30039 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF 19UP111TIN0 BUILDING-P.1.ECTRICAI. PERMITNO. O O �a
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BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 30039
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BUILDING PHO,IEC'1'IDENTIFICATION
BUILDINGADDRPSS: SANITARY NO. APPLICATION SUBMITTAL DATE
A2LII WJ l Tota �� I,>'/ , 377- 7Si Z q`Z6
OWNER'S NgME: � PIIOM1I /�� COME Gy�NpM.: LIC NO
7 s Q A'.� 063f9`l. NIC COMPROLN
4HCHRECT/ENGINEER: LIC NO: ADDRESS ,ne� 4 - ❑
CONTACT PHONE: •V// BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
1> r ❑ ❑ ❑
LICENSED CONTRACTOR'S OR'CIARAHONQ'fY ELECTRIC PERMIT FETE
1 hereby affirm that I cost licensed under provisions of Chapter 9(commencing LOB DESCRIPTION
OW OZ with Serthm7(gky.fDivfsion3oflhe Businessand Profusions Cede,endmylicenseis RESIDENTIAL
F O full force and effect., PERM1'I'ISSUANCE
GVUPU License Clsss Lic.it 390Xq ❑SFDWL C]KITCHEN REMODEL.
�<y tram Cnntrac�• fS j�( 1r�1� - APPLIANCES-RESIDENTIAL ❑ADDITION MRING RE-PIPE
ARCI HIPUTS DECLARATION ❑MULTI-UNIT TRUCTURAL
F A
PANELS
Z O n Z I understand my plans shall M used as public retoolsM IFICATION
OZ C UPT020OAMPS ' ❑INTERIOR HIMNF.Y REPAIR
�� u1 Licensed Poor e..ional 201-I010OAMPS IMPROVEMENT
••t
OWNER-BUILDER DECLARATION OVER 1000 AMPS '
e�Cy 1 hereby affirm that 1 am exempt from the Contractor's License Law for the ❑BATH REMODEIJREPAIR (]DEMOLITION
aL U following Mason (Section]031 s,Business and Professions Qule:Any city or county SIGNS ELECTRICAL. ❑OTHER
C) which requires a pemut to construct,alter,improve,demolish,or repair any structure
yPrior n in fa,Mmuc,elso requires the applicant for such Permit o file a signed statement SPECIAL CIRCUCUMISC. -
�d $f
that he is liecreed,nnsuvnnothepmrvisionsaftheCromomslicenseLaw(Chvpmr9.
ID GOO"(commencing with Section 7000)of llivision 3ofthe BusWessnnd Pmfexsfons Code)or TEMP.METER OR POLE INST. 40[1
MMERCIAL:
A.q m p( that he is exempt merefmm and the basis for the alleged exemption.Any violation of EW BLDG/ADDITION ❑DEMOLITION
Section]N1.5 hony a,plicun,for,,pernot.subjects the applicant to a civil penalty of POWER DEVICES ENANT ❑FOOD SERVIC13
of mom than five hundred dollars(3500).
= I,as owner of the r y ye p y g geneses MPROVEMENT
Cn pnpcn.arm min ecawiah wa nos Neirwle cam tion, SWIMMING POOL F.LECIRICwJl do the work,end the suumme,is not intendedar offered forsale(Sec.7W4,Business TI
Wa and Professions Cade:The Contractor's License Law docs not apply to an owner of ODTLETS-SWI TCHES-FIXTURES
property who builds or improves Womem.and who docs such walk himself m Nm o ds
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ ET.
sale l[however,Ne building or improvement is sold within one year nfcompderion,the SQ.FT.FLOOR AREA , S/SQ.FT.
owner-h olds,will have the huNea of proving Nm he,did nm build or improve for por-
n pose of svleJ. -
❑I,as owner of the pmpeny,am exclusively contracting with licensed comruchas to TOTAL:
collator,the Project(Sec.7W4.Business a ad Profession,Caw.,Io.Convectors Li- SEP acts 61996
resoe,Law doom not apply m an owner of partially who builds or improves Weacon,and QTY. PLUMBINGPERMIT FEN.
who contracts for such projects with a comeremr(s)licensed pursuant o the Contractor's
License Law. PERMIT ISSUANCE
❑ lemexemptunder S.. .B&VCmathisreason I i (" ,4 us ,.r.
f Owner Daae
ALTER-GRAIN&VEMI'-WATER(EA) VALUATION
WORKERS COMPENSATION DECLARATION BACK FLOW PROTEGE DEVICE
I hereby affirm under Penalty of perjury one mf the fol lowing declarations; 75
_
❑I have and will nounaoin a Certificate of Consent to.1f.hxvac far Workers Compere DRAINS-FLOOR,ROOF,AREA,CONGO
wnion,as provided for by Section 37M of the labor Cale,for the perfonnmtce of the STORIES TYPE CONSTRUCTION
work for which this profit is issunl.' FIXTURES-PER TRAP /
❑ 1 have and will maintain Workers Compensation Insursnce,as acquired by Section
3700 of Ne Labor Code,for performance of the work Our which Nis permit is issued. GAS-EA.SYSTEM.I INC.4 OUTLETS DEC.GROUP APN
My Workers Compcmatinn lnsumn cancer and Policy not3hcrvre:
Carie;: 44!/f iI.� Policy No.: `°U�'�G• GAS-EA.SVSTP.M-OVER4(EA)
13RCf OFICATEONEXEMPfION MOM WORKERS'
COMPENSATION INSURANCE GREASUINDUS1 RL WASTE INTERCEPTOR
(This section need not bemmpleted if Jteperent is for onehundnd do[]..1$Hp) BUILDING DIVISION FEES
nr less.) GREASE'I'RAP PL.ANCHECK FEE
I certify than in the perfacrancsofthe work for which this permit is I...tot,l slall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any manner m as to become subject to the Workers Compcn- ENERGY FEE
Oz Wkst LuwmoICuld.r.tie.Date WATER HEATER WNENT/ELECfR
77 Q Applicant - GRADING FEE
a V) NOTICE TO APPLICANT,If,after making this Cenificnte of Exemption,you should WAFER SYSTEIM TREATING
F ' become subject to the Worker's Compensation provisions of We labor Code.you most SOILS FEE:
forthwith comply with such provisionsonhixpecad shall hedeemedrevoked. WATER SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMff SQ.NE PAID
L) O Thereby affirm theses almrc isuconawction lending agency for the Pcr6rmance of Date Receipt
V. Ir the work for which this person is issued(Sec.3091,Civ,C.)
I"' Lender's Name TO'T'AL:
Leadds Address a 'TOTAL:
I certify that 1 have read this appfcationand state that the above inh+mmtion is BUILDING FEE
tAA comect.I agree to comply wife all city and county ordinances and state laws arming to QTY MECHANICAL PERMIT FEE
building ctmmruction,and hereby omhmiietapressmon ses of this city to enter upnnthe SEISMIC FEE
abovcmentioned progeny for inspection purposes. FERMI I'ISSUANCE -
(WC)agree to save,indemnify and keep harmless Ne City of Cupertino against ELECTRIC FEE
liabilitics,judgmenrn,trials and expenses which may in any way uceme ugaiost sold Cay ALTER OR ADD TO METH.
in consequence of We granting of this permit, PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI,NON-POINT AIR HANDLING UNIT(TO ROW CPM)
SOURCE REGUI ATI MECHANICAL FEE
+ > y AIR HANDLING UNIT(OVER ILCOM CPM)
`�YC' CONSTRUC IONTAX
Sign.( pr unoConvucto, Date EXHAUST HOOD DMIDUC) HOUSING MITIGATION FEE
HATARDOUS MATERIALS DISCLOSURE
Will We applicant or future building Occupant store orhanddehmmdons material HEATING UNIT CTO 100,000 BTIJ)
as de@red by site Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(.)^ IWATING UNIT(OVP.R I(10,1KKI BTII)
❑Yes k�/�
o VENTILATION PAN(SINGLES R[SID) PAID
Will Ne applicant or future building occupant use equipment or devices which - Data Receipt k
emit h irardoos air cartoonn...a as defined by the Bay A.Air Quality Management BOILER-COMP(31HP OR 100,000 BTU)
District'! TOTAL:
Dyes MAO BORER-COMP(OVER I00,00d BTU) -
I have real the buaatJous mmerns m under Chaser 6.95 of the Cali- AIR CONDI HONER
requiremen p ISSUANCE DATE
fomia Health&Safety Cotte,Sections 25505,25533 anti 25534.I understand Nat if the NEW RESIDENTIAL MECH. SQ.FT. -
buddfngdoer mu currently have.tor sta.,Wer it is my responsibility to nmify fee aecvpam
of the requirements which must be met prior to issuance of a Certificate of Occupancy.
Owner or amhmiml agent Dote 1G1'AL; ISSUED BY:
OFFICE
> MAX CWENG 8, ASSOCIATES. INC.
• . Consulting Engineers
6472 Camden Avenue,0211
Tel:408-2660767,Fax:408-2688916
September 10, 1996 File: 234.1.
i
Ms. Susanna Wong
Lad Realty, Inc.
4855 Atherton Avenue
San Jose, California 951.30 �����q
�ED
Re: Review of Fooling Cracks at: SEP 2 5 1996
1001.1 Glillowbrook Ct.
Cupertino, California
BLDG, INSPECTION DEPARTMENT
Dear Susanna: CITY OFCUPERTINO
PURPOSE:
At your request, we have visited the property mentioned above on 9/6/96.
The purpose of this site visi.L- was ONLY to review the following items:
1.. one crack at: garage fire wall footing,
2. one crack at rear exterior footing,
• 3, garage slab cracks.
DESCRIP"1'ION:
This is an one-story wood framed single family residential building.
There is about 1200 square feet in living area and 400 square feet
in garage. It: was built ahout forty years ago. It has composition
roofing, sLucco finish exterior wall, conventional spread footing
covered with raised wood floor framing.
FINDINGS:
Based on our site visit on 9/6/96, the l'oll.ow.i.ng items were noted:
1. Garage fire wall., a vertical. 1/4" footing crack was located about
10'0" from ttie side yard.
2. Real exterior wall, a vertical. 1/4" footing crack was located about
10'0" from the rear corner.
3. Garage, a 1./4" to 1/2" slab crack was running from the garage entry
to fire wall.
4. Garage entry, there is an one inch differential sett leemen-Fbet en�
the center to both ends of garage entrance. The center was 1--1ted4up.
��cJ UN hq Y
AN °^r
(Continued on next: page)
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11 P C 18A6�'� 9
• Cr
OFFIff � Y �r(�
- September 10, 1.996
Project: 234 .1.
• Page: 2/2
(Continued)
DISCUSS IONS/[Zr�COI•fhfCPIDAT I ONS:
Discussions and/or. Recommendations respond to findings are summarized
as follows:
Based on the findings above, there is a sign of possibility that the
foundation might have a differential settlement at the entire right
building. When the entire right foundation settled, a stress would
be created to the perpendicular footings. The stress might cause the
footing cracks. All cracks were Located about 1.010" from the end at
three perpendicular footings.
To minimize the possible further sett-lement:, we suggest to provide a
underpin at the existing footing. Refer to attachment for details.
Max Cheng & Associates, Iric. are not Geotechnical Professionals, and
are not qualified to recommend any soils criteria. Therefore,
Max Cheng & Associates, Inc. shall N071 be responsible for any further
foundation movement, if: any.
we recommend that a further survey and monitoring for the possible
• foundation movement- lie provided by a Geotechnical Engineer.
LIMITATIONS:
The opinions and recorrunendaL-ions presented in this report were
provided according to generally accepted structural engineering
practices. [,to other representation, express or implied, and no
warranty or guarantee is included or intended as to the professional
opinions or recommendations provided. We are not: responsible for
the existing building structural integrity.
This review is conceptual. and qualitative. It is intended to verify
the presence of major structural connections and to identify major
deficiencies. Accuracy of dimensions, number and location of fasteners,
type and grading of miterial.s, and similar features of the work were
not: checked in detail. We do not undertake the guarantee of the
construction, nor do we relieve the contractor from his responsibility
to produce a completed project conforming to the report.
Please feel free to call. us if you have any questions regarding this matter.
S' Gere. 40�_ 0'
Max Ct eng, P.E. w ern
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_ Gun.uliinu Engineers
6472 Comdon Avonua, 111 San Jono, 'CA 95120
(4013!2.63-6767