29317 AP4Y% ANT�O FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI TY OF CUPERTINO - BUILDING-ELECTRICAL. PERMITNO.
BUILDING DIVISION APPLICATIONA`ERMIT .. PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION 29317
BUILDING ADDRESS: 'SANITARY NO. APPLICATION SUBMITTAL DATE
oaf (�=A 7/Z
OWN=MH:_ PHONE: kACTOR'S NAME:lAtiblO�'^ LIC NO:
C lVl? NIC C OLp
\RCHITECT/ENGINEER: LIC NO: ADDRESS: �.w�l r� �7 J ❑
4'T1'ts C
CONTACT: PHONE: - BUILDING PERMIT rNFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG QLEA PLUMB MUCH
LICENSEDCONTRACTORSDECLARATION QTY. ELECTRIC PERMIT FEE ❑
1 ne�enrarfian mwa aEn R,eased ansa,provisroms of,name,9(eaEnmrneiag JOB DESCRIPTION
a'Z with Seainn]Uf1U)of Division3ot the Business and Professions Code,anJ mylicensc is
00 in fol force end effuct. PERMIT ISSUANCE RESIDENTIAL:
aVV Lice Ci / Lie.M 7Uo572 - ❑SFDWL [I KITCHEN REMODEL
� LL1D Contractor APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RFPIPE
p�'
'q DECLARATION DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL.
Z [understand my plans shell b,uredos public records MODIFICATION '
UPT0200AMPS �,//•
4 ININTERIOR El CHIMNEY REPAIR
P 4 Licensed Professional - 2111-IBII(IAMPg IMPROVEMENT
OWNER-exempt,km'lhcARATION ' OVER 1000 AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
Q I hereby affirm that 1 am exempt Truro nhe.Comrscu Code:Amyx Law for the
tY�5,06Vwhichfollowingrtamaermiint ]ommuctusinid,not at,irorPmfdemolsh,o" nycity orcourtycoure SIGNS ELECIRICAI. ❑OTHER
F p y which requires a permit re,anew,[,ulcer,improve,demolish,or repair any wharrent _ ^ ^ e
m� prior to issmnee,also rcyuiresthe applicant for such penninnfileus'igneJ statement SPECIAL CI RCUTL/M LSC. J
�} that he isl;an.sed pursuant to the provisions of the Contractors License LawUspier9 tom-- `al
X00 (commencing with Section 7")of Division 3 of the Business and Professions Code)or TEMP.M1:71; ORPOLEINSL COMMERCt-A _ W
C. that be is exempt therefm n and the basis for the alleged exemption.Any violation of ED NEW BLDDG/ALDDQ DRION DEMOLITION
Section]031.5 by any applicant for h n permit subjects the applicant to civil penalty of POWER DEVICES E' ❑TENANp FR 1'2 1996DSERVICE
ore
y not mthan five hundred dollars($500). lMPRO
C [11.
I,as owner of Ne Property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
will oaths work,and the.stmcture is not intended or offered Reraale(Sec.7014,Business ❑OTHER
m and Ponet'aous Code:'I bit Contractor's License Luw dna nm apply m naownar of OUTLETS-SWI'FCIIES-FIXTURES
a pmpeny who builds ter improves thereaa mad who does such work himself or through ON DEPA
his own employees,provided that such improvements arc not intended or offered for NEW RESIDENTIAL ELECfR SQ FT. p1y�gR�pAp
sale.It hms.ol the hui ping or improvement is sold within one year of completion,the VV[ CUTIN VSQ,Fr.
mer-build,,will have did bufden of proving shot bo did am build or improve La tin,- -
�1 poseofsel..) - - - 1
J'Q ax owner of Ne pmpsmY am exclusively comm ting with licensed contracmrs to
`
construct the project(Sec.]M4,Business and Professions Coal no Cmardctors Li.
se Law dos notapply to an owner of property who builds or improves thereon.Emit QTY, PLUM BING PERMIT FEE
who contmen hirsuch projects with.cmarmhr(O lic.medpursuant,,,he Conwemrs
Lieenu Law. PERMIT ISSUANCE
Iamexempt under Sec. ,B&P C for distinction
- ALTBR-DRAIN&VENT-WATER(BA] -
Ume - VAIAATION -
' caner WORKER'SCOMPENSATION DECLARATION BACK . W ROTECT.DEVICE
1 hereby ill mai under Certify oeperjury one of the following dcdamt Co Gr
stood,is
and Fusidel forbineCenl37W of the sent toLabor self-hCarlo,]is,
Workerse,of he DRAINS RROOF,AREA.COND. STORIES TYPE CONS ION
work I as Provided for ni Suction 3]W of the UrBar Coda for the performance n1 the
week Lave and on,permit is issued. FIST PER TR
❑1 have end will maintain Wak,rs Come of the w rk for which
h required by Section
My Work0 of theer
Labor Code,for tinsurace cancer anti work fowhicnte: permitisissued, GAS-EA STE d INC,40UTL8P5 'OCC.GROUP APN ,
My Worker's Compensminn Insurance carrier end Policy numMr are:
Carrie, Policy No.: GAS-E reh1 V 8A)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASE/INDUSTRI-AGSM&RCEPTOR BUILDING DIVISION FEES
Millisecond neednot beeutnpleledifthepeanit is forma,hundred dollars 0100)
or lay.) GREASE TRAP PLANCHECK 128
kens fy that inth<per(orme )fthe wurkforwhim thispermitis issued,lshall SEWER-SANITARY-STORM EA.200 FT.
nand L is any person in any tk ,o@@ mnecnta�Ete syplynmthe Wmrkem'Contpen- ENfiRGY FEE
,z . tion Laws of Otl s"f�JL^1L
zlisO pplicant / m ny, � WATER HEATER W/VENT/8L8C'1'R GRADING FEE
NOTICE OIC T:IL after making this C<niReate of Exemption,you shooed WATER SYSTEM?kBATING
heeome subject m the Worker's Compensation provisions of the labor Code,you omit SOILS FEE
Ilenhwith canply with such provisions of this Nonit shall he deemed revoked WATER 58RVICF.
Q
'Z CONSTRUCTION LENDING AGENCY NEWRISIDENTIALPLMIL SQ.FT PAID
V Q Iherebyal mocha there is a conswetinn lending agency for performance of Data Receipt
the work lin which this permit is issuc l Ses.3097,Cis,C) "
O I----�E Lender's Name " TOTAL:
').r LUiI Lenders Address 'TOTAL:
1� 1 certify that I have read this application and state that that above is brmation is BUILDING FEE
i..E&0 comm.I agree to comply with all city and county ordinances and state laws relating¢; QTY, MECHANICAL PERMIT FEE
U Z building construction,and hereby authorize representatives of this city to enter upon the SEISMIC FEE
above-mentioned property for inspection p,nand a. Its
(We)agree mauve,indemnify a ad keep harmless the City of C.Niinn against PERMD'ISSUANCC ELECDtICFEE
l'ahilities,judgments,cos sunt ex moss whichnsa in an
n p y ywuy roma uguimtsend City ALTER OR ADD TO MF,CH,
in consequence of th ming of is permit. PLUMBING FEE
APPLICA NT U' 'RSTA A 'D WILL CO TH ALL NON-POINT AIR HANDLING UNIT(TO I0.00s)CFM)
t SOURC LA ION MECHANICAL 128
AIR HANDLING UNIT(OVER lo,B00 CPM)
Z CONS'TRUCTIONTAX `
igm reofAnthemI/Co Date EXHAUST HOOD(WADUCU HOUSING MITIGATION FEE
HAZARDOUS M09RIALS DISCLOSURE
Will the applicant orfumre huddingacupunt stored,handle hmdudoas malarial HEATINGUNIT(TOI(N),000B'PLp
as defined by the Cupenina Municipal Cade,Chapter 9.12,and the liealth and S.Ldy -
Code.Suction 25532(0)? HEATING UNIT(OVER 10tio01 BTU)
❑Yes Ditto R
VENTILATION FAN(SINGLE RESID) PAID
Date Rewlpt#
Will the applicantinants building by
rn Bay Area
Air Quality
.nage ant BOILER-COMP OHP OR I of'of10 BTU)
it transitions us air contaminants tee Defined by the Bay Area Air Quality Managemrnt
ct?
El Yes - El No BOILER-COMP(OVER IW,INg)BTU)
I have rem the hazvdous materials p AIR CONDITIONER ISSUANCE DATE
requirements under Chapter fi 95 of the Cali-
fornia Health&Safety Cole,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.FT.
building does not tmmntly have a tenant,that it is my resptmsihllhy m nolfy the occupmt_
n(the requirements which most h act poor m issuance of a Cenificam of tkcupancy. 'vV//)
Owner or outbnnzed agent Date O
ISSUED BY:
OFFICE ' " 1
F
®" 10300 Torre Avenue
ul, Cupertino, CA 95014 •
Cipe.rti l0 Building Division
(408)777-3228
(408)777-3333 (fax)
January 15, 1996
M-Path Interactive
10455-A Bandley Drive
Cupertino, California 95014
SUBJECT Permit: #29317
Dear Homeowner:
We have been cleaning out our files in the Building Department, and contacting those
people with permits which have remained "open".
According to our inspection records, the subject permit has never been finaled. 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 records show the
subject permit as finaled, would you please contact us so we may complete our records?
If the permit is not signed off your permit can be reactivated and 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 CUPERTINO
i
Christy Akatiff, Administrativ erk
Inspection Query for a Specfic Permit 1/21/97
• PERMIT# SITUS ST SITUS STREET Lot# INSDESCRIPT InsType DATEDESIRED DateDone
29317 10455-A BANDLEY BLDG FINAL 2/28/96 2/28/96 •
29317 10455-A BANDLEY ELEC 2/28/96 2/28/96
29317 10455-A BANDLEY MECH 2/28/96 2/28/96
29317 10455-A BANDLEY T BAR 2/28/96 2/28/96
29317 10455-A BANDLEY T BAR/DUCTS 2/29/96 2/29/96
29317 10455-A BANDLEY T-BAR CEIL 3/1/96 3/1/96 -
29317 10455-A BANDLEY BLDG FINAL 3/7/96 3/7/96
29317 10455-A BANDLEY ELEC FINAL 3/7/96 3/7/96
29317 10455-A BANDLEY MECH FINAL 3/7/96 3/7/96
29317 10455-A BANDLEY PLMBG FINAL 3/7/96 3/7/96
29317 10455-A BANDLEY ABOVE BAR 3/11/96 3/11/96
29317 10455-A BANDLEY ELEC 3/11/96 3/11/96
29317 10455-A BANDLEY MECH 3/11/96 3/11/96
29317 10455-A BANDLEY PLMBG 3/11/96 3/11/96
�r
Page 1
Inspection Query for a Specfic Permit 1/21/97
• Ins actor Units Pass/Fail Code
JB 2 N i
JB 2 N
JB 2 N
JB 3 N
JB 2 N
JB 2 N
.cc 2F
cc 2F
cc 2F
cc 2F
cc 2P X
CC 2 P
cc 2 P
cc 2 P
• i
Page 2