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22066 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project IddeYentificatat`ioon-. �+� X1�771 ``,,- - PERMIT NO. f/� /n1 I�'1� Build ing Address: OJI7C.) SG6�ic_ LLjW�• Y20V V wnere�1 a one. - t�QAI>T� CITY OF CUPERTINO-BUILDING DIVISION Contractor', mu: Lk.No APPLICATION / PERMIT —2'3�'J JV BUILDINGELECTRICALPLDMBING-MECHAMCAL CATEGORY CONIROLp '� -BUILDING PERMIT INFO • �c.P �S� QTY`.'•: ,EtiHCTRIGPE12hfIT t '•,''.•FELT,•' - . . Add. PERMITISSUANCE LI .NSED CONTRACTOR'S DECLARATION I hereby affinothat l am licensed under provisions of Cha erg commune- APPLIANCES-RESIDENTIAL Ingwlth5eR1on7000)of DlWsion3o(the Busines,andl'�ofnsloneCude,and my `.'SFJ`,-p'r�(�(�#✓ license lein full In deffeci. '2s"2,6 ✓� PAN©9 LlcenseC Lk.X JJ 7 D ContractorUP TO 200AMPSL ARCHITECTS DEC A 1 N 201-1000 AMPS u 0 Z oI understand my plans shall be used as public records OVER 1000 AMPS • "" FI'. EFyG.a,6,j` $/SQ.FT. �qv CC t Licensed Profeasbnal SIGNS ELECTRICAL OT OWNER-BUILDER DECLARATION `N - SPECIAL CIRCUIT/MIST 411/ z F, owing asses.(hat l am 31.5,Bxempt fromBusiness a d Professions ode:nae Law for the p0{ !�'I o following reason.(Section 7fll1S,Business and Professions Code:Any city or ./a O Zt"'n9 cmntywhichrequresapert ttommtmd,alter,impmve,de=lbh,orrepair 7EMP.METEROR POLE INST. gP u,� N anystmdum priorto its Ls,uame,alsorequlresthe applirantfm such permitto file a signed statement that he is licensed pursuant to the provision of the POWER DEVICES Qb O u, Contractor's License Law(Chapter 9(mmmencing with Section 7000)of Dlvi- 30�' slon 3 fthe Buanessand Profesflon Code)orlhat he is exam therefromand SWIMMING POOL ELECTRIC VALUATION Gthe basis for the alleged exemption. Any violation of Section 7MIS by any OUTLETSSWITCHESFIXTURES applicant fora pemut subjects the applicant to a civil penalty of not nnrethan five hundred dollars($500). NEW RESIDENTIAL ELECTRSQFI. STORIES TYPECONSTRUCTION �n ❑I,as owner of the property,or my employees with wages as their sok compensation,will do the work,and the structure is not Intended or offered for Osale(Sec.7044,Business and Professions Cade:The Contractors License Law docs not apply to an comer of property who build,or improves thereon,and p' who does suchwork himself or through his own employees,provided that such OCC.GROUP RES.UNITS improvements are not intended oroffered forsak.If,however,thebulldinger TOTAL: i provemantissoldwlthinoneyearofcomplRioMthemvner-builderwlllhave , thijurden of proving that he did not build or Improve for purpose ofsak). }y; . 'PGDMBING"PERMIT ":FEE FLOOD ZONE APN u L as owner of the property,am exclusively contracting with.....d PERMIT ISSUANCE contractors to construct the project(Sec.7014,Business and Profession,Code: The ContmRorb License Law does not apply to an owner of property who ALTER-DRAIN&VENT WATER(EA) Wilda or Improves thereon,and who contracts for such peajecta - - with a '.FEE'-SUMMARY' abactor(s)licensed pursuant to the Contractor'sLicense Law, BACK FLOW PROTECT.DEVICE I am exempt under Ser. B&P C for this reason Owner Date DRAINS FLOOR ROOF,AREA,CONTI. SANITARY Y_ N_ RECEIPT X WORKMAN COMPENSATION DECLARATION - FIXTURES-PER TRAP SCHOOL TAX Y_ N_ 711 hereby affirm that I have a certificate of consent to self-0nsure,ora RECEIlT p certificateofWorker'Compemationlmuranmoracertifkdmpythereof TS c. GAS F.A.SYSTEM-1 INC.40UTLETS• PARK FEE Y N 3800,Lab C.I Polityp GAS EA.SYSTEM-OVER 4(EA) n, ' Com BUILDDINGING DIVISION FEES Certified copy with the copy Is with city e ity inspection division.cGREASE/INDUETRL WASTE INTERCEPTOR PLANCfiECK PLE ❑ ' CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID CC COMPENSATION INSURANCE SEWER-SANITARYBTORM EA.200FC. Date -Recel t# ' kZJ (Thissection need not be completed if the permlt b forons hundred dollars ($100) .) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N I rertrtifytifythat lathe performance o(the work(orwN<h this permit is issued, — I shall not employ any person In any manner sa as to become subject to the WATER SYSTEM/TREATING workere Compensation Laws of California.Date PAID - ZZ Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Rece1 f# O, NOTICETO APPLICANT.If,after makingthls Certificatuaf Exemptian,you should be..subject to the Workers Compensation provision o(the Labor TOTAL: fN Code,you moat forthwith comply with such provision orthb pernetshall be BUILDING L W j deemed revoked. , CONSTRUCTION LENDING AGENCY SEISMIC FEE ztoo Q. IherebyafOrm that there isaconstruction lending agency forthe perform- TOTAL: - ELECTRICFEE M Z. anceofthewarkforwhichthbpermitlslssued(Sec.3097,CIv.C.) O`O (ander,Name , . PLUMBING FEE LL F LendereAddmsa QTY:''/'" MECHANICAL PERMIT `+FEg " O W Icertilythatl havereadthis application and statethattheabove Information MECHANICAL FEE C iscorrect.l agree to complywlth all city and county ordinances and gate lawn PERMTTISSUANCE FEESPAID: >. N relating to building construction,and hereby authorize representative,ofthit - Z city to enter upon the abovementioned property for inspection purposes. ALTER OR ADD TO MECH. Date R2Ce1 f# _ (We)agree to save,Ind emnlfy an d keep harmless the City of Cupertino - P against llabllltLes,Judgments,costs and expenses which may in any way accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: ago Inst ea to con nstoome of the granting of this permit, 012 EiANDLING UIVI'f(OVER l0,000CFM) CONSTRUCTION TAX ^ Signature of Applicant Contractor Data, EXT1AUSTHOODfW/DUCT) - CONSTRUCTION TAX PAID: . HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardoua HEATING UNIT(TO lai"BTU) Date Recei t# I material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code�+.-S�ection2S532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: i F-1YesL_I No Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE ' which emit haaardousalr contaminants as defined by the Bay Area Air c , ca, Quality Management District? BOILER-COMP(31-11'OR 100,000 BTU) '?Yes ; FB No ' have read the haze oils materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTTl) the California Health&Safety Code,Sealona 75505,25533 and 25534.I understand that lithe building does not currently have a tenant,that it is my NEWRESIDENTIALMECH. - SQ.FT. - responsibility to notify the occupant of the requirements which moat be met prior to Issuance of a Certificate of Ocmpa acy. - RKp IB — �� �•�.a..,��� ` Owner or authorized agent Data � I�-+ `4�?"' '4,�f - TOTAL: ISSUED BY:f / �TlV� aft�, OFFICE COPY 07-/08/91 14:59 'H`4?.i 887,.3019 '� LEA ENGINEERING »!•% Terry .Brown ` Z001 t ,� LEA,' G ENGINEERINj: ''!VG ENGINEERS. L"kND SURVEYORS._..t 26229 Eden'-Landing Road, Suite 2 Hayward, California 94545 Jul B, 1991 Phone (415) 687.4086 Y FAX (415) 887-3019 Terry Brown Construction 21721 Granada Ave . Cupertino, CA 95014 Attn : John Cline Subject : Brown/Kanter Residence 10360 Scenic Blvd . , Cupertino Job No. 91045 Dear John: It is acceptable to me to attach an HD2 holdown to . a 5/8" anchor bolt in place of the strap holdowns located at the central courtyard- area around the oak tree . Very truly yours, FPOFESSIONq �Q�O4F�PEYC. lF�Fy� , � 9 Z Je ey Le exP.tiz-arsz rt Civil nee Its, ; ciw� I