29503 r`APPLTr*NTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOBUD,"INC-ELECTRICAL. PERMIT NO. O
BUILDING DIVISION APPLICATION/PERNIIT PLUMBING-MECHANICAL.
BUILDING PROJECT'IDENTDTCATIIIN
BUILDING ADDRESS: r SANITARY NO. APPLICATION SUBMITTAL DATE
b
ER'S.NAME: s - E: sNTRACTORLI
'S NAME C NO: ^2—^99
_ N/C. CONTROL k
elCHITECTfENGINEER: LIC NO: A DRESS z ❑
CONTACT. PHONE: BUILDING PERMIT INFO
�� //� ❑ Consultant Ftts Paid by Applicant(Initial) BLDG ELECT PLUMB MF.CH
( ❑ ❑ ❑
LICENSED CONTRACTOR'S DF.CLARA'HON QTY. ELECTRIC PERMIT FEE
I hereby affirm don 1 nm licensed under pruvisimts of Chapter 9(commencing JOB DESCRIPTION
,nr04Z with Section 7000)at Division 3 ofihe Business and Professions Code,and my license is RESIDENTIAL:
00 in full foreeande t. PERMIT ISSUANCE
1ly _ ❑$FDWL ❑KITCHEN REMODEL
UZU� Liccnso Li<.a pppLIANCCS-NFSIDENTIAL 'OpDDITIGN ❑PLUMBING R&PIPE
yQ a Dice Commcmr
ARCHITECTS DECLARATION [3MULTI-UNIT ❑STRUC URAL
Z O�Z I understand my plans shall be used as public records PANELS MODIFICATION
OZ- 00 UPTO 2AMP$
F,..I.- Luemed Professional ❑INTERIOR CHIMNEY REPAIR
s55 Cy OWNI?R-BUILDER DECLARATION 201-IOOOAMPS IMPROVEMENT
1 hereby affirm now 1 um exempt from the Contrunor's License Law far the OVER HE0 AMPS 0 BATH REMODEUREPAIR 0 DEMOLITION
3 O 6 U following reason.(Section 7031 5,Business and Profession.,Code:Any city or county SIGNS ELECTRICAL. ❑OTHER
which"mo,'a permit ,,canstmet,alter,improve,demolish,or repair any immune inb
I- prior to its issuance,also requires the applicantfor such pemdl to file a signed statement SPECIAL CIRCUIT/MISC.
p. that he is licensed pursuant to theproviium,or the Coprocubs License Law(Chapter 9
f�..00 (commencing with Section 700B.Onvision 3ofthc Bminessand Professions Codd)or TEMP.METER OR POLE INST. IAL COMMERC
a a e that he is exempt Nerefmm ani the basis for she alleged aicmpsion.Any violation of 0 NEW BLDG/ADDITION 0 DEMOLITION
Section 7031.5 by any applicantfor a permit subjects the applicantto a civil penalty of POWER DEVICES
torn OTENANT FOOD SERVICE
ZZZZ tmore than Eve hunJrtJ dollars yempl. IMPROVEMENT
Q ❑ I,as mwner of the prnpery,or my employees with wages os their sole compensation, SWIMMING POOL ELECTRIC
w 11 do the work,and the shuaurc is not intended or offered for sale(See.7614,Business OTHER
and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS-SW I'I'CHIls-FIXTURES
.. pmpery who builds or improves thereon,and who does such work himself or through
his own cmplmyecs,provided Nit such impmvemems ore mol intended or uffcred far NEW RESIDENTIAL ELECIR SQ FT,
vale.If,howevcv the building orimpmvement is sold within one yetrofcompletion,the SQ.FT FLOOR AREA $/SQ.FT.
owner-builder will have the burden of proving that he did not build or improve for for,
pea of cola.).
0 1,as owner of the property,am exclusively contracting with licensed conarmars to TOTAL:
construct the project(sec.7044.Business end Prefcssinne Cale:)The Contractors cansa Lawdoes not apply to an owner adiuminvert,who builds or improves themor,suit QTY. PLUMBING PERM FEE ;z-
Licarso
who contracts for such projects with a contrwasus)licensed pursuant to the Conuuctors u �Low. PERMIT ISSUANCE
I am exempt under Scc. ,R&P C for Nwm
is rn
ALTER-DRAIN&VE ATEll ) ALUATION
Owner Dale
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTF EVICE
1 hereby affirm under penally ofperjury one of the following declarations:
I have and will maintain aCenificae of Consenuo sdGinsure for Worker's Compen- DRAINS-FLOOR,R REA,GOND. STORIES TYPE CONSTRUCTION
ration,as provided for by Section 37M of the Ldwr m
Cale,for the performance of the
work far which this permit is issued. FIXTURES-PER TRAP
have and will maintain Worker's Compensation Insurance,as required by Section
7 )of the Labor Cale,for performance of the work for which this permit is issued. GAS-EA.SYSTHM-I INC.40 OCC GROUP APN
My War T, o sAe sauon Duriong Cartier end Policy
Camcr. Policy No.� @1')h� GAS-EA.SYSTEM-OVER 4(EA)
CER gCAB OF EXEMPTION FROM WORKERS'
COMPI?NSATION INSURANCE GREASUINDUSTRL WASTE INTERCEPTOR
(This section need non b,completed ifthe perosit is for one hundred dollars 1511p) BUILDING DIVISION FPFS
or less.) GREASE TRAP PLANCHECK FEE
Iccnify thm arrive paforource,ifthe work for which this permit is issued,I shall SEWER-SANITARY-STORM EA.200PP.
not employ any person in vny manner m as to Income subject to the Workers Compen- ENERGY FEE
,Z sation laws of California.Date WATER HEATER W/VENT/ELECTR
O Applicant GRADING FEE
i E NOTICE TO APPLICANT:R;uhe,makin this Ceripsiae of Exemption.you should
tN-t g P WATER SYSTEM/1'NIiATING
F become subject y the Workers Compensation pulls hal of the Labor Cade,you must SOILS FF.E
W �
forthwith comply wird such provisions or this permit shall be deemed rewkei. WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY
agency NEW RESIDENTIAL PCMB. SQ.FT. PAID
V O work
by which his
that them isaco (Sczs 3097,Cing agency for the performance of Data ttiptp
0Hthe Leadeek for which Nis permit is issued(Sec.3097,Civ.CJ
O U Lenders Name TOTAL:
W Lender's Address - 'I'O"fAL:
I eerily that 1 have rend this application andstate that the nM1ova inPonnotlom is BUILDING PEE
r0./z comm.I agree so cotnpty with all city anJ county ordinances and state laws relatingm QTY, MECHANICAL PERMIT FEE
V 7- building construction,and hereby authorize representatives of this city to enter upon the SEISM IC FEE
p
Owd agree to save,indemnify and keep hw
idw ve-mcmioned mpcny for inspection purposes.mless the City of Cupertino against PERMIT ISSUANCE O ELECTRIC FEE
Iiabilities,judgmenu.costs and expenses which may in any way vccme against mid City ALTERORADDTOMECH.
in consequence of the granting of this permit. PLUMBING FE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
SOURCE REGULATIONS. MECHANIC
AIR HANDLING UNIT(OVER I0,000 CFM) CONSTRUCTIONITON
TA
Signatureo Aitplicant/Conuamur Data EXHAUST HOOD(W/DUC3) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will Nevpplicma or future building occupant store or handle hazardous material HEATING UNIT LTO 100,000 BTU) a
as defined by the Cuisminm Municipal Code,Chapter 9.12,and the Hea1N and Safety
Code,Section 25532(0)? HEATING UNIT(OVER RM"BTU)
Oyes 0No VENTILATION PAN(SINGLE RFSID) PAID
Will the applicant or future building t use equipment or devices which Data Receipt g
pA dby the
BOILER-COMP 0 HP OR 1110,000 BTU)unit icshazardous air contaminants ms defined by the 13uy Arca Air Quality Management TO
Dishier?
E]Yes No
BOILER-COMP(OVER 100,000 BTU)
❑
I have paid the hazardous materials requiretwna under Chapter 6.95 of NAIR CONDITIONERe Cali- ISSUANCE DAT �y�/r
forms Health&Safety Calc,Sections 25505,25533 and 25534.I undersand Nat if the NEW RESIDENTIAL.MECH. SQ.FE 17 ��_ JI
M1uilding dors wlcmnendY hnvcamnant,Nmit is my mAom 1hilitymnutify Neottupant Ol V
of a require ms wbic st he I prionm svnnce of a CeniOcam mf Occupancy.
Owner or uuNonzc cm DataTAL.: ISSUEDBY:
OFFICE
&, (.I
10300 Torre Avenue
Cupertino, CA 95014
oC
Cupertino Building Division
(408)777-3333 (fax)
February 4, 1999
Homeowner
19907 Beekman PI
Cupertino, CA 95014
SUBJECT: Permit# 29503
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, 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, Administrative Clerk
Printed an Recycled Paper