28834FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .l
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CIJPERTINO BUILDING - ELECTRICAL.
ffJG DIVISION APPLICATIONIPERD1 T PLwtnwc - ntecnnivlcnl'
PERMIT NO.
28834.
BUILDING PROJF.CI'LDI:NfIFICA' ON
INGADDRESS.
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.SANITARY NO.
APPLICATION SUBMITTAL DATE
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CONTACT. PHONE:
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BUILDING PERMIT INFO
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❑ Consultant Fees Pald by Appllcont (Inifinl)
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BLDG . ELECT PLUMB MECH
LICE ONTNACfOR:S DE LARATION.
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
wr
with Sect.mEX)o).fD A fNC Rao, IP f.saiom Crvle ani nylire Is
in full
ense force and effect /s�j -s
License Cl. 1. 'cp "" °�'�`'I -
Dmc Cnnt t
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CLL•CTRIC PF,RMIT
FEE
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JOB DESCRIPTION
RESIDENTIAL,
❑SFDWLO KITCHEN REMODEL
❑ADDITION _ ❑PLUMBING RE -PII'C
❑MULTI -UNIT' ❑STRUCTURAL'
MODIFICATION .
❑INTERIOR. .❑CHIMNEY REPAIR„
IMPROVEMENT
❑BATH RCMODEIREPAIR ❑ DEMOLITION
❑OIIER .
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PERMITISSUANCH
AI'PLIANCF,S RC,SIDENTIA4 -
ARCHITECTS DECLARATION -
understand y pl... hall be used as public records
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PANELS
UP 10209 AMPS ,•-
Licensed Professional
OWNER BUILDERDCCIARATION
i hereby f that atplf tth Contractor's I the
reasom. (Section 7031.5 Budim,, and P f Cwt A.Y ty ar aptudy
which requires permit to construct, It p demolish, repair any Wctu
201 IMAMPS
OVER I000AMPS
SIGNS ELE�ThICAL -
rte,]
}
A�
prml l Issuance. I: y th ,v tf 1, tt fil S Itit c1
slim h If .. d p u n active Pm f d Contractor's L
(coo gwth Sect ]IXXI) fD t.i n3 fish R JP f .Cod).,
;•
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SPECIAL CIRCUIT /MISC
r a
TEMP. METER OR POLE INST
COMMERCIAL:
a e a
tt•
y
1-, }
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F-
�" a..
in.( he xt opt fludef t told the bit,!, f 'he ulhgul exempt t r Any v elation of
Section 7031.56 beam for objects icantme civil pcnah f
Y anY aPP Permit sub e t the app] y n
not mom than five hundred dollars (8500). „
❑1, nw ewnentl the pnap,ny, nr my entpinyees with wugcs....ei(Se 7W4, B.,!.On,
will dothewons Cosh, structureisnotim icensur off, does of apply town Business
and Professions Crs (it i ue C as thereo License Law s such not apply to .n owner of
his ..y who builds or sided that thereon. and who does such work hlmx.,:, O,,d through
his own employeese provided slim such impms or altered ter
I
arc not iyear
❑NEW BLDG /ADDITION ❑DEMOLITION
❑TIiNANT ❑POOU SERVICE
IMPROVEMENT '
❑OTHER
POWER DEVICES ^.
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SWIMMING POOL EhF.CfIUC
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OUTLETS - SWITCfiFS- PIXTURIS
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NEW NF,SIULNTIAL [LECfR SQ FT.
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cold within ofd
ervbuilder will have the burden of In thin M1C did nw built nr improve for par-
own, Lhowevec 11 havelthe bur en of In roan isat heidone ymr, improve
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SQfFT'FLOO�ARF.A
S/SQ. PT.
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0 1, as ale)
❑1. n f the pmperY exclusively ucontracting , dot) the a..mmmoism
rat' ttb project (Sc 7044 Business u dl f 'Cd )Th C amrx I:
oy �
(g ���
6 5
T(
.y
QTY. PLUMBING PHRMIT
H
mr, eL ,d tapply t n fpropeny h builds p thereon, and
who contracts for such prjects with a commands) licensed pursuant t th Crmactnrs
a
PERMIT ISSUANCE ��
License
a Loss,
exemp under Sce. ; B & P C fcrddv reason
Vi Curt 11NO
ALTER - DRAIN & VENT - WATER (G)
BACK FLOW PROTECT DEVICE
�,/�/
ey
Own - Data
VALUATION
WORK[R.ICO'MPI:NSATIONDE CARATION
Ili by If 't made, pe hY f one ofthe following declarationo
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DRAINS - I,00R, tOOFARFA, CORD.
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=I/ li sound will C rtf t of C m , a 11 n,am towtalinlh,r, C iPCn -,
. o, as provided for by Section 3] W of the Labor Code, for the perform amc, of the
workforwhichshi, man is isa.M. '-
M 1 have and will mman)1in Worker's Contpcnandn 0 Insurunce, as rcyulr d by, Section
'SIDRI
a,
I YPE COL NSTR�U.
CT ON -
-
FIXTURES- PERTRAP
-
370dof the laMn Code, fan he pedommnceoflhe work for which this permit is issued.
My WOrker'a Comp nyyItion lnsu � ce artier and Policy pp re
GAS -EA .SYSTEM -IINC.40117G.ETS
OCCGROUP
APN '
Carricra5'flrl` "I�L1A^1 Policy N..:!
GAS EA. SYSTIiM- OVER4(EA) t
CERTIFICATE OF EXEMPTION FROM WORKL'NS'
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7�O
r~Na
Fa
COMPENSA'1'ION INSURANCE
• (Thisecnion need not he compinW i f the penult is loran, hnndoeddnllms(i 1 1X)
m less.) r
1 certify that in the performance of the work for which this permit is issued, l shall
not mnplwsfC ymmm,r sit us to ]aroma xuhjed mtbc Wnrkcrn'Cnmpcm
satinn laws of Corson In an
alifnmin. Date
Applicant
GRFASEIINDUSTRL WASTE INTIiECEPTOR
BUILDING DIVISION FEES
- r
GREASETRAP I, I
PLANCHECK FEE
SI?WBR - SANITARY - S
STORM EA. 200 FT.
ENERGY FEB
- -
-
WATER HEATER W/VENTII?LECTR
GRADING FEE
NOI' ]CRT O APPLICANT: fl. offer making this Certificate of Exemption, you should
become subject to the Workers ComPedualom provisions of the Labor Canto, you must
WATER SVS'fEM /I'RI3A'1'ING
SOILS FEE
GL7
Gi
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forthwith comply with such provisions or permit shall he deemN revoked
CONSTRUCTION LENDING AGENCY
I hereby affirm that here is a conehuction lending agency for the Performance of
the work for which thispaimit is cat (Sea 309], Cic C.)
Lender's Name 1
WATER SERVICE
PAID
Date Receipt#
i
NEW ROIDENTIAI, PLMIL• SQ. FT.
TOTAL:
LUIi
CL
Lenders Addmss -
TOTAL:
,1 certify that I have read this application and state that Me abuse fort is
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BUILDING FEE
L11
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carst agree tocomply withal] city and county ordinances and state laws relating to
building comnaction, and hereby authorize representatives ofthis city to enter upon the
QTY. MECHANICALPERMIT
FEE
SEISMIC FEB t
atawe- nealinncd pop rty to iu,sa, ion purposes
(we) agree tp.,a, indemnify and keep hornless the Cityol Cuperfincti,dret
PERMIT ISSUANCE
ELECTRIC FEE '
liebilities,judgmems,ensts and expenses which may in anywayaccrue againniacl City
in nsoquence ofthe granting ofthis permit. -
ALTER OR A00 TO MECH.
PLUMBING POPE
AIR HANDLING ON] T(TO IDOgI CFM) -
-
MECHANICAL FEE ,
APPLICANT UNDERSTANDS AND WILT. COMPLY WITH ALL NON -POINT
SOURCEE E�GULATION
A IR IANDLING U NIT (OVER I RWO CFM)
CONSTRUCTION TAX 'r
/f ZP! /� /Y 19 /r ♦ /�' /��
/ •reif V
Signature nVContraCcm/rG // a
HAZARDOUS MA'TERIAIS DISCLOSURE
EXHAUST HOOD(W/DUMT
HOUSING MITIGATION FEE
HEATING UNIT (TO 100.0IXt BTU)
Will the applicant or future building occupant store orhandle havallous material
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as defined by the Cupertino Municipal Cade, Chapter 9.12, and the Health and Safety
Cock, Section 25532(u)'1 / sd '�
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HuA'TING UNIT (OVER I Iy003 BTU)
❑Yes �/ x
�'YO
Will the applicam or future building occupant use equipment or devices which
anal hmalloms it conaminnmsas fned by the Bay Art. Air Quality Management
District' /Je
❑Yes, ,. r�Nn;,'. ,/e
PAID
VENTILATION PAN( SINGLE RESID)
Date Receipt#
BOILER - COMP(3HP OR 100,000 BTU)
TOI'Ah:
tlOILBR- COMP(OVER'100.MOB'I'U)
'
AIR CONDITIONER
I have read the hazardous materish requirements under Chapter 6.95 of the Cali-
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ISSUANCE DAT
NEW RESIDENTIAL MECH. SQ PI'.
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boom. Health &'Safety Code, Sections 2.5505, 25533 and 25534. I understand that if the
building does not currently have a tenant. that it ismyiesrymsibi ]ity tomnifytheoecupam
ofthe requirements which most he met prior to issuance of. Cedifcme of Occupancy.
ISSUED BY:
Owner or au horin d agent Dare
'TOTAL:
' .'OFFICE'
0
•
10/11/95
,s
City orb
Depnrtmout
Project Nan
Enforcing Olrc
Permit Number
O CJ�t6
The above named project has been granted an exception from the requirements of the State of California
Title 24 accessibility standards, based upon the following criteria:
i. The cost of access fcature(s) is ±$ 30 , 000
2. The cost of all construction contemplated is *— $ 5 6 , 0 0 0
3. A. The impact of proposed improvements on financial feasibility of the project is
± $28,00 over the budget
B. The access feature increases the cost of construction by ± $ 3 0 , 0 0 0
4, The accessibility features) which would be gained or lost is shallow sloping ramp
5. Type of facility under construction is . Redwood deck
It is used by the general public for the purpose of private Club House use
The following persons provided information on the above section:
S P Cas a on Hoskins Engineers Inc.
Firm Firm
P.O. Box 1405, Morgan Hill 501 S. Bascom A ose
Address Address IJIj
Signature
The determination of unreasonable hardship and this documentation do not allow a blanket exemption
from the access requirements. The exception provided for by this form applies to the following item of the
project:
Shallow ramp access and total facility upgrades
As specified by Title 24 (check one)
l () 1. Equivalent facilitation will be provided, as specified in Section
O 2. Equivalent facilitation will be provided, as determined by this enforcing body.
See Section . Equivalent fictilitalion will be
O 3. No provision of equivalent facilitation is necessary. See Section
The legal constraints are
The physicril constraints are
O 4, The approval of in appeals board is necessary to ratify the determination of
unreasonable hardship. See Section
and Section 2- 105(b) 110.
The legal constmints are
The physical constraints are
. •
This documentation and determination of unreasonable hardship ire developed in consultation with:
IQ/11/95 13:55 '$4087773933 CITY CUPERTINO
ADDENDUM TO IMMASONABLE HARDSHIP
� 003/003
To assist the Building Department in making a better decision, it is suggested the Applicant provide the
following information:
1. Total cost of entire project: ± $ 2 6 , 0 0 0
2. Total cost of project with full compliance and adherence to all handicap requirements:
± $56,000
3. DitTerence in Cost (s) ± $ 3 0 , 0 0 0
4. If you feel tltnt full compliance is too much of n hardship for your project, please itemize your
reasons: This protect is the dryrgt removal and replacement of an
exterior redwood deck. The cost burden for the correction of the
hazardous conditions exis gthe deck alone arc taxing the
homeowner's funds. The existing sloped site grades & existing re-
taining wall construction greatly inhilts h moy J � replace-
ment of the existing 1:10 access ramp. Full compliance will make
the deck repair unfeasable and tixa_p1".s7.e �
• 5. , what are you proposing to do in an affort to upgrade the handicap features of your property?
Upgrade handicap parking add curb ramp and signage.
. r wimvard/hrdshp
2.
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