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LOT NO.
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APPLICATION FOR BUILDING PERMIT
CITY OF C_ UPERTINO
Sanitary No.
Date 196--1�-Permit No. /0 Cj O
A plication is hereby made for a permit to 57;
a story, Type <? 1-ra�/P X Building
to be occupied only
in accordance with
Plans, Specifications and Plot -Plan filed herewith. PI Ck Fee
Estimated Value of Improvements, $ �d0_ ' - Fee $
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino wil e complied with.
Owner;? oro d C"a117 Address /oiS''f
By Address_ lO/ V I/ So. AY7/4 A ear i�;,P
Phon -3- o i s
Approved
State
BUILDING INSPECTOR
• LOT NO.
NO. STREET
W Z LI TIO FOR BUILDING PERMIT
so:
Y CITY OF CUPERTINO
LL
0 V �MQ 1 �)`6
Sanitary No.
LLDate 196 _ Permit No. Al 6
r O
o PITY 1i {� �de f r a per to_ � ► i�C'�31 ED.t!%L� LLQ
z in ate" story, Type _ _Ih%! ` 1`>�1 Building
Q W
to be occupied only as in accordance with
0 o plans, Specifications and Plot -Plan filed herewith. P1 Ck Fee 7 !�
zt Estimated Value of Improvements, $ 1 0OG Fee $�
z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J Zall other laws applicable to the construction, location, and use of buildings within the City of
J o Cupertino will b compl' with. ���
3 N Ownetft) 2?I/ 4' ^ Address
a By_W P �i 1 005 (�.8Address_ �Q �tGI
'`� y[41
_ U Phone, `�
Approved ..
State License_-
13_q? BUILDING INSPECTOR,
Lot No.
No. Street
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
File No. Q Q
Sanitary No.
Date 196
pplication is hereby made for a permit to
to be occupied only as
a , w stAV, Type
in accordancif- ith Plot Plan, Play( and Specification died herewith„
m
Estimated Value of Improvements
WO
FEES
Dwr.er
:ontr. �.
Phone r�.i�%-edY t
$ SCOL70 °
Plan Check $ 7
Address p04p
Address 8'-,0 '
State License 0 54 9,
Approved _C /
APPLICATION FOR ELECTRICAL PERMIT
Date 196 L FEE$ L
Ulew
Conti. Address •O
Shone Zs'Z '3, Y• State License " y
Approved
APPLICATION /FOR PLUMBING & GAS PERMIT
Date d O 196 S' GAS FEE.$..,
PLUMBING FEE $
:ontr. Address��/•p
'hone State License d?
Approved
APPLICATION FOR APPLIANCE PERMIT
)ate 196 FEE$
:ontr.
Phone
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
Address
State License
Approved
y Y/
APPLICATION FOR ELECTRICAL PERMIT
Date 196 L FEE$ L
Ulew
Conti. Address •O
Shone Zs'Z '3, Y• State License " y
Approved
APPLICATION /FOR PLUMBING & GAS PERMIT
Date d O 196 S' GAS FEE.$..,
PLUMBING FEE $
:ontr. Address��/•p
'hone State License d?
Approved
APPLICATION FOR APPLIANCE PERMIT
)ate 196 FEE$
:ontr.
Phone
Applicants agree not to violate any of the
Workman's Compensation Laws of the
State of California
Address
State License
Approved
19�C IDi? I TION A,P,� R A -LS
V p a04""�ICDING
FOUNDATIO
WATER SYSTEM
Date
Ins pector
i
TERIAL
UNDERFLOOR
TOTAL FIXTURES.
CIRCULATING HEATERS
UNDERGROUND
FIXTURE FEE
_ tector
FRAME
BLOWER FURNACES
Date
e
MAIN DRAIN FEE
SUSPENDED UNIT
ROUGH COMPLET C
. Inspector
LATH & PLASTER
vt(40
STORM DRAIN FEE
nspector
FINAL
nspector
WATER SYSTEM FEE
GAS PIPING
'
Date Ins.oector
D to
actor
ELECTRICAL
OUTLETS
SERVICE SIZ
SWITCHES.
DE G OU
IROUGH
nspector
PERMIT FEE
. je`16ate
Inspector
RECEPTACLES
WIRI G
FIXTURES
wenA.0 r J
FINISH WIRING [ V L
Inspector
H.P. CHARGE
to r-
FIXTURES �o
s pector
Date -
Inspector
PERMIT FEE
_
Motors ��'
.pector
TOTAL FEES
—
FINAL b
Date
Inspector
PLUMBING & GAS
MAIN DRAIN
SIZE
MATERIAL
STORM DRAIN
SIZE
MATERIAL
WATER SYSTEM
I SIZE
FEE
i
TERIAL
UNITS
TOTAL FIXTURES.
CIRCULATING HEATERS
UNDERGROUND
FIXTURE FEE
PARTIAL ROUGH
BLOWER FURNACES
Date
e
MAIN DRAIN FEE
SUSPENDED UNIT
ROUGH COMPLET C
MISC
Do td
pector
STORM DRAIN FEE
MAIN DRAIN
�'
Date
nspector
WATER SYSTEM FEE
GAS PIPING
'
TOTAL FEE
D to
actor
GAS PIPING FEE
FINAL f
r,+
Date
nspector
PERMIT FEE
MISC
Dote
Inspector
TOTAL FEE
MISC
VaTe Inspe CTor
APPLIANCE
TYPE OF APPLIANCE
UNITS
FEE
TYPE OF APPLIANCE
UNITS
FEE
CIRCULATING HEATERS
REGISTERS
BLOWER FURNACES
COMBUSTION VENT
SUSPENDED UNIT
MISC
GAS RANGE
MISC
GAS DRYER
PERMIT FEE
FLOOR FURNACE.
TOTAL FEE
INSPECTED
Date Inspector
Lot No.
No. Street
CITY OF CUPERZIHW
APPLICATION FOR BUILDING PERMIT
Sanitary No.
File No.
Do to 19
_-Applicatiop is hereby rngpeq for a permit to
0 A&a `story, Type
to be occupied only as
in accordance with Plot Plan, Plans and Specification filed herewith„
Estimated Value of Improvements $
FEE$ Plan Check $
Ownerbr9 Address
Contr. Address
Phone State License
Approved
APPLICATION FOR ELECTRICAL PERMIT
Date
19 FEE$.
Contr.
Address
Phone
State License
Approved
APPLICATION FOR PLUMBING & GAS PERMIT
Date
19 GAS FEE $
PLUMBING FEE $
Contr.
Address
Phone
State License
Approved
APPLICATION FOR APPLIANCE PERMIT
Date
19 FEE$
Contr.
Address
Phone
State License
Approved
Applicants agree not
to violate any of the
Workman's Compensation Laws of the
State of California
on i -
RECORD OF INSPECTION APPROVALS
BUILDING
MISC.
DAD FINAL
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINAL BLDG.
UNDERGROUND ROUG
ROUGH WIRING
FINISHED WIRING
FIXTURES
MOTORS
FI
ELECTRICAL
DATE INSPECTOR
PLUMBING, GAS & APPLIANCE
DATE INSPECTOR
MISC.
MISC.
BACK FLOW REQ.
SANITARY NO.
UNDERGROUND;ROUGH
PARTIAL ROUGH
ROUGH COMPLETE,""
MAIN DRAIN
FINAL PLBG.
FINAL GAS
FINAL APPLIANCE
DATE INSPECTOR MISC.
CITY OF CUPERTINO
APPLICATION FOR RESIDENTIAL BUILDING PERMIT
AND
CERTIFICATE OF OCCUPANCY
oo/u»^mm /maPsorOw m/v/a/mm
�
DEPARTMENT USE ONLY
pvonanonoivauay-----------------oom--------.
REQ.: Plans.... Survey .... CaIcs: Struc ..... Energy.... Elect ..... Mech.
� P--- ----- -' -'-- _Dat'-
oote�`�'���'�-u/
Validated By oom........................ �
---'--------'_------� �
Compensation Certificate Verified ay .................. Date .........................
r�Permit Fee �'a
p|on ohoo� re�-�esode���r��!!��' nct. .�---) *-����±��^�
� # .'-..*
`
Strong Motion '~nA'f.�'o�eo.1............................. ........
4N Plumbing Permit roo .............. ............. --------- _'�
� s|om,ioalPonnnFeo -----------'���^��^^�`���
`
Mech. �
va'^~^~~~'y -°~ --'------ '----'
Residential Construction Tax ........................................ *... ...................
Misc. Foo . $ .......................
misv Foo-'--------------------'$ --
TOTAL FEE PAYABLE $ 13 t, 7 (o
ZONING REQUIREMENTS�
oonu uooponnn� vananoo � parunoepacov---'
Approved
'-'ay--------_-------'Date ...........................
PUBLIC WORKS REQUIREMENTS
Incroachment pennu-------o�nms000mon�------'
���N�u,u. Gutter, aiuewam, Driveway: nop/000---. nomuc--'
' Gower ............ Conn. Fee *................ Water ................ Meter $ ................
Agreement for Completionm Public Works Improvements .-----.
Plans chooxou oy--' Date ........ Approved ey--' oate.------.
APPLICATION FOR ELECTRICAL PERMIT
PERMIT INSTALLATION NO. EACH FEE
New Residential occupancies Flat Rate
1251-1500 32.00 2501-2750 4o.00 ..............................
�Permit Fee ................................................ $6.00
TOTAL sLsorR/oAL psnm/r FEE (Plus penalty if app.[])
INSPECTION
RECORD
�OF
1st Struct. Improvement on Parcel: Yes .... No .... Area of Bldg ...............
Separate Structure ............ or Addition/Alteration to Exist. Bldg ...........
11
s
"I certify that in the performance of the work for which this permit is
issued I shall not employ any person in any manner so as to become subject
to the workman's compensation laws of California."
SIGNATURE OF
��
PERMIT NUMBER
TO IN
FOR APPLICANT FILL
STREET ADD�PES PROJECT:
�OF
1st Struct. Improvement on Parcel: Yes .... No .... Area of Bldg ...............
Separate Structure ............ or Addition/Alteration to Exist. Bldg ...........
'Contractor: City Bus. Lic. #
"I certify that in the performance of the work for which this permit is
issued I shall not employ any person in any manner so as to become subject
to the workman's compensation laws of California."
SIGNATURE OF
--I certify that as the applicant I am licensed unde, the provisions of the
Contractors License -Law and further that my Licens, No. ;:;Ve.4re.71
I certify that I -9m exempt from the "Licensed Required" provisions of the
Contractors License Law. (State basis of exemption.)
1 hcreby acknowledge that I have read this application and state that the above is
t,orrect and agree to comply with all City Ordinances and State Laws regulating
I (We) agree to save, indemnify and keep harmless the City of Cupertino
against liabilities, judgments, costs and expenses which may In any way
accure against said City in con quencp of^ granting of this permit."
SIGNATURE OF
NOTE: When properly validated this form constitul'e"s a Building Permit. This
permit expires and becorifes null and void should work not.be commenced within
120 days from validation date, or should authorized constiniction be suspended or
abandoned for a period of 120 days after work is commenced.
APPLICATION FOR PLUMBING PERMIT
PERMIT INSTALLATION NO. EACH
FEE
i
I I
Misc. (See Ord. Current) .........................
TOTAL PLUMBING PERMIT FEE (plus penalty if app. -7]) $,10
APPLICATION FOR HEATING/COOLING PERMir
PERMIT INSTALLATION
NO. EACH
FEE
TOTAL Htg./ Coolg. Permit Fee (plus penalty iF app. E]) $
./
y ,'-- L' \
Sheet 2
L'Y OF CUPERTINO BUILDING PERMI
Permit NO: -_a0 01
Address: O' .S' �'�/ 4V-6--
Date: 3
BUILDING PROJECT IDENTIFICATION
Applicant's Mailing Address
Address of Building
Owner's name
Telephone No.
Contractor's Name
Contractor's Mailing Address
Architect or Engineer
Architect's or Engineer's Address
Lic. No.
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions -Code d my license is in full force and effect.zd r,
License Class � / Lic. Number `
Date �Contractor
ONVNER•BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License
Law for the following reason (Sec. 703115, Business and Professions
Code: Any city or county which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars (S300).):
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such
improvements are not intended or offered for sale. If, however, the
building or improvement is sold within one year of completion, the
owncr•builder will have the burden of proving that he did not build
or improve for the purpose of sale.).
F1 1, as owner of the property, ant exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business and
Professions Code: The Contractor's License Lav does not apply to
an owner of property who builds or improves thereon, and who
contracts for such projects with a contractor(s) licensed pursuant to
the Contractor's License Law.).
E]I am exempt under Sec. B.&P.C. for this
reason
Date. Owner
WORKERS' COMPENSATION DECLARATION
I hereby a.Tirm that 1 have a certificate of consent to self -insure,
Or a certificate of Workers' Compensation Insurance, or a certified
copy thereof Se 800, Lab.C.,. n
Policy \ Cumpanyp�TG �osr ✓� �L.ni�
Certified copy is hereby furnished.
Certified copy is filed with the county building inspection
depart e t o Aunty artmen
Date Applicants j�art
CERTIFICATE OF EXEMPTION FROM NVORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
hundred dollars ($100) or less.)
I certif},that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to become
subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you., should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit. is issued (Sec. 3097,
Civ.C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county-
ordinances
ountyordinances and state laws relating to building construction, and'
hereby authorize representatives of this county to enter upon the
above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
"OWNER -BUILDER VERIFICATION
"Attention Property Owrer:
"An.'owner-builder' building permit has been applied for in
your name and bearing your signature.
"Please complete and return this information in the envelope
provided at your earliest opportunity to avoid unnecessary delay
in processing and issuing your building per^it No building permit
will be issued until this verification is received.
1. 1 personally plan to provide the major labor and materials for
construction of the proposed property improvement (yes or no)
2 1 (have/have not) signed an application for a
building permit fcr the proposed work
3, 1 have contracted with the following ptrson (firm) to provide
the proposed construction:
Name.
Address City
Phone Contractors License No.
4. 1 plan to provide portions of the work, but 1 have hired the
following person to coordinate, supervise, and provide the major
work-
Name
Address City
Phone Contractors License No.
5. 1 will provide some of the work but 1 have contracted (hired)
the following persons to provide the work indicated:
Name Address Phone Type of Work
Signed:
Property owner
Social Security number _
Date:
•
A
*I
.APPLICANT TO FILL. IN INFORMATION WITHIN'RED LINES - USE BALL POINT PEN ONLY
BUILDING -- APPLICATION & PE
BUI LDI NG'PROJECT I DENTI FICi I WHA
-
/iy �OBUILDING_ ELECTRICAL- PLUMBING - MENICAL
�G `
PERMIT NUMBER
oAl�+ADDRESS
[Ioo/4
PLAN CHECK VALIDATION
OWNER'S -
NAME QTY. ELECTRIC PERMIT FEE
.e of PHONE '
CONTRACTOR'S
NAM
OUTLETS - SWITCHES - RECEP 5.00/1.00
5'p uc.nio. G
LIGHTING FIXTURES 5.00/1.00
-
DATE OF APPLICATION
CONTRACTOR'S
ADDRESS , ,APPLIANCES
ADDRESS
//t /
3q2 (/ {/ f T T PHONE Ff -
- RESIDENTIAL 4.00
PANELS 5.00
ARCHITECTSIGNS,
OR
ENGINEER - -.
' LIC. NO.
6.00
PLAN CHECK FEE
P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ENG.SPECIAL
ADDRESS
CIRCUIT S,QO
PERMIT VALIDATION
'
TEMP. METER OR,POLE INS. 15.00
ZIP
'
APPLICANT'S _
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
tY��
LICENSED CONTRACTORS DECLARATION
'I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business'and
Professions Code nd my license is in full fore anG feet
License CI ss Lic. Number G
ISSUANCE DATE
CUFERT
BLDG.
ELECT.
❑
PLG.
❑
MECH.
❑
Date - Contract , e
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License'
'Law for the following reason. (Sec. 7031..-5, Business and Professions
Code: Any city or county which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed Statement that
he is licensed pursuant to the provisions of. the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
` J IV r
I BUILDING PERMIT
n INFORMATION
. MISC. - . REFER TO
VALUATION $/FT.
�O
/- Q
- ' PERMIT ISSUA _ 6.00
ELEC. CONTR. -L
ELEC.
TOTAL
PERMIT Tp n
_
QTY. PLUMBING PERMIT FEE
-
t„� rORIES',,,
TYPE CONSTR.
by any applicant for a permit subjects the applicant to civil penalty
of not more than five hundred dollars (5500).):
-
ALTER DRAIN &VENT -WATER (EA.) '4.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure'is not
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA,COND. 4.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property _who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
ments are not'intended or offered for sale. If, however, the building.
F I XTUR ES - PER TRAP 4.00
SO- F7, FLOOR AREA
TOTAL ACREAGE
T
GAS - EA. SYSTEM - 1 INC.4 OUTLETS 4.00
or improvement is'sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im
prove fdr purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with
. -..
GAS - EASYSTEM -OVER4 (EA) 100
BUILDING USE
RES IND CON PB Other
S
INDUSTRIAL WASTE INTER. 20.00
licensed contractors to construct the.project'(Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
io an owner of property who builds or improves thereon, and who
LAWN SPR IN KLERS - 1 INC 5 V.B. 5.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.)' 1.00
contracts for such projects with a contractor(s) licensed pursuant to
the Contractor's License Law.
SEWER -SAN -SANITARY-STORM EA. 200ft/8.00
TRACT NO.
PARCEL NO.
1 1 am exempt under Sec. ' , B.&P.C. for this
reason
WATER HEATER W/V ENT 4.00
Date Owner ''
WATER SYSTEM 4.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 4.00
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure.
or a certificate of Workers' Compensation Insurance, or. a certified
ZONING
ENG. SITE NO.
copy thereof (Sec. 3800, Lab.C.). p
Policy No. CO In , ny
F IRE SPRINK
V N
❑
ENERGY 7.24.
V N
❑
❑ Certified copy is hereby furnished.
❑ Certified y Is fit thg city inspection division.
Applicant- y s �//�--��=•�
MISC. - REFER TO ORD.
CERTIFICATE OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 6.00
FLOOD ZONE
A.L.U.C.
PLG. CONTR. LIC. N0.
PLG.
TOTAL
COMPENSATION INSURANCE
(This section need not be completed if the permit is for'one
Y EJN ❑
V EJ N ❑
hundred dollars (S 100) or less.)
1 certify that in the performance of the work for which this per-
mit is issued, 1 shall not employ any person in any manner so as to
QTY. MECHANICAL PERMIT FEE
.
FEE SUMMARY
-BUILDING
become subject to the Workers' Compensation Laws of California. -
'Date Applicant
ALTER OR ADD TO MECH. 4.00
NOTICE TO APPLICANT: If, after making'this Certificate of Ex-
APPLIANCE 4.00
PLAN CHECK
FEE
/ f O
IP
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit.shall be deemed revoked.'
AIR HANDLING UNIT (TO 10,000 C. F.M.) 3:00
AIR HANDLING UNIT (OVER 10=C.F,M.) 5.00
SEISMIC FEE
SZ%
CONSTRUCTION LENDING:AGENCY
I hereby -affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address •'
HEATING UNIT (OVER 100,000 B.T,U.)7.50
ELECTRIC
I certify that I have read this application and state that the above
VENTILATION FAN.(SINGLE) 3.00
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
- BOILER-COMP(3H.P. or 100, 000B.T,U.) 4.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives' of this city to enter upon the
above-mentioned property for inspection purposes.
MISC. - - REFER TO ORD.
(We) agree to save, indemnify and keep harmless [11e City of
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said , ' y in consequence of the
CONST. TAX
'
PERMIT ISSUANCE 300
.
granting of tl ' ennit. .
�'/
ti V I1
'MECH. CONT. LIC. NO.
MECH.
TOTAL
TOTAL
7
SIg a ure of Applicant/Contractor D to
OFFICE COPY
CITY CpconERTi«m
CITY OF CUPERTINO 1
R{�
1
APPLICATION FOR RESIDENTIAL BUILDINGP6O��� ~ '
AND
L CERTIFICATE OF OCCUPANCYP /\ �
Bu|Lo|wm INSPECTION DIVISION^ '
DEPARTMENT USE
ONLY
Plans Received By ........................ ~.......................
Date ......... ..............
REQ.: Plans.... Survey .... Calcs: Struc.__
Energy.... Elect ..... Mech ....
7e1-1000 26.00
2001-228o
oy.so----..-----.
1001-1250 28.80
uum—0000
*u.00----------.
12e1-1500 ' 32.00
Permit Fee _(plus penalty ' applicable)
........................ ---------- ............
Plan Check Foo U000 uopoonor$--.
not. # ..........)$'_---_
snomv Plan cxook Foo (Dep. m$ ........
Rot. # ........ $ .-------.
Strong Motion Fee ...........................................................
$ .---^J[���
Plumbing Permit Fee ...................
$ .......................
Electrical Permit Fee ......................................................
$ --,'--'--�
Mach. Htn/coo/n. Permit o----.-----.
$ .---............
Residential Construction Tux ........................................
Misc. Foo ----------------------'�--�(�—�'�01_—
$..
Misc. Foo -----------------------$
FEE PAYABLE
..... �
....TOTAL
$
ZONING REOUIREMENTS
against liabili i d and pan as hich may in any wa?
%ncosts
accure against Ci t nse c t gr ting of this permit'
SIGNATURE OF
NOTE- When properly validated this form constitutes a Building Permit. This
permit expires and becomes null and void should work not be commenced within
120 days from validation date, or should authorized construction be suspended or
abandoned for a period of 120 days after work is commenced.
APPLICATION FOR PLUMBING PERMIT
Cond. Use Ponn/t # .... ....... Variance # ............
Parking Spaces ............
Approvedov...........................................................
Date ...........................
pnmaoxmomPermit ...... *................. Grant oxEasement ........................
'unb, Gutter, Sidewalk, Driveway: nopaoo.......... ..........
Sewer --' Conn. Fee ................ Water ................ Meter $ ................
Agreement for Completion ovPublic Works Improvements ..................
Plans chooxou By Date ........ Approved By Date .------
Psnm|T INSTALLATION
Light Outlets ............ Switches ............
Fixtures ............ Receptacles ............
TOTAL NUMBER (less than 1000watts) —'
Cooking Unit --. Ovon---' .........
Garb. oisn--'Dishwasher .............
MOTORS: 1*Po,less .........................................
Greater than 1 Hpnot more than sHp.......
Temporary Power Pole o,Service --1ooamp
200 amp.
NO.1 EACH I FEE
*.5«
—' »'»»
2.00 __
-- 2.00 .......
...... 3.50 .. ............
ozm 'L---
....... . r.00 ... L ---
TimeClock .................................... .......................... L—.11 1.5« ... L---.
New Residential Occupancies Flat Rate
u—000sq. ft. ouu.00
1501-1750
oo*.00----.-----..
501-750 u*.ao
1751-20000
or.so----.-----..
7e1-1000 26.00
2001-228o
oy.so----..-----.
1001-1250 28.80
uum—0000
*u.00----------.
12e1-1500 ' 32.00
2501-2750
**.00 ..............................
Permit Foo---------------'.
$6.00
TOTAL ELECTRICAL psnm/T FEE (Plus penalty nu»».[0m
Final —Public Works ...........................................................
���
PERMIT NUMBER
FOR APPLICANT TO FILL IN
ST REET ADDRESS OF PROJECT:
1st Struct. Improvement on Parcel: Yes.... No .... Area of Bldg .... ..........
Separate Structurg ........... or Addition/Alteration to Exist. Bldg ...........
r,
Owner:
Z�
Contractor
Contractor's Address:
"I certify hat in the p mance work for which this permit is
issued no a arson an so as to become subject
SIGNATURE 0
ow
"I certify that as lican, I am c.ns.d unde, the provisions of the
Contractors License Law and further that my Licens, No . ............................
I certify that I am exempt from the "Licensed Required" provisions of the
Contractors License Law. (State basis of exemption.)
I hereby acknowledge that I have read this application and state that the above is
,�orrecl and agree to comply with all City Ordinances and State Laws regulating
I (We) agree to save, indemnify and keep harmle the City of Cupertino
against liabili i d and pan as hich may in any wa?
%ncosts
accure against Ci t nse c t gr ting of this permit'
SIGNATURE OF
NOTE- When properly validated this form constitutes a Building Permit. This
permit expires and becomes null and void should work not be commenced within
120 days from validation date, or should authorized construction be suspended or
abandoned for a period of 120 days after work is commenced.
APPLICATION FOR PLUMBING PERMIT
PERMIT INSTALLATION
NO. EACH
FEE
TOTAL PLUMBING PERMIT FEE (plus penalty if app. C]) $
APPLICATION FOR HEATING/COOLING PERMIT
PERMIT INSTALLATION
NO. EACH FEE
TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. 0) $
CITY UG CUPF,RTINO IEISPL:CTIO1! REiCORD (Office.Copy)
0465 10144 So. Blaney___.__
PL'P11IT T10. SANITARY DIST. NO. LOT NO. A1)1)I:I;SS
Remodel/doors D. Heldman
PROJECT 0UNER JOB SITE PII014E NO.
PERMIT ISSUED Date ELECTRICAL
Bu:ildin 6-22-81 Date Insp.
Electrical ].'ower' Po_l.e
PIumhinn ~`
Under ,round
Hechan.ical Rc)ugh Wiring_
Temp. Gas/Ellcct. Ualls
Solar Ceiling
Tire Sprinkler Fixtures Int/Ext
Si.n Hotors..
Grounding
Hisc. Temp. Power
FINAL INSPECTIONS
Date j Insp.-
r,-,.
15U 11,1j.W s
Date I Insp.
foundation
Pre-Gunite
Slab-Hembrane
Bond Beam
Underfloor Girders
Floor Steel
Tiedowns
Diaphrams
Seismic Bracing
halls -Panels
1, rame
Lath
Wallboards Int/I?xt.
Firewalls
Other
Not Aunroved
Other
INot Approved.
PLUMBING
Date
Backflow
Insp.
Underground (j� Q/ (�,,,,(. /p.a4l
Underfloor
Fire Dampers
Partial Rough
Fireplace
Rough Com let
(,rease Duct & hood
Solar Rough
One Hour Shaft
I -later & Insulation
Condensate Drain
Main Drain
Equipment Anchorage
R/of/S Drain
Flues & Comb. Air
Gas
Other
--a C,51h4
Not Approved
Not Approved
MECHANICAL
Date
Underfloor S.H.
Insp.
Ducts-& Insulation
Fire Dampers
Fireplace
(,rease Duct & hood
_
One Hour Shaft
Condensate Drain
_
Equipment Anchorage
Flues & Comb. Air
Other
Not Approved
BUILDING
c
ELECTRICAL
r
s PLUMBING
MECHANICAL
MISCELLANEOUS
1 �
C''_ "= O F C U P-- R T I N 0 - 4
Building Division.
-IROJ CT..
ADDRESS D / S �.L
0?s TER JJ 19-0 7C1 y IF I—J/
ADDRESS
REP
ARCHITECT
REP.
CONTRACTOR
REP.
SUPT.
DATE PEC
NC: /7 �/�
119 A,/ PHONE
PHONE
PHONE
PHOPdE
PHONE
DATE '1=1.
FILE
SA,
BLDG. TYPE
OCC. GROUP
VALUATION $
TO TRUCT. ENG.
dDGIP/Ll&�CK. FEE -�j
BLDG. PERMIT -E
CAP FEE
TOTP.?• FEES
LARKS
BLDG. D_--.
2IG. DEPT.
PLA KING DEPT.
f Le
n d
1-COLWTY iI;'ALTH
L_TTY TIRE _LPnSF.PL
T'dDUSTRIPJ, WASTE
—
STRUCTU 3_ , ENG.
r 3d
SXll L, iY i) STRICT
SOILS I' l7-ESTIGATION
SOIz`. CO (ACTIO r
10300 Torre Avenue
Cupertino, California 95014
Telephone: (408) 252-4505
DEPARTMENTOF PLANNING AND DEVELOPMENT
Cttfq of CW perti»a
January 14, 1982
P.O. Box 580
Cupertino, California 95015
Mrs. Dorothy Heldman
10144 S. Blaney Ave.
Cupertino, Calif. 9501.4
Dear Mrs. Heldman:
When an inspection was made of your addition, it was noted that the
bar sinks in the units were changed to double compartment sinks. This
is a possible indication to us that ,you are contemplating a second unit
within your dwelling and, of course, is not permitted under present zoning
ordinance without prior Planning approval.
We are requesting a letter ,from you stating that you.understand that
an apartment unit within your dwelling is not permitted without proper
approval from the Planning Department.
If you have any questions, please contact this office.
CITY OF CUPEKINO
i
John Busto,
Building Official
JB:hm
r �,
MELVIN R. HILL INC.
RCE 19704
410 W. SUNNYOAKS AVE.
CAMPBELL, CA 95008
(408) 866-1546
17 N ove mbe r 19',811
BLDG. INSPECt+- JCITY
OF C�,'cri ; �JJ f
Dorothy Heldman
10144 South Blaney Avenue
Cupertino, CA 95014
Dear Mrs. Heldman,
I have examined the drainage plan drawn by Frank Oldham for
your property at the above address. The plan is sufficient
to provide for drainage from your property with the following
additions or changes:
1. A new downspout should be installed in the roof of
the .garage at the low point of the roof. This is
near: the . southwest corner of .the overhang.
2. All downspouts should,connect to splash blocks and
drain away from the building. Preferably they should
be connected to catch basins.
3. An additional dry- well was put in near the front steps.
This shodld be connected to the proposed dry well
by use of a 4 inch cast iron pipe.
4. Two inch iron pipes should be. changed- to• 4 inch. cas.t
iron.pipes.
5. At each of. the. two dry wells, and at the center of the
driveway, a catch basin should be installed by using
a 12.inch diameter reinforced concrete pipe and a steel
g.rate°
A
6. The concrete walk on he east side of the house should
be sloped to drain to the catch basin. in the center of
the driveway.
7. -A new catch basin should be installed in the dirt area
easterly of the driveway. A 4 inch cast iron pipe
should be connected to the curb on the easterly pro-,
perty line.
8. The catch basin in the center of the driveway should
be connected to the proposed dry well with a 4 inch
cast iron pipe.
If these recommendations are carefully followed, the lot will
drain properly.
If you have any questions, please feel free to call me at my
office.
Yours truly,
Melvin R. Hill
R.C.E. 19704
.t1d a 6J 2
I FL
1
f r' L110
clk
N f':►..� ��Lk,r1 c_' e. r+•>�'. j ' %1 c v,S r,,,�7 jir�•, % '
IN ACCORDANCE WITH THE CITY OF
i
BLDG. INSPECT'ON IDEPARTMEI
T1�/y 3• ?
�� CUPE�TINO C DES D ORDINANCES
Imo) 0
,;3 !
CITY OF
RTINO I
tSIGNED
Tr;iS se of
ns and specificatisns MI�S'
athall times end it is un'.
ptoon the
/s /
2-
/,y,� t p� rp `L� �1 iiJ'P'' C
awfulbe
e any or afonlafrcrrn
on same without
-- - _
wiittengpeimaes
the buirding Dept., City of Cupe, t;no.
The stamping of thisAiend an specifications
SHALL NOT be he,d to pe.mit
- '
or to be aii
approval of the violation of any. provisien!!
of any City Ordinance or State Law.
I 1�
'''
N f':►..� ��Lk,r1 c_' e. r+•>�'. j ' %1 c v,S r,,,�7 jir�•, % '
IN ACCORDANCE WITH THE CITY OF
Z.�eLrI C
T1�/y 3• ?
�� CUPE�TINO C DES D ORDINANCES
Imo) 0
tSIGNED
Tr;iS se of
ns and specificatisns MI�S'
athall times end it is un'.
ptoon the
/s /
2-
/,y,� t p� rp `L� �1 iiJ'P'' C
awfulbe
e any or afonlafrcrrn
on same without
-- - _
wiittengpeimaes
the buirding Dept., City of Cupe, t;no.
The stamping of thisAiend an specifications
SHALL NOT be he,d to pe.mit
- '
or to be aii
approval of the violation of any. provisien!!
of any City Ordinance or State Law.
1
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CITY OF. C
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RE: Heldman's Res.;
10144 Blaney Ave.,_
S81-1-110
DEAR ANGELOO,
THE STRUCTURAL- ASPCETS OF THE ABOVE REFERENCED.PROJECT
R EV I E W E -W7`A E. C K E XT
HAS` BEEN: ND,,,4H CdMME S' A N D,
-FI.NDINGS ARE.
"'AS FOLLOWS S:'
OW
1. Need registered civil, or structural or architect
signature and stamp on the engineering calculations.
Footing design and calculation do not conform with
the 1976 UBC Table 29.A and Table No. 29-B item 5.
e
en
iI
3. In al the structural layout and the framing
Pidn is
not complete.
TECHNICAL ANALYSIS, INC.
1578 Stubbins Way, San Jose, CA 95132, (408) 259-6800
MR. ANGELO LEBER, Jan 31, 1981
PLANNING_ AND BUILDING DEPT.
EITY OF CUPERTINO
PERTINO, CALIFORNIA.
RE: Heldman - 's Res.;
10144 Blaney Ave.,
581-1-110
DEAR, ANGELO:
THE STRUCTURAL ASPCETS OF°THE ABOVE REFERENCED PROJECT
HAS BEEN'REVIEWED AND CHECKED. COMMENTS AND FINDINGS ARE
AS FOLLOWS:
Need registered civil, or structural or architect. -
signature and.starrip on the engineering calculations.
2. Footi-ng design and calculation do not conform with
the 1976 UBC Table 29.A and Table No. 29-B item 5.
3. In gerieral the structural. layout and the framing
plan is not complete.
THESE -ITEMS SHOULD BE CORRECTED AND RECHECKED
BEFORE A PERMIT IS ISSUED.
tAorP caF '.vim
- x 2
i VVV
rp— L_ ► v e- l -o -c5,0 r,j IV k t -aa -3 44
�u7v �..00F. 35#}c.3` = toy
144
S � JAN27�
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-3 z
4 8
-1-570
CAJ
of3- -:Z . 2
ell
_ 0323 X43x oCy , X3 = X3.1-7 s
• � 01ST � Fis-� --..,3��.'� :S � P� c. • �. i � ?� � , - 3 3F _. � �'ca 8 • 3 � % ..� S "�.
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t 3' i .25 1325 x 18 X 2-z5
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��- i2 50
E-FU2l2
C
10300 Torre Avenue
Cupertino, California 95014
Telephone (408) 252-4505
Cit4 of Capertbw
DEPARTMENT OF PLANNING AND DEVELOPMENT
April 19, 1979
Mrs. Dorothy Heldman
10144 S. Blaney Avenue
Cupertino, CA 95014
Re: SPECIAL INSPECTION AT 10144 S. BLANEY AVENUE FOR RE -ZONING FROM R-1 TO R-2
MRS. DOROTHY HELDMAN, OWNER
Dear Mrs. Heldman:
The following is noted as a result of a Special Inspection at the above address
pertaining to Electrical; Plumbing; Mecahnical; Fire, Life and Safety; and General
code requirements.
ELECTRICAL:
1. Provide a new 200 amp electrical main meter panel and disconnect with
extension wiring to a sub -panel within the front unit.
2. All existing wiring must be modified in order to provide separate circuits
for each side. No cross over permitted.
3. Kitchen wiring shall conform to 1975 N.E.C. and provide 2 (two) 20 amp.
circuits for small appliances in addition to required cooking appliances..
4. Outlet receptacles are required to be spaced on all walls per Sec. 210-25(b),
1975 N.E.C.
PLUMBING:
1. Provide bathroom facilities per Sec. 1305(b), 1976 U.P.C.
2. Provide a separate water supply gate valve to each unit.
3. Provide calculations for fixture unit demand load to insure existing water
line size is correct.
4. Provide plumbing layout for newly created unit and include waste, vent
sizes.
Page 2
-Special Inspection
April 19, 1979
PLUMBING - continued
5. Provide a 2 -way sewer clean-out within 2 -feet of building.
MECHANICAL:
1. Provide separate heating systems for each unit per Sec. 1311, 1976 U.B.C.
2. Complete City of Cupertino Energy forms which are enclosed. One for each side
unit is required.
3. Provide separate hot water tanks for each unit and show all locations on plan:
FIRE,' LIFE;... SAFETY: ,
1r Provide.. emergency..egressper.Sec.':1304, 1976 U.B.C.:.
...2.. Provide a smoke detector in each unit upper bedroom hallway per Sec. 1310(a),
1976 U.B.C.
3. Provide construction details of new stairway per Sec. 3305, 1976 U.B.C. for
width, height, stair tread, rise and run maximum 8" minimum tread width 9".
GENERAL:
T.. Off street parking requirements.
2. Required covered parking.
3. Provide construction wall details of the separation wall between units #1 and #2
and include provisions for sound transmission for wall and floor/celing per
• Ch. 35, Sound Transmission, 1976 U.B.C.
4. Provide required light and ventilation in accordance with Sec. 1305(a), 1976 U.B.C.
5. All minimum room sizes shall conform with Sec. 1307(a), 1976 U.B.C.
ZONING:
Make application for re -zoning for duplex from single family dwelling.
The fees for
this Special Inspection
are $75.00, payable to the City of Cupertino.
Should you have any questions, please
contact the Building Department.
Sincerely,
Fees determined as follows:
3 hours x $25.00 per hour
= $75.00
less deposit
= 50.00
Angelo Leber
BALANCE DUE
25.00
Building Official
AL/lf
Encl.
a of cu
Pertiro
T4: Angelo- Leber
" DATE: April 19, 1979
FROM: Ed I.1urphy
SUBJECT: SPECIAL- INSPECTION'AT 10144 S. BLANEY AVENUE
MRS. DOROTHY.+HELDMAN, OWNER',
TOPIC.: REQUEST FOR A RE-ZONING FROM SINGLE-FA14ILY RES.IDENTIAL,TO 2-FAMILY•RESIDENTIAL,
FROM R-1 'TO .R-2 ZONING.
The following is the Code requirements for this change
A)_-Front liveable area:,
1. Kitchen #2'shall be-changed and conform'to.1976 Uniform-,Piumbing-Code.
2.. Wall separating front liveable-area•from rear liveable area shall-conform
to Chapter 35-,„Sound Transmi'ssion.Control section of 1976 U.B.C.”
3• Light and ventilation shall conform with Chapter 14, 1976 U.B.C., Section'
1405 in all habitable,rooms.
4. Stairways shall con-form-to-Sec,.' 3305,•1976AU.B:C.'and serving'an occupant
load of less .than 10 can be 30 inches in width. ' ,Handrails may project
from each side�o;f a stairway a distance of.3-1/2 inches-into the-required
width. '
5. The kitchen wiring shall conform to 1976-National Electrical.Code and provide
2-20 ampere circuits for_the small appliance-loads in addition to other
wiring'for,operation of cooking a'pp
licances. These receptacles shall not
be ext'en'ded. to any other areas.
6.' Provide'a new electrical main meter and disconnect..-with extension-wiring to
a.sub-panel with 'the front unit.,
7. Receptacles shall be placed on new-walls in accordance with Sec. 210-25(b),
1975 N,.E. C:"
B) Rear Liveable,•A.rea.: -
1. ,The pla.n�. does not show additional furnace or'hot water heater. It would be :..
necess-ary'to`provide for heat and hot.wafer in the rear unit,.. New Energy
calculations required for all new-created areas.
2. The above would require heating calculations, and .the separation of"heat ducts
for the two..units or .the closing of•some of the'existing duct work.
• J'
Cites of Cuperti»o
TO: 'Angelo Leber, Building Official '.
-DATE: April ,5, 1979`
FROM;: Ed Murphy'. -Electrical Inspector
SUBJECT. SPECIAL INSPECTION AT 10144 S.'BLANEY AVENUE
Mrs. Dorothy Heldman, Owner
The owner requested on March 30, 1979 that a Special Inspection be made -of
the above -captioned property to,determine the possibilities.of re -zoning -her
present single family residential to multiple zoning.
The'main structure is a two story frame building that.coul'd be -remodeled to _
a 2 -family structure., There would be some modificio needed to the electrical
system, and probably it -could be best to -place 2 n'the main str.-uct'ure
and feed the- interior.through a sub -panel within the structure.
The; 'owner also asked about., addit'ion.al units on the rear' of the property.
I r.eferred.her to the Planning Department to ascertain the correct zoning
requirements: 'I, also advised'the owner' to get an architect to complete her plans,
before cbntacti`ng the` Planning Department.
EM{,lf
Eam
i/ %A-?RL1CAT;IO FOR PLUMBING PERMIT
MAY 1 iC Y.OP CUPERTINO
1968 sanitary No.
llat �` ,
, 196 Permit No Z O 0.1 O E-4—
ul 1-Y OF t IERTINg Pee 3 9 oe
Application is hereby made to City of Cupertino for a permit to install Plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner
CONTRACT(9R, AGENT
Phone 37o'-' 24"7,'
License /. o 61 <�- 71
A�
Address Add
rea I
later
Sprinkler Valves I 1 11 Water Sys. Fee I i r ap
RECORD OF INSPECTION
Final I