22528 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY C
Building Pmwt ldemlfkaaon FELWT NO.
Building Adders,: 22528
2/P5 2 6,4lev <.f" G.oxt
me ALDAIE
e_ 7A_-5'1r0 CITY OF CUPERTINO-BUILDING DIVISION -
• G �' COn T / Lk.No APPLICATION / PERMIT
COId�B� , BUII,DING-ELECRtICALPLUMBINGM NlCAL CATEGORY CONTROLI
chltect/Engineer: Lic.No:
Q ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Aaare..: Cl� PEee,ETlssuANCE
LICFNSEDCONTRACTOR'SDECIARATION
Iherchygfection7 that) Nalco iuM usinesbbruof Castomi 9(¢,rude APPLIANCES-RESIDENTIAL JOB DESCRIPTION �
ingwlth it Mlinmea fNvldan3 ofthe Buslnesand l'rofrtd¢uCode,and my
lime b in fuff��fo d d(ect. PANES
UP TO 2DOAMPS
Lkenae( Lic.. G 1 0�
i Date$' Contntar
ARCHITECTS ECIARATION 201AMAMPS
quq�aa rs0� IuMereand my plum WBbe used upubkc records. OVER 1030 AMPS AFrFLOORIAR
Licensed Professional SIGNSELBCTRICAL
G OWNER-BUILDER DECLARATION SPECIALCRCUTT/MTSO
F. 5 1 hereby./firm that I am exempt from the Contractor's License Law for the
pp q�y following reason.(Sodom 7ml5,Bushes a nd Professions Cade:Any city or
67.^3 TFAIP.MEfER OR POLE INST.
F� county which rtqulmaapermttrnmmtrut,alter,improve,demolt+h,or repair
q anyatsuture prbrta la fesuance,abo respuknthe appRantf¢wch pemdt to POWER DEVICES :•
Li Yd G Nc a signed statement that he In lloenaed pursuant to the provisions of the
0363u, Contraotor9 License Law(Chapter9(rommenMg with Section 7(100)of Dm I- SWIMMING POOL ELECTRIC
O sion3ofthe BuMmsand No(esbnsCode)ordunhebeae therefromaM VALUATION
QfS $ the baab for the alleged exemptkn. Any Adatbn of Section 70.115 by any
A appllrentforapermlt eubjcaatheapplk.tt..dW]pe.Hydna.o thin SSWIICFDSE),NRFS
�i fiNt'r fired dollars MW(B. NEW RESIDENTIAL dEC7R SQ}T.
Lf 1,as owner of the property,or my employees with wages as their sale STORIES TYPECONSTRUCITON
compensation,wllldo the w.dk'ana the strormse is not Intended or offered for
oo sain 5ee 70K Business and Professions Cade:The Comaaor'.Lime law
does not apply to an owner d property who builds or improver thereon and -- OCC GROUT'. RIS.UNITS '
0.0. who does such work himself¢through hlaown employers,provided that such
Improvements are not Intended oroffemd fasale.If,however,thewlldingor TOTAL
Improvement bsold withboneyearofcvmpletbRthe owner-widerwi0 have
t1al2urclen of proving that he did not wild or Improve for purpose of sale.), QTY. PLUMBING PERMIT 'FEE
"L as owner of the property,am eeclu,d sly mntracting with licensed - IIDDD ZONE AM
contractors to construct the pm)et(Sm 7014,Bossiness;and Professions Code: PERMIT ISSUANCE
The Contrstoe.Linens Taw dace not apply to an owner d property who gLIF]i-DRAIN&VENT-WATER
lou Bela or imp.thecon,and who contracts, fee such p(o)M. with a
+ctm(.)lloenaed pursuant to the Contractor'sLlanse Law. BAIX FLOW PROTECT.DEVICE FEE SUMMARY
LJ 1 am exempt under Sec B k P C for this reason OU`ES1bF FEES
DRAINS FLOOR RODF,AREA,COND. SANITARY Y_ N_
® Owner Data - RECEIVE f
WORKMAN COMPENSATION DECmeto DN FD(TURFS PER TRAP SCITOOL TAX Y_• N_
01 hereby affirm that I have a artlllute of cement
nt to aeB-losure,o s RFLFII'I'Y
certificate of Workers'Compensadonlmuma a a¢Nfied copy thereof ISe Lb q GAS FA.SYSTF]M-11NC40I1TLEI5 PARK FFP Y N
3f W,
Pdky l'a , ECIaT-7 �� REa
GAEA.SYSTEM-OVER 4(EA)
Ca n.."y i h`n`�b"h"drtwed ropy b flkd with the Illy inspection division S BUILDING DIV]SION FEES
1� pyis ' GRFASE/WDUmEP
tL WASTE INTERCEPTOR PLANCHECK FEE
.
CERTIFICATE OF"MON FROM WORKERS GREASE TRAP PAID
COMPENSATION INSURANCE g_•m .SAN EARY-STORM FA Z)OFI'. Date RCCCI IN
(Ties sectlan need not be completed if the perout b f¢one hundred dollars .00
Rt I verifm3 WATER HEATER W/VENT,/E-ELTR ENERGYFEE Y N
I¢not thatothe persoan¢dthewok so as to which become
1.issued,
I orlu not employ any nems In any mnia.Dat s to become subject to the WATER SYSTEM/TRFATING
WokeniCompensation l�wa of California.Date PND
0 Z Applicant MNEW RESIDINIIAL I'LMB._SIFT.
:I
e Date Rcoel HI
Z 0 NOTICE TO APPLICANT-. -
N should becomsubject to the Workers''Comperaubn provisbm of the Labor TOTAL
Code,you suss fart hwhh comply with such provisions or this permit shall he
WdecmM revoked. BUILDING 111 .
CONSTRUCTION LENDING AGENCY ISMIC FEE
Q. I hereby affirm that them is a construction lending agency for the perform : ELECTRIC FEE
7 Z an¢.1 the work for which this penia[is tsoed(See 304/,Cl,C.) TOTAL .ef' d
00 eMer'.wer PLUMBING FEE /ZOO
IL F Iender'.Addreas QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW I cenlfythatl have mad this appllrstlonand slatethal the above Wummian
4 bmmoct,l:grtctocomplywkh&UdtyardmuntyaNlnan d.atelam PERMIT ISSUANCE FEES PAID
>. 03 relating to wilding construction,aM hereby autwrb<representatives of this
I.- In
city to enterupon the awvr�nibned property for inspection purposes. ALTERORADDTOMECH.
� — (Weagainst
agree to save,Edw olty.nd«keep��1meC any Cupe�e AIR HANDLING UNIT 10,000 CFM) —Date ReOTAL
gs1m %gi City a gme x y ywYSUBTOTAL:
galmll..��CNy this pend.
AIR HANDLING UNIT(OVER to,aaa CFM) CONSTRUCTION TAX
-.ffGApeplI.d/Cmvactar Date IXIIAUSTHOOD(W/DUCT, CONSTRUCTION TAX PAID:
HAZI R DOES MATERIALS DI SCI.OSVRF
WRl the appkanrt¢futum wilding occupant store or handle havudous HEATING UNIT(TO 103,000 BM DatC RCCEI IN
motem,l as defined by the Cupertino Municipal Code,Chapter 9.17,and the r
Ileahh and Safety Code Section 75S37(e)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: /. Do
❑ Ye Na
Wllltheappllamo W.bnlldi.g.p..tu.Nuipr¢modevlm VENTILATION FAN(SINGLE RESID) ISSUANCLDATE
wh,tld M ageme usilrcontamWntsas deRmd bythe BayArca AU /��
Quality Mavgemem 7 BOILER-COMP(iFil'OR 100,000 BTU) Q
4. No
havcreedtheha& art rtalerl STat.ulremenaunderClaper6.95 of BOILER-COMP(OVER1W,o00 BTIn �f
the
understand
t HeaBh A Sadefy Cade, ca vara 75.5,5,have
at and 75534. I l T
rsponaMytontifythhat orr dart nathe requireents tenant.that Itis ct NEW RE9DEJi1AL MECN. ;IF7.
responsibility to notify the occupant d the requirements which must onset
prbr to lauame daCerbOotc o/Oaapamy. 'sulk
Owner authorized agent Date TOTAL: ISSIIEDBY:
OFFICE COPY
B.A.S.S.
SROCONSTRUCTION SEWER REPAIR • BACKHOE SERVICE
P.O. Box 701, Pleasanton, CA 94566
1-800-458-8315 Lic. #618108
march 14, 1994
City of Cupertino RECEIVED;
10300 "forre Ave. MAR 1 '1* 1991
Cupertino, CA. 95014 M of CUPERTIN0
Attn: Jerry Brager BUILDING 0M.
RE: 21852 Gardenview Lane
Dear Jerry,
To the best of my recollection the septic tank at this location was inspected, if
not by yourself than by another inspector who covered for you during some time off
you took during the month of August, 1991.
We used the same procedure to abondon this tank that we used at all of the
other jobs in that area performed from July 1991, through November 1991. The
e� procedure used is as follows:
1. Pump out tank
2. Break out bottom of tank
3. Get inspection
4. Backtill with sand
If you have additional questions please feel free to contact me at (800)458-8315.
Sincerely, j1�t
Bud Mahl AR 18 19gd
B.A.s.s. � rION 0
OF CUp T,8r4ftN
• BM:cm