30457 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO "' BUILDING-ELECTRICAL. PERMIT.NO. - O
BUILDING DIVISION APPIACATION/PERMIT ,PLUMBING'MECHANICAL.
" BUILDING PROJECT IDENTIF'ICAPFON
457
BUILDING ADDRESS: 2 /"1f . - SANITARY NO. APPLICATION SUUHMI JAL DATI
C
OWNEJi. :SNAM - t PHONH CO TRACTOR' NAME -LIC NO:
CONTROL#
d'� ' YTYL1C1✓h on 22�'
RCHITBCT/ENGINEER: LIC NO: ' A([J�p/�2�E�$/S:•�'••�- 1 t- "'��/- � '❑
M/O �.Lr AfirU� lAt.
CONTACD PHONE:„
i '. DUILDING PERMIT INFO
- . .❑ Consultant Fees Paid by Applicant(Initial) BLDG eLF.CT .F,PLUMB MECH
L - LICENSED CONTRACTOR'S DECLARATION - QTy, ELECTRIC PERMIT FEE 5
1 hereby affirm that 1 am licensed under provisions of Chapier.9(com uchring JOB DESCRIPTION
Z with Section 9000)ofFsvision 3 ofthe Busi and Pf.:ion Code,and lice se is
00 my PERMIT Issonrvce RESIDENTIAL,
m full force and effect
Nu L cense Class L'c.A `❑SP�WL ❑KITCHEN REMODEL.
Date - -Contractor APPLIANCES-RESIDENTIAL �{DDITION ❑PLUMBING RE-PIPE
ARCHITECT'S DECLARATION - a MULTLUNIT " '❑STRUCTURAL
I understand my plans shall be used as rolw records PANELS
Z O y, .p 'MODIFICATION
OZ^O UPT020AMPS ❑INTERIOR ❑CHIMNEYREPAIR
Licensed Professional' 201-1IXNIAMPS IMPROVEMENT -
% OWNER-BUILDER DECLARATION, OVER IJOB AMPS ❑BATH REMODELBEPAIR ❑D1iMOLITION
fG W 1 hereby affirm that 1 am exempt from Ihe,Gentmemrs License Lawlor the -
O y U following reason.(Section ID3 L5,Basins.,and Professiovs Code:Any city or county SIGNS ELECTRICAL ❑OTHER
WO m which respires a permit m arm...act,ulie,improve,demolish,or repair any swcmre
I prior to its issuance,also requires the applicant for such permit o Ne a signed statement SPECIAL CIRCUIT/MISE.
y
that he is lioutsed pursuant m the provisions oflhv Connacmr,v license Law(Chapter9
GAO (cont g rh5f '1000) fD"io 3 ftheR ens dP f..' sCode)or TEMP MP.'fl?MORPOLEINST.
d c .that h th tl fr m a d theh e.f it II 6 1 exec pt Any violation of
703156 t' ❑ BLDG/ADDITION [I DEMOLITION
Set
y y rep tat bj t tb poli n 1penalty of POWER DEVICES
nnl more than Tse hundred
dollars(8500). ❑TEPA ❑FOODSERVICE
yQ ❑ las owner ofthe propos my employees with wages as their 1 npematios, SWIMMING POOL ELECTRIC IMPROVEMENT
will do the%m,1Lmd flacquawar,is not intend) ff ed for I (Sri.7044,Business ❑OTHER
[A a and Professions Code:The Contractors License Law docs net apply.to an owner of OUTLETS-SWITCHES-FIXTURES
6 property who builds or improves thereon,and who does such work himself or through
his awn employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ FI' p `
sale:If,however,the huildiral improvement is sold within one year ofcumpletion,the ✓ SQ.FT.FLOOR AREA $/SQ.'ET.
owner-builder will have the burden of proving that he did not build or improve for our-
.. pose m"ale.l. S•- ��. p p'173
❑1,as owner of the property,am exclusively contracting with licensed conuamun m 3y
construct the Project(Sec.7044,Business and Professions Code:)The Contractor's Li- 00
cense Law does not apply to an owner of property who buddxai improves(hereon.and QTY. PLUMBING PERMI B
who contracts for such projects with a conuacun(s)licensed puisuuvt to the Contmclers
License Law. PERMIT ISSUANCB
❑'f am exempt under Sec, ,B&P C for this tso
'ean
ALTER-DRAIN,&V T-WATER .A) .
Owner Date .. - VALUATION ,
WORKER'S COMPENSATION DECLARATION, BACK FLOW PROTECT.D. CC Q^ 7n >
V�0 I hereby affirm under Penalty of territory one of the following declarations:, (7I /f.Ll
I hevnand"ill maimuinn Cemgcatenf Consenvo sell'-insure for Worker's Compen- DRAINS-PLOOR,ROOP,A REA,Crs
STORIES .TYPE CONSTRUCTION
series,as provided for by Section 3700 of the Labor Code,for the perfommnce of the
work for which this permit is issued. FIXTURES-PER TRAP
❑I have and will maintain Workers Compensation Insurance,as required by Section
3900 of the Labor Code,for the performance of[lie%ark for which this permit is issuul.. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
Cmal. 's Gs'peneainp insr Pol cy NnY nye+ / e/
VV Fier urs_ rr Yhil't2T GAS-EA.SYSTEM-OVER4(EA)
CERTIFICATEOFEXE PTION FROM WORKERS'
COMPENSA ONINSURANCE - GR WASTE INTERCEPTOR
(Thissection need not be completedifthe permit is farone hundred dollars P$100) - Bll11..DINO DIVISION PEES -
or less.) GREASE TRAP PLANCHECK I2C -
Icoal l'y that in the'Barnanceof the week for which this permit is issued,Ishall SEWER-SANITARY-STORM EA.200 FT. ez
not employ any person in any manner so as m become subject the Worker'Compete ENERGY PEE
Z .cation Laws of California,Data I I ISO
O A licant - WATER HEATER W/VENT/F.LEC'
PP - GRADING FP.P.
NOTICN become TO APPLICANT If,after Compensation
this Certificate of Exemption,you should WATER SVSTEM/1'kCATING
RFai I["
become subject,the Worker's Coons or hisprovisions Ml he Labor Code,you mull SOILS FEC`
Lit ry forthwith comply with such provisions or permit shalt bedeemetl rcvnkeA. WATER SERVICE '
Q
'r U O CONSTRUCTION LENDING AGENCY NEW RESIDENTIALPLMB. SQ:FT. PAID �_
I herchy afftmvhe,there iso construction lendingagency for the pedometers,of Data Reeeipl
w he work for which this pemdt is issued(Sec.3197,Civ.C.)
Q U Lender's Name 'TOTAL:
[,brief,Address TOTAL:
1 certify that 1 have read this application and state that the above immour don is BUILDING FEE
h oor'ce,I agree'.comply with all any and county eminences and state laws relating to QTY. MECHANICAL PERMIT
"U building construction,and hereby authorize representatives of this city to enter upon the SEISMIC PEE
above-mentioned property for Inspection parpose, -
W a g PERMIT ISSUANCE( gree m save,indemnify and keep harmless the City of Cupertino a airol ELF,CTRI,FEF,
Iiabilitiev,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MLCH.
n cmnscquenev of tha pointing of this permit. PLUMBING FEE
PLIC U D STANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(T010,000 CPM)
RCE REG A NS. MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUCTION TAX
Si mare of ApplicavtlCommncmr ,t Ditto I EXHAUST HOOD(WMUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant stare or handle hazardous material HEATING UNIT(TO I00,0)(Il BTU)
as defined by the Cuaenim Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532m)] - HEATING UN IT(OVER 100,000 BTU) -
4,11i"hhh,
❑YesNoVENT IEATION FAN(SINGLE RCSID) PAID
Wildlthe...ikota or(.tare bun lding compact'use equipment or devices which Date ReceiptNmit hpzaru n air mntaminanls as defined by rhe Bay Arca Air Quality Management BOILER-COMP QHP OR 100,000 BTU)
I _ TOTAL:
❑Yes 7 N - BOILER-COM P(OVER 100,000 BTU) -
I have readm
tho hazardous amdaH requitement.,ander Chapter,6.95 of the Cul i- AIR CONDITIONGRs ISSUANCEDATE
tiarrHealth&SafetyC, Sections 25505.25533 and 25534.1 understand That if the NEW RESIDENTIAL MECIL SQ.PT.
ptine note rl hasp atenanr,Ihw itis my rcsponsihilityronoti[y the nwupam mems wRtic mustbemupiionoissuaneeofa Cmilwaleof Occupancy. �I
t-mi,der or authorized agent Dare
TOTAL: ISSUED BY:
OFFICE
• ® 10300 Torre Avenue
City ul'
Cupertino,CA 95014
Cupert1110 Building Division
(408)777-3228
(408)777-3333 (fax)
' April 3, 1997
Homeowner
10387 Amistad Ct.
Cupertino, CA 95014
SUBJECT Permit#30457
Dear Homeowner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open".
• According to our inspection records,the subject permit has not been frnaled. Many times
an inspector will sign the permit in the field, but neglect to report all of the information to
the clerical staff for input into the computer. If your permit card shows the final sign-off,
would you please contact us so we may complete our recofds? If the permit is not signed
off, an inspection could be scheduled for final closure of the permit
If we do not hear from you within ten(10) working days, we will dispose of the file and
remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERRTINO
Christy Akatiff, Administrative Cler
0
Poled on Recycled Pacer