20109 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
building Project ldentlflcalon - PERMIT NO.
Building Address: s. ./ /�O O n
�o c G J
nero came: one: A A
J4,-*: N- Nl9 n) CITY OF CUPERTINO-BUILDING DIVISION QQ
Contrscters Na me: LIc.Net APPLICATION / PERMIT L'--l__q_6 [fir//
Architect/Engl BUILDINGELECTRICA4PLUMBING.MECHAMCAL CATFCARY CONTROL X, L L7
'O 1 Qtt ELECTRICPERMIT FEE BUILDING PERMIT INFO"
Address:-' PFRMRTISSUANCE
LICENSED CONTRACTOR'S DECLARATION `
]hereby affirm that l am licensed under provisions°f Chapter9(commenc- APPLIANCES-RESIDENTIAL I JOB DESCRIPTION
iogwith Section 70M)of Dlvision3efthe Busies and Professions Code,and my
license is in full force and effect. PANELS
License Class Lic.X
Data Contractor
ARCHITECT'S DECLARATION 701-1000 AMPS
pqqP±±o77 I understand my platy shall be used as public records. OVER 1000 AMPS n ,SQ.FT.FLOOR AREA
_ f/SQ.FT.
E Z Licensed Professional SIGNS ELECTRICAL
QQ�G OWNER-BUILDER DECLARATION SPECIALCIRC[IIT/M - r'1f'• I (-
f„ Ihereby affirmthat l am exempt from the Contractor's License Law for the n .
7p following reason.(Section 7071.5,Business and Professions Code:Any city or I\V/
OZt.r9, TFN.P.METER 0RI'OLE]NST. (l li'
F5 countywhich eequiresa permit
sitancomruteuct alter,quirestheapmvertfors ch,ormpair
mitto
ya any at signed pdemeits Issuance,aborexi pursuant to the prevision of to POWER DEVICES
c.O file a signed statement that he V lfcensed pursuant to the provisions of the 7
0�t; Contractor's License Law(Chapter 9(commencing with Section 7000)ofDivi- SWIMMING POOL ELECTRIC
'105 won3 efthe Businessand ProicialmoCode)orthat he is exempt therefromand VALUATION
�.'_ the basis for the alleged exemption. Any Violation of Section 7MI5 by anyj OUTLETSSWITCHHSFIXTURES
0�
applicant fora permit subteen,theapplicant to a civil penalty of no morethan
n five drexl wnerofthepr. NEW RESIDENTIAL ELECTR SQ.Fr. STORIES TYPEC NSTRUCTION'
L161,as owner of the property,or he employees with wages r thele wk
Z6 compensation,wllldothe work andtheshucturebnot Intended or offered for
O sale(Sec.7044,Business and Professions Cade:The Contractors License Law
�j docs not apply to an owner of property who builds or improves thereon,and OCC.GROUT' RES.UNITS
doessuch work himself orthrough his own employees,provided that such
improvements are not Intended muttered for sale.It,however thebuilding or TOTAL:
improvement n,sold within one year ofcompletion,the owner-bullderwili have
th�*rden of proving that he did not bund orbmprove for purpose ofsale.). QTY. PLUMBING PERMIT F•EE
LJ L as owner of the property,am exclusively contracting with licensed FLOODZONE ATN
contractors to construct the project(Sec.70441.Business and Professions Code: PERMIT ISSUANCE
The Contractors License Law does not apply to a,owner of property who
rIaL
Wilds or Improves thereon,and who contracts for such ptojects with a ALTER-DRAIN&VENT-
WATER(EA) -
,P.2tfractor(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY
to L5 I am exempt under Sec. B &P C for this reason BACK FLOW PROTECT.DEVICE
DRAINS' FLOOR ROOF,AREA,COND. SANITARY Y N_Owner Date RECEIPT X
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRA]' SCHOOL TAX Y N
❑I hereby ortum that 1 have o certurate of consent to opytheree ora `-h`Yl RFLEB'T M
380i,abof Worken'Compensatlonlnsurance ora certified copythereof(Bee. r GAS EA.SYSTEM-1 INCA OUTLETS �� PARK FFR Y N
3800,lab Cd X
Policy Xis
RECEIPTGAS FA.SYSTEM-0VER 4(EA)
Com any - BUILDING DIVISION FEES
�
Ccitlned copy b hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
❑Certified copy bfiled with the city inspection division. �_� (�/� ��/ �Q
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE7RAP PAIDLL— lr Ell J�
COMPENSATION INSURANCE SEWER-SANITARY-STORM F.A.XIOFT. Date ReCCI t#-LjZ4
(Thissectbn need not W completed if the permit n,forone hundred dollars
(5100)or less') WATER HEATER W/VENT/ELECTR 2 ENERGY FEE Y_ N_
I mitify that In the Performance of the work torwhich this permit Is Issued, 7
I shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING �y��' pp,,..,,
W°rimm'Compensaben Lawsof Califorma.Date PAID —E -90 IM9
O Z Applicant NEW RESIDENTIAL PLMB. �.FT. Dat¢ Recei t# %cr
Z O NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you
Hshould become subject to the Workers'Compereatton provisions ofthe Labor TOTAL:
N Code,you=at forthwith comply with such provisions orthis permit shall be UIL TNG "E
deemed revoked.
LI CC 7 CONSTRUCTION LENDING AGENCY s y SEISMIC FEE'
CL IherebyafRren that them us a construction lending agency for the perform TOTAL. ELECTRIC FEE
7Z fiance of the work for which this permit is Issued(Sec.30W,Civ.C.) s
O O ILmders Name - - PLUMBING FEE
U. F 1Lcidera Addreas QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW I�locrtifythatl have read thisappBcatlonand atatethattheabove,Information
1 liscorreat.I agreeto comply with all city and county ordinaries and state laws I PERMIT ISSUANCE 12ZC) FEES PAID:
7. relating to building construction,and herebyautimmee rcpresentativesofthb
.F N city to enter upon the abovn.men'oned property,for inspection purposes. ALTER OR ADDED MECH. Zc�
? (We)agree to save,indemnify n d keep harmless the City of Cupertino Date Receipt#
V a a 4 1 Ities,ju Renters, a dexpenseswhiorayinanywayamrue AIR HANDLING UNIT(T010,000CFM) SUBTOTAL:
gaunt Id CByin ague oft granting of la permit.
AIRHANDLING UNIT(OVER 10,000C{M) CONSTRUCTION TAX
�( CONSTRUCTION TAX PAID:
r �
V5itItheappHunt
cart/ hired. to IXFWIlST HOOD(W/DIKTI
HA] RDOUSMATERIALSDISCLOSUR
or future building occupant store or handle hazardous HEATING UNIT(TO ID0,000 BTU) Date Receipt#
material as defined by the Cupertino Municipal Code,Chapter 9.17,and the
I lealth and Safety Code Section M33(a)T HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑ Yes , MN.
Will the applicant or fimme building occupant use equipment or devices I VENTILATION FAN(SINGLE RESID) 2 IS$UAN E,DATE
which emit hinadousair contarmeamas defined by the Bay Arca Air E� �
Quality Managerrem District? BOILER-COMP OIm OR 100,000 BTU)
4 YesNo
za
have read the ha �us materials requirements underchapter6.95 of BOILER-COMP(OVER mdse BTU) Jul'i
the California Health&Safety Codc,Sections 2550.5,M533 and 25534. I _
understand that tithe building does not cumently have a tenant,that it is my NEWRESIDENTIALMECH SQ.1.7
respomity to notify the occupant of the requlrements which must be met City of Cupertino
prior to issuance of a Certificate ofOceupanry.
Ownerorauthorizedagcat Date TOTAL, ISSUEDIy'4ij1/ f
OFFICE COPY
'F
Marc Robinson Associates
ARCH. IT,ECTURE AND PLANNI .NG
DATE: 9/25/90 NO INSPECTION DEPARTNU
TO: CITY OF CUPERTINO
20380 TOWN CENTER LN. 11220
CUPERTINO, CA .
RE: ADDENDUM
MAHAN RESIDENCE
_ X9630 LAMAR CT
CUPERTINO, CA.
THE 2 X 8 FLAT AT THE ROOF TIE-IN OF THE ADDITION TO THE
EXISTING ROOF (SEE ROOF FRAMING DETAIL 8/S1 ) HAS BEEN
REVIEWED BY THE STRUCTURAL ENGINEER AND IS SUITABLE FOR
SUPPORTING THE CALIF. FRAMING CONDITION.
IF YOU HAVE ANY QUESTIONS, PLEASE DON ' T HESITATE TO CALL:
SSS INNC,EREL
MARC ROBINSON
oQp,OF FSSIpN9�
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No v 5
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�r9jf OF cw\o'�\P
3523 Dahill Court San Jose • California 95121 (408) 270 - 1187