S 1408APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CPYT OF CUPEMPINO [it)ILD1NG-ELECTRICA L
BUILDING DIVISION API'LICA'I'lONMERMIT PLUMBING -ME"IAN I CAL
I4UILI11NG 1'ROJECI' IDKNI'IFIC-ATI0.N
YlitIT NO, OH
l\i4
BUILDING ADDRESS'
Dry I V�
SANI'T'ARY NO.
AI'PLICA'll(IN SUHMITTAI. DALEcfl
0��1/ PHONE:
IV--_
P
CONI'RAMORS NAMF: LIC NO:
NEC
❑
CON "IRol, p
-CI II'IPCr/ENC INFER: LIC NO
ADDRESS:
CDN'TAC'E 4 IIIJONE: row
A/0Q �Q��� �2_'�74y
L 1 1
1 "LICENSED
❑Cunwltan[Fecs Paid by Applicant (initial)
''; BUII:DING PERMIT INFO
I. ELECT PLUMB MI?CII
❑
CON I RACE ORS DECLARATION
II ny rnmvh tl neat 1 p fort perry a'nmenr'ns
OwithS 't' ]o0fnnfD l Ol lirmi and Pr Rssinrt. Culcand tyla...'s
in full force and eRed.
Liam -Class Lil or
4Vl Date Cob,acrnr
P. AHCHI'1'IiM'S DECLARATION
y
n IunJenwnd my plums sM1ull lw uscdropuhlic reaMs
QTY ELECTRIC PERMIT FEE
_
"
JOB DU RIPTION
RESIDENTIAL
❑SPIIWI. ❑ KITCI IIiN REMODEL
_ DDITION ❑PLUMBING RI?-1'll'L?
❑MIJIM-UNIT' ❑IGRUC'IURAL
MOIIII7CAT10N
1f7iN'1'81tION [ CHIMNIiY REPAIR
/l MYROVLMI3NT ❑ SWIMMING POOLS
❑ RKI'H REMODEURI'PAIR C1 DEMOLITION
1:1OI'I II?R
PERMIT ISSUANCE
APPLIANCES -RI1.c1UliN°II AL
PANFIS
tIP'IU 200 AMPS
haensnl l'mfnannal
OWNERBUILDERDI!CLARA110N'
C I hereby affirm that 1 um exempt man the Conrracmr's Lrcxnvu Lida for the
U following mmnn. (Section "IID I5, Ifuvineas and Professions Calc Any la, Or county
F+
y whirl requires a Icrmit to, ctolliculolol ird, al¢r, unpruve, demolish, fi repair an)' etfucmrc
plioOosts leased, r,aboluinrs me npplieam tar each panni nYkusig,, ulamment
� mat M1c iv Ercnsal puouunnu mcpmv lnX)I'Wr Cnn,mnor�e lJucnec l_'aw tCJaP,e9
(cox ilinS ai 9000) I [).,Avon 3,ddhe H I f —' 'Ced, 'r
C hot for ', pt thmf d he bvi,i, for41.111tied vocconion \ Y violinran of
m' Sect' n11131,5 by anyalll n fora Icialit subjects theapplicall todl pe"ItvufPONIIt
h not 'I", (ban re
an five Imadd dollars 08,50X3.
wiLo the Owner of ml pmpen,meI%Or my emntended xi ofered tmmeirrole nrrnpcnsmion.
will Jnthewor,,Cd.TheCortmunomm�Jnt nndfernlf rsale($ec. 9004. Bueinesx
e
^ arta Yrnferainnn Cut¢ The Contnnnor'e 1 ic'cnnc LawJnrr nn, apply m uu )war )f
pmpony who huilJs nr improves thereon, and wM1n mKs such work htmselfarmron
Liv own employees, provided that such improvements are not intend red i
sale, I f: lay"', ,he huilding or i,ut ,mentis snod wrhlnm vol, n,l'
er-builder will lutve the banderol pro ing that hodal ant .. uOc
❑ L I"tl p p ty i IY t S In t t
ismoII pro,oO (See 91D41f .-., unit l f.. -Cd Icause Law I rpply of prnp.ny who builds n t es there. at
whornnraur Para vh pn9utnw mucnntmaorin)ImenscJ para t
IJrr c L, .
❑Imnc, mptunder Sec. .BM for mlsreeson
netD
2111-IINXIAMI'S
OVER I(M AMYS
SIGNS I?LFAI'ItICAL
SPECIAL CIRCIII IIMITC.
TEMP METER DR POI.) INS,
❑ NEW RLDCIADDI,[ON ❑Dpichou UON
❑ T Q
�,E26F AN FOOD SERVICIi
�l
❑OTIIF.R
C�ry �F bF1reHIIhE
IIIVI('I?S .. "
SN'ISIMI (llr'.Ii RIC
'I'. 'LC SSWI TC $ 75
N s ' H ID . RIC S
SQ. ETI'. FLOOR AREA
��
nav
$/SQ.FI'.
J
PLUMBING PERMIT 'FEF.
"
PERMITISSUANCE
AILI HR -GRAIN & VENT-WA'I'FR (EA)
NAATION.
JA V
NORKI RSCitrIs, ryON DFCI \RAIIDN
I h by !fJ I fhe� ry f t1 f 11 g dWr f
❑ 11 d ''ll C nl nfL n If' t N A '. C prat"
satlon ,rev tlul btrhy Ssn on 1700isftl Lbv Calc, for tl prdrumL of the
walk far an h it ma 1.
SII J 'II 'i WakOvI Compen,al"I, I. y Ih- Terrtt
3700 10 Cale, ,I p f cloo,oldhe workl 'h 10:1 l:.......l.
SIy Workers COnlxnsm 1 s¢e re nJ Yoe rl omnis ares
Cartier: policy Nn.:
CIdLIFICA'1'13Olt I?XE VI'IONFROMWORKERS'
C(IMPENSAGON INSURANCE
(11111 sorban rotation tc amp+l Ivd if,he penton is far onehunalred dollars ($ItXII
nr less.)
IIO(HY thatm the
an, as Iv co (mock Wupm niuieissttCoolleJI
notempby anyprnon in any manner sO as mlemme enbjemmthe WnrAcn'COn,pvm
motion Laws of 6Jifnmta. One
1 Applinm,
13ACK FLOW VROTFC'I. DEVICE
DRAINS- FLOOR, ROOF' ARRA, C.OND.
STORIES
OCC. CROUP
9q
'I Yl'. CONSTRUCTION
AI'R
)
✓Lv SOI -dl
/
IIX'1'11R15 PER TRAP
GAS IA TY,S'I'EM-I INC40U'IIJOS
GAS - EA. SYS] 'ILM- OVER 4(EAI
GREASIYINDIIS'IRL WAS'T'E IN'I ERCEINDR
CRIiASI! TRAP
BUILDING DIVISION FEES
VLANCI IECK ITIF
SEWER-SANTIARY-STORM GA 210 PIL
IiNERGYEEE
WA'I'Hlt HEAL'lilt W/V IEN'I IIA.1?("IIt
GRADING PER
j NOTICE!3Yl API'LIe Wlak:If. C nnsatinpr Cenilicam of ELabortiod you......
beutme I .Nrn,n, o Wb 11 oo Cmnlwneatlon pm tune 91 the Labor Cale, you met
r IurtLwl,h rximPly wl,h cud, Pmviuior,. anhie permit )Lull he Maucd mvoAaJ.
I
CONSTRUCT ION LENDING AGENCY
I hereby ammo that then iea ecn.¢mmhoo lending agency for the performance of
'he work for which Los palb.0..'nrncal (Sees 3091, CO. C.)
Lender's Name
WATER 848111!.1/IRIiAfWC
SOILS PIiE
WA'1'EH SIfRVIC'E
PAID
Date Receip,k
NEW RESIDFN'I'IAL PLMR. SQ, FT
If \L:
BUILDING EH �+
Lrnde! AJd
I nee Jct11 Ithis ''IIf't a.rt,h'It1 'I to
hortra g t ply a II Ih J t) J I. Pt g o
sel'If'h' ly mennnpoa me
hoodoo .wdbn. ands by 11fial a purposes
ahuvcmm�,lnnorl Drupeny our la5pcnlnn PUToms_
(We) agmc to save. indemNfy land keep hannlms the Cip' of Caperton) against
liabilities .judomcnts.croll and expenso which) dyin any wayac,dN,ainslwi1Cly
APPLsal„n¢c of the grmtl„g u(,his ,x-r,nit.
ICANT IIN'DERSTAN'DSANDWILLCOMI'Ll' Will II ALL NON -POINT'
SOURCE RFGIII.AI'ION'S.
3
:ignatumo ApplicmWC7c n¢'mr Dm
IIAZ.ARDD ” MATERIALS DISCLOSURE
Will mcappli... I o, fume nllJingan,pum smear hunJluhnmrrl..... mensal
a1 defined by be Cupenlno ,Municipal Coda Chapter IIJ2, and the Ilealm and Safety
Cale. Smtion 255T1(a)p
❑Kx L] No
Will the applicant or men bo ilding by the p me rquipnmm or devices icer,
mit hantrJnus air commnirurmv;av definal by the Bay arca Air Qnaldy Munagennen,
Ilistrid'!
�l'es Ej
Ihtmenaddid hannda,abrall. all reryomnrcul under Chupmr G 95 of ,hoCali-
fomia lledm A, Safey Ctcle. Section25
s 505, 2,5533 and 25534. 1 undiabi man if me
building ares not current, haven tetmnt, that nismy nvrysib111ty
m,o nota thenccuprmt
of he reyJucmoms which nest he,nu, prior lar ..loam ufla CcrtiOemc of OCcopvncy.
TOTAL
QTY. MECHANICAL PERMIT FEE
SEISMIC JEE
ELECI RIC FEE
"IAMBIN(F PIiE
I'13k MIT ISSUANCE
AGfFH OR Al1I1'R)MECII.
AIR HANDLING UNI (Lot 10,IXXICYM)
MECHANICAL FEE.
C(1NS'I Hl1C'CION'!AX
A I R I I A NDLI NG ON I'P(OV HR 10 dond Cl
EXHAIISTHOODOv/DOCq
IIOUSINC MI'CIGAI'IONIIiIS
HF,AI'INOUNI'I'(1011)0,000H'1'll)
HEAPING UNIT (OVER hinooddH'1'G)
PAID
Date l itM
p
V F,N'1'IhA'OON IAN(SINGLE RIISIUI
HOILIiR-COMI'(3HP OR IIXI fMNI RTU))
'I'O'IAh:
BD11.1!H- COMP(OVER 1(0.000 BTU)
AIR CONDI 'IIONEII
ISSUANCE IJA'IE
ISSUED"Y
NF.W N13IDEKI"IAL S11iCII. tiQ. FL
Owner Or mal arircd agent Done
'I[
orf I —I ��
Homeowner
10857 Barranca Drive
Cupertino, CA 95014
SUBJECT: Permit #51408
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 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.
11
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, Administrative Clerk
P,,W�d nn R,m"lo l °near