S 1362 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY
OP CUP
BUILDING-ELECTRICAL PEt r No. 1362
BUILDING DIVISION APPLICATIONFPERMIT PLUhnBNG-hll?CHANICAI'
INILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO APPLICATION SUBMITTAL DATE
OWNS A li: PFp1I3� I ^�r� O 'T'RACTOR'S Np,M���O` ' ICN
!%rlirrL,, '` U g0QIRA s'l11 (v NIC CONTROLp
ARC IITECI'/FNGI F.R: LIC NO: 1/1yN5� N. �LhQ" II Gu �
)NTACT: - PHONE: I\/-/ BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLIDO ELF:gr PLUMB MECH
LICENSED CONTRACTOR'S DF,CLANATION QTY, •ELECTRIC PERMIT FEE lo1B'Y�n�r scRl`LPrpI�LoN
1 hereby from that I um licensed under provisions of Chapter 9(commencing
Ooo wth Sation]IXp)ofUivision Sof the Business unJ PntfiesionsCode,andmylicensels RESIDENTIAL;
F W in{lull farce and eff«t. PIiRM111S5UANCli SFDWL ❑KITCHEN REMODEL.
ZUU License Class Liak APPLIANCES-RESIDENTIAL EDITION ❑PLUMBING RE-PIPE
FZ oum Conlmcmr
vs6q'� MULTI-UNIT ❑STRUCTURAI.
ARCHIL'ECTS DECLARATION
PANUS MODIFICATION
z ip-Z l Ium rw
ndersndmyplansshallM.ad.publicerds
OZ4- UPT0200AMPS ❑INTERIOR ❑CHIMNEYREPAIN
r-4ty Licensed Prnfessiand 201-1000AMPS IMPROVEMENT C]SWIMMING POOLS
OWNER-BUILDER DECLARATIONOVER IINN)AMI'S ElBATH REMODEUREPAIR ❑DEMOLITION
I hemby affirm that I am m
exept Immolate Commnnr's License Law for the
iry5..J q U fallowing ransom(Secran 703 1.5,Business and Itafeesmas Code:Any any or county SIGNS ELECTRICAL ❑OTIIFR
7+15 q 1- which require,a permit m commtet,aIle,improve,demolish,in,repair any swcmre
F'q.0 prior nt its issuance,also requires the applicant for such Permian file o signed statement SPECIAL CIRCUITMISC.
•ppp$ y fleaheislicen.smlpursuannmore movoonaof the Cmunceers License Law(Chapter 9 p
(commencingwith Smllmn7(XM)ul Divixinn J ofthe Business and Professions Codeine T'EMBME 'ROI )L COMMERCIAL'
1,q a K that he is exempt therefrom and the basis for the alleged esentption.Any viall mina of ❑NEW BLOGJADDITION ❑DEMOLITION
W..y Section]031.5 by anyapplicant for a Permit subjects the applicanuo or civil 1 DEV I ❑TENANT FOOD SERVICE
p[p-ZQnot more than five hundred dollars($5110). IMPROVEMENT
[]las owner ofthe property,or my employees with wages as their sole tat smion, IM I. iC
'z•5Q will do the work,and the structure Lwot intended oroffered liar sale(Sco,74H sine ❑0'I'41EN
Rl and Po'fessions Code:".Cenlmmm's License law does not apply as an 1.E -SWITCI - 'NR
4' property who builds or improves thereon,and who does such work himself o rough
his own empleyas,provided that such improvements ate not intended or m d for N FNTIAI,PFC11 SQ FT.
sale.If,however,the buidrignr improvement issued within mneyea.of compete SQ.FT.FLOOR AREA USQ.f4.
mormbuilder will have the burden of proving that he did not build or improve
pose of sale). ��
'PUPAL:
1,as owner of the pmµny,am eactnsively contracting can licensed ennvucmrs m
conswcnbe project ISce.7044.Business and Professions Cove:)'Hic Conlracmr's Li-
arseLaw does not apply to an ownerofprepeny who builds or improves thereon.and QTY. PLUMBING PERMIT FEE
whocmdoccatiesuch pntjeaswith a comments)licensed ammom isthe Centmeme,
License Law. PERMIT ISSUANCE
0 latest rS _.B&P C for this rosemn
ALTER-DRAIN&VENT-WATER IEA) p1.UAT10N
Date
WORKER'S C) sNSATION DECLARATION BACK FLOW PROTECT.DEVICE
I herciy affirm under pen. of pctyury one of the followingdculandium: 6FAR 13
l have and will maintain a Ccndraneof Cunanl to self-in sure far Worker,Cooper- DRAINS-FLOOR,RODE AREA,COND. "P�NCHECK
TYPE CONSTRUCTION
as provided for by Section 37M of the labor Cade,far the performance of the
ork for which this permit is issued, FIXTURES-PER TRAP
I have and will nmiarom Worker's Compensation Insurance,as required by Section
3700ol'the labor Code,for the perfmnnance afire work forwhich this permit is issued. GAS-F.A.SYSTEM-]INC.4 OUTLETS ST
My Workers Compensation Insurance canner and Policy number are:
Canner: Policy Na.: GAS-F.A.SYSTEM OVER 4(EA)
CERTIFICATE OP EXEMPTION FROM WORKERS' GREASUNINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE GDIVIS10NPlm
(Th LvsenionneedmtMcomplctadll lhepeman is homaramadrWdollars($11p) GREASETRAP
or less.)
I cenify that in the performance of the work forwhich this permit is issued,l shall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any manner so as m beammembjeet m the Workers'Compem ENERGY TEL'
,Z action Laws of Co,ffomia.Date WATER HEATER WNENVBLECfR
O Applicant CRAU
y NOTICETO APPLICANT.If,after making this Cenifica a of Exemption,you should WATER SYSTFM/TRF.ATING
SOLLSTDa
I-' Momma h comp m the Worker's Compensation this provisions of the Lahr Code,. maw
W ti fimhwith comply with such provisions or this permit shallMdecmcd revoked. WATERSERVICE
a CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMD. SQ.Irl'. PAID
L)0 Iname,affirm t hat there isamnstructiaa leadmgagencr Teethe perfannnnce of Receiptp
CLF the weak for whichthis permit is issued(Sce.3097,Civ.C.) .TOTAL:
QU Lenders Name
rW Lender's Address TOTAL:
y I teddyNal 1 have read this applicatioaln snot stem Ththe aMwe information is BUILDING TTI
iF-i N corect.I agree to comply with all city and county ordinances and state laws relating to QTY, MECHANICAL PERMIT FEE SEISMIC FEE
L) Z holding conavuclion,and hereby authndre representatives ofthis city to enter upon the
shove-mentioned property for inspection parpns, PERMIT ISSUANCE
ELECTRIC PEE
(We)agree m arm
save,indemnify and keep harmless the City of Cupenian agaimsl
habllitic,judginenes,insisted espencea which may in any any aeeruexgaintl soil City ALTER OR ADD TO MECH. PLUMBING FEE
In consequence of the gran ing nI this permit.
APPLIT UNDERS NDS D W .-CO PLY WITH AL1.NON 'OINT A1µHANDLING UNIT(TO IO,IKK)CFM)
SOUR Ton MECHANICAL PEE
/ AIR HANDLING UNIT(OVER 111,IX0CIM) CONSTRUCTION TAX
Si,ammenfA,licanVConmua" am EXHAUST HOOD(WIDUCT) HOUSING MITIGATION FEE
HAZARDO MATERIALS DISCLOSUI
Will Ncro,licamt or future bulldialmlialsntwnremr handle hnmNaus mdemil I HEAHNG UNIT TO 100,000 BTU)
as defned by the CuWaino Municipal Code,Chapter 0.12.and the I lcallh and Safety
Coda,Section 255320)1 HEATING ON I LOVER 100,000 BTL)
CJ Yes E]No VINTILA'1'ION FAN SINGLE RISS IDI PAID
Dam Receipt#
Will a ha applicant or future buileingacupans ice cquipmenron devices which BOILER-COMP LHP OR IM.(M BTU)
n buvuNnus air atmaminea s as defined by the Bay Area Air Quality Manageinem TOTAL:
tin r BOILER-COMP(OVER 100.0(NI BTU)
❑Yu E]No
I have read the hamnlons maenals mathematics under Chapter fi9501 he Cali- AIR CONDITIONER ISSUANCE DATE
fomia Health&Safety Coda Sections 25505,25533 and 8534.I umbereland Nal d the NEW RESIDENTIAL MFCH. SQ.FT.
mildingdoes not currently have a tenant,that it is my sponsihilay to artily Ne occupant rn
of the mquirentenls which most be met Prior as issuance oft Certificate of Occupancy. �\�/��\ w
Owner mamhmineed agent Data TOTAL: ISSUED BY: �•
OFFICE
y 10300 Torre Avenue
Cit}- of Cupertino, CA 95014
-
Cupertino Building Division
(408)777-3333 (fax)
L
March 5, 1999
.' Property Owner \
t 10311 N. Blaney Ave
Cupertino, CA 95014
SUBJECT: Permit# S1362
Dear Property Owner:
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 C�UPE�RTINO
Christy Akatiff, Administrative Clerk
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