S 1442. �r..aoee wrtnu unrulu RFn I IMPQ . I IQF RAI I -POINT PEN ONLY
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CITYOF 'OPERTINO BUILDING -ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING. MECHANICAL
tlUILIRNG PROJECT IDENTIFICATION
PE IT NO.
1442
UILDING ADDRES� � v cAdo f1
SANITARY NO.
APPLICATION SUBMITTAL DATE
W F.R'SN Me _ PHONE:
t G
CHITECTIBNCIINEER: UC NO:22--Z
ONTRAC 'OR:S NA E: (r` LIC NO: O�/
CoC S a 1p1p Z_
S:
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NIC
❑
CON'IKOLM
CONTACT: PHONE:
-
. BUILDING,PERMIT INFO "
LDG ELECT MECH
❑ Consultant Fees Paid by Applicant (Initial)
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y 14-
.PLUMB
LICENSED CONTRACTOR S DECLARATION
1 hareby all re tM1 I I d d 0 [ Chapter 9 (mon ro g
0)ofD 3 lithe BusinessPrecisionsCade suit my Issues, is
Section 100ermar ness and
it 1,mree and eRuct 3��2--
Licaeu Clasx 1JC.N
Dam Cnntmwr n oI S
ARCHITECT'S DECLARATION 6 Cq
lunderslandia,qunsshall It as puhlkremmc
QTY. •. ELECTRIC PERMIT, FEE
.. '. .,
)O SCRIPTION
RESIDENTIAL,
❑SPDWL KITCHEN REMODE:1.
[]ADDITION El PLUMBING RE -PIPE
0MULTI-UNIT ❑STRUCTURAL
MODIFICATION
El INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT ❑SWIMMING POOLS
..
PERMIT ISSUANCE
APPLIANCES -RESIDENTIAL
PANELS
UP T02U(IAMP5
lm
Licens'herefhy
2V 1HHIAMYS
.�
Q
O y U
�O.]
OWNEthat I m-RGI^DEIRomDECLARATION
ufErrse
ex he oeLicenxe Law for the
following rwson. (Section ]NLS, Easiness and Pmfevsionv Code: Any city nr county
Which barriers PermtJ constructp d ilisM1 p ny structureyyJJ prior It) its issuance, also requiresthe applicant Jh permitl tire a signAl statement
❑BATH REM L/R��n'e7R �EMOL
❑ OTHER +�--^-���`��
OVER IOIHIAMPS
SIGNS ELELTRICAI.
SPECIAL CIRCUI'I'/MISC.
�y
QQ
p o W
'a�Ctiy
�Qnot
Cl
tbuth dp tl theP fIh Contractors L L (Chapter9
(nn "g 115 t ]I]fNl) fD "" i fN B.- s 11 f4sa CwE)nr
that he s exempt therefrom and the basis for the alleged exemption Any violation of
Section 1131.1 by any vpplieamf.. uperntit subject the apeleant to v civil penalty of.
more than five hundred dollars ($500).
prrpe y, ormy employees with wagesmthcir wlamm,Bm,ilon,
❑I, ax ownern[We n
awdu,but apply1044, Business
writ dathework, ande: umul roti
TEMP METER OR POLE INST.
COMMERCIAL: -
❑ NEW BLDG/ADDITION ❑ DEMOLITION
El TENANT ❑ FOOD SERVICE
IMPROVEMENT
❑OTHER
POWER DEVICES
SWIMMING POOL FLECTRIC
m
he License Lowdoernalapplytolf awnuaf
and Professio:u Code: TM1a
WThETS- SWI 'fCHFS-FIXTURES
NEN RESIDEN'fIAI. P.LP.CTR SQ PT.
11
ed,thrde ardw
Dopory own who builds ar aided b rsuchi and who docs such work himself or Through
salown employee,, provided met such imps sold w ere not mendedo, o0emd for
sale. If, however lM1e building orimpmvenmm is sold within ane year rf completion, the
SQ.IT. FLOOR AREA
$/SQ. FT.
owner -holder will have the human Leaving that he did oat build or improve forpur-
Osl;;u owner of the property, um exclaeivaly summering with licensed CAn,...I. a m
construct the perfect (Sec. 70,14 Business und Professions Cad,) The Gmlrami e Li -
i -c se Law does notapply t f property who builds orloprr.esmera d
rears,,
-
P e'pp
1 i1
R
TOTAL:
QTY:' ',;'-PLUMPING PERMIT FEE.
whocotterats for such protects with vcrntrau ro) licensed Purnam tome Cantmdars
License Law.)41*
1 am exempt under Sea , B & P C fonhis reason
eq
PERMIT ISSUANCE�r
Datu
VENT FIE )
ALTER -DRAIN&R
- , VALUATION
%//ry V
r
WORKER'S COMPENSA LION DECLARATION
BACK FLOW PROTECT, DFVkkCE
I hereby art nn under penalty of perjuryane of me following dcelarvtions:
❑ILave and%HE maintain a Certificate ufConsent to self-insum for Worker's Camper -
satins, a. ..... dead for by Section 3]00 of are Labor Gds, In the folmormnce of the took fur which this pemdt is issued.
DRAINS -FLOOR. ROOF, A
STORIES
FIXTURES - PER TRAP
❑ 1 have and will mutation Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the perf..mnneeof the work for which this permit is issued
GAS - EA. SY STEM -I INC. 4 OUTLETS
OCC.GROUP
LIYPIC,O,NRUCOON
My Workers Grmpenrve Insurance earner and Policy uumhera
Carrie, .Z E NI Policy No.:We I'S ( 037L`iLn
7 GAS - EA. SYSTEM -OVER 4(EAJ
GREASEYINDUS'I RI. WAS' TE INTER •PTO
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
NULL 1 OUIVI?
(TM1is section readout be completedodue,urmit is faranehundreddollars($100)
or Icsn.)
GREASETRAP
LANCHP,CK PFF
SEWER -SANITARY -STORM EA. 200 FT.
ENERGY PEF
Ir ify that in the perfommnee ofind work for which this permit isissred, ]shall
not employ any Person in any manner so as to become subject to the Workers' Compen-
WATER HEATER WNENTELECTµ
GRADING PEP.
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cation I.zwc of California. Data
Applicant
NOTICE. TO APPLICANT: Ir, otter making this Certificate of Exemption, you should
become subject ed the Workers Compensation provisions of the Labor Code, you most
forthwith comply wills mch pro visions or this permit shall Ito deemed revoked.
CONluareaTmNLENDING AGENCY
Iherehy affirm thvuhme int mnswetion lending agency fnnhe porformnnwaf
the work for which thispernd shared s( Seo. 3097, Civ. C)
Lender's Name
WATER SYSTENVI RP.ATING
SOILS FEE
WATER SERVICE
PAID
Dote �eip1H
NEW RESIDENTIAL ]'LMB. SQ P.
TOTAL:
TOTAL,
Lender's Address
I certify that 1 have read this application and sure that the shave infammdon isBUILDING
coved. l agree to comply with all city and aunty ordinances and sued laws relating to
building construction, and hereby authorize marawrutives ofthis city Mauer upon the
Ir
QTY. - MECHANICAL PERMIT :FEE'
SEISMIC FE•
PERMIT ISSUANCE
ELECTRIC FILE
above-ment tied property for inspection purviews.
(Wo) agree to nave, immunity and keep taintless the City of Cupertino agun.rl
/•
PLUMBING FE I
liahiliticv, �udgmans, wpty and expenses which may many way carve against said City
in curve of the mantiri this permit.
ALTIIRORADD TO MEC]{.
A1µ DANDLING UN I'I'(TO EBar CPM)
MGCIIANICA TEE -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE. REGULATIONS
AIR HANDLING UNIT(OVER 10,000CPM)
CONSTRUCT] NTAX
q
3���/�
Signature or Applies I actor );tic
HAZARDOUS MATERIALS DISCLOSURE
EXHAUST HOOD(W/IIUCT)
HOUSING MITIGATION FE
HEATING UNIT (TO 100,100 B'IITT
Will desppllcnm it, fair. Em1dingoecuc I atom or handle hamorkas morerial
as defined by the Commune Municipal Code, Chapter 9. 12, and the Ileal@ and Satcty
Calc, Smtien 25532m)Y
HEATING UNIT (OVER IOQOINI BTU)
VEN'1'11.ATION FAN (SINGLE RESID)
EJ Yac n No
-
PAID Date Receipt N. _
BOILER -COMP (3HP OR 100.00) BTO)
Will the applieam re (more building occupant use equipment or devices which-
emit hakrdous air contaminants as defined by the Bay Area Air Quality Management
'TOTAL:
BOILER- COM P(OVER 100,000 RTI])
DisrieY7 -
❑Yes E] No
AIR CONDITIONER
I have retro the hazardous materialsrequirements Under Chapter 6.9i of the Call-
ISSUANCE DATE
NEW RESIDENTIAL. MFCH. SQ. RI'.
thus ifm°
build does&Safety Cora, Sedum 15505,25531 istoyondmelab umleny the
not currentlywhich have umyreapu
orbuildingnedoe hedem pthat
or Occupancy. or one rrquiramems which must he mm poor to'usuance alis Cenificmc oL (kreupancy.
a Certificate
TOTAL
ISSUED BY, V
Owner or authorized agent Data
OFFICE
-14
of
Cupertino
February 4, 1998
Homeowner
10195 Avocado PI
Cupertino, CA 95014
SUBJECT: Permit # S 1442, furnace/ac
Dear Homeowner:
10300 Torte Avenue
Cupertino, CA 95014
Building Division
(408) 777-3333 (fax)
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open".
According to our inspection records, this permit has not been signed off by the Building
Department. Many times an inspector will sign the permit in the field, but overlook
reporting all of the information to the clerical staff for input into the computer. If this is
the situation and your permit card shows the final sign -off, would you please contact us
so we may complete our computer records? If the permit is not signed off, please call to
schedule an inspection for final closure of the permit.
Because of the large volume of paperwork within the building department, we cannot
separately monitor the progress of each permit. We ask that you give this notification
your immediate attention. If we do not hear from you within ten (10) working days we
will remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrati e Clerk
Pored on Recycled Paper
POSTTHIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
NUII. G DIVISION 1
BUILDPW PROJECT IDENTIFICATION
PE ITN°.
1447,
-Au1I.vAGADDRESS:--
SANITARY NO.
APPLICATION SUBMITTAL DATI
U
NER'S NAME: 1 PHONE:
1
'OWRACIDR'S,NAME : <",
I LICNO� .: ,
- _
NIC
❑
CONTROL#
ARCIIDECDENGINEF.R; LIC NO:
ADDRESS;
INSPECTIONS..-�,'
DATE INSPECT
❑ Consultant Fm Paid by Applicant (Initial)
-BUILDING PERMIT INFO
[LG PLUMB MECH
T � 9' In
FOUNDATION/PIERS/H.D.S.
INSPECTION RECORD
NOTE: ALL GRADING AND DRAINAGE
SHALL BE INSTALLED TO COMPLY WITH
THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
' JOB DESCRIPTION
RESIDENTIAL,
❑SFDWL ❑ KITCHEN REMODEL
C1 ADDITION ❑PLUMBING RE -PIPE
❑MULTI -UNIT ❑STRUCTURAL
MODIFICATION
0INTERIOR ❑ CHIMNEY REPAIR
BATH REPMENT g,0 SWIMMINGPOOLS
❑OTHER
UPER GROUND
PAD/SETBACK-CERT
GARAGE SLABS/PREGUNITE
POUR NO CONCRE7E,UNTIL ABOVE HAS BEEN SIGNED-
TO ARRANGE INSPECTION
CALL AFTERNOONS (1:00 PM - 4:30 PM)C]
777- 3228 MONDAY TO FRIDAY 24 HOURS BE-
FORE REQUIRED INSPECTION. JOB ADDRESS
AND PERMIT M ARE NEEDED WHEN PHONING.
UNDERGROUND/SLAB
PLUMBING
IiLECTRICAI.
DO NOT POUR FLOOR UNTIL ABOVE'HAS� BEEN, SIGNED
COMMERCIAL '
0NEW BLDG/ADDrnON ❑DEMOLITION
❑TENANT ❑FOODSERVICE ^-
IMPROVEMENT o
;GOTHER
_
ATTENTION CONTRACTORS:
NO PERSON(S) SHALL PERFORM WORK ON
THIS JOB SITE WITHOUT BEING IN COM-
PLIANCE WITH WORKERS' COMPENSATION
INSURANCE REQUIREMENTS.
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS
INSULATION
.INSPECTION SPECIAL INSPECTION REQUIRED ❑
DATE
INSP.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED.
ROOF SHEATH/DIAPHRAM
PLUMBING,
'I'IJBS & SHOWER PAN
0FCHANICAL
ECTRICAL/POOL BOND
FRAMING/STAIRS/E. EGRESS
INS ULATIONNENTILATION
COVER NO WORK UNTIL: ABOVE HAS BEEN SIGNED
I,XTERIAL SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD.DOWN
SHEEI'WROCK/SHEEMOCK SHEAR
j6
4
EXTERIOR LATH/W-SCREED
SHOWER LATH
P A I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN.SIGNED,
MAR -41
('I
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
nIUYV
OCCUPANCY
ELECTRICAL
GAS
FINALS.'''it;:`.'SY.�,.'j#gtnrr-•�`y�,�A-„ r
LAS TEST
-
GRADE,,-.
FIRE :�
HANDICAP,.,
ELECTRICAL
�tJMBING
l[CHANICAL
FNERGY
CERTIFICATE OF OCCUPANC
VISUAL FINAL ONLY
HUILDING
IMPORTANT:ISSUANCE
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION!!
DATE
ISSUED BY..
'OCCUPANCYOFBUILDINGISNOT PERMITTED;'
UNTIL BUILDINGFINALrIS SIGNEDLD
ac—J,efIptNG'»