29525 i APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY. l ' '
CITY OF CUPERTINO; ' ' . BUILDING-ELECTRICAL ,• PERMIT NO.
IfUICDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL t ��J 5 2 5
BUILDING PROJECT IDENTIFICATION '
B ING DDRE S: - - SANITARY NO. APPLICATION SUBMITTAL DAD
e ve:
E 'S P HETRAC
(0 I^/ / NIC CONTROL N
CHITECTTNG1 I R: LIC NO: F S: ❑
CONTACT': - PHONE: - - BUILDING PERMIT INFO
'❑ Consultant Fees Paid by Applicant(Initial) BLDG - EL PLUMB MECH'
El
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE s
1 hereby affirm chat I am licensed undo pro,isiaes of Chapter 9(commencing JOB DESCRIPTION
, Oz wiIF Section]001ft of Division 3 ofthe Business and Professions Code,and mylicense is PERMIT ISSUANCE - RESIDENTIAL '
O in full farce and effect.
�Uzj License Cl ss Lia,»_ ❑SFDWL ❑KITCHEN REMODEL
y6L Dete - Commcmr APPLIANCES—RESIDENTIAL ❑ADDITION; ❑PLUMBING RE-PIPE
'F,Dy CHITECT'SDECLARWW& [IMULTI-UNIT - ❑STRUCTURAL
Z O m 4�k I understand my plans shall be used as public records ` PANELS MODIFICATION,
024p'a `, UP TO 200 AMPS ❑INTERIOR [I CHIMNEY REPAIR
5r 201-1000AMPS - IMPROVEMENT
Y11 _ QWNEinexemDERDECLARATION - OVER1000AMPS ❑BATHREMODEUREPAIR C:1 DEMOLITION
O Uel 1 hereby.(leer lbw 1 am exempt s an the fessContractors License Law for 0e
LLd following reason.(Secion]OJLS.Business and Professions Gyle:Any city or County -SIGNS ELECTRICAL El OTHER
0 F which requires a Permit or consumer,alter,improve,demolish,or repair any structure
1W-5 prior to its Issuance,also requires the applicant for such permit to file.signed Statement SPECIAL CIRCUIT/MISC.
y that he is licensed pursuant to the provisions ofthe Contractors License Law(Chapter 9
GCZ (commencing with Section 7g10)of Divisinn3mfthe Businoss.nd Professions Code)or TEMP.METER OR POLE INST. COMMERCIAL _
that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑DEMOLITION
Section]031.5 by any applicant for a permit subjects thea applicant to a civil ❑NEW BLDG/ADDITION
y not more than five hundred dollam($500).' PP penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
pI]1,ee owner of Nepmpeny,or my employeeswith wages ns lheirsmle compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
will dm the wmrk.and the swnam is oat intended oraffered fors Ile(Sec.7044,Business ❑OTHER
Ila and Professions Cade:The Contractor's License Law does not apply to an owner of OUTLETS—SWITCHES—FIXTURES
4' property who builds or improve..thereon,and who does such work himself or through
his own employees,provided that such improvements are not intended or offered far NEW RESIDENTIAL ELECfR SQ FT.
sale.If,however the building or improvement is sold within one year ufcompletion,the - SQ.FEMOORAREA $/SQ.FT,
owner-builder will have the burden ofproving that he did not build or improve for par-
pose of sale.).
1,as owner of the properly,am exclusively contracting with licensed contractors to
construct the project(Seo.7044,Business and Professions Code:)The Conuazt 's L' I) A�
cense Law does not apply to an owner of propemy who builds or improves the n d TY. PLUMBING PERMIT FEE �� 1.
a whoconuacts for such projects with a contrador(s)licensed pursuant mthe Co tar
License law. PERMIT ISSUANCE
❑ lam exempt under Sea ,B&PCfonh' re o
tINSR
VBNT—WATER(EA)
Owner Dace r L`r ALUAT
WORKER'S COMPENSATION DECLARATION ECT.DEVICG11 - s
I hereby affirm under penalty ofperjury one of the following declarations: fk//l Y(J
❑Ihave and will maintain aCmificate ofConsem to self-insure far Workers Compen- OOP,AREA.COND.,• STORIES TYPE CONSTRUCTION
sadon,as provided for by Section 37M of the Labor Code,far the performance of thew kfurwhichthtspermitisiamed. APhave and will maintain Worker's Compensation Insurance,es required by Section ofthe Labor Cade,for the performance ofthe work for whichthis permit is issued. -FINC.40UTLETSOCC.GROUP APNMy Work/'Jr',�y,'pa a carrier and PolicyComer: Policy No RO E 4(EA)CERTIFICATE LR EXEMPPION FROM WORKERS'COMPENSATION INSURANCE W STE INTERCEPTOR
(This sectio.need not be completed ifthe permit is formae hundred dollars IV.,) BUILDING DIVISION FEES
or less.) - - I GREASETRAP
PLANCHECK FEE
" (certify1.thea.,.mallore of le work for as 1.
permitisarsued,I'Cimpshall SEWER—SANITARY—STORM EA.201)FE not employ any person in any manner eu us m become subject m the Worker'Compen- ENERGY FEE x
Z Applicant
Laws of California.Dace
O WATER HEATER WNENT2LECIR
'yy�A O Applicant
lea [A NOTICE TO APPLICANT:If,after making this Certificate GRADING HE
e of Exemption,you should ,
become subject m the Worker's Compensation provisions of theLabor Code,you must WATER SYSTEM/TREATINGSOILS FEE
forthwith comply withsuch provisions or this peen t shall he deemed revoked. WATER SERVICE
Q
,Uz CONSTRUCTIONLENDINGAGENCY NEW RESIDENTIALMMIL SQ.FT PAID
L) Iherehy (firm that there rsaconsWmimn lending agency for the perfornc
mae of - Date Receiptp
LL l-+ the work for which this permit is issued(Sec.3097,Civ.C.)
V Lender's Name TOTAL:
{kI Lenders Address TOTAL:
)y I cenif rim,1 have read this application and Stam that the have information is - BUILDING FEE '
Vl cored,I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE -
6) 7- building construction,and hereby radiation representatives afthis city to enter upon the SEISMIC FEE
i hove-on ctimad propeny for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE
Imbilities,judgmenis,costs and expenses which may in any way accrue against said City -
in consequence of[be Standing Of this Permit. ALTER OR ADD TO MECIL PLUMBING FEE
APP ICANT UNDERSTANDS AN WILL COMPLY WITH ALI.NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
SOU11{CE REGULO ONS, 'L/sy�1 MECHANICAL FEE
�.yd`'n,�O rOJ //IiAIa 4�I���, AIR HANDLING UNIT(OVER CFM) CONSTRUCTION TAX
Sig nature of AppUl ucoontracmr ,Date EXHAUST HOOD(W/DUC) HOUSING MITIGATION FEE
AZ RDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100.000 BTU)'
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) -
❑Yex E]No - I VENTILATION FAN(SINGLF RESID)' PND'
Will the applicant or future building occupant use equipment or devices which -
Data Receipt#
emit hazmd nos air contaminants as defined by the Bay Area Air Quality Management BOILER=COMP(3HP OR 100,000 BTU) -
District? TOTAL,
❑Yes 1:1 No - BOILER—COME(OVERIMONBTU)
I have read the hazardous materials AIR CONDITIONER
requirements under Chapter 695 of the if - ISSUANCE DATE'i
fomia Health&Sa(ely Code,Smtiore 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.FL
building does not currently have a tenant,that it is my responsibility to notify the occupant
of the nquirements which must be met prior m issuance of a Cenifmme of Occupancy.
Ownermamhonzai agent Dare - TOTAL: ISSUED BY:
OFFICE
&Cilvol,
10300 Torre Avenue
Cupertino, CA 95014
-1f
1pel th-10 Building Division
(408)777-3228
(408)777-3333 (fax)
January 15, 1996
1�
Homeowner
20632 Cheryl Drive
Cupertino, California 95014
SUBJECT Permit: #29525
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"
JAN-16-97 THU 08 :32 PM NAOHIKO&RIE MORI 408 255 2867 P. 03
POST THIS CARD NEAR FRONT OF BUILDING
CIYY OF PRRTINO PERMIT H�
BUILDING DIVISION avu.Dt 6 PROJECT IDENTIFICATION 9521
B�JR IND AnnR1sB: i SANIIARYNU. APPLICATION SUBMI HAL DI
ON't�I S LAVE. � � ( �, I PH ` TRA sy'+�.+Ei }g O: 1
1:14 ! K) `P rL1It 1tC, C. V -S NIC Nrc (ONl'ROLY
+,C HI'IECT/ENCINEER: LICNO; ( 5$, �, /�r ^,� I� /�/li I` ❑
BUILDING PIiRMI'f INFO
1NSPGC'TIONS DATE INSPEC. ❑ Consultant Fecl Paid by Applicant(initial) BLDG ELE. PLUMB MECH
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD ❑ ❑ 13
IOD DESCRIPTION
RESIDENTIAL
UFER GROUND NOTE: ALL GRADING AND DRAINAGE AL
PAD/SET BACK-CERT SHALL BE INSTALLED TO COMPLY WITH 11$FDN2 0 KITCHEN REMODEL
THE APPROVED PLANS AND CITY OF ❑ADDITION ❑PLUMBING REPO'E
GARAGE SLABS/PREGUNITE _ CUPERTINO STANDARDS. ❑MULTI-UNIT CSTRUCiURAL
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED MODIFlGTION
TO ARRANGE INSPECTION 0INTERIOR ❑CHIMNEY REPAIR
UNDERGROUND/SLAB CALL AFTERNOONS (12:30 PM • 4:00 PINI) o IMPROVEMENT
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ❑BATH aESIODEDREPAIR ❑UF.MOLRION
OTHER
ELECTRICAL FORE REQUIRED INSPECTION.JOB ADDRESS
DO NOTPOUR FLOOR UNTILABOVE HAS BEEN SIGNED AND PERMIT H ARE NEEDED WHEN PHONING.
COMMERCIAL:
AT'TEN'TION CONTRACTORS:
PLUMBING ❑NEW BLDCVADDI'f ION ODEAIOLITION
MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON ❑TENANT ❑FDODSERVICE
THIS JOB SITE WITHOUT BEING IN COM-
IMPROVEMENT
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION ID OTHER
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP.
PLACE NO SUBF'LOOR UNTILABOVE HAS BEEN SIGNED
ROOF SHEATH/DIAPIIRAM
i PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECI'RICALIPOOL BOND
FRAMING/STAIRS/E.EGRESS
INS U LATIONN ENTILATION
COVER NO WORK UNTILABOVE HAS BEEN SIGNED
EXTERIAL SHEAR/HOLD DOWN
INTERIOR SHEARAIOLD DOWN
SHEETWROCKISHEETROCK SHEAR
EXTERIOR LATH/W-SCREED
SHOWER LATII
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY _
ELECTRICAL
OAS
FINALS
GAS PEST
GRADE
FIRE
HANDICAP r t
dOWELECIRICAL
PLUMBING
MECHANICAL '
ENF,RCY
VISUALFINALONLY CF.RTICICATE OF OCCUPANCY ❑
BUILDING I.NIPORTAN'C: ISSUANCE DATE
OCCUPANCY OFBUILDING 1S NOT PEOMITVI? PLEASE READ REVERSE SIDE BEFORE
UNTIL BUILDING FINAL IS SIGNED BY BUILDiN CALLING FOR FINAL INSPECTION!!
INSPFCTGR