28159APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OFUPERTINO BUILDING -ELECTRICAL
G APPLICATION/PERMIT PLUMBING - MECIIANICAL
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
PERMI'I'NO,
28159
BUILDING ADDRESS f^_c�al�' Wf0y , /ten �]1 o
2`41 5 `W M �+\ LOTM Q
SANITARY NO.
API'LICATIONSOBMITfAL DATE?
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OPHONE:
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QTY. ELECTRIC PLRMI'f FEE
BUILDING PERMIT INFO
Lg DO BLIiCf PLUMB MECII
PERMIT ISSUANCE
JC�J/� � ❑ ❑
LICENSED CON 'IRAC'I'OR'S DECLARATION
Ihcmbyaffirn mat l ton licensed underprovinmerifChapter9 fcammencingwilh
APPLIANCES -RESIDENTIAL
\/!� I C NIPwa-J`��
`f�\',y/ _,— (�/`�f'_�'�`�S
3 — s
Section 7000) of Division 3 of the Business and Professions Code, and my license is in
full force and effect
License Cass Lic.N
PANELS
UPT0200 AMPS
Date Commemf
RCHITF.CT'S DECLARATION
I understand my plans shall be used as public records.
201 - 1000 AMPS
+ • I�
OVI?R IlODAMPS
SQ. MT FLOOR AREA
$/SQ. Fr.
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
SPECIAL CIRCUIT/MISC.
I hereby affirm mm I ate exempt from On Contractor's License Law for the
TEMP. METER OR POLE INST.
following remon.(Section 7031.5, Business end Professions Cade: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any strucmrc
prior to its issuance. elsorequires the applicant for such permit to file a signed statement
POWER DEVICES
Our he is licensed pursuant to the provisions ofthe Convectors License Law(Chapter
9 (commencing with Se 7000) of Division 3 of the Business and Professions Cede)
SWIMMING POOL ELECTRIC
VALUATION
or that he is exempt bombard and the basis for the alleged exemption. Any violation of
Section 7031.5 by my applicant for o permit subjects the applicant to o civil penalty of
OUTLETS -SWITCHES-FIXTURES
nommen hall five hundred dollars($500).
❑ 1.nowneroftheprnWnXormyemployaswithwagesmtheirsolecompcnsetion,
NEW RESIDENTIAL F.LP.CTR _SQPT
. .
STORIES
'TYPE CONSTRUCTION
will Jo the work, and theslmcture is not intended arefferedfarsale(Sec. 7044, Business
and Professions Cede: The Contractors License Law does not apply to an owner of
propcnywho buildsor improves thcrean,and whodoessuch workhimmlforthrough his
ownemployces, provided that such improvementsa snot intendedarnffered fusels. IL
OCC. GROUP
RFS. UNITS
TAE:
however, the building or improvement is sold within one yesrofeompletion, the owner-
builder will have the burden of proving that he did not build Or improve for purpose of
QTY. PLUMBING PERMIT 1
axle.).
❑ I. as ownerofthepmpeny, am exclusively contracting with licensed eontrnaon m
FLOOD ZONEAPN
onsvuct the project (See. 7044, BmI0e59 end Ford ..into Code:) The Ciro an or9
License Luwdoes nil imply loan owncrofpmpeny who builds or improves Orman, suit
PERMITISSUANTI
who contracts for such Projects with acontranor(s) licensed pursuennothe Contractors
License Law,
ALTER (PA)
PEE SUMMARY
❑ I am exempt under Sec. , B & P C for this rasOn
RACK FLOW PROTECT. DEVICE
ANITARY YN
RECEIPTp
Owner Date
WORKMAN COMPENSATION DECLARATION
DRAINS- 19.0011, ROOF, AREA, 'ONO.
SCHOOL TAX YN
❑ Ihembyaffirthlhmlheveacenificwenfanwntlowlf-insum,oramnificwco(
WOrkem'Compensmion Insurance or a certified copy therenf(Seo. 3hoq Lah C.) which
FI%'TURPS-PER TRAP
RECEIPrp
PARK FEE Y N
covers all employee's under this permit.
Policy M
GAS - FA. SYSTEIvFI INC. OUTLETS
RECEIPT H
BUILDING DIVISION FEES
Company
GAS - EA. SYSTEM -OVER 4 (EA)
PLANCHECIK FEE
❑ Certified copy n herehy furnished.
GRPASEANDUSTRL WASTE INTERCEPTOR
GRADING FEE
❑ Certified copy is filed with the city inspection division.
CERTIFICATE OP HXEh1PION FROM WORKERS'
GREASETRAP
SOILS FEE
COMPENSATION INSURANCE
SEWER -SANITARY- S'T'ORM IA. NOFT.
ENERGY FEC
('this section need not be completed if,he permit is foronehundrad dollars ($100)
or less.)
WATER HEATER W/VI?NT/EI.HCTR
I tend fy that i n the performance of On work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Workers
PAID
WATER SYSTEM/IREA'TIING
Campensmion Lawsof Califimit. Data
Data Reails,N
Applicam
NOTICE TO APPLICANT: If, after making this Cerifieam of Exemption, you should
NEW RESIDENTIAL PI.MB. SQ. PIL
TOTAL
become subject to the Worker's Compensation provisions of the Labor Cole, you must
forthwith comply with euN, provisions or itis permit shall he deemed mvokmd.
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirm thanhere is a construction lending agency for the performance of
the weak far which this permit is issued (Sao 3097, Civ. C.)
TOTAL:
ELECTRIC FRE
Lender's Name
Q'rY. MECHANICAL PERMIT FEE
PLUMBING FEE
Lenders Address
I certify that I have read this application and state that the above information is
correct. I agrcem comply with all city and county Ordinances and slam laws reining to
PERMIT ISSUANCE
MECHANICAL. FEE
building construction. and hereby uuthome representatives of This city to enter upon the
above-mentioned property for inspection purposes.
ALTER OR ADD TO MECIL
CONSTRUCTION TAX
(We) agree lesson, indemnily and keep harmless the City of Cupenin gains,
liahililies,jud sentiscons expenses whichmayin any eya n. said Cit'
AIR HANDLING UNIT (TO 10.000 CFM)
in ca seyuen oft gciddr, patmit.
AA
J-
AIR HANDLING UNIT (OVER 10,00) CFM)
SignammifApp' VC racor Ume
EXHAUS'THOOD(W/DUCT)
PAID
HEATING UNIT(T0100,000 BT1D
fl RDOGS MATERIALS DISCLOSURE
Data RaeiptN
BEATING UNIT (OVER I W.(00 BTU)
TOTAL:
Will the applicant or fuwre building occupant store or handle hazardous material
a defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
VENTILATION PAN (SINGLE RESID)
vs
Code, Sentinel 25532(0)7
1:1 Yes 11 No
tubnilding occupant useequipmentur devices whichemit
Will applicant or fure
BOILER-COMP(3HP OR 100mO BTU)
,
ISS ANOE DATE
,
BOILER-COMP(OVER 100,000 BTU)
merdous air contaminants as defined by the Bay Area Air Quality Management
Di'mra?
07 1995
❑ year ❑ No
NI?W RESIDENTIAL MIiCFl. $Q. i'I'.
JUM
1 have read the hmndous materials requirements under. Chapter 6.95 of the
California I Ieallh & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
Ci i T ur krUrth I INU
if the building does not normally have aaned
m, that it is my responsibility m notifythe
Occupant ol'the requirements which most he me, prior to issuance of a Certificate of
/���//7/�/
Ikcupaney,
d/
l At
I.1wE0 BY:
Owner or. uwhorized agent Dam
TOTAL:
OFFICE
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PROPERTY ENGINEERS T: (408) 370-3070
:5027 Kingston Way, San Jose, CA 95130 • General Contr. Lic. 585895 Fax: (408) 370-3071
BUILDING INSPECTOR, 6/12/95
CITY OF CUPERTINO.
Re: 22659 WEEPING OAK CT.
Permit H 28159
1) 30 corroded level -jacks were replaced. 5 jacks were left in place out a total
of 35 jacks.
2) All new jacks were installed at the exact same location where the old ones
were removed from. No addition or omission were made.
3) Existing concrete footing was reused and was not disturbed with the excep-
tion of drilling 1/8 In pilot holes for concrete nails. The footing
appeared to be in good condition.
4) All jacks (old and new) were painted with corrosion -resistant paint.
r
• GEO G S MO AI
Contract r