30896 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILDING..ELECTRICAL,., PERMrr NO. 30896'
., BUILDING DIVISION ' APPLICATION/PERMIT PLUMBING-h1ECHANICAL
` - F BUILDING PROJECT IDENTIFICATION
BOLDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
O ERS
�NAME: - - PHONfi`/�, C N'1'RACMI2'S ME. ^ 1 IIC NNO 0 IT
!/�+CA✓' / /� �NV O �O 0'�I- /.A„S YL1 1 I✓.•� J IO�(/ NIC CON'1'ROLN,
ARCHITECT/ENGINEER: LIC NO: A
PDRESS'.
CONTACT: - PHONE: - BUILDING PERMIT INFO
- ❑ Consultant Fees Paid by,Applicanl(Initial) BL G ELECT PLUMB. MECx r
..
LICENSED CONTRACTOR SDH usn of ION Q�'y ELECTRIC PERMIT FI?P. -
1 h by ifnn thm 1 am licensed i J v s of,C pt 9(comics c is JOB DESCRIPTION '
WOSL with Section JIXMI)ol Division Runt e': JI si.n.CJ aWtnylia 'e is t"
X00 PERMIT ISSUANCE ' RESIDENTIAL,
"
F� Lien
-effect, / /v ❑SFUWI. TCHIiN REMODEL
HUV Lcen Cla. LcN AI'ILIANCGS-RESIDENTIAL ❑ADDITION PLUMBING RE-PIPE
�66 are Canaan '
,-Doo
ARCH' CTS DECLARATION PANELS ❑MULT4UNIT ❑MODICfURAO
Z 0t2Z n -.'.Iyplun IM used asyyyie usuals4 t _ N..k MODIFICATION
OZ_ �/y��•�l W'TO200AMPS w 'L AN
r Ktlal Luce, PmficilmnoXI ❑INTERIOR []CHIMNEY REPAIR
OWNER-BUILDER DECLARATION 01-IWOAMI'S IMPROVEMENT
G 1 hereby affirm thutd ant cona pl from the Contractor's License Law lin Ibe OVER IM0 AMPS ❑BATH REM(yYl,�',F�I )EMO ITIQ�� �,
3 a Florian g re'akon.(Section 7031.5,Basins,,,and Pnhfcisi...Cade:Any city.,cormy SIGNS ELECTRICAL ❑0'f HER.. N�', A
W which requires a permit m coustroo,all,improve,demolish,or repmr tiny 9meture
h.,_0 prior to its issuance,also requires the applicant for such peril o file a signed statement .CIAh CIRCUIT/MISC.
f;!(ythat he is licensed pumuanuo the mcOa es.0h.Contractor's License Law(Chapter 9 _
uI�G900 IOU"
O (commencingwith Section]0001 of DivininnJnf the li.sinenzand l'rofesntons Ctde7 nr
m 'TI3MP.METEROR POLE INST. - � CGMMEHGIAI: '
lY q o K tYa xem
he is ept Nerefmm and the basis Tor the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
iYl1^t Section]113 E5 by airy applieum Info permit vuhjecs the unl pplieam a civil penalty or. .POWER DEVICES
mol more Nen five hundred dollars Issue). ❑TIiNANT+ ❑FOODSERVICE
�d �r I,us owner'of the prapeny,many empluyecs with wages us their sole unnpensmire, SWIMMINGPOOL '.E HIC IMPROVEMENT
Is,p.m will do the work,and the shaman, 70,W. ❑
is not intended or offered for.1,(SeeZD ,Business' " OTHER
L�se said professions Cotte:The Carl...tar"License Law does not apply to an owner of UTLLTS-SWI FIXTURES
p upeny who builds nr improves thereon,and who J.es such work hien or I"ongB a
his own employees,provided th i tech irepr.vemems are not intended m offered for NEW RESIDE. AI:E SQ FR
sale.If,however.the building or impmvemenl is sold within oeeyeur of completion;the. I SQ.FT.FLOOR AREA $/SQ.PL" '
ovsaenhuildccr will have the burden of proving that he did not build or inmaroic for par-
• poseol'saleJ. Ap('' ..
❑1,as owner of the properly,no exclusively contracting with licensed commemrsto '
onsmuct the project(See.7044,I+usinws and Professions Cobo)The Gmunetors Li. �N�--•'�1 /7 q •� D
ase Law d.esnotapplym an ownerof properly who builds or int nvesmek.n,sad QTY PLUMBINIYPE IIT FEE _ P� R
who contracts for such projects with a contra does)licensed pcmuam in the Committees
License La, PERMIT ISSUANCE �Ip� Q
❑I am exempt under Sec. B&PCfafhis reason n p
Owner - Dam ALTER-DRAIN&VENT-WATER(I: - VALUAT
�WORKHR'SCOMPUNSATION DECLARATION � HACK FLOW PROI I;C`f.DEVICE- ICI7Y� Qr�lyNyy,�
ON
'l hereby attar under penalty of plops,oneof the following declarations: �5/ /
] Ihaveaadwill mainminaCe tificateofConsenttoself-inmrefor Worker's C.mpe - DRAINS-FLOOR,ROOF,AREA,COND. `S"TORIES TYPE CONSTRUCTION
lop dimi,us provided for by Section 3700of the Lotus Cale,for the verf.cntanre of the -
warkforwhichisp
Neresitisirmcd. FIXTURES-PER TRAP ^ ,
I have and will rommin Worker's Comike,down lrouodce,as required by Section
3700.fthe Labor Cal Bmhepcd n ce L'A
of work for which this permit is issued. GAS- .SYSTEM-I INC.40UTLETS�
yWorks', nn alien lnsu user lerond Policy moubtrame. OCC.GROUP- ANN
' - -
Carrier. —Policy No.: r' GAS-EA.SYSTEM.OVER 4(EA)
CERTIFICATEOXF,MPTIONPROMWORKERS' ,;; GRIiASIJINUUSTRI.WAS'I'EIN'I'ERCEPTOR
COMPENSATION INSURANCE B I i DIVISION FEES
need net In completed if the pwouit is future hundred dollars(SIM) GREASE'TRAP
orlessJ - -
pLANC1IECK
Icenify that in the pert.mhancc n(the work for which this permit is issued[shall
not em to un - SIiWER-SANITARY-STORM EA.200 FT.
p y ypemon in any manner nn usm become suhjenmihe Wnrkcri Compen- - HN5120Y '
zZ cation laws of California.Date
O Applicant WATER HEATER WNENT/ELECTR GRADI d`402
NOTICE TO APPLICANT.If.after mrkingthis Cenilicme of Exemption.you should WATERSYSTENUTRCATING
a L'" become suhicct m the Worker's Cnmpensmion prov sirs of the Latter Cnde,Yon most SOM '61
0. iw? forNwilhcomply with sash pmvisi.ns or thispemlit shall he JeemeJrev.kuL ' WATERSERVICE
� 2 CONSTRUCTION LENDING AGENCY NI?W RESIDENTIAL PLMIL SQ 17. , PAID
V 0 Iherebyaffirmtho0here k.emurunion leasta, geecyfiathe perfomance.f Had - Receipt
LJ. i- the work for which this permit is issued(Sec.9097,Civ.C)
0{� Lenders Name` TO'I'AI.:
Lcadcr'u Addm,a -
y' I c'eniry that 1 have read this application and state liber the above inforetion is BUILDING ILC
Vi corrut.I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE
V building conswainn.and hereby uuthorim reprenemetiven of thin city to enter upon the SEISMIC FEE
above-menti.neJpproperty for inspection
pkeep I.s' PERMIT ISSUANCE ^
(We)ugme n,wse,inJunnify nnJ kap hermles>the City of Cupertino against BLECfRIC ITE L
liabilities,judgments,cosuundexpenuswhich may in any wayaccear.,imisaid City ALTER OR ADD TO MECIt.
recgmencc of the gmming of this pcnnit. PLUMBING
APPLICANT 'NDERSTANDS A'#) 'LL COMPLY WITH ALL ONR NT AIR HANDLING UNIT(TO 10,(00 CPM)
SOURCF A ATIONS. MECHANICA FEE
AIR HANDLING UNIT(OVER 10,010 CFM) CONSTRUCi'1 TAX
_-919
ii,ilidtoure,of Applicat/ nl ter ' - . Date EXHAUST HOOD(WIDUCT) ,• HOUSINGMITIGA NFEE
AZA DOUS MATERIALS DISCLOSURE
,Will the applicant or future holding Uccupom store or handle hazardous material IIHATING UNIT(TO 100,000 BTU) a
as defined by the Cupenind Municipal Cade.Chapter 912,and the Health and Safety ,
Ghdq_Section 25532DC) - , HEATING UNIT(OVER IDEOM BTU) '
a E]Yc. 1 ❑No VENTILATION FAN(SINGLE RESID) PAID )
W'll th pplicant or fuI re building ccupanl use equipment or devices which - Date Re. apt N
t headlands air contaminants a defined by the Bay Area Air Quality Management BOILER-COMP(311P OR'IW,000 RTU) TOTAL:
)isvict] m BOILER-COMP(OVER 1(O,0M BTU)
• n. ❑Yes ❑No. "
Ihave wad the hmnrdous materials
e Cali-
AIRCONDITIONER' - ISSUANCEDA'I'E
requirerncnts under Chapter fi.95 of th
• fomlu Health&Saint,C.Je„Sections 25505,25533 red 25534.I undem rad ilia if the NEW RESIDENTIAL MECH2 SQ.lel', - O
building does nm cure
tndy have a meant,that it is my responsibility to notify the sr.,.I
« of Ne requirements which most he ma prior m issuance or a Ceni retire of Occupancy, u \I/a�}��ag_
C Owner or unsuited agent - Died TO1ISSUF1
DBV:TAL: -a+�r I
OFFICE
Analytical and
s r Environmental Services
Material Analysis'''and'6ractdrization Service
April 17 , 1997
Mr. Rusty Trevino
O.T. Construction
7505 Whitehurst Road
Gilroy, CA 95020
RE : Air samples at
10321 Stokes Avenue, Cupertino, CA
MACS Lab Project #97-148
Mr. Trevino:
In response your request a MACS Lab Technician collected one
Transmission Electron Microscopy (TEM) sample at the above referenced
location.
• This designated samples was collected on the Second Floor above the
stairwell of the residence. The sample was delivered to the Laboratory
under chain-of custody.
Analysis by Transmission Electron Microscopy (TEM) indicated that no
asbestos structures were detected in the sample.
The original laboratory report is enclosed for your records.
Please feel free to contacts us if we can be of further assistance.
Yours sincerely,
Maheen B. Doctor, PQR NQS?
Assistant Director of Field ServicesO1\O��p(�N
amlonure
2070A Walsh Avenue • Santa Clara, California 95050 • 408/727-9727 TEL 1-800-MACS LAB 408/727-7065 FAX
MACS Lab, Inc. TEM Airborne Asbestos Analysis
2070A Walsh Avenue
Santa Clara, CA 95050-2542
• (408) 727-9727 Report
MACS Lab, Inc. -
Field Service Department Person to contact: Roy Mabus
2070A Walsh Ave. Contact phone: (408) 727-9727
Santa Clara CA 95050
FAX phone: (408) 727-7065
Corresponding invoice number: 49531
I>Z AHERA
Job Number: 97-148 Report prepared on: April 17, 1997 at:16:26
-Job Description: 10321 Stokes Ave.
Sample:
MACS Lab Sample Number: A49531-1 Client Sample Number: A-1
Client Sample Description: 2nd floor above stairwell
-Background .
I Received OK: Yes. Accepted for analysis: Yes
analysis Results:
Total asbestos 0 ' < 22.0 < 0.005 < 0.005
Non-Asbestiforms: Material Structure
.count
TEM magnification: 18,9oox Air PUMP: Elapsed time: 163 minutes(from client data shoot)
Area analyzed: 0.046 mm 2 Average flow rate: 11.2 liters/minute(from client data sheet)
Analytical Sensitivity: Sample volume: 1834 Iters
22.0 structures per mm2 Filter: Mixed Cellulose Esters,
or 0.005 structures per cc diameter 25 mm area 385 mm2
End of report.
Microscopist: Laboratory manager:
• CKB (signal (signature)
a�da�
This report may not be reproduced except in full and with the permission of MACS Lab, Inc.This report relates
only to the items tested.Samples will be destroyed after six months. MACS Lab is a NVLAP accredited
laboratory, number 101948. No product endorsement by NVLAP or any agency of the U.S.Government may be
Page 1 claimed as a result of this analysis.
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II
KENNETH NELSON
• Registered Civil Engineer
940 Saratoga Ave. Suite 215
San Jose, California 95129
( 408) 247-2898
April 21, 1997
Job No. 976022
Building Inspection Department ��(��� D
City of Cupertino , 1 ��CC
10300 Torre Ave. APR 2 1
Cupertino, CA 95014 1991
BLDG.INSPECTION DEPART ENT
Subject: Residence remodel at 10321 StokeATYAf re.UFggpApbt�no, Ca.
Gentlemen:
At the request of the-Contractor, Rusty Trovino, an inspection of
the subject project was made by the undersigned on April 17,
1997 .
• The inspection was made to visually inspect the framing of a new
4x10 header between the Breakfast Nook and Family Room. The span
is 8 feet and the header supports the gable end wall of the
second story above. A second existing 8 foot long header above
an existing, window (now to be an . 8 foot sliding door) was
verified to.'; be a 4x12 #2.
Both headers -were analyized and found to be very adequate to
support the anticipated loads and both header supports are
bearing on existing two story continuous concrete foundations.
Therefore, the headers in question meet with my approval .
If there are any questions regarding this subject, please contact
my office.
Very truly yours,
JH
Ke eth Nelson
Registered Civil Engineer #22023 No.22a19 9
Ua Eq.83497
KN/kn s
cc: Rusty Trovino lA�FOrCA0FpP`'\v
•