30219 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL P17RMTT NO. 30219 O ��`9r�
BUILDING DIVISION APPLICATIONIPF.RMIT PLUMBING-MECHANICAL.
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATF
6 elbj a,9- x"7zoa6
OW ER'S NAME,: PHONE: CONTRACTOR'S NAME: - LIC NO:
1 I k e / O H y NIC CONTROL p
�NRCHITEC VE GINNER: LIC NO: ADD(F:S: ❑
IStb e LLA64r fgvt
CONTACT: PHONE: BUILDING PERMIT INFO
77 t 7�7a,
E:1 Consultant Fees Paid by Applicant(Initial) BLDG EL PLUM MEC1
L 7
LICENSED CONTRAC IOR'S DI?CLARATION QTY. ELECTRIC PERMIT FEFi
O K Z 1 hereby affirm tial 1 nor licensed and......Wims M Chapter 9(commencing JOB DESCRIPTION
{{yy with Section]000)of Division3ofthe Business and Professions Cr+M,and mylicenu is RESIDENTIAL:
FWD full force and efffy5ll PERMIT ISSUANCE
MF.UU� License Chas 16— C-2/ Lic,N 671.2 ,7 � ❑SFDWL ❑KITCHEN REMODEL
NQ are Co...In, a CG APPLIANCES-RESIDENTIAL. ❑ADDITION [3 PLUMBING RE-PITH
D is, A CHITECTS DIFCLARATION ❑MULTI-UNIT ❑STRUCTURAL
ZOr`r'jr? 1 I auction, ;,Ians shvllbemedns.ublien.cos PANELS
MODIFICATION
CZ4— L ��?_ UP TO 200 AMPS U El INTERIOR ❑CHIMNI?Y REPAIR
1-.4L j licensed professional
201-1000AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION OVER IOOIIAMPS
YW�¢'i 1 hereby affirm Thal 1 am exempt from the Contractor's License Law for the ❑BATH REMODEUREPAIR C]DEMOLITION
L�yS a U{fallowing reason.(Section]031 5,Business unit Profession+Code:Any city or county SIGNS ELECI'RICA ❑OTHER
I++LL O hw¢" which recluses a permit to construct,alter,improve,demolish,or repair any structure
mel prior tar its issuare,.h.requires the applicant for such permit o rile a signed statement SPECIAUCIRCUIT/MI.C. - 1 �—
i+ Ilial he is licunsW pursumnuothe prmisions o[the Carmtuemr's License Law(Chapter9
p0 (commencing with Section 7001 Division 3 ofthe Hasineonnd puttitslo,s Code)or THMP.MR1 IIR OR POLE HT. COMMERCIAL'
a c K that he is exempt therefrom add the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION Cl DEMOLITION
LLSection]031.5 bymy applicam for.permit mtjecblhe applicant to a civil penalty of POWER DEVICES
nor more than rive hundred dollar%($5W). ❑TENANT' ❑FOODSERVICE
r+�Q ❑I,es owner of the property,nnny emPlnyces with arse's as Omit sole rompensatinn, SWIMMINGPOOI.I?I TRIC IMPROVEMENT r
0 will do the work,and the structure is not imendedoreffered formic(See.JM4,Business ❑ THER D G CWI
aand Professions Code The Contractors License Law does not apply to an owner of OlIT1.ET5-SWI tIGS-FIXTU S v/
prn.eny win builds nr improvs thereon,snit who does such work himself or,trough - -
his own employees,provided it,.,such impnwemare ems anot itncnded of offered for NHW RESID TIAL.RLECTR SQ FII xJ O C e'1L
vele.If.harvest,the building or improvenwm is sold within one yearafvomplctian,the SQ.FII FLOOR AREA f!h S/SQ.FT.
owner builder will have the burden of proving that he did not build or improve for poo k- it
C
pose of min.)
❑ I.as owner of the property,am exclusively contracting with licensedeommmorsm TOTAL-: -
consumer he project(Sec.II}N,Samoa.and Pmfemmus,Code U The Cantor.
Li- JUL 'J9 U 3 Q 'ICI(]
ase Low does not apply loan(tamer ofpropeny who builds or improves mercon,and QTY, PLUMBING PERMIT FEE
who commetx formOr project,with it anntraetor(e)licensed pursonol 1.the Cnntrncmds CITY ur
License Law, PERMIT ISSUANCE WrCri I IIY )
❑1 am escmpt under Sec. ,H arP C f.nhis rearm
Owner HN. y _ AL's' -DRAIN&VONT-WATF.R(EA) VALUATION
WORKER
COMPENSATION DECLARATION BACK W PROTECT'.DEVICE
I herchy affirm under penvlry of perjury ane of the following Jeclamtions:
❑ I have and will maintain a Certificate of Consent to self-insure Ra Workers Compen. DRAINS-F R,ROOP,AREA.GOND. .STORIES TYPE CONSTRUCT ION
submit.as pm,idad for by Section 3700of the Labor Code,for the performance of the
work for which this pcman is issued. FIXTURES-
❑I have and will nwimma Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for performance ofthe work for which this permit is issued. GAS-F.A.SY T. 1IN(�.4 OUTLETS
OCC GROUT' ANN
My Worker's Cstand Policy number are:
Carl Policy Na: err AGr GAS-EA.SYS tM OVER 4EA)
CERTIFICATI?OPTION FROM WORKERS'
COMPENSATION INSURANCE GRFASUINDUST LWASTEINT CEPTOR
finis section mead not Ise completed if the perm,is formic hundred dollars(SIM) BUILDING DIVISION IT4S
or less.l GREASE]'RAP PLANCHECK FEE
I cenify for in the performance ofthe work for which this permit is issued,Ishall SBWER-SANITARY-. RM EA.20H IT.
not employ any person in any mum¢.sn aLs m hecnme snhjeq In the Workcrn'Co.,,,- ENERGY FEL?
Q z sationlawsof Califomia.Dae d--��i- E 1> WATER HEATER WN 'LIiCfR
7 O Applicant GRADING FEE
NOTICE TO APPLICANT:IL arler making this Cenilicote of Exemption,your should WATER SYSTEM PA'rING
ata become subject to the Worker's Compensation provisions if the Labor Cade,you must SOILS FEE
{A forthwith comply wit such Provisions or this pertain shall be deemed resulted. WATER SERV(
CONSTRUCTION LENDING AGENCY agony NFW RESID IAh PLMB. SQ,FT. PAID
V Q I hereby afbfmmalmerc is issued
lending agency for the poli imrm.na of Date Recti N
O f✓ the work for which phis pemtin is issued(Sec,t(19].Civ.CJ -
IxndersName TOTAL:
Isnder'n Address ,TOTAL:
•�" 6. I cenify that 1 have .it this application and nate that the move Intonation is BUILDING FI: Lal
V) correct.l agree to comply with all city and county oNiameas and state laws relatingm QTY. MECHANICAL PERMIT EE
U building construction,and hereby mthomze representatives ofthis city 10 enter upon the SEISMIC FEE
above-mentioned properly for inspection purposes, PURMIT ISSUANCE -
(We)agree to save,indemnify and keep hamtless the City of CuNnum against ELI:CTRIC FEE
liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MFCH. PLUMBING FEE
In consequence of the granting of this pernll.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOU REGULATIONS, AIR HANDLTINGUNI' (TO 10,0011 CPM) MECHANICAL THE
-
'
AIR HANDL GUNIT(OVER I0.000 CPM) CONSTRUCTIONTAX
�bg"°1°
.L /•pflliiccanV anurl/1' Datee I I?XI{AUS'1'll0 HOUSING MITIGATION FEF.D(W/DUCT)11Al RDOUS MATERIALS DISCLOSURE
Will theapplicaml arfuture buildingrncupuntnomor handle humNous material HEATING UNIT\O 100,010 BTU)+
a.defined by me Cupertino Municipal Calo,Chapter 9.12,and Ilio Health and Safcty
Cade,Section 25532(a)] HEATINGUNIT(O 7klW,(110 TU)
❑Yes lam PAID
RESID) Rec<iPtN o
Will the mlplicam or filum huLWing occupan0 use equipment m devlcu which VENTILATION FAN(SI Data
mil hicumbua air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP TRIP( I (Ne,BTU)
District] TOTAL:
❑Vas zlv-� BOILER-GQMP(O ,R 1000O U7
I have mad the infamous mammals - AIR CONDITION.R
m.15533 ms under Chapter 6.95 of me Cali- ISSUANCE DATE
foods Healgdues no Safety Cade,ea Boris 25505,25531 esp 25534.1 undemznd that if me NEW RE.SIDF.NTIAI,MECH. SQ,FT.
building Aocs not tsnhich huvcainetP(Irlitismy.,)fasihilltytonotifytheoccupant ,
(traNiey-yruilnm�ents which mull he and prinnnissuantt ofn Cenifeae.fo^aa'vory.
04d, rr malmflzcfg� , Date TOTAL: ISSUED BY:
o+
OFFICE
FROM : NCSS & ASSOC. PHONE NO. 406 376 6677 Sep. 2E 1996 05:53PM P1
•
KENNIETH NIELSON
940 Saratoga Ave. Suite 215
San Jose, CA 95129 (408) 247-2898
September 27, 1996
Emily Chen
10190 Bret Ave.
Cupertino, CA 95014
Re: 11641 South Stelling Road Cupertino, CA.
Lot 1
Dear Emily;
Per your request we have reviewed the subject property to check the construction of
the graded pad and formwork for the building foundation. We find the pad and forms
.have been constructed to accommodate positive drainage away from the building
• foundation in accordance with the Grading and Drainage Plan prepared for this site.
Top of form elevation varies no more than 114" from true elevation. The pad and top of
foundation elevations are more than adequate to provide better than minimum
clearance required for the crawl space. Also, the building foundation as located on
the subject site falls well within prescribed setback lines and there is no potential for
any encroachments. Thank you for this opportunity to be of service.
Sincerely,
Sid Nash
Project Manager
\ J�6 � 7
Kenneth Nelson, RCE #22023
cc: Dave Scannell, Cupertino Building Dept.
CIVIL ENGINEERING'STRUCTURAL DESIGN*SURVEYING*LAND PLANNING