S 1148APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING,-BLEurRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL
P IT NO.
J 11 A 8
BUILDING PROJECT IDENTIFICATION ..
T
BUILDING AIIDRLSS. t�
Do4'lIS L7an��ey QSIV�
SANITARY NO.
APPLICATIONSUB
MI SUMI'ITAI. DATI
` ( 7
ULi'NER'S �GAt C �OVn W at 7H�, I'HONIi:� -OS SZ
A x � Q
C( r�Q("p S L: 1 LIC NO:
r (� O Yl aJ� Yla P `I 10 N
N/C
❑
CONTROL p
A3Q mQ 4GINJi[R: �1 OYYsL r A �NO: C 491 5
/ �I Y1
ADDRESS: -
1ff
CONTACT: PHONE p o
_ p' S � C � �, V, 3y Vv,ak �i Lj _ p O s2
❑'Consultant Fees Paid by Applicant (Initial)
BUILDING PERMIT INFO
IT
1 DIN P I3 f
LICENSED CONTRACTOR'S DECLARATION
I hemby aRrm that I am licensed under provisions of Ch rob -9 (cummemcing
with Sv,tvm700EofDi,obn3 ofoho Businessand Pmfusai... Coo andmyIleemcis
in full force and effect.
LicenseClass Lic.M
Date Contractor.
t
QTY ELECTRIC PERMIT FEii
JOB DESCRIPTION
RESIDENTIAL
-
CSPDWI. C KITCHEN REMOTE].
CAUDITION El PLUMBING REPIPE,'
❑MULTI -UNIT' CS'TRUCfl1RAL
S I MODIFICATION
ION
❑INTERIOR CCHIMNEY REPAIR
IMPROVEMENT E] SWIMMING POOLS
C HATH REMODELIREPAIR ❑ DEhIOLI DON
PERMIT ISSUANCE
AIIPLIANC17S-RESIDENTIAL
ARCHITECTS DECLARATION
I understand my plans shall be, toed as public records
PANELS
UP TO 20() AMPS
LsenxJ Pmlesstonal
. OWNER -BUILDER DECLARATION
I hereby M. that I am exempt from the Commemex License Line for the
201-10fRAMPS
OVER 1000 AMPS -
following maws. (Section 7031.5, Business and Professions Conde: Any city or county
which requires a permit to construct. he, improve, demolish, or repair any smtcture
prionoiti.... net, also regolms the applicant forsuch permiuo rile a signed statement
that he is licensed Poll ..nO. the previsions Of the Comments s License Law (Chapter 9
(commencing with Section 7") of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the hasis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permil subjects the applicant to a civil penalty of
not more than five hundred dollars S500).
❑ 1.mowmermf the properly, Or my employees with wages as their sole cantpensmion,
will do the work, and thesuumure isnot intended or offered for sale (Sec. NW, Business
and Professions Code: The Commcmrs License Use dors not apply to an owner of
Property who builds or improves thereon, and who does such work himself ar through
his own employees, provided that such improvements are not intended or offered Iter
sale. If. however, the building or improvement is sold within one year ofcnmpinion,the
er-builder will have the burden of proving that he did not build nr improve for per-
pose o1'sale.)
SIGNS ELECTRICAL
C Ol HER
SPECIAL CIRCUIT'/MISC.
TEMP. METER OR POLE INST.
COMMFR IA L.
El NEW BLDG/ADUI'I'ION ❑ DIiM OLI TION
CI TENANT ❑ FOOD SERVICE
IMPROVEMENT
COTHER
POWER DEVICES
SWIMMING POOL ELECTRIC
a
r
OUTLETS -SWITCHES -FIXTURES
NEW RESIDENTIAL ELEC'I'R SQ Fr.
19.F6FIgDQRAREA
i/ii �F VV
5/SQ.FT.
TOTAL /
❑has Owner, of the property, am exclusively contacting with licensed I:n carmra m
cumsm..I the project (Sec 704 C Business and Professions Cmle:)'nc� Gmnucmr's Li-
cense Law does not apply to an owner ul properly who build! Orim".,a merenn,and
who contractsf... ch Fogecu with a comments) licensed pursuant m the Contractors
License Law.
C I um exempt under Sec. _ , B & P C fmnhis reason
1
JAN 2 3 ANS'D
y�r
�l'1 (,if �Urz I'j III10
-
QTY: ' PUIMBING PERMIT F �
-
PERMIT ISSUANCE?
Owner Our,
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of pe jury one of the following declarations:
1 have and will mainmin a Certificate ofConscm m self -insure Lim Worker's Compen-
sation, as Provided for by Section 37W of the Iabm Code, for the performance of the
work for which this peram is issued.
❑ 1 have and will maintain Worker's Compensation Insunmce, as required by Section
37M Oldie Labor Code, fnrthe performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier: Policy Nn:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
or less) (This section need not be cemplemd if the permit is Porous hundred dollars (S 1 hot
1 cattily that in the performance ofthe work fnrvehich this permit is issued, 10.11
not employ any person in any manner so us to become subject to the WorkersCompen-
sation Laws of Calirmrnia. Dam
Applicant s
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject In, the Worker's Compensation provisions of the labor Code, you mus,
forthwith comply with such provi,vinns or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirms that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec 30)7, Civ. C.1
Lender's Name
Lenders Address -
I certify ,hut 1 have read this npplicmien and slate that the above inharmain i is
renl agree tat comply with all city and county ordinances and state laws relating in QTY
building construction. and hereby authorize representatives of this city to enter upon the
shove -mentioned property for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of Cupertino against
ITabilities, judgments, cons and expenses which may in any way accme against said City
n consequence of the granting Of this Iarntit.
WFLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
;OURCE REGULATIONS.
Signature of Apphcanl/Conlmetur (late
HA9ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building oecupa , store or handle hazardous material
as declined by the Cupenimo Municipal CMB Chapter 9. t2, and the Health unit Safety
Code. Section 25532(x)'!
❑Yes CNo
Will the applicant or farm building reent ass equipmentw
or device. hich
Fipun
Fit
hazardous air contaminants as defined by the Bay Area Air Quality Management
Strict]
[]Yes F7 No
1 have Rad the hmardous materia, myuimnems under Chapter 6.95 of the Cali.
("-in health & Safuy Code, Seedons 25505, 25533 and 25554. Inn denim ¢I that if the
building does Out cutrenny have o tenant, that it is all responsibility m notify the notation
of the ngoiremcnts which must be met prior to issuance Of a Cenificam of Occupancy.
Owner nr authnnzed agent - Date
AMER - DRAIN & VENT- WATER (EA)
BACK FLOW PRO(PEC . DEVICE
DRAINS - FLOOR. ROOF, AIf EA, GOND.
FIXTURES - PER TRAP
GAS -EA. SYSTEM-] INC.4 OUTLETS
GAS - EA. SYSTEM-OVEk 4 (EA)
GREASUINDUSTRI. WASTE INTERCEPTOR
GRIiASE TRAP
SEWI7R- SANITARY -STORM EA, 211(1 FT.
WATER BEATER WNEINGUELECLR
WAI17R SYSTEMG KEATING
WATER SERVICE
NEW RESIDENTIAL PLMR. SQ. FT
MECIJANICAI. PERMIT
PERMIT ISSUANCE
ALI'EROR ADD TO MECH. -
AIR HANDLING UNIT (TO 10,000 CFM)
AIR IIANDI.ING ONI'f (OVIN I o,Wd CFM)
EXT FAUST HOOD (WMUC )
HHA'HNG UNIT (TO I WOOD ITID
HEATING UNIT (OVER 100.0Q) BTU) '
VENTILATION FAN (SINGLE RESIT)
BOILER -COMP (3IfP OR 100,000 BTU)
BOILER - COMP(OVER MOD() RTU)
AIR CONDITIONER
NEW RESIDENTIAL- MECIL SQ, IT.
O . Ad" r''
BUILDING DIVISION FE,
PLANCHECK FEE
ENERGY FIE
GRADING FEE
SOILS FEE
PAID
D m crar" #
` TOTAL
DUILDkrvG FEE
FEE SEISMIC FEF. O
ELECTRIC FP
PLUMBING EE
MECHANIC ..E
CONSTRUC'T'ION TA
IIOUSINGMITIGATION TE
PAID
Ore. Refelpl N
TOTAL:
ISSUANCE DATE
ISSUED BY:
J L ---.itialc
of,
Cupertino
February 4, 1999
Apple
10475 Bandley Dr
Cupertino, CA 95014
SUBJECT: Permit # 51229 & S1148
Dear Homeowner:
10300 Torre 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 irito 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 Cle
r,
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