23189 APPLI"ANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
�� Building Project Identification - - PER-WT NO.
Culiding Address: .
/0/ "r-r-WE)OD DkIvc-- 23189
nere sine. one: APPLICATION SUBMII IALp
52g -0x—)& CITY OF CUPERTINO-BUILDING DIVISION
Contractors Name: Lm.N. APPLICATION'] PERMITIt
BUILDING-ELECTRICA4MUMBING-MECHANICAL CATEGORY CONTROL N
Archftect/Engineer: Llc.No:
_. QTY ELECTRICPERMIT FEE BUILDINGPERMIT INFO
Add.. �,f�-/l�E -PERMITISSUANCE ❑ 7�
LICENSED CONTRACTOR'S DECLARATION �L11
I hereby affirm that l am licensed under provisions of Chapwr9(commenc APPLIANCES RESIDENTIAL JOB DESCRIPTIONIngwlth Section 7000).!Division3oflhe Businessand PmfessionsCode,and my
license is in full fora and effect. PANES I r
censeChss C.nt
DContract �ENJ Rhe � -.e
Date or -.
ARCHITECT'S DECLARATION 20I-1000 AMPS
a -� $/SQ.FT
A .
O Zp in Ev E
I understand my plans,shall be used as public records. OVER IWO AMPS r, a �V i
Licensed Professional SIGNS ELECTRICAL
6 OWNER-BUILDER DECLARATION -"' pp B R
z 7 �' ���, {{{{
'G srEcucc Rcu T/M SC
L., 7 Thereby affirmthatlam exempt(romth.Contractor's Lkenre Law for the
U O_"� following reason.(Section 7031.5,Business and Prolessbns Code:Any city or Q
OZF.� TEMP.METER OR POLE ITV ST. DAT
�p countywhich requknapermit towmtruct,alto%Unpmve,demollsh,orrepalr
O < anystructum prior colts Issuance,also requlresthe applicant torso&permit to . POWER DEVICES
a U file a signed statement that he is licensed pursuant to the provisions of the --�
Contractors License Law(Chapter 9(commencingwith Section 7000)of Divi- SWIMMING POOL ELECTRIC
O sion3ofthe Businessand Profession Code)orthatheh,emm therefromand VALUATION
O O the bash,for the alleged exemption. Any violation of Section by any OUTLETSSWITCHESEXTURES / 0 ,4
D
applicant fora permit subjects the applicant to a civil penalty of not more than
five undreddollars($500).
6,m NEW RESIDENTIAL ELECTR SQ.FT. RIES TYPE CONSTRUCTION
GG1l eRns owner of the property,or my employees with wages r thele sok
c ene$ion,Business andldothe roreadk and h.swde:Th Conot trended License d for
Law
O sale(Sec.7094,Business and Pro(esslon Code:The Contractors License Law
3� does not apply to an owner of property who builds or improves thereon,and OCCGROIII' RES.UNITS
who docs such work himself orthrough his own employees,provided that such
Improvements are not intended oroffered forsale.If,however,thebullding or TOTAL:
Improvement usold within oneyearofcompletion,theowner- ilderwlll have
ttfi_p.rdm of printing that he did not bund or improve for purpose of sale.). QTY, PLUMBING PERMIT FEE
LJ L as owner of the property,am exclusively contracting with licensed FT.ODD TDNE APN
contractors 44,to mntruct the project 70Business and Profession Code: PERMIT ISSUANCE ,a
The Contractors don not License Law donot apply to an owner of property who
raALTER-DRAIN k VENT-WATER(EA) V
Wilds or Improvs,thereon,and who contracts fn such pioyets with a FEE SUMMARY' '
oBill.ctor(n)homord pursuant to the Contractors License law. BACK FLOW PROTECT.DEVICE
LJ 1'am ex under Se B&P C for this mason
N
Avner_ OUTSIDE FEES
Date DRAINS FLOOR ROOF,AREA,COND.' SAMTARY Y_
WORKMAN COM 'NSATION DECLARATION RECEI'TN
❑I hereby affirm that I have a certificate of consent to self-Insure,or aNIXES PER TRAP SCHOOL TAX Y , N
certificate of Workers'Compereatlon Inurarmora certified copythereof(Sec. RE- NN
3SOO,Lab C.) GAS EA.SYSTEM-]INC.40UILRS o0 PARK FEE Y_ N_
RECEIPT N
Policy N GAS EA.SYSTEM-0VER 4(EA)
Com ray BUILDING DI VISION FEES
ECertified mpy h,he d with the
ad.city - GREASEANDUKRL WASTE INTERCEPTOR PLANCHECK FEE
❑Certified copy h,filed with the city Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.20017. Date Remi tN
(This section need nut be completed If the permit Is for one hundred dollars
($100)or less.) WATERHEATERW/VENT/ELECTR ENERGY FEE Y_ N
I certify that In the performance of the work forwhich this permit Is h,sued,
1 shall not employ any person,In any manner so as to become subject to the WATER gyS7EM/TREATING
Workera'Compensationlaws of California.Date PAID
O Z Applicant NEWRESIDENTIALPLMB. SQXT. Date Remi t#
Z O NOTICE TO APPLICANT:R,after making this Certificate of Exemption,you
should become subject to the Workers'Compensation provisions Labor TOTAL:
CCI/1 Code,you most forthwith complywithmch provblons orthh,permit shallbe BUILDING FEE
LU > devoted revoked.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
t1 Iherebyaffirmtlat there is a mntructlon lendlegagency forthe perform TOTAL: ELECTRIC FEE
M Z arcc.f1hewockfororhichthis permit h,Issued(Sce.3097,Civ.C.) ..
02 lenderm
s Nae OD PLUMBING FEE <>7D
IL 1 Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICALFEE
Icertlfy that]have read this applicallonand slatethat theabovelnformation
O W
6. roomed.I agreeto comply with all city and muntyordinances and state laws PERMIT ISSUANCE FEES PAID:
>_ relating to building construction,and hereby authorize representatives ofthh,
(_ W city to enter upon the above-meNioned property for inspection purposes.- ALTFRORADDIOMECH.
z (We)agree to save,indemnify an d keep harMese the City of Cu ped Inca Date Receipt#
V agalnt liabilities, mats and expenses which may In any way acerae AIR HANDLING UNIT(TO 10,"CFM) - � SUBTOTAL:
agal 'Pty In inns ena oI the it g of this permit.
AIR HANDLING UNIT(OVER 10,000COM) CONSTRUCTION TAX
SI&wuuwof ApphIxrt/Contractor Date ex AuST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS] TERIALSDISCLOSURE ,
Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BN) Date Recef [N
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
I ealth and Safety Code Section 25532(x)? HEATING UNIT(OVER 100,000 BTU) TOTAL: I 3.
❑ yr, ',- MNO
WRItheapplicant or future building Occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit harardous air contaminants as defined by the Bay Area Air '
Quality Management District? BOILER-COMP(311POR100,0001ITU) p.' D
❑Yes• ❑F�No H
(have re.dthehazardousmaterialsmquimrnentsunderChapter6.95of MOILER-COMP(OVER100,0006N)
Ila 'the Gnfornla Health&Safety Code,Section 2550.5,1x533 and 75534. I
understand thatilthe building not mrrentiy have atenanithat lth,my NEW RESIDEMIALMECH.-SQ-FT �Q� 'I p, 1gg�
responsibility to cad ify the occupant of the rcyutiverms which must be fret 1r/ I
prior to issuance o!a Certificate Of Goo pa
CII Ur ,UPEHIINU
Owner or authorired agent Data ISSfIED BY:
TOTAL:
OFFICE COPY
r- :J. -V at, 4419
a
.� ► :. y, / .app /J �f� � (J g�4
By.......... Y:........DATE. � !�.,G SU/BJEpCTls..'rr/'./.S/Lff(ilS-C.Rc:_.SSPr..Yl.24L.:._... SHEET NpO.q..........O F..r. ......
CHKD. BY................DATE................. .._.I ....................... JOB NO...L..R,,.�P...Q.�P.a+........_..
................................................................... ...... o —C—.�. ........ _._.
r�[G�.P1<'tl:L._} ... ....._......._...._..._ -----..._......_..._._...._..........._.._._.
' . Ai shfi. 3 ,cadet KENNETH NELSON'
Quhf- Registered Civil Engineer
Referen4ces_:..__(.1)_.1-q9/ Ed.,_UBC _ 940 Saratoga Ave.
(408)247-2898 Suite 215
Design Load Assumptions : (psf)
San Jose.California 95129
LL DL
Roof '
1�0 _-.7.7--
Ceiling
Sloped Cl'g.
1st Floor ! --.....-..._ Q\ OFESS/p2
2nd Floor -' �fC�H /VF�� �tn
0 2c>
Ext. Walls L__ w Y No. 22023 z m
Int. Walls - cr L'1 Exp. 9-30-93
- --- --- APPROVED
Party Walls_ _ _-- ..._-IN ACCORDANCE WITH THE CITY S� Com-
. - CUPERTINO CODES AND ORDINANCES �OFCN-W
Wind _ .
-2,7--CV_
- --. DATE ` _ _ ) BD
Seismic vs =_D_ _W -SIGNED_ Qa f3✓—�—�
This set of plans and
specifications MUST
Timber Construction Desi &aGr$ttLriialobatelltimese(Iditisun
__ .. a any changes or alterations
-With CzrrYeti:>s::Luinber_'GxadiEtY�(iliiul'�
on same WILTiout written pormissloo from
Use Grady'. building Dept„ (''ty of C pertino.6
—the stamping of this flan at'� id f (repetitive use)
Struct. Light SHALL NOT-bo held to permit of to ba ?A
Framing (4 x 4) Apprpg of tho vic4gg n of toy prOV09 %
d1 any City 9rtlina1,,,e or Slatu�tsC�.
Struct. Joists, 111 1500 1.8 1750
Planks 6 Rafters Dense 112 1450 1.7 1700
U2 1250 1.7 1450
Light Framing & Std.
Studs (4 x 4) Grade 600 1.5
Beams 6 Stringers Dense Sal.
Struct. 1900 1.7
Beams 6 Stringers Sel. Struct. 1600 1.6
Beams 6 Stringers Dense #1 1550 1.7
O1 1350 1.6
Post 5 Timbers Dense #1 f 1400 1. 7
R1 f 1200 1.6 OREN COPY
KENNETH NELSON
Registered CMI Engineer Joe 'Orl ��?QeW47nQ
SHEET NO. OF
CALCULATED BY DATE
940 Saratoga Ave.
(408)247-2898 suite 219 CHECKED BY DATE
FAX(408)2'¢j-7898 San Jose,California 95129 SCALE- lai-Mo, 9'zC* 49&-F
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KENNETHe9YNELSON Joe /01?r LPJck ujocot -or, di. �.
Y. Q
ll Engineer SHEET NO. OF
CALCULATED BY „ • I_, DATE
(408)2472898 940 Saratoga Ave.Ste.215 '
Fax(408)247.2898 '- San Jose,CA 95129 CHECKED BY (( DATE
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KENNETH NELSON
JOBc �on�Jnp
Registered Civil Engineer Z
'n--k
SHEET NO. OF
CALCULATED BY. AA DATE
(408)247-2898 940 Saratoga Ave.Ste.215
Fax(408)247-2898 San Jose,CA 95129 CHECKED BY DATE
SCALE Joh Aln, 9,V iza 04 Sr
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