23539 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
_
Building Protect Identification PERMIT NO.
Building Aridness:
36� tucc.t=�rzt9 ?. " 23539
iters ante: one:
1.A w�s SZ-zz 3 CITY OF CUPERTINO-BUILDING DIVISION
C mratlora NAne: `/ , Llc.Na. APPLICATION / PERMIT
b`^-"� 2.ZO^ Z BUILDING-ELECTRICALPLUMBINC-MECHAMCAL CATEGORY CONTROLN
Architect/Engineer Lie No:
9TY ELECFRICPERMIT FEl.. : BUILDING PERMIT INFO
Add.:j56.� �[((,(_Q�' r3u�( gf PFRMITISSUANCE PLUMB�
LICENSED CONTRACTOR'S DECLARATION
]hereby offumthat l am licensed under provisions of Chapter 9(comment, APPLIANCES-RESIDENTIAL - JOB DFSCRB'770N
ingwllhge on7000)of Dlvielon3ofthe Buss MdProfes onsCode,andmy
IlcenI is in full roe and effect. PANELIN TQ S d
LlcenaC ss S LIC N_---�
Date Cantneor
ARCHITECPS CLARATION 201-1 O00 AMPS
Mo z I ndcm(and-jp_ +r' , t1n bile mound. OVER IMO AMPS SQ.FT.1•LOOR AREA f/SQ.F7.
1 )}o(essWna)— f SIGNS ELECTRICAL
e
OWNERxNLDER DECLARATION SPECULCIRCUIT/MISC
zL, � Iherebya(firmthat lam xempt(romthe Contractor's License law forth,
p p following reason.(Section 7031.5,Business and Profession,Code:Any city or
9z cauntywhichrequireaapemttocoostmd,alter,unprove,demolbhorrepair 7IINP'METER OR POLE INSf. /
q'� a any structure prior to Its monsoon,also requires the applicant for ouch permit to POWER DEVICES
P V file a signed statement that he b licensed pursuant to the provisions of the
G673,w�
Contractor's Licence Law(Chapter 9(commencing with Sectlon7000)of Dlvl- SWA{hONG POOL ELECTRIC �-
VALUATION
9an3afthe Bu.n.and Pr A.m .Code)orthathelaexempltfierefromand
the basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLMS. SWI.ICHES-FIXTURES
applicant for a permit subjects the applicant to a civil penalty of not nitre than
five trundledsownerlars oft rM. SQFr. SPORIES TYPECON UCDON
1,as owner of the property,or my employees with wage,es their sole NEW RESIDENTIAL ELECTR
compensation,wflldo the work andthe structure isnot intended or offeredfor Igo`'
M sale(Sec.7064,Business and Professioro Cade:The Contractor',License law n � � Il �1 V
does not apply to an owner of property who builds or improves thereor,and
whodoes such work himself or through hisown employees,provided that such \ G6 ° S
Improvements are not Intended orn(fered Eurasia.If,however,thebullding or T Y
improvementbsold withinoneyearofcomplml mtheowner-builderwlll have
lFaptMen of proving that he dm not bund or improve for purpose of sale.). QTY, .PLUMBING PERMIT
L j L as owner of the property,am exclusively contracting with licensed PFRAf1.I,155IlANCE E
oa
contactors to corutruct the pmjW(Sec 7064,Business and Professions Code: _
Th.Cantador's License Law does oat apply to an owner of property who ALTERDRAIN&VENT-WATER(EA)
builds or improves thereon,and who contracts for -
for each pipewith a FEE SUMMARY
oialladoral licensed pureuantto the Contractor's License Law. BACK PLOW PROTECT.DEVICE
LJ I am exempt under See B k P C for thin reason
Owner Y OUTSI DE FEES
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
Date RECEPT N
WORKMANCOMPENSATIONDECLARATION r SCHOOLTAX Y N
❑I hereby affirm ce
that I have a rtifuste of consent to aFIXT'URF_S
PER if-Insure,or RECEIPTNY
certificate ofWorkers'Comperuation Insurance ora certified ropytherea((Sec. GAS FA.SYSfEM-I INCA OUTLETS PARK FEE Y N
3800,Lab C.)
Policy N CAS EA.SYSTEM-0VER 4(EA) RECE TT M
Com any BUILDING DIVISIONFEES
F2G."ed copy b herebyfurnished.city GREASE/INDUSML WASTE INTERCEPTOR PLANC14ECK FEE Art
ed ropy b filed with the city Inspection division. —l. 1
CERTIFICATE OF O(EMPTION FROM WORKERS' CREASETBM PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 200FT DR R
CrWsmdton need nd be completed lithe permit bfor oa hundred dollars
($1I carifytha WATER HEATER W/VENT/ELECTR ENERGY N
lartdylhat In the performance o(thework forwNth this permit is issued, —
Ishall not employ any person In any manner n as Is become subject to the WATER SYSTEM/TREATING Worken'Compensatlon lawn o(Gllfamla.Date PAID
O Z Applicant NEWRESIDENTIALPLMB. SOFT. e Remi thi
Z p NOTICE TO APPLICAno the making this
Ceroniateof Exemption,you
ahold you
=at forthwith
t to the ply with
suchprovisiCompensation provblms of the Labor TOTAL:
dq Code,you muet(orthwlth comply with such provisions orchis permit shall be �a1I
W � deemed revoked.
CL CONSTRUCTION LENDING AGENCY SEISMIC FEEI 11
Ihembya(firm thatthere ba construction bndiagagency,forthe perform- ELECTRIC J E wti
D Z ...of the work for which thio rmB ed'(Sec.3097,Civ.Q
V O I<ntlere Name -. PLUMBING
LL I- Lender's Address QTY. MECHANICAL PERMIT " ' E fFEESPAla.
CAL •-E
O W Imdi(ythatlhavereadi) a BatbnaMpatethattheabovelnformation
1 la rormct.lagreeto compl with all cilyand rountyordlnanceaand cote laws PERMIT ISSUANCE hhandconcesangelZ city to enter upon the abov&nAmivad property(or irspecllon purposes. ALTER OR ADD TO MFCH. ,Cel tN
— Me)agree to ave,indemnify an d kncp hamdeas the City of Cupertino
against fiabifities,judgments,meta and expenses which may In anywayaccme AIR HANDLING UNIT CTO 10,000 CFM) SUB OTAL:
against said City In ronadryence of the granting of this permit. AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION
Signature of Applicant/Contractor Date EXHAUSTflOODM/DUCT) - CONSTRUCTION TA PAID:
HAZARDOUS MATERIALS DISCLOSURE
Wllltheappllant orfutumbullding dccupant atom orha Mle haranlous HEATING UMT(TO 100,000 BTU) Date - RMe t�
material as defined by Me Cupertino Municipal Cade,Chapter 9.12,and the
HeAth and SafetyCade Section 255320)2 HEATING UNIT(OVER 100,000 BTU) TOTA
❑Yea No
Will the Applicant or Nm building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DA
which emit haardma air contaminants as defined by the Bay Area Air
Q�jality Management Ds'(r)atl BOILER-COMP OHP OR 100,000 BTU) I
YeaNo
ereadlhehossa ma terialarequlremenbunderChapter6.95of BOILER-COMP(OVER 100,(100 BM
the Cal'doa+.mb Health k Safety Code,Sections 25505,25533 and 25534.1 n w
A
understand that if the building does not coriently have a tenant that It b my NEW RESIDENTIAL MECH. SQ.FT Y
responsibility to notify the occupant of the requimmenb which must be met
Prior to once aCediflate anry.
mor authorised agent - p /—
SSUEDOY:
a
OFFICE COPY
'i
AUGUST E. WAEGEMANN .
CONSULTING CIVIL ENGINEER
555 PALM AVE., SUITE 205, MILLBRAE, CALIFORNIA 94030 PHONE 415-697-7700 FAX 416-259-9909
s
March 4, 1994
Lifetime Pools, Inc.
910 San Antonio Rd.
Palo Alto, CA. 94303
Attn: Ray Whitford
Re: Residence of:
Mr. & Mrs. Paul Lauvers
21362 Milford Drive
Cupertino, CA 95014
Gentlemen:
. Please be advised that I have inspected the excavation, re-
inforcing-steel placemerit for the above ref erence`d+-'project and
find it to comply with our design requirements. The originally
submitted structural design is appropriate for the site
conditions and should be used for the construction of the
swimming pool.
If you have any questions, please feel free to call.
Ver Truly yours,
*Ast L. Wae nn
6925
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