29545 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO BUILDING ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION 29545
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
oiFIKI
OWNER'S NAME: - H E: mak- CONTRACTOR'S NAME: LIC
O S O I I r�� K�T/r / V NIC CONTROLis
4RCHITECT/ENGINEER: - - LIC NO: ADURE.S: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
12qU (D �� / ❑ Consultant Fees Paid by Applicant(Initial) PLUMB
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby afprm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
X00with Secliom?OW)ofDivision 3oPlha Imlinan
essAPrmm
fmsslon,Cmdgandy0ccnm I, RESIDENTIAL:
I F m full force and effect. PERMIT ISSUANCE
�UU License Class Lia# ❑SFDWLCHEN REMODEL
Fs4W Date Contractor APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
I„ Dto ARCHITECTS DECLARATION PANELS [I MULTI-UNIT ❑STRUCTURAL
OZ�z I mmersmnd my plans shall be used as public remlds MODIFICATION
UP TO 200 AMPS ❑INTFRIOR El CHIMNEY REPAIR
F.�. WQW Licensed Professional 201-IOMAMPS
�W j OWNER-BUILDER DECLARATION Contractors
BATH R IMPROVEMENT
W 6 I hereby.affirotSect thus 1 am exempt from the CanvactCu License Law for @c OVER 100']AMPS ❑BATH REMODEVRePAIR (]DEMOLITION
W,U which following reason.(Section 7031.5.Business and Professions Cafe:Any city m county SIGNS ELECTRICAL •❑OTHER
W O m¢F which requires a permit m construct,allaq improvc,'demmlish,or repni,any structure
volt prior to hs issecial'slso requires lheapplemat for such pmmit to fila.anaedmatemenl SPECIAL CIRCUIUMISC.• rN.he is licensd'extual ,,rheprovisiomsof the Contractor's License Law(Chapter9
1�- (commencing with Section7")of Division 3 of the Business and Professions Code .COMMERCIAL)m 'i'EMP.METER OR POLE(NST.L Wthe he is exempt Iaerefmm and the basis fits the alleged exemption.Any vipenalty of ❑NEW BLDG/ADDITION ❑DEMOLITION
Section than by hundred canar,t$5 ermit subjects the applicum toacivil penally sf POWER DEVICES
not more than five hundred tlWlars(8500). ❑TENANT ❑FOODSERVICE
I,as owner of the progenytar my employees with waes as their sole comensationSWIMMING POOL ELECTRIC IMPROVEMENT
will do the work,and file structure is not intended proffered formle(Sce,7044,Business ❑OTHER
and Puldnesm.,Code:no Cerull rs License Law doe,sol apply man owner of OUTLETS—SWITCHES—FIXTURES
a' property who builds or improves thereon,and who does such work himself ar through IL
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELEC 1t SQ FT. '
sale.If,however the building or improvement is sold within one year of completion, SQ.FC FLOOR AREA $/SQ.Ff.
wner-builtler will have the burden of proving that he did not build or improve for par- - 4ti Jo
poo of mle.).
E)h as owner It the property,am exclusively contracting with licensed contractors to TOTAL: /{h O
nsrroct the pounder(Sec.7044,Business and Professions Code)Tho Contractor's Li- n .1
cense Law does not apply to an owner of property who builds or improves thereon.and QTY PLUMBING PERMIT FEE �� ,
who contracts for.such projects with a animators)licensed pursuant to the Commando's
License Law. ' PERMIT ISSUANCE ULL{r 996
F1 am interna rack,Sec. ,B&P C for his reason y7{/nfI
ALTER—DRAIN&VENT—WATER(EA)
Owner Date VAEUATION I
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby affirm under penalty of perjury one of the following declarations:
❑(have and will maintain a Certificate of Consent to allf-insure for Workers Compen- DRAINS—FLOOR,ROOF,AREA:COND. -
amiom,as provided for by Section 3700 of the LOM.Cale,for the perforomme of tae STORIES TYPECONSTRUCTION
work far which this permit is issued. FIXTURES—PER TRAP `
❑I haveand will maintain Worker's Compensation Insurance,as required by Section
3700 of the bur Code,forte pdffirra em,of the work for whichthis permit is issued. GAS—EA.SYSTEM- INC.4 OUTLETS
My
es
Coin tion �gr,�artier and Policy �W}�prykr�.sa�Q. �• OCC.GROUP APN
sd/V Policy Nu:�Qi(3X GAS—EA.SYSTEM-OVER 4(EA)
see CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEIINDUSTR,WASTE INTE R
This section need not be completed If the permit is forone hundred dollars($100) BUILDING DIVISION FEES
of less.) GREASETRAP
PLANCHECK FEE
Icertifythntinlheperformance ofth work (( h this permit is issued.I shall SEWER—SANITARY—STORM EA. FT.
nor employ ony Pers i any man f s �F�em m the Workers'Co.,.- ENERGY FEE
,Z mtian Lwsof Cu am' of ��
z O A licant WATER HEATER W/VENT/ELE
PP —. GRADING FEE
NOTICE TO LIe WorkFIT If,after g this C icre,of of Exemption,yon should WATER SYSTEM?REATING
1" S' become suhjem m the Worker's Co saris.provisions of the Labor Cnde,you must SOILS FREE
!� Q forthwith comply with such provisions m this permit shill ha deemed avoked. WATER SERVICE 10,
-
O
CONSTRUCTIONisoexaLENDINGnGENCY NEW RESIDENTIAL PCMB. SQ.Ff. PAID
A. Q l for by whithismthpermit i isawnsw,.,30[ending agency for the performance of Readapt
A. H Ne work for which this permit is issued(Sa.309'h Civ.CJ
Q V Lender's Name TOTAL:
{1a Lender's Address
fy 1 unify that 1 have rend this application and state that the above lnfnrmation is BUILDING PEE
y cnnect,lagree ro comply wish all city and county ordinances and tele lows relmingm QTY. MECHANICAL PERMIT FEE
V building construction,and hereby sulfuric representatives of this city m enter upon the SEISMIC FEE
above-motioned preperty for inspection purposes. PERMIT ISSUANCE,
(We)agree to save,Indemnify and keep hwmleas the City of Cupertino against ELECTRIC FEE Lk
liabilities,judgments,costs and expenses which may in anyway accoe againslsom City ALTER OR ADD TO MECH.in consequence of the Emitting of this permit, I
MBING Ciiii
APPLICANT .PERS IDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM)
SOU .ER 'UI, f10 . HANIC FEE
AIR HANDLING UNIT(OVER 10,"CFM) STRU Et
,Ga. of Applicarate"mracm, Date EXHAUST HOOD DGDUC)HAZARDOUS MAT (ALS DISCLOSURE SING MITIGATIO SEE
Will the applicant or future building occupant score br handle hazardous neerial HEATING UNIT(TO I W,000 BTU)
as defined by the Cristo Municipal Cade,Chapter 9.12,and the Ilealth and SafcfyCade,Section 25532(01 HEATING UNIT(OVER I00,WO BTU)
❑Yes ❑NoVENTILATION FAN(SINGLE RESIDE
Will the applicant or future building r use a tri mem nr devices which Dam Recei #
pp gbytheB q p BOILER-COMP(3HP OR 100,0110 BTU)
mit hazardous air are
as defineA by rile Bay Area Air Quality Manageinenl
Disc an TO
E]Yrs (J No BOILER—COMP(OVER I W,000 BTU)
I have heal the hazuodous materials requirements under Chapter 6.95 of Ne Cali AIR CONDITIONER
u ISSUANCE DATE
fornix Health no Safety Code,Sections 2thati 25533 and 25534.1 understand the if the NEW RESIDENTIAL MECH. SQ.Ff. - (c
ofrepimnot ncurrently have hod, a,im...itis.a responsibility mnotify theucupent _ , '1
of the rcquiremems which must be that prior m issuance of a Cenificme of Occupancy.
Owner or authorized agent Date - ISSUED BY:
OFFICE
0 Cityol,
10300 Torre Avenue
Cupertino, CA 95014
Ctlpel th10 Building Division
(408)777-3228
(408)777-3333 (fax)
March 24, 1997
Homeowner
19742 Bixby Drive
Cupertino, CA 95014
SUBJECT Permit#29545
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, the subject permit has not 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
Christy Akatiff, Administrative Clerk
•
Printed on Recycled Paper
—' i nw I. I`l IuAh I-HUN I Ul- bUILUING
•:G,,,. CITY OF CUPERTINO PERMIT NO.
BUILDING DIVISION _ 29-5
7, df
BU WIN DRESS: 7L+tl;tte"'{ DB Rib PROJBCI'R76NT�ICATIONJ:Acr'.'!,
SANITARY NO, APPLICATION SUBMITTAL D;'.
r lU 1 04 11 �rB�'• r i CONTRAsJ'0 'S NAME: ` ;/` - r '
/ .- �,7� ',.� 2T/�J-7 K lrc tilF -' NI CONTROLM
QHIItiCI'/gNOINEBR: r WC NO: ADURFSS: I"`.
adse. ". '' r . aBUE Dwo PERMIT wFo
INSP8CfI0N8q ,' DAT$ -BVSPEC: ❑ ConsWtant Fees Paid by Applicant(Initial) BLDG BLp,Cf PLUMB
FOUNDATION/PIERS/H.D.S.
INSPECTION RECORD '
LIFER GROUND JOB DESCRIPTIQN
NOTE: ALL GRADING AND DRAINAGE aFSIDBMTUL ��_R/qc
PAD/SETBACK-CERT SHALL BE INSTALLED TO COMPLY WITH OSFDwL NEN Rem04 i:
S AND
ITY
Ij Ii
GARAGE SLABs/PREGUNITE THE APPROVED CUPERTTOARRANGEIIYSPECTION ❑IANTERIORIT ❑MODIICHIMSTRUCTURAL
yTION 1
POURNO'CONCRETBUNTII.ASO yBHASBEEN,§lONEP CALL ATO R RANGEOONS NSP TI C4 00 PM) ❑IM IMPROVEMENT
BATH
❑PLUMBING REP
UNDERGROUND/SLAB )
PLUMBING ❑BATH REMODEUREPAIR ❑DEMOLITION %r =�
777.3228 MONDAY TO FRIDAY 24 HOURS BE- ❑OTHER
ELECTRICAL FORE REQUIRED INSPECTION, JOB ADDRESS
?D NOTPpURFL00R ABOVBHAS'B AND PERMIT MARE NEEDED WHEN PHONING. �r
.. N'?'1-E:._. .-.. N'SI//��NBD' -
PLUMBING ATTENTION CONTRACTORS: NEW OLMADDITION ❑DEMOLITION
MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON ❑ENAO IMPROVEMENT ❑FOODSERVICE •.;
ELECTRICAL THIS JOB SITE WITHOUT BEING IN COM-
PLIANCEWITHWORKERS'COMPENSATION ❑OTHER
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULATION SPECIAL INSPECTION REQUIRED ❑ DATE IN.r. a
,P1;ACENOSUBFLOOR;UNTB;;ABOVB gpgl.I. IOC INSPECTION
ROOF SHEATH/DIAPHRAM
PLUMBING
41
TUBS&SHOWER PAN
MECHANICAL y.2,
r F.LECTRICAL/POOL BOND
\ FRAMING/STAIRS/E.EGRESS 'ZJ'�a✓� ,�
INSULATIONNENTILATION 0��2.,�ej ? '•'t
iCOVER�NO,WORK,UNTTUABOVE,11AS BEFiN§,, NBD ''-
EXTERIAL SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN "
SHEETWROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREED ( .
SHOWER LATH
4N0,TAPB,0R PLASTER UNTIl,.ABOVB NAS BEEN S10IVED,:
SCRATCH COAT - , e
SEWER/WATER
,,TEMPORARY APP4OVALSiPf, ; �"5
OCCUPANCY I'{
ELECTRICAL
GAS t
GAS TEST " {
GRADE ' r
FIRE n
HANDICAP '�;; Vr
ELECTRICAL
PLUMBING )
•MECHANICAL
;NERDY
VISUAL FINAL ONLY CERTIFICATE OF OCCUPANCY 14D
BUILDING ,..,(
IMPORTANT: ISSUANCE DATE .:
05CUPANCY;OPI)II&DIN6 NOT,PERMITTER PLEASE READ REVERSE SIDE BEFORE
NTILaBUi'D I �IyGgNyBA U CALLING FOR FINAL INSPECTION 11
AP LICANTT POSTING COPY ISSUED Dr.