31242 (2)APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAI. PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL 'LJ
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❑ Consultant Fees Paid by Applicant (Initial)
FEE
FEE
0
BUILDING PERMIT INFO
ELECT PLUMB MECI
NOB DESCRIPTION
LICENSED CONfRACI'OH;S DECLARATION QTY. ELECTRIC PERMIT
1 hereby a1Erm that ].at licensed under provisions M Chapter 9 (cntmnencing
mSmIi.n70O0r.fDivisism3of Buzinesa
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the and l'ofcssionsCNe, and mylicemcis
PERMITISSUANCE
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in full force an��rfM�p
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❑STRUCTURAL
Licere, C� Lie.N
Ome—�/n— Conner APPLIANCES—RESIDENTIAL
yah
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ARCHITECTS DECLARATION
PANELS
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1 codemm�d my plum -hull TV used as public vacuous
024-0
UP TO 201 AMPS
F 4 t W
Licensed Prolessionol
201-IOIMIAMPS
OWNER -BUILDER DECLARATION
CC w Q
O A. U
License Law for e OVER Iak1AMPS
1 hereby ufrrm That 1 ant exempt from the Comranarx th
following reason. (Section 7031.5, Business Professions
?0.5,
and Cade: Any city ur county SIGNS ELECTRICAL
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which requires a permit to mmuma, alter, improve, demolish, or repair any .from
prior to its issuance, also requires the applicant for such Permit o file a signed ovement SPECIAL CIRCUIT/MISC.
� Y
Nm he is licensed Farman,In the provisiorsofthc Comreters Lienton Le, (Chapter 9
(commencing with Section 700C) Division 3 Business 'I
I+w 0
Or afthe and Professions Code)or TEMP. MEE. R OR POLE INST.
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'hot he is exempt rhenium and the basis for the alleged exemption. Any violation of
_
Section 7031.5 by any applicant fora prour subjects the applicant m a civil penalty of POWER DEVICES
7, Z Y
nut more than five handout udollars ($5(10).
i❑1,
as owner ofthe properly. or my employees with wages as heir sole compensation, SWIMMING POOL ELECTRIC If
isnot
WF
willdnthc work, undbentmclum intended orofl'arcd mrsale(Sce.70I4. Business
'g—
and Professions Code: The Cernacmrs License Law due. not apply to an owner of OUT LEI SWITCHES —FIXTURES
properly who builds or improves therm., and who revs such work himself or though
his own employees, provided that such improvements an, not inrt.ded nr oRered for NEW RESIDENTIAL ELECIR SQ PLl
.sale. If, however, the huilding or impr venter is sold within one year of completion, the
mer -builder will have me burden of moving that he did not build or improve for put.
pose of soled.
❑ 1. its owner of the property, am exclusively contracting with licensed mnnactors to TOTAL:
construct the pojttt (Sec. 7034, Business and Profusions Cad_ The Commamr's Li -
cause, Law dev, not apply to an owner of property who builds or improves thereon, ant] QTY. PLUMBING PERMIT
who contracts for such prtjects with a contractor(s) licenced pursuant in the Commerce's
License Law.
PERMIT ISSUANCE
p lamexemptunder. Sec. ,B&PCButhisrcacon
Owner Date AUTER & VENT— WATER (EA)
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT. DEVICE
+.7not
I hereby afftrm under penalty of perjury one of the following declarations:
I have and will maintain a Ccnilicam of Consent to self -insure for Worker's Compen- DRAINS— BOOR, ROOF, A REA. COND,
ion, as provided for by Section 3700 of the labor Code, for the performance of the
rk fur which this permit is issued. FIXTURES — PER 'TRAP
1 have and will maintain Workers Compensation Insurance, as required by Section
0 ofthe Labor Code, for the performance of the work for which this permit is issued. GAS— LA. SYSTEM-] INC. 4 OUTLETS
o
Wor i" m -tion dPolic
• as raft
/✓ Oq/iUTCI
rtier. /O/• OFl/cora Policy Na: GAS— EA. SYSTEM-OVHR 4(LA)
CERT119CAfL' OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE GRGSFIINDUSTRL WASTE INTERCEPTOR
(•ITisw6onneWnotbecompletdifthemcnnit is Emacs hundmddollan(ERN)
in".) GREASETRAP
I nattily do, indoepa,fannantaufthe work l'or which this permit is owed, Isball
SEWER—SANITARY—STORM IA. 209 Ff.
employ any person in any manner sr as m become subject the Workers' Compen-
or laws of CWifmnia. DateWATER
HEATER wNENT/ELECfH
TICE TO APPLICANT: IL after making this Cenificete of flaampum. you should WATER SYSTEMnRRATING
ome subject m me Workers Compensation provisions of the Labor Code, you must
hwith comply withsach this be deemed
�.
provisions or permit shall revoked. WATER SERVICE
as
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CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ. PT.
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I hereby affirm that mere is a construction lending agency forthe performance of
[Jan f•-'
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lenders Name
lender's Address TOTAL:
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I certify that 1 h.vc read this application hand stare that the above informmion is
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correct. I agree a. comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT
building construction, and hereby authorise representatives of this city In enter upon than
above-mentioned property for inspection purposes.
(We)hgrec to save, indemnify and keep harmless the City of Cupertino against PERMITISSUANCE
liabilities, judgments, costs and expenses which may in any way acemc against said City
ALTERORADDTO?t
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT AIR HANDLING UNIT (TO TOM) CFM)
SOUR EGULATIONS.
pp AIR HANDLING UNIT (OVER 10.000 CFM)
Signet Ap tcaryContractor Dare EXHAUSTHWD(W/DUCI')
HAZARDOUS MATERIALS DISCLOSURE!
Will the applicant or fume building Occupant store or handle hamrdous material HEATING UNIT (TO I W,(MM) BTU)
hs defined by the Cupertino Municipal Cede. Chapter 9.12. and the Health and Safety
Code, Section 25532(.)^ HEATING UNIT (OVER 100,000 BTU) -
❑Yes nNO
VENTILATION FAN (SINGLE RESID)
Will the applicant or future building Occupant use equipment or devices which
tit haamdous air comaminamsas defined bysha Bay Arca Air Quality Management BOILER— COMP CUP OR IWAOO BTU)
,met?
L] Yes C1 No BOILER — COMP (OVER IOO.0f BTU)
1 have read the haeallous materialsAIR CONDITIONER
requiremcros under Chapter h95 of the CWi-
broom Health & Safety Code. Sections 25505, 25533 and 25534. 1 understand that if me
NEW RESIDEN'T'IAL MI CH. SQ. Pf.
building does not currently have a larval. ma it is my responsibility m mnify the Occupant
Of the requirements which rand Tactual prior to issuance of a Canlfiette of Oeeupancy,
Owner or aumonced agent Data TOTAL
OFFICE
FEE
FEE
0
BUILDING PERMIT INFO
ELECT PLUMB MECI
NOB DESCRIPTION
RESIDENTIAL•
❑SFDWL
❑ KITCHEN REMODEL
❑ ADDITION
❑ PLUMBING RE -PIPE
❑MULTI -UNIT
❑STRUCTURAL
M IFICATION
❑ INTERIOR
IMNEY REPAIR
IMPROVEMENT
CI BATH REMODEUREFO R ❑ DEM LITION
[]OTHER
COMMERCIAL-
0
OMM RCI
❑NEW BLDG/ADDITION [I DEMOLITION
❑TENANT ❑ FOOD SERVICE
^IMPROVEMENT
SQ Pf. FLOOR AREA VSQ. IT.
PA 11)
r1B A,rn,.
BUILDING DIVISION FEES
PLANCHECK FEE
ENERGYFEE
GRADING FEE
SOILS FEE
PAID DRee
TOTAL:
BUILDING FEE
FEE SEISMIC ME
ELECTRICTEE
PLUMBING FEE
MECHANICAL FEE
CONSTRUC'HON TAX
HOUSING MITIGATION FEE
PAID
Data Rmaipl a
BY:
ISSUANCE
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CIVIL ENGINEER
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Job No.
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STEVEN A. ARNOLD RCE 12301
STEVEN A. ARNO
•
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}Civil Engineer, Inc.
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1671 THE ALAMEDA, SUITE 305 . SAN JOSE, CALIFORNIA 95126 . TELEPHONE (408) 286-9111
June 12, 1997
City of Cupertino
Building Inspection
10300 Torre Avenue
Cupertino, CA 95014
SUBJECT: Masonry Chimney for the residence
21529 Edward Way
Cupertino, CA
Gentlepersons:
At the request of Jones Masonry, I made an on-site
inspection of the existing single story masonry chimney
located at the subject address. The existing chimney had
been removed down to the shoulder revealing the fact that no
structural steel was placed in the chimney.
I have attached a sketch that depicts one method of re-
installing the masonry chimney and attaching to the wood
frame wall of the existing residence.
Should you have any questions, please feel free to contact
me.
Respectfully submitted,
Steven A. Arnold
Civil Engineer
CE22301
cc: Jones Masonry
ffflc� ca"
Boo I&Sp , 171997
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STRUCTURAL DESIGN . LAND SURVEYING • BUILDING INSPECTION .
GENERAL CIVIL ENGINEERING SERVICES
1(r
STEVEN A. ARNOLD — Civil Engineer, Inc.
•
1671 THE ALAMEDA, SUITE 305 • SAN JOSE, CALIFORNIA 95126 • TELEPHONE (408) 286-9111
June 12, 1997
City of Cupertino
Building Inspection
10300 Torre Avenue
Cupertino, CA 95014
SUBJECT: Masonry Chimney for the residence
21529 Edward Way
Cupertino, CA
Gentlepersons:
At the request of Jones Masonry, I made an on-site
inspection of the existing single story masonry chimney
located at the subject address. The existing chimney had
been removed down to the shoulder revealing the fact that no
structural steel was placed in the chimney.
I have attached a sketch that depicts one method of re-
installing the masonry chimney and attaching to the wood
frame wall of the existing residence.
• Should you have any questions, please feel free to contact
me.
Respectfully submitted,
Steven A. Arnold
Civil Engineer
CE22301
cc: Jones Masonry
STRUCTURAL DESIGN . LAND SURVEYING • BUILDING INSPECTION .
GENERAL CIVIL ENGINEERING SERVICES
STEVEN A. ARNOLD — Civil Engineer, Inc.
0
e
1671 THE ALAMEDA. SUITE 305 -SAN JOSE. CALIFORNIA 95126 • TELEPHONE'(408) 286-9111
June 12, 1997
City of Cupertino
Building Inspection
10300 Torre Avenue
Cupertino, CA 95014
SUBJECT: Masonry Chimney for the residence
21529 Edward Way
Cupertino, CA
Gentlepersons:
At the request of Jones Masonry, I made an on-site
inspection of the existing single story masonry chimney
located at the subject address. The existing chimney had
been removed down to the shoulder revealing the fact that no
structural steel was placed in the chimney.
I have attached a sketch that depicts one method of re-
installing the masonry chimney and attaching to the wood
frame wall of the existing residence.
Should you have any questions, please feel free to contact
me.
Respectfully submitted,
Steven A. Arnold
Civil Engineer
CE22301
cc: Jones Masonry
STRUCTURAL DESIGN . LAND SURVEYING . BUILDING INSPECTION .
GENERAL CIVIL ENGINEERING SERVICES