30150 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. - PERMIT NO. 30150
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BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL.
/I �/� ' I /� BUILDING PROJECT IDENTIFICATION
BUI/DA2)RESS�O /v�&WVC .`T/UC&-ZAA b SANITARY NO, APPLICATION SDBMI'ITAL DATE
OW ER'S NAME: .��gS/� 7177 20 OpIi1HACT01t'SNAMt: 1 L}C NOt NIC - - �C NTROLp
AR 1'ECT/ENGINEER: kC-..0 LIC NO ' SURES$: QAV/ fTG7 ❑
Ae i 5'2332 6 •� 2¢6
CONTACT: PP DON.. BUILDING PERMIT INFO
1i 4 �w/�/�/ _ �� ❑ Consultant Pees Paid by Applicant(Initial) L� rLUrIH MECH
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE STI
1 hereby otfwt thm I am licensed under ,pmvidoas MChapmr 9 fi ommemiag JOB DESCRIPTION
Ol�00 with Section 7000)of Division 3 ofthe Business and l'rofeclum.Cade.and licenseis RESIDENTIAL:
FsOp w, y PERMIT'ISSUANCE
in full lorcc and c '
tY�F DSFIJWL ❑KITCHEN RIiMODEI.
QUk�3 Li«nse C,jps Lick APPLIANCES-RESIDENTIAL
�za Date — Comrunor []ADDITION ❑PLUMBING RE-PIPE:
I„ ARCHI'I'IiCfS UECLAItA IO PANELS ❑MULTI-UNrr ❑STRUCTURAL.
Z O M 1 uodersmnJ my plans shall be used us public mmNs MODIFICATION
O Z UPT0200AMPS
0,y,� Licensed Professional - - 201-10m)AMP5" DIMPROVORMIiNT [I CHIMNEY REPAIR
OWNER-BUILDER DECLARATION
I hereby OfPom,het 1 am exempt from the Contractors License Law for the OVER PRO AMPS 0 BATH REMODEL REPAIR 0 DEMOLITION
OyU fnBowing reason.ISenion]031.5,Business and Professions Code Any city nr county SIGNS ELECTRICAL ❑OTHER
LLO F' whi tI requires a permit to coriumet,tiller,improve,demolish,or repair any atmemre
priorto its issuance,also requires the applicant for such permit to file a signed statement SPECIAL CIRCUIUMiSC, L—
} that he ix licensed pursunnuo Ne provisions of the Comnuous License To (Chnpter9
pp (commencing with Section 7000)of Division 3 ofthe Business and Promasions Core)., TEMP.MISTER OR POLE INST. OMM RAA
Bathe is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
`r. Section 7031.5 byany applicant rot a pent,itstib,lects the upphietat to a civilpenaltyof POWER DEVICES
W r� t more than live hundred dollars($5(111). ❑TIiNANT ..� ❑FOODSERVICE
^?Q Cl 1,as owner of Ne property,onny employees with wages as their sole compensation, TSWIMMING POOL PLECrRI _ IMPROVEMENT!. P !h
Q will do the work,and Restructure is not Morocco oroffered for.s:Je(Sec.7044,Business DOTHER
and Professions Code:The Contractor's License Law does not apply to an owner of OUTLIO S-SWITCHES-FIXTURES
propeay who builds or improves thereon,and who does such work himself m through
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ PT.
sale.If.however,the building or improvement is sold within one year ofcompleiian the 161/1)SQ FT.FLOOR AE $ISQ.FI�
o
er-builder will have the burden of proving that he did not build or improve for pur- si V/- LP,-
pse of sola).
1,as nwnm ar the pmpertr,con axeTrtamely contrtiedng won hpensed a,mmems m tnIIIV(J
comwct the point ISec.7044,Business and Professions Codc:)The Contractor's
renw Law does not apply to an owner mproperty who builds or improves therear,and QTY. RING PERMIT FEE
whacnmmms forsuebpmjeat wilt,awmmemr(s)liccusevIEum au to thoconwctors
License Law. PERMrr
O,I am exempt under Sm. ,B&P C for this mason
ALTER IN W 'FR IEA)
Owner Date -VALUATION
WORKER'S COMPENSATION DECLARATION BACK 11.15W O7.DEV �!
1 hcrehy affirm under penalty of penury one of the fol lowing JttSarmion.v: oco/—
❑ Ihaveandwilloom" na Cedificme afConsenuo xlf--insure for Worker's Compen- DRAINS-FLOG -,A ,GOND. STDRIES 'TYPE CONSTRUCTIONtolm.,as provided for by Section 3700of the Labor Code, th
Ce,for e perfouncoo,of the
work for which This permit is issued. FIXTURES-PER TRAP
1 have and will maintain Workers Compensation Immource.as required by Section
37W of the Labor Code,fin the performance of the work for which this permit is issued. GAS-EA.SYSEll.1-1 INC.40V S OCC.GROUP APN
My CumWr:rkers C1�rk ytsyBtncgcyrjprand PolicyoN1icy pg glc.�rrJ.1./ GAS-EA.SY5O?M-OVER 4(EA)
CERTdff- IFICATE Or EXEMPTION FROM WORKERS' •1 �T
COMPENSATION INSURANCE I GREASFIINDUSTRL WASTE INTERCEPTOR
('This section need not be completed if the permit is for one hundred dollars 1$100) BUILDING DIMS NIg3CS
ar less.) GREASETRAP PLANCtIECK PEE 14at—
rod
Loy a.,thmin the pMy....ce of chew vcmuw,hich Nis permit isissue..lshall SEWER-SANITARY-S'I'DRM v 00 FL
ation employ anyplifoaiaany manner su us Tn hecon,e snbjecnnthe Workers'Compen- ENERGY FEE
OZ moon Lnxs of Cnlifomia.Date WATER HEATER WNG
z O Applicant - GRADING PER
rNi NOTICE TO APPLICANT:If,after making this Cedificxte of Exemption,you should WATER SYSTEMIT REAT'ING
a7 become subject to the Workers Compensation provisions of the labor Code,you must SOILS F
W fodhwirh comply with such previsions or this pcm,it shall beJcmeJ revoked. WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMtl. SQ.FT. PAID
L)0 k far by wheffiwrhmmai them isac d(Scr.0IC,Cing agency for the performance of Dat Receiprk
o b+ Newark for which this pennh is issued(Sec.309],Civ.C.)
(� Lenders Name - TOTAL:
Lenders Address - TOTAL:
y I cerify that I have read Nix applicm con and state than The above information is BUILDING iE 0n
qIZ) commit.I agree to comply with all city and county ordinancev and state laws relating to QTY. MECHANICAL PERMIT FEE
x buildingcoastmctian,ane herebyamhdrize mpmsenmtivesnfthocitym coerupon The SEISMIC .E
above-ounationed pmpedy for inspection proposes.
(We)egme to save,indemnify and keep harmless The City of Cupertino against PERMIT ISSUANCE ELECT RIC FEE
liabilities,judgments,cmt,endexpcnses which may in anywayaccme against said City ALTERORADDTOMECII. PLUMBING FliE
in conecyuenue of the granting of this pem,ir.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT('1'010.(X1)CFM)
SOU ER V ONS. MECHANICAL FEE
G AIR HANDLING UNI I(OVER IOAIIDCFM)
i�_f(/[,(/( CONSTRUCTION TAX
Signnmrco Applica or Dam EXHAUST HOOD(W/DUCT') HOUSING MITIGATION FEE
HA]. OUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hueemous material HEATING UNIT '0"1
as defined by the Cupir ino Municipal Code,Chapter 9.12,and the Nto I and Safety
Cole,Section 25532(0)'/ HEATING UNIT(OVE )
71 Vice No VENTILATION FAN(SINGLE HI-SID) PAID
Otte Receipt4
Will the applicant eicaut iufuwm building by the p use equipment or devices which BOILER-COMP(3HP OR 100,00(1 BTU)
is hazardous air contaminants us delinW by the pay Arca Air Quality Management
DislrinY BOILER-COMP(OVER 100,1100 BTU) TOTAL:
Cl Yes � Otho --
I have man the hmvdnus mmeriais p AIR CONDITIONIiR ISSUANCE DATE
Brain Malcontents 25533 ntsuMcr L11 ndersto of the if
fomiu,ime,&Safety Co le,Sectionst,thwu 25533 it ,ibili(understand thatif Ne NEW RESIDENTIN.MECH. $Q.FT.
huihe m darn urn cunenth hu must
a me M Nat n is my ce ofasCe ity es noify the occupant
of the reyvimnems which man be met Martin issuance of a CenificOte of Ocuuryncy. -
Ownen,r authormed agent Datc TDTAL: - ISSUED BY:
OFFICE
-� HOSKINS ENGINEERS INC.
501 SOUTH BASCOM AVENUE
SAN JOSE, CALIFORNIA 25128
Tel: (40S) 271-7800
Fax: (40B) 571-2340
September 6, 1996 Job 960602
Silvercreek Development Company
Post Office Box 246
Boulder Creek, California 95006
Attn: Mr. Timothy McDonough RECl VEDD
SEP 16 1996
Re: Reinforcement Placement Observation
McGee Residence Pool BLDG. INSPECTION DEPARTMENT
10250 Scenic Blvd. CITY OF CUPERTINO
Cupertino, California
In accordance with the request of Silvercreek Development Company, Hoskins
Engineers Inc. performed a site visit to the above referenced project on September
6, 1996. The purpose of this visit was to observe the reinforcement placement in the
pool excavation for general conformance with the pool construction drawings
40 prepared by Hoskins Engineers Inc. dated June 21, 1996. Tim McDonough of
Silvercreek Development Company was present at the time of this visit.
It was agreed that cleaning of the excavations to attain the 3" clearance from
reinforcement to earth as required by the construction drawings will be completed
immediately prior to gunite placement and no reinspection of those conditions is
required by this office.
The pool and spa reinforcing appeared to be in general conformance with the
construction drawings referenced above and the engineering design intent.
If you have any questions regarding the above please do not hesitate to contact this
office.
QROFESS/�N
Sincerely,
~��``��f H A. QU��gcF'yG�
HOSKINS ENGINEERS INC. ' P 30 1999 / ^'
m
S2832
Eric Snyder Joseph A. licirAUC I A �P
Engineering Technician Structural En eer qTF OF CAE,FOR�
ENS/mk
60b02.906