torre end effep
FZty Date tic G Iic.N UP TONIOAMPS
.n<LLN
Date CLCTS DI 301-1000 AMPS
ZOyS ARCIIHLCTS DI:CIANATION OVER Ipp AMPS A � lI, ARF ai S/SQ.4T.
O Z-2 l urdnrxtmd my plwa shall M urW v public entad.,
F,y W SIGNS ELECTRICAL
�ywQyy LicrnvN 14nfcuional
OWNER-exempt RDECGRATION SPECIAL CIRCUIT/MISC. U
Xd0�0 ER
1 hcrtby affirm that I mn ,Bum Tmnn 0e Contr.ctm'a Lignac law co the
fullowingriines. Seeds.co313.Bwi�sad Re.deram Conk:,on e iciry mcmmty T11dP.MEfER OR POLE INST. /^
(=,SON¢ wM1ich mryves•pandl mconwrveLdm,impove.dor IW.m rtlmir any awclurt U
E YJ +viortoileieauvla.almrcquimes capplicntfor,uchpemdttoRle0nipelstatement POWER DEVICESJ
DAT
Ws QpK that he islKcvM pumwtmth<provldvu of the Conv>lars Licxnu law(Clraptcr
a1�LL 9(comencing will Section]pp)of Divitien J ofthc Busircs and PmfnvIXu Code) SWLMMWG POOL ELECTRIC VALUATION.�
w N IXchat be m
ne.epl de,efnm and the M1esis fartbe.11'ecci e.em mm.Any vlolatioom' C
tZT SeOion 1031.5 by anyepplicam Inc. im. v pertmbjem.the a,fcam toe civil penalty.f OUTLETS-SWITCHES-FIXTURES D
Q not mta
han five hdnN doll.n($5W).
K � ❑ I,asawnerofthepmpeny,ormyempinywwith we8uavtheirsolerontpensvion. NE.W RFSID0411AL ELECIR SQ.PT STORIES TYCON 1
a3� will do the wmk,and the.truaure in nit intended ocmfi Wf«vk(Sec.7(W4.Bmi.
aM Itarar'a.s Cnde:The Con moon's License law doe not apply 10 an.wren or
property wM1O Wildamintptovee thcmnn.ardwMdouauch wmk
If,M1inualfIXthmugM1M1OCC.GR P RES.UNITS
nwnemployeo.poridWthat such tmgovenenu.rt rat imeMcd IXaffeml forsle.
hvnvm.lhe buildin8 m impovemcm u add within arc yea of mmpkuon,the ownv-
bwlder will have the burdenf p
oroving Nat he did not ImM on impaomc.ve fm purpof TOTAL
tittle.).
❑ I,uowrcrof de W^PenY.amculuaivdYcantractmg with licensN amurtmm QTY' PLUMBING PERMIT FEE FL ZON APN
ewe t the ptojct(Sec.7O .Ron.and Prada.Code:)The Cost..,
License law dou nd gtplyman nwrtnn(propmy who build.IX impovn thvmn,aM PERMRISSUAN(CE
.N,rmnYla Ectmch onj:cT,with secedr.ctmra)licensedpusuemmtM1e Comosemla
I.iccmu law. ALTER-DRAIN&VENT-WATER(RA) FEE SUMMARY
❑ I ant caemm underSea. ,B&P C fon 1ni.rea..m BACKFLOW PRIJIIiCI'.DEVICED F.FS
SANITARY Y N
Owner Date RIiCI;IPI'N
DRNNS-FLOOR,ROOF.AREA.CONI.
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ IhertbY affirm thallheviceceruR^„-ofconmtmself-irume,mamti0cate of RECEIPT.
Wmkcn'Comperwtian insurance m.cmiReJ copy therm((Sec.JB00.lab CJ which FIXTURES-PER TRAP PARRFEE Y N
covm all empbyee'a uMc thn Remit. GAS-EA.SYSTEM-I INC. OUTLETS RECEIPT N
Polity. BUILDING DIVISION FEES
Conal GAS-EA.SYSTR.M-OVER 4(EA) PIANCHECK FEF.
❑ Certified copy is hereby fYmnlel '
❑ CMirtdC yiSfticdwithlM1 6LYins{cctimdivitiml GRFASFIINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXISIPIION FROM WORKERS GREASETRAP SOTS FEF
COMPENSATION INSURANCE
(lhixa ,ionnc<dtwl be contpinM ifthepmm,is Intone bundnW doll.($100) SEWER-SANITARY-STORM EA.IT11)FT. ENERGY FEIF
tint)
I ccnify charm 0c pertamiaxcufice wort,nor which t14 err it it med.lehell WATER HEATER WNPNT/ELEC1'R
rut empl,any penin in any manner nci na to becarc subject to the WcnA. PAID
z Cmnperueuon Taws of California. Date WATER SYSTEMfREATING Date Receipt.
Applkw
OD NOTICE:TO APPLIGNT:If..fla rtukin/this Certificate of Exemptim you ilwuW NEW RFSIDFNTIAL PI-MB. SQ.FT. TOTAL
p > r `bjem i.'eWorke.Cmnpamisfi.nom, 1'he labor Cade,you nH.r
amply w ith suchpwiaim.or Ni.Permit anatl be keeneel nevoked. BUILDING FEE
0. Q CONSTRUCTION LENDING AGENCY SEISMIC Pei. 1
1 haffirm that there i.v conuruclion lending egenry Int Inc Ecrf..of
U p crthy the work fm which th s enol in i.oM(,,e.3091.Civ,C.) TOTAL ELECTRIC FRE
I snder'n Nvmc
1,rnder'x Addc
ts QTY. MECHANICAL PERMIT FEE PLUMBING FRT?
I ccnify the11 neve tend this ii,flevtlon and sane Nat Ile above mrommuan is
cotmT. l agree to comply with ell city end county colimmcca and stere laws relining to PERMIT ISSUANCE MECHANICAL.FIT..
F"' z i'l—e-marmtmed and hereby outhon naTrrefrnmdvo of this ciry tomer up�ntk CONSTRUCTION TAX
V Z abuv(Wentiarmd try minspn' ALTER OR ADD TO MECFI.
.. (We)egm t hitvtifY m I ep batnilea the Ciry of Cff
'net
liabilitim.jd espn cb m. ' weY acrecry AIR HANDLING UNR(TO 10,100CFM)
In nerequ{yee{ hecf Ni AIR HANDLING UNR(OVER 10,"CFM)
rune
of Appii..,, ntnct Del EXHAUST FOOD(WMUCTI
PAID
rune o
HAZARDOUS MAIRIALS DISCLOSURE HEATING UNIT LTO 181),0(10 BTU) Date Rncipt.
Will the applium IX home buildingnccuWnl 4nreart hendlc hii.cloua rtwtcriul HEATING UNI'C(DVEJi IIq,Uq tlTU) T
as deRnd by the Cupmino Municipal Code,Cmptn 9.12,aM the Hee11h ant!Safety
Coda,Section 25533(a)^
❑Ya ❑No VENTILATION FAN(SINGLE RFSID)
W Odrt vconnare IX(mas defirtn{b,N, �use ryuip An mdcvimcna,, emll ^
BOILER-COMP LHP OR 100,008 BTU) ISSUANCE DATE
M1vartbus e4 carllaWn.nrs as de0nd by the Bay Ara An Queliry,Metugvcrnt BOILER-COMP(OVER 100,000 BTU) r A 1 D
ct1 ❑Yee ❑No NEW RESIDENTIAL MECIL. SQ.FT, /J
I bocce read the M1laardnua matenele rec ireci oder Ch.pter 6.95 of the 9 1994
California I lea ht&Safety Code,Sectims 25505,25533 std 25534. 1 urdcrdatd that
ifthe
imm of doesnotcurmmlybavcamtun6Nin it is my revpo,eoil. 10 nmify the Ci y
rapwl nr be regwtcnrnl.,whim lttnal Ic rne1 poor 1n ia.a.na ar.Cenirtcom of 11 Uh L'Ur
Ownerocombo v,,J'cnt Date TOTAL: ISSUED BY:
OFFICE
KIHLTHAU, INC. Consulting Engineer
1030 Connie Drive, Campbell, CA 95008 • (408)379-6561
December 7, 1993
Maniam and Margaret Algaratnam
10424 Dempster Avenue
Cupertino, CA 95014
Re: Family Room and Living Room Masonry Fireplace
Repairs for the Above Residence, Cupertino
As per your request, I made a site visit on December 3, 1993 to the above
referenced residence to check the structural integrity of the existing
fireplace chimneys to recommend repairs of damage that were discovered during
the routine sweeping maintenance recently performed.
The extent of the damage found on the fireplaces during my visit indicated
that both chimneys are cracked at the roof level and need to be rebuilt. The
rebuilding shall be performed by tearing down the chimney stacks to the
shoulders The repair shall consist of rebuilding the new chimney using
standard masonry construction with (4) #4 . vertical rebars [(1) at each
• corner] and standard ties around the rebars and straps to the roof framing.
Your selected contractor should refer to the standard masonry fireplace
construction specifications available at the City of Cupertino. The vertical
reinforcing bars are to be epoxied in place (6" minimum into the base
masonry) and beginning the rebuilding from.that point.
This report was prepared using standard engineering practices and principles
subject to the limitations of the visual observations used. No warranty as
to the condition f the structure beyond what has been expressly written is
implied. you y questions regarding this letter, please do not
hesitate to all.
T moth M 2 lthau
go. C09
.C.E. 40834 UPI
b�
JAN 19 1994
BLDG. INSPECTION
ENL
I;UPERTINQ�
0MCE copy