S 0356 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMSIT NO. 0356
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING PROD ECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO. APPLICAl[ON SUBMITTAL DAII,
OW ERS NAME PHONE: p CONTRACTOR'S NAME: LIC NO
:
W ��� `— /0& 0 kwllllw-44 r Ct& . C IO(e7? N/C CON ROLA
' ARCHGM ENGINEER: LIC NO: ADDRESS F-1 Z�z
CONITTACT: PHONE:: BUILDING PERMIT INFO
A4-/,✓ ,w vj.4- Z`13 BOJ/c'XLi ❑ Consultant Fees Paid by Applicant(Initial) BLDG IiLGCT PLUMB MECH
❑ ii ❑ ❑
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
I ims 70 to mfl that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
W0p with Section](I(10)of Division3nfthe Business and professionals Gxk,acrd mylimnacis RESIDENTIAL:
F in full force and cffcctt� PERMIT ISSUANCE
W� G%b YS CSFDWL C KITCHEN REMODEL.
F.UZ t,,) I,icenee Cl:yy��.e Lic.a
N< Dme3la� _Crmrucmr APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
Z pD to „''`”, ARCHITEMPS DECLARATION PpN1i1S ❑MULTI-UNIT C1 STRUCTURAL
Z 1 undersand my plans shall used uras public records MODIFICATION
OZ—� ` UPT02MAMPS a ❑INTERIOR ❑CHIMNEY REPAIR
<r<4F"{y Licensed Prnfecaonel 201-1000AMPS IMPROVEMENT SWIMMING POOLS
OWNER-exemp ERm the Commuters
OVER IWAMPS
�p]u CC 1 heresy affirm that 1 run exempt from the Convumor's License Law for the [I BATH REMODF;VREPAIR DEMOLITION
3 a U following reason.(Section]031.5,Business and Professions Coale:Any city or county SIGNS ELECTRICAL C OTHER
IL L4 which requires a permit to construct,alter,improve,demolish,or repair any structure �'
test%
I:—� prior to its issuance.also requires the applicant for such permit m file a signedslmement SPECIAL CIRCUIT/MISC.
that he is licensed Planned 10 the Provisions ofthe Commuctor's License Law(Chapter 9 1. Illy
D�j—GOA (commencingwith....un]000).fDivi.am 31fthe Business and Professions CrvlOor TEMP.MFTER OR POLE INSL COMMERCIAL:
that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION C DEMOLITION
iuClLL
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of POWER DEVICES
F.
} no more than rive hundred dollars($300). ❑TENANT 017001)SERVICE
^S C L as owner of the property,or my employees with wages as their sole compensation, SWIMM I NO POOL ELECI'R IC IMPROVEMENT
a will dothe work,and the swaurse is not intended orol@red forsale(Sec.]044,Business ❑OTHER
6 and Palestinian,Code:The Contractors License Low does not apply to on owner of OUTLETS-SWITG FIXTURES
prepeny who builds or improves income and who does such work himself or through
his own employees,provided that such improvements art not intended or offered for NEW RFSIDENTI ECTR SQ Fr.
sale.If,however.the building or improvement is sold within one yearofcompleion,the SQ.FT.FLUOR All II S/SQ.FT.
owna-builder will have the burden of proving that he did not build or improve for put AN
-
peso of ruled.
❑I,as owner of the property,am exclusively contracting with licensed c.nlrxclacT to LA
construct the project(Sec.7014,Business and Punfessi.ns Code:)The Contractors Li- pq Q
cense Law does not apply 10 an owner of property who builds or improves SeatY on,and QTPLU I PERM FEE PAID
who contracts for such projects with u cranmctoos)licensed pursuant to the Comrecomes a
License law. PERMIT ISSUANCE L 8
- ❑lam exempt under Sce. ,B&PC fonhif rexsnn
Owner Uma
ALTER-GRAIN&VENT- VALUAW R 1QN1u
17Glk '
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE Cj,ll Ur VVr"
I hereby affirm under penalty of perjury one of the following declarations: N
❑ I have and will maintain aCcroficamof Ccnsenuo relf-insum for Workers Camper. DRAINS-FLUOR,ROOH AREA,COND.
sari..,as provided for by Section 37M of the labor Order,for the Infirm nonce of the STORIES TYPE CONSTRUCTION
wo Is for which this permit is issued. FIXTURES-PER TRAP
have and will maintain Workers Compensation Insurance,as required by Seen,).
39W of the Labor Code,for the performance of the work for which this permit is issued. GAS-PA.SYSTEM.I I NC.4 OUTLETS OCC.GROUP qPN
My Worker'a Compensation Insurance carrier and Policynarit 7, s�
Comer: L PION Na: O Ts✓ 7 GAS-EA.SYSTEM-OVER 4IPA)
/.V.( CEROFIC TE OF E%L•MI'fION FROM WONKERS' GRLASP/INDUSTRL WASTF.INTF.RCEPIUR
COMPENSATION INSURANCI?
(Thissecti.n sad not be completedn
ifthe permit is for hundred dollars I$Win GREASETRAP
Ii UILDING DIVISION FEES
or less) PLANCHECK ME
(certify ohminthe Perforanydmance alofthe.1a.bc for adjuelhto the Wiisiss'Cionea. SEWER-SANITARY-STORM EA.200 FT.
non es Law any person in any manner so nx m become suploa ro the Workers Cnmpen' - ENERGY FEF.
Z ration Lawn of CulJomia.Date
z O Applicant WATER HEATER WNENT/ELT:CTR
PF GRADING ILG
.Na NOTICE TOAPPLIe Wark IL afar making this
ovisi.cmc of Exemption.you should
.,I WATER SYSTEM?REATING
a become a comp us the Workeh Cons or
is provisions of the labor Code,you must SOILS FEE
�1 forthwith comply with such provision nnhie permit shall he deemed revoked. WATER SERVICE
r-rO CONSTRUC ktirmHON LENDING AGENCY NEW RESIDENTIAL PLMII. SQ,PI', PAID
I bcrwhich rte t Pe there isoed(Slc.ina ler ding agency ficlhe perf.rrnuncc of )at R¢C¢Ipl#
(L wr the work for which this permit is issued(Sm 3097,Civ.C.)
0 U Lendels NameTOTAL:
Lundels Albania TOTAL:
p. 1 certify that I have read this application and state that the above information is BUILDI G E
V1correct.l agree to comply with all city and county ordinances and stale laws relating ,I QTY. MECHANICAL PERMIT FEE
U4 buildingconstruction,andhumby loan o,representatwes.f this city to anter up.a the SETS E
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino againnl PERMIT ISSUANCE HLEC
liabilities,judgmelns.ecsts andexpcaseswhich mayin any way accrue against said City q1:1'ER OR ADD TO MF.CII.
in consequence of the granting of Box permit. PLUMH>A FEE
APPLICANT UNDERSTANDS WIND WILL COMPLY WITH ALL NON-POINT AIR HANDLING
—
UNIT(TO 10.(00 CFM)
SOUR
MICHA 1
L /a, AIR HANDLING UNIT(OVER I0.000CFM) CDNSTR ON'it
X
Su mureof p barl .mmcln Doe
I EXHAUST FOOD(W/DUCT) HOUSING MITIGA'ION PEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazmdous material HEATINGUNIT(TO100,0I01ITU)
teas defined by the Caliendo Municipal Gude,Chapter 9.12,and the Health and Safety
Code,Section 255321a)? HEATING UNIT(OVER W0.000 BTI)
❑Yes CNo
VENTILATION FAN SINGLE RESID) PAID
Date Receipt#
Will the applicant or future building by he
neee.AilQm.rdeviceswhich BOILER-COMP QHP OR IMAM BTU)
•mit hazardous uireonmminanls as defined by the Bay Arce Air Quality Menegwnem
District?
❑Yes CN. BOILER-COMP(OVER 100,0I10RTU) _
1 have read the Instructions materialsrtquirtmems under Chaplet 6.95.fine C.R.
AIR CONDITIONER I UANCE DATE
local Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MSCI I. SQ.FE
building does not currently have a tenant,that it is my respmsibilhy to notify the occupant
ter the requirements which must he met prior to issuance of a Cenilicmc of Occupancy.
Owneroramh.nzed not Dam TOTAL:
ISSUED BY:
OFFICE
• '�-• 10300 Torre Avenue
(_ite of Cupertino, CA 95014
Gapertm` 0 Building Division
(408)777-3228
(408) 777-3333 (fax)
March 20, 1998
Homeowner
10350 Bonny Drive
Cupertino, CA 95014
SUBJECT: Permit 9 S0356, electric
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 finaled 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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
P"'red on Pecva!od Papa,