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28046 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPERTINO tl ILD1N.-ELECTRICAL PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL 28046 BUILDING DIVISION BUILDING PROJECT IDENT'IFICAT'ION BUILDINGADDRFSS: LII,` - a TARYNO. APPLICATIONSUBMIITALDATE 1 2-6 L 5 OM� NITp 4 .' OWNEq$NAMF.: e PITON@�'�j'I� CO ACTOR' NAM �rvC gy229 -7 U 65 J f1��f,�- J(�/I 9 N/C CONTROL N I.� SL IRCIIITECI'/EN NF,FR: LIC NO: Ai DRESS. OCC Da k6,,d`I? %Og CONTACT: PHONE: BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE DL G ELECT PLUMB MECH PERMITISSUANCE ❑ ID 0 LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL. JOB DESCRIPTION 1 hereby affirm that am licensed under provisions or Chapter 9(commencing with u,100 Section 700o di'Division 3 ofth<Business and Professions Code,and my license is in PANELS ` �— ` "w full force ands e 2 +FZW License Cl.:, 2 .21Lw., 2 31 1 UPT02MAMPS f`Sot, . VQme t yr Q d Da¢ Commcmr al'V'a 201-10110 AMPS FyZ ARCHITECTS D[CLA TION SQ.FE.FLOOR AREA S/SQ.FT. Z O o�— 1 understand my pl...hall he used as public records. OVER 1000 AMPS 0%—M W SIGNS ELF.CIRICAI, Licensed Professional Yyd'6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. KOi V 1 hereby affirm that I aexempt from the Contractors License Law for the '11,00 m milowingreawa(Sotian 7031.5,Business and hoodssians Cade Any city or cuumy TEMP.MET ER OR POLE INST. f'a ')< which¢quires a permit to construct,alter,improve,demolish,or repair any structure �w}— prior to its issuance,also requires the applicant for such Permit o filea signed statement POWER DEVICES w=pa0 that he is licensed pursuant m the provisions of the Contractor's License Law(Chapter SWIMMING POOL ELECTRIC de.o� 9(commencing with Section 90110)of Division 3 of the Business and Professions Gale) VALUATION W=w ar that he is exempt therefrom and the baslsfar thealleged exemption.Anyvlolationof FZQ Section 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of OUTLETS-SWITCHES-FIXTURES G not me than Boo, rofhe rodny,larmyem).. NF,WRESIDENTIALELECIB _SQ.FT. STORIES TYPECONSTRUCOON fL�x ❑ Lwowncrafthepropeny,ormyemployed oraeed forsafe(Sole 0,EU Business and y 3. anti dothe wons and the he Co alownesnot intended eve Law does of applye(See 7044,Business and proper, who Code:The Contractors License Law does or apply to an owner of own eny who builds or improves ch improvemen,acessuch work.,eforcolf..gh his empinyccs,prnvided that such impmvemenmxnrenotimmndcdoroflercdforsaIt.If. OCG GROUP RES.UNITS however,the building or improvement is sold within one yearof completion,theowner- TOTAL: builder will have the burden of proving that he did not build m improve for pur,we of vile). ❑ I,as owner oflm property,am exclusively contracting with licensed emmascorsm QI'Y. PLUMBING PERMIT FEE FLOOD ZONE MIN nmwet the project(Sec.7014.Business and Professions Code:)The Carni tumor's License Law does not apply roancovacm ,,mix t,whobuildsorimpoeves thereon,and PERMIT ISSUANCE who contrasts forauch projects with a contranogs)licensed punmemmme Camranm's ALTER-DRAIN&V - ER License Law. feTA I FEE SUMMARY ❑ I am exempt under Sec. ,B&P C far this rcamn BACK FLOW PRO CT.DEVICE OUTSIDE FEES SANITARY YN Owner Dew Is, RECEIPT. DRAINS-FLOG ROOF,AREA,COND. t WORKMAN COMPENSATION DECLARATION SCHOOL TA% YN ❑ Thereby affirm that l have a cenifica¢ofconsent to self-insure,or a cenifirmeof FIXTURES-P .TRAP RECEIPI'p Workers'Compensationlnsumncemacertl6edco ymereof(See.3800,Lab CJ which PARK FEE Y N vers all �rt cr Mia t I #vIt 1 GAS-EA SY TEM-I INC.40 ETS RUCBUILDING DIVESIIOON FEES Panay x V' I V1 - so PLANCHECK ComCen� ,V�cN�o'Ppy-i`i, celbby`-'�ffuf�ndshe 'ms ISI GRFAS�NDUSTRI.WASTES OR GRADING RpEF. S CERTIIICATE OpfM ON OMWORKII-RS' GREA. :TRAP SOILS FEE COMPINSATION INSURANCE (Thivsmion need notbecomplened lithe pe—his forms,hundred dollan(SIM) S2 R-SANITARY-ST .A.200 ENERGY B m less.) I amity that in the peammomme of me work for which this .if is issued.[,hall ATER HEATE N T/ELECfR � not employ any person in any manner so as to became subject to the Workers r PAID Compensmion laws of C.H omia. Dam WATI2R SY$TE ING (Dye/ Receipt. 0 Z Applicant .Z O NOTICE TO APPLICANT:If.after making this Cenificale of Exemption,you should 'SIDENTIN.PLM SQ.ET. TOTAL. ^ become subjectm the Workers Compensation provisions of the Labor Code,you must > forthwith comply with such provisions or this permit shall be domed revoked. BUILDING I. �. f,CONSTRUCTION 0. Q CONSTRUCTION LENDING AGENCY SEISMIC 11 U1 hereby of!that there is a construction lending agency far me pmmormande of z the work for which this permit is issued(Sec.3097,Civ.C.) ELEC RIC 6 L.L. Icnders Name p PhUMBIN'FEE F Lenders Address QTY. MECHANICAL PERMIT FEF, U 1 certify that 1 have read this application and state that the above information is MECHANIC. .PEE correct.I agree to comply with all city artd county ordinances and state laws relmingto PERMIT ISSUANCE F" building construction,and hereby amhodxe representatives of this city to enter upon the CONSTRUMIO TAX U Z above-mentioned property for inspection purposes. ALTER OR ADD TO MECIL (We)agree to save,indemnify and keep hanNess the City of Cupertino against bobilides.judgmems.cost,and expo hicbmayinany way accrue against said City AIR HANDLING UNIT CTO 10,000 CFM) in corew,imace of ngartingetthpee tlq AIR HANDLING UNIT(OVER IO.IXI)CFM) Signahmv fl un ocor Sol EXHAUST HOOD(W/DUCD PAID y HEA TING UN ('1-0100 ..0a)BTU) Date Reimto i ARDOUS LTMATERIALS DISCLOSURE Will the applicant or future building necupam store at handle haysrdous mamrial asdefined by the Cupertino Municipal Ccde,Cha,tm V12,aM the l lealmand Safety HEATING UNIT/OVER 100,WO BTU) OTA : Cade,Section 25532(.)! VENTILATION PAN(SINGLE RESID) ❑Yes IS§UANI D rE Will the applicuntnffu urebuilding occupant useeyiiipmalia devices which emit BOILER-COMP(}HPDR 100.000 BTU) hazardous ail comundnums a,defined by me Bay Area Air QuAny Management BOILER-COMP(OVER 100,000 BTU) AY O n? Cl 19Yes No NF.W RLSIUFNITAL MECH. SQ.Ff. C� 95 1 hove mad the hoz es materials rcqulrcmems undo Chapter 6.95 of the VF LAN Califomiu Health&Safety Code.Sections 25so5,25533 and responsibility I reconstitution 41+Il� Ifthebuildingdoes ntly have¢emmnt that.is my msponsibfa onotify the occupant of IM r u be et prior m issuance of a Certifeme of omoapanmy. owner or authoriu aero If Dam TOTAL: ISSUED BY: OFFICE SAY AREA STRUCTURAL, INC . GENERAL ENGINEERING CONTRACTORS 1185 OCEAN AVENUE,OAKLAND,CA 94608 (5 1� 7(a tp• U U : T - 70 -8570 STATE UCEWE A.8 N422931:ENGWEERNG AND CONSTRUCTION.BONDED • INSURED 66JJ LILIbPbp I�IUUL}�aaa U(I�� CALIFORNIA SLATE UCENSE IC-21:OEMOUTION • HAZARDOUS SUBSTANCE REMOVAL AND REMEDIAL ACTION MAY. 91995 Brace Crawlspace and Garage Walls for inc— A41 ateaaily onattFrame,Resi1D EINSPECTIONDEPARTMEril 20197 Las Ondas way, Cupertino CITY QE CUPERTINQ In the garage, bolt the exterior walls with 5/8 wedge anchor bolts on 3-4-foot centers . In the crawlspace, install 2 1/2 X 2 1/2 X 1/4-inch angle iron to connect the floor joists which rest on the mudsill to the foundation. Connect angle iron to . joists on three to four foot centers with 1:/2-inch diameter machine bolts and to the foundatior;q �, two 1/2-inch diamter wedge anchor bolts . dd;--- IN ACCORDAOVED CE TTINO CODESVVITH THE CITY nd.± DAT AND ORD CITY CES . SIGNED This setof"-- be keptPlans and ;;pNifir.3t n> tl lawful to on the job at 1 � . MOST a,'. ti..1 rd ' I V r�Vu u to make am, It is un T n tutu on same withou ct1F„ ey or the t w Iterationsp 51/I rL° building n u-- ns ion UC s*vR t g`3 8 wept., C.!v of CL. from _ Y The stamping Cl this ee,I, o• 7 IO 0 II � Panan:i I (y'Hiu-1�3r1`h� W SHALL NOT be ha•: I, Pec fications 3/ u - ©i PProv nN't or t t •2 o o f the viefalion of , be an N Y City 0 a t;Eh: , ,1r atat V P, visions i � 2- MAW taw, ( e1 OPC Id I •1-ypical nical Wcdgc Anchurbult CC//SS1199 1 t. 2�I�1�� Oti1p�lS_ l- --- -- —.. - W — stiexrG1 ee�I FCA I) Framine Through µl 0 GII 5 bolt V2 M JD. ot, � . OFA nchor Anelc �- • bolts Iron Shcar,alled/Cripple Sind Frame 3'•:� 0 (�. . R NE CE OF ail T�-,(r,f tlC�d�r,[�_ R-,XK J01'JT TO 4�� pAOYA pf4� p,ST Q�pFESSIp� r` c¢ No. 418942 -x c T C M' A. GENERAL m n u r y Q us GINEERING fr ¢ COP y ; ����JJJJ * 6Xt'•/Z-11-98 't STq CIV 1\ of Cq- 1 '95 09:59AM $CIF CERTIFICATES OAKLAND P 1/1 Wr ^ t AT P.O.BOX 420807,SAN FRANCISCO,CA 84142.0807 bSia COMPENSATION k INSURANCE Iti CERTIFICATE OF WORKERS'COMPENSATION INSURANCEe" `" ; u 3., APRIL 13, 1995 POLICY NUMBER: GRP 1/5 7 1—UNITO 9216-9C4-;,- CERTIFICATE EXPIRES: 10-01-95 r aA ," •* �•h.� ta�{t CITY OF NUT CREEK BLDG. SP. DEPT. 166 0. MAIN ST. ' NUT CREEK, CA 94596 1/ \C tI This Is to certify that we have Issued a valid Workers'Compensation Insurance policy In a form approved by the Califomla Insurance Commissioner to the employer named below for the policy period Indicated. +f` This policy Is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer. u,1 . We will also give you TEN days'advance notice should this policy be cancelled prior to Its normal expiration. . This certificate of insurance Is not an Insurance policy and does not emend, extend or alter the'coverage afforded by the Policies .listed herein. Notwithstanding any requirement, term, or condition of any*contract or other document'wlth respect to which this certificate of Insurance may be Issued or may pertain,;the insurance afforded by the. policies described herein Is subject to all the terms,exclusions and conditions of such pollcies. 4000, " '.PRESIDENT . EMPLOYER r BAY AREA STRUCTURAL, INC. 1185 OCEAN AVE. OAKLAND, CA 94608 1P � • s e