27521 (2)APPLICANT TO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OF CUPERTINO, ,- LECTRT2"a.
APPLICATION/PERMIT PLUMBING - MECHANICAL27521
BUILDING DIVISION BUILDING. PROJECT IDB\ FIFICATION
PERMIT NO.
BUILDING ADDRESS:
SANITARY
SANITARYEAPPLI�nObl
SUBMITTAL DATE
/g� sn s,� �/
SOV GD-w^� wA / UNIT; '• LOT If
WNERS M �+^ M r. _� PI{DNB:
CO R CI OR;SN E: ` LICNO:R`!'1LL1GV l� L)'F/W_WNl
ARCHI'I'EC gL LIC NO: 23
N S
.soN/CTROL#
ADDZ,.o� �� TVA "'•(J
CONTACT- PHONE:
QTY. ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
LEC PLUMB MECH
ll^(Ar.
M=Z
FOO
ND` W Z If� 1(E
PERMITISSUANCE
LICENSED CONTRACT'OR'S DECLARATION
I hereby affirm thin am licensed underprovisionso'Chapter9(commencing with
Section 7001 Division 3oflhe Business and Professions Code, and my license is in
full force and effect.
APPLIANCES - RESIDENTIAL
3
r
PANELS
FZw
rnQy
ZoyZ
O Z _ O
Pe E' W
Qy�;
�'w<
,fie,5eOWE
tsl'3 t.
ON.Q4
'WY2
W W <0
aiou
yxj_y
FZQ
5=0
��p%
a3—
License Class Lim.#
DateContextm
UP TO 20D AMPS
�w.a
201. 1000 AMPS
ARCHITECTS DECLARATION
1 understand my plans shall be road as public records.
OVER 1000 AMPS
SQ.FT,FLOORAREA
$/SQ. FT.
SIGNS ELECTRICAL
Li<cnuJ Professional
OWNER.BUILDER DECLARATION
I hereby affirm tha 1 an exempt from the Contractor's License Law teethe
following reason (Section 7031.5, Business and Professions Code: Any city or wumy
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to File a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9mommencing with Ssman 70)(HAf Division 3 ofthe Businessinf Professions Castle)
of
SeemheisesbyiN.pplicerefrom and the ma for. Pettit sreem,hedesemption. civil
not omthanSveanydreddollars$50H. tsubjects the applicant ¢recivil penally or
not mom than five hundred dollars ($50H.
❑ I, as ownemOM1epmpcny,ornryernployees with wagesastheirsule<ompervsadon,STORIES
will do the work. and the suen
ucmm is not imdedorofferel forsuk( cv.T044, Business
SPECIAL CIRCUIT/MISC.
TEMP. METER OR POLE MST.
POWER DEVICES
SWIMMING POOL ELECTRIC
V
✓�bl`'YN) �•
OUTLETS -SWITCHES- FIXTURES
NEW RESIDENTIAL ELECTR SQ. FT.
TYPE CONSTRUCTION
and Prefessinns Cole: The Commclor's License law does not apply m an owner of
pmpeny whobuilJwrimprovestherenn, and whndces such work himself nnfl, nmgh his
empluyen,provided thnsucM1improvements are noonandedorofferW forsalc.Lf,
OCC. GROUP
RES. UNITS
however, the building or improvement is sold within one yearofcompletion, the owner-
builder will have the burden of proving that he did not build or improve for purpose of
TO
QTY. PLUMBIN PERMIT FEE
sale.).
❑ I,mownerofthepmpeny,amexclusivelycontmningwimlicensedcommwmto
ILOODZONE
APN
construct the project (Sec. 70W, Business and Professions Cade:) The Contractors
License Law does not apply to an ownerofpropeny whobuilds or improves thereon,und
PERMIT ISSUAN
whocommctarorsuchpmjea wimacontwy(.%)licenmdpunumito eCmm toes
License Low.
ALTER -DR &VENT -WA I:R (G)
FEE SUMMARY
❑ I am exempiunder Sec. , B & P C for thio reawn
BAC O W PROTEFP D VI
O SIDE FEES
SANITARY YN
Owner Dare
RAINS - FLOOR, ROOF, ,C ND.
RECEIPTp
WORKMAN COMPENSATION ofcon DECLARATION
❑ Ihereb3vffimnhm lhave acminca¢ofarmem mself-insure. ore cenilicat
Workers Compensatura
ion Insnce 00. or a cenified copy thereof 38Lab C.) w ch
covers all employee's under this pcnnit.
HOOLTAX Y__N
RECEIPT;
FIXTUR -PE
PARK FEE Y_N
RECEIPT;
GAS - Y .M1 INC.4O �
.
GAS -GAS .M- ER
Felt, #
Company
BUILDING DIVISION FEES
❑ Canifiedc.,nierebyfumished.
PLANCHECK FEE
❑ Ccnificd copy is fled with the city inapecdon division.
GREASFII'D TRI. INEFERCE
GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
EASETRAP
SOILS FEE
CHAssection need not becomplcW ifthe permit is much, hundred dollars ($100)
orlrosJ
SE ER-SANITARY-Sl'OR .200IT.
ENERGY FEE
Q
Icenifylhatinthe Performance.f the work for whichlhis permit is issued, I shot[
any mvmer an as to become subject to the Workers
nm play an�y;�,pve,,rssro�n�!i;n�
C t sAfto /
pli1, < t
WA �RHFATERW/V /ELECTR
WA SYSTEM/r TING
PAID
Date Receipt;
T ADPL , Co ng this Ceni ns of th ------ ion, you should
become subjectcoply theWorkers Compensation provisionso!the Labor Code,yeses most
forthwith comply with such provisions or this permit shall be deemed revoked.
NEW R IDE AL PLMB. SQ. FT.
T A .
BUILDING FEE �s
lq
�
l
(� 0
CONSTRUCTION LENDING AGENCY
I worka,eby flirt that is a ed(See construction lending97,isagency for the performance of
the dar', N r which this permit is issued (Sat 3097, Civ. CJ
Lender's Name
SEISMIC FEF.
TOTAL:
FJ,ECfRIC PEE
QF
V
F' y
L) Z
Leadds Address
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
I certify that I have mad this application and state that the above information is
comem. I agree to comply with all city and county ordinances and state laws relating to
building construction. and hereby auNorire mpresentativesofthis city mentor upon the
property for inspection purposes.
above-mentionedER
PERMIT ISSUANCE
MECHANICAL FEE
ALTORADDTOMECH.
CONSTRUCTIONTAX
(we) agree m save, indemnify and keep harmless the City of Cupertino agoina
liubiloics,judgme,ns,custa andeapereas which may many way sccmeagdns, sen City
AIR HANDLING UNIT (TO 10,000 CFM)
nscquene sating. is pctmit.
AIR HANDLING UNIT(OVER I0.000CFM)
/ 3/
Sig amre-nf ApplimmUCon cmr Date
EXHAUST HOOD(W/DUC)
PAID
HEATING UNIT (TO 100,000 BTU)
HAZARDOUS MATERIALS DISCLOSURE
Data R¢eiNt;
Will the applicant or future building occupant srom or handle hamrdous mnrerial
as defined by the Cupcninn Municipal Car] , Chapter 9.12, and the Health and Salety
Cale, Section 25532(a)'!
HEATING UNIT (OVER 100.000 BTU)
L.
VENTILATION FAN (SINGLE RFSID)
❑ Yes ❑ No
BOILER-COMP( 3HPOR Io0,D00BTU)
IJ;/;TE
IS 11A)VB!! l6JJ
Will m
the applicanrfumre mx
buildinguc<upauequipmcntma
devicwhichcmit
air comaminanu as defined by the Buy Arca Air Quality Management
District?
BOILER
OILER -COMP (OVER 100,00(1 BTU)
.hazardous
ID Yrs 0 N
m
I have read the hurdous materials requirements under Chapter 6.95 of the
aR11 %(1nS
1x%S7
C/f �
NEW RFSIDENTIAI. MECH. SQ. FT.)
California Health & Safety Code, Sections 25505, 25533 and 25534. l understand that
if the building does not currently have a tenant, that it is my responsibility to notify the
ottupam of the requirements which must he met prior to issuance of a Certificate of
Occupancy.�./
tar
tt��
LVr�t iL /(v�J
BY�
Owner tar awhorm,ed agent Dam
TOTAL: ISSUED
.. B Y.....�../Y.r...... —DATE
CHID. BY- ............ -OATE
......_...................-..............
•
SUBJECT/{el SHEET NO -1 ...... O F_ _...:...
.................. .. .....vL%-�............................ JOB
.................. .......C_✓..,eI_".t!. c,.._....C..P_.........._._......_..........
References: (1)11?R/ Ed. UBC
Design Load Assumptions: (psf)
LL DL
Roof
Ceiling
Sloped C1'g• _.....------......_
1st Floor
2nd Floor
Ext. Walls =--
Int. Walls --..------.--._---
Party Walls,-
Wind
alls._Wind
Seismic vs =A,
Timber Construction Design Criteria
With C l,';? ? Lumber `Grading Rules
Use Grade
Struct. Light
Framing (4 x 4) U2
Struct. Joists, #1
Planks 6 Rafters Dense #2
#2 .
Light Framing 6
Studs (4 x 4)
Beams b Stringers
Beams 6 Stringers
Beams 6 Stringers
• Post 6 Timbers
Std.
KENNETH NELSON'
Registered Civil Engineer
940 Saratoga Ave.
(408) 247-2898 4Suite 215
San Jose. Califomia 95129
oQ�p�-�SS/pN l
9
p G
Y Z z
W No.22023 e7 m
o: Li Exp. 9-30- --7j
s C[VI\- �Q
T
q1 nr r At kF
fl.EGERED,
SAN 31 1995
BLOB. INSPECTION DEPARTMEM
CITY OF CUPERTINQ
f E x 106
1450
1.7
1500
1.8
1450
1.7
1250
1.7
Grade
600
Dense Sel.
Struct.
1900
Set. Struct.
1600
Dense O1
1550
U1
1350
Dense #1 f 1400
111 f 1200
1.5
f (repetitive use)
1750
1700
1450
KENNETH NELSON
Registered CIMI Engineer
(408) 247.2898 940 Saratoga Avo. Ste. 215
Fax (408) 247-2898 San Jose, CA 95129
9
7
.. . ..... .. ........... . .. .... .. .....
10/
4
....... ..... .. ..... .
. . . ..... ...
JOB
SHEET NO. — OF
CALCULATED BY — DATE
CHECKED BY DATE
SCALE Ja25-Va.':9.66
pma ml J ,..r .. 0i'm
14
...... .. . .
......
.. ... .......
.. . .
... ... ........
............ ....... .
pma ml J ,..r .. 0i'm
14