29291 A%FLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPFRTINO BUILDING ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONMERMITPLUMBING-MECHANICAL 29291
BUILIIING PROJECT'IDENTIFICATION
BUILDINGADDREBti: SANITARY NO. APPLICATION SUBMITTAL DATE
� 6�. ' � \zi l�lro
OWNER'S NAME: P NH: CONTRACIOR'SNAME: LIC NO:
�2/L P-rte f rZr'✓ ZOSo 4 IS, NIC CONTROL x
\RCHITE(.T/ENCINEER: LICNO: ADDRESS: ❑
//SO /L./Ya 1, .d Nes IYL- S. V.
CONTAC. PHONE: BUILUfNG PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLJNG ELECT PLUMB MECH
LICENSED CON'TRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE ❑
I hereby aRrm mat 1 am licensed under provision of Chapmr 9(commencing JOB DESCRIPTION
�0z with Sedi.n]011tp of Uivisinn3ol'Ne Business and l'rofessiensCode,and mylicenx is RESIDENTIAL:
C in full force and efelf PERMITISSUANCE `�
�UIUU" Liccnse CI." Lic,M OSFDWL "'*KITCHEN REMODEL
y za0. Dem Contractor APPLIANCES—RESIDENTIAL ❑ADDITION �PaLUMBING RE-PIPE
Fy ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
z O:d Z I understand my plans shall be used as public recnd, MODIFICATION
Oz UPT02MAMPS ❑INTERIOR [I CHIMNEY REPAIR
P41- Licensed professional 20I-1000AMPS IMPROVEMENT
W 6
OWNER-BUILDER DECLARATION OVER I(KKIAMPS [I BATH REMODEfJREPAIR [I DEMOLITION
yy�d 1 hereby anion that I am exempt from the Contractor'a License law for the
W O t1 U following remnn.(Section 7031 S,Business and Professions Cub:Any city or county SIGNS ELECTRICAL ❑OTHER
RI (twhich requires o Permit memorial.almr,improve,demolish,or repair vny swmurc
�0 prior to its issuance,also requires thevpplicum fm such plonat to Rlcnsignedmiumneat SPECIAL CIRCUIT/MI.
Nat he is licensed purcuanuo the provisions of the Contractor's License Law(Chapter 9
� GAO (commencing with Section AOO).f Division 3 of my Business and Professions Code)or TEMP.METER OR POLE ST. '
a a p 6' Nat he is exempt Nemfrom and the basis for Ne alleged exemption.Any violation of W BLDG/ADDITION ❑DEMOLITION
Y•
Scallion 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of POWER DEVICES s
^vs ❑TENANT ❑FOOD SERVICE
Z} nm more Nan five hundred do)[. IMPROVEMENT
O ❑ I,es ownerk the Pm .15 is employees with wages rvalc solecompensation. SWIMMING POOL ELECTRIC
_ will do Nc work,and memmmurc is not intended nroffereJ for sole lSeu.]wa,Business OTHER
and Professions Code:The Contmctnrs License Law doss not apply to an owner of OUTLETS—SWRCHES—FIXTURES
property who builds.r improves thereon,and who does such work himself or through
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ P.
sale.If,however,the building or improvement is slid wiNin nuc year of completion,the SQ.FL FLOOR AREA s/SQ.FT.
onvair-lamilder will have the burden of proving mat he did not build or improve for
par-1,as owner of the pnmperty,.n exclusively slid commctin,with licensed contractors i. T
onsWct tb<pmjttt(Sec.]IWq,Business and Pml'cssionn C.JcU The Cannnanr'V Li. )
scums Law does..,apply loan .,of property who huildsm improves thereon,and QTY. PLUMBING PERMIT FEE
whoconaticts for such famees with a contmemrfs)licensed pursuant the Gmhactore nit.
License Law. PERMIT ISSUANCE 3119
❑ I am exemptunder Sec. ,11&1'C for thin reason
n
OwnerDam ALTER—DRAIN&VENT—WATER(FA) VP yAl UtTlyFlltU
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
ry
I hereby affirm under penalty of perjuone of the following declarations
❑I have and will mainmin a Certificate of Consent o self-insure for Worker's Compel- DRAINS—FLOOR ROOF AREA,COND, w, XymocqC 11 TYPECONSTRUCTION
cation,as provided far by Section 3700 of the Labor Codc,far the Perfommm.of the
work for which this permit is issued. FIXTURES—PER TRAP
❑ I have and will maintain Workers Compensation Insurance,as required by Section
37Mofthe Labor Code,for the Performance of me work for which this permit is issue. GAS—EA.SYSTEM-I INC.SUTLEI' OCC. UP ANN
My Worker's CoInsurancecatlon Insurance carrier and Policy number arc:
Carrico Policy No.: GAS—EA.SYSTEM-OVER J(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCEGREASUINDUSTRL WASTE INTERCEPT-
('Ihis section need no,be completed if the Perm is for one hundred dollars IS IB(B BUILDING DI SION FRIESor IessJ GREASE TRAP PIANCIIECK PEE.
I certify that in the performance of the workfrwhich this Permit is issued,l shall SEWER—SANITARY—
act employ any person in any manner so as m become subject to Ne Wmkns'Compan- STORM 1?A.2W Ff. ENERGY HE
O ,z. Varian Laws of California,Date WATER HEATER WNENTIELECTR
7 Q Applicant GRADIN HE
q y NOTICE TO APPLICANT:If,otter making this Cerifirwe of Exemprinn,you should WATER SYSTEMCKEATING
F^ become subject o the Worker's Compensation provisions of the labor Code,you muu OILS FF.
IS, i,,,t forthwith comply with such previsions or this permit Nall be deemed revoked; WATER SERVICE -
Q
.0.7. z
CONSTRUCTION LENDINGAGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID
V Q thereby ich'hi that issuomwWon lending agency for Perfammvnce of Date RtteiptM
IL H the work for which this penmdt is issued(Sec.3(19],Civ,CJ
U Lender's Name TOTAL:
Tilfender's Adtlrcss
1 certify that 1 have real this application and state that the above infatuation is BUILDING FEE
(0./1 correct.l agree at comply win all city and county curb...swiandstmelawsrelalingum QTY, MECHANICAL PERMIT FEE
L) z building construction,and hereby authorize represmmtives of this city to enter upon the SEISMIC FEE
`� above-memi.ned property for inspection purposes. PERMIT ISSUANCE
W,)agree to save,indemnify and keep ironies,the City of Cupertino agnin.a ELECTRIC FEE `
livbilities.paturems,costs and expenses which may inany way accme.gaima said Ci,y ALTER OR ADDTO MECH.
in consequence of the granting of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IBM)CFM)
SOURCE REGULAT19w,
MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,1100 CFM) CONSTRUCIONTAX
S' mm of AlplicandContractor Data EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCL RE
Will the applicant or future building occupammore or handle hazardous material HEAPING UNIT(TO 100,000 BTU)
as defined by the Cupertino Municipal Cole.Chapter 9.12,and the Health and Safety
Code,Sation 25532(a)'! HEA'T'ING UNIT(OVER 100,001 BTU)
[3 Yes FIN. VENTILATION FAN(SINGLE RESID) PAID
Will the applicant or future building ecru equipment or devices which Date Reccipt k
pp g the
use quip BOILER—COMP 13HP OR 100,011(IBTII)
mit hazardous air conmminsnD as defined by the Bay Area Air Quality Management
TOTAL.:
❑Yes ❑Nn
OiDistrict?District? BOILER—COMP(OVER 100,00 BTU)
I have read the hazardous materials requirements under Chapter 6.95 of the Cull- AIR CONDITIONER ISSUANCE DATE
(nmia Health&t come Code,Setons 25505,is
and 25533.1 understood Net if the NEW RESIDENTIAL MECH. SQ.FT.
building docs not currently have a tenant,that itis 53 rend 25 34.110 notify Ne that
if
of rhe remittances which mus Ire met prior,.issuanm of a Catificzte of Occupancy.
Owner no a ammued agent - Data TOTAL: ISSUED BY:
OFFICE
•D. Citv
10300 Torre Avenue
uf
Cupertino, CA 95014
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
September 23, 1996
Homeowner
19761 Bixby
Cupertino, California 95014
SUBJECT: Kitchen Remodel: Permit# 29291
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
Christy Akatiff, Administrative Clerk
Pun red on RnCldeO Rnpor ,