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APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. 312 A ag
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL JK L 4 4
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: / SANITARY NO. APPLICATION SUBMITTAL DATE
i a >6 Vo a- P_A;A16 /' J -
OWNER'S NAME: PHONE: CO RACTORS NAMF LIC NO:
I S. - 17ES S a 0 3S Nrc co ROL a
�RCHITECT/ENGINEER: LIC NOADDRESS
❑
/OS& /7 11 A yE C'!Jm bell
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLD ELECT PLUMB MECH
❑ ❑ ❑
LICENSED RACTORS DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby )of that 1amfthlicensed B.underprovisionsof Chapter 9 my licensees JOB DESCRIPTION
O�Z with$ati.n]pp)ceDivisi.n3.ltho Business and Professions Code,and my license is
WOO PERMIT ISSUANCE RESIDENTIAL:
FC�WE in 9fincand eRece//�•'f� �9D3r•p - ❑SPDWL ❑PLUMBIN RE-PIPE Fr U U Date C x C� < Lin.R J g -
yQ,a Dam Contractor APPLIANCES-RES IUENTIAL ❑ADDITION ❑PLUMBING RF.XIPE
Fay ARCHI I'ECI`S DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z p y Z 1 understand my plans,hall he used a,public evened, r .. MODIFICATION
OZ- - UP TO 200 AMPS -
p ' ❑IMPROVEMENT REPAIR '
[=,y..FW Licensed Professional 201-IOW AMPS IMPROVEMENT
CY�� OWNER-BUILDER DECLARATION - OVER IIXIO AMT'S D BATH REMODEUREPAIR DEMOLITION
C Q I hereby aRren thin I am exempt from the Courtrai License Law for the
K3yU following reason.(Section"/03 L5.Business and Professions Code:Any city or county SIGNS ELECfRIG\I. DOTTER
W W n which rquims a permit to construct,alter.impose,demolish,or repair any structure
Fy�Oa prior to its issuance.also requires the applicant for such Permit o file a signed statement SPECIAL CIRCUIT/MISC.
Ihm he is licensed pur.met n the provi,iomsofthe Contrader's License Law(Chapter 9
W�0_ (commencing with Section 70M)o(Division 3 ofthe Business and Professions Code)or TEMPMETERORPOLEINST, COMMERCIAL:
a q day that he is exempt therefrom and the basis for the alleged exemption.Any violation of [I NEW BLDG/ADDITION D DEMOLITION
W Lr. Section 7031.5 by any applicant for.permit objmts the opplimmte a civil penally of POWER DEVICES
- —m GIMPROV ❑FOOD SERVICE
Fl more than five hundred dollar,($51X1).: IMPROVEMENT
D I,us.wnor of the pmpeniy,or myrntployccs with wages us their sole compensmion. SWIMMING TOOL ELECTRIC61
$y'F� will do the work,and the structure is not intended oroflcred far sale(Sec.7I94,Bu.vinesv DOTTER
WW 3 w and Professions Code:The Contractor's License Law does not apply m an owner of OUTLETS-SWI ICHFS-FIXTURES '
prupeny who builds or improves thercne,and who does such work himself nr through his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECfR SQ FT.
sale.IL however.the building.,impmvemnnt is sold withinune yearnfccandidian.the SQ.FT.FLOOR AREA $/SQ.IT.
owner-builder will have the burden of proving that he did not build or improve for par.
,x of role.).
❑1,sit owner of the property.am exclusively contracting with licensed contractors it) Two •�JIf /�
onmmcr the projem(Sec]034,Business and Prn(essionr Cale)The Contractor's Li- ONIA3dn.) ao Ali:
cense Law does not apply m an owner of prolixity who builds or improves thereon,and QTY. PLUMBING PERMIT n�s�•aa�
who contracts for such projects with a cmmucaor(e)licensed pursuuat rotor Contractor's WSM1/Id
I
Liccnxc la W. PERMIT ISSUANCE CL
am exempt under Sec. ,B&P C far this reason
Owner Date ALTER-DRAIN&VEWT-WATER(FA) VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROI'ECI'.DEVICE Q ' Y�./ d
I hereby amrm under penalty of perjury one of the following declamlmax
Qlh.ve wdwill mainoina Cenifimte of Conserv to,elf-insure for Workers Compete DRAINS-FLOOR.ROOF AREA.COND.
ration,as provided for by Section 37W of the Labor Cade.for e performance of the STORIES TYPE CONSTRUCTION
rh
work for which this permit is issued. FIXTURES-PER TRAP
I]1 have and will maintain Worker's Compensation Insurance,as required by Section
37M of rate labor Code,for rhe necromantic of the work for which this permit is issued. GAS-EA.SYSTEM.I INC.4 OUTLETS OCG GROUP APN
My IN k,,' Compensation lnsuonce carrier and Policy nu �b�r -
Carrier: ��• n✓t/br Policy No.: �O (1.3fl GAS-EA,SYSTEM-OVER 4(EA)
CERTIPI� nI.OF EXEMPT ION FROM WORKERS'
COM 1117NSA I ON INSURANCE GREASHANDUS1'RL WASTE INTERCEPTOR
fIU11.DINC )IVISION FEES
(This.uction need nolMwmnpleted if rho pemnir is for one hundrcA dnllne,($11X1)" GREASE TRAP
or less) PLANCHECK PCF
toy any fm eosin any
of lite work for woke this the it is Workers'
ompainl SEWER-SANITARY-STORM EA.2W FT
not employ any person in any manmr:m as w become subject the W.rkcsx'Compos- ENERGY FEB
OZ Nation lawsof California.Date WATER HEATER W/VENT/ELECTR
Z 0 Applicata 1CONSTRUCTION
E
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEMOTHEATING
a ; become suubc,m the Workers Compensation Provisions of the Labor Cede,you must
forthwith comply with such provisions m this permit shall be deemed revoked WATER SERVICE
0
Z• CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMO. SQ.FT.
U� 1herehy affireft,there isaamamminn lenlm,ii,ency far the pc&umured of Receipta
the work for which this permit is isxucd(Sce.3097.Civ.C.)
Q ULeader'a Name TOTAL:
Lender's Address TOTAL:
SI certify that 1 have read this application and state that the above information is -E
h correct.l speed to comply with all city ad coumy or firmer,and one rows re boring m QTY. MECHANICAL PERMIT F
U Z building construction,and hereby auNarix representatives of this caym enlerupon rhe FEF.
above-mentioned property for inspection pugiowx. PERMIT ISSUANCE
(We)agree to rare.indemnify and keep harmless the City of Cupertino against C FTIiabilities.judgmend,costs and expenses which nay in any way accrue against said City ALTER OR ADD TO MECH.in nuquence of the granting of this permit. GF EAPPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFNDSOUvR/C/f�REGULATIONS. ICAL 'EEfJ( 0� f— yAIR HANDLING UNIT(OVER 10,000 CFM) UCTION AX
QQQtgnoture.f Applie.ZIR'amor
DOUS MATERIALS DISCLOSURE- Dam EXHAUST HOOD(W/DUCT) HOUSING MITIGAT NFEE
Ff
Willy he Capetian
Muni ipal Cg e.Co fe store ad t e Health and medal HEAPING UNIT('10 IIXLWO B'IU)
as d,Sec by the Cupertino Municipal Cale:Chapter 9.12,and the Health.and Safay
Cada Section 25532(n)1 - HEATING UNIT(OVER IW.(KKI BTU)
E3 Yes GNo VENTILATION FAN(SINGLE RFSID) PAID
Will thea applicant or future building occupant use t or devices which Dater Racip
pp gn pan Area
Air Quality
BOILER-COMP LHP OR l W."BTU)
mit hamrdous air conaminanu as def neJ by Inc bay Arca An Quality Mmagemenl TOTAL'Dnsmfl? BOILER-COMP(OVER 100.000BTU)
E3 yes UNn .
1 have read the hoenedmts mnteduk ergniremems under Chapter 6.91 of the Cali- - AIR CONDITIONER - ISSUANCE DATE
bions Health&Safety Code event ms 25505;25533 and 25554.1 under,di I Iia d the NEW REMDENT[A].MECH. SQ.Fn
of thengsloesnolcunrenly h.vco m me(
it is mnuccofnsC,mfrwrofCen,anupnm '
ante rcgairements wmcn marlxmet ndmrm iaa,nanne nraeaniEmte.ffxeap.n.y. .
Owner or mfflmm d.,car Date TOTAL: ISSUED BY:'
OFFICE
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CALCULATED BY___ STEVEN A. ARNOLD JOB NO.: )0 3 =17
h Civil Engineer Y
CHECKED BY 1671 The Alameda Suite 305 DATE:
•GNED BY _ SAN JOSE, CALIFORNIA 95126
RCE NO. �_ __— PROJECT:
C/!/miner ,eao/actMOn� PAGE: OF�__
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CALCULATED BY STEVEN A. ARNOLD JOB NO.: /D3- 9 7
CHECKED BY Civil Engineer 8✓�
1671 The Alameda Suite 305 DATE: z, 9 7
IGNED BY SAN JOSE, CALIFORNIA 95126 `
/ . -PAGE:_
RCE NO. �_ PROJECT: 641/nn Ike Iacr a 7
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STEVEN A. ARNOLD — Civil Engineer, Inc.
1671 THE ALAMEDA,SUITE 305 • SAN JOSE,CALIFORNIA 95126 • TELEPHONE(408)286-9111
•
July 9, 1997
City of Cupertino
Building Inspection
10300 Torre Avenue
Cupertino, CA 95014
Subject: Masonry Chimney Replacement
11262 Lajolla Ct.
Cupertino, CA
Gentlepersons:
On the 8th of July 1997 , I made an on-site inspection of the
subject masonry chimney and discovered that there is no
reinforcing steel in the chimney. I have prepared a sketch
that depicts the correct method of attaching the chiminey to
the single story wood frame structure.
Respectfully submitted,
OF S/A-/
Steven A. Arnold ��Q ��� q� p,�r��
Civil Engineer
CE22301 1A y 2301 y°
X p
cc: Jones Masonry E . 9.30.9
IV
4j OF CAIk&�Q
PAID
AX 15 ev
STRUCTURAL DESIGN • LAND SURVEYING • BUILDING INSPECTION
GENERAL CIVIL ENGINEERING SERVICES