S 1306 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
4;RJ
PY OF CUPERTINO HUIL)ING-ELF.CI'RICA I, PEI`IT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMIIING-MECHANICAL �J 1306
w I\DI LDING PROJECT I DENTIFIC'A'1'ION
11.U1NG ADDRESS: � �� � � 1 �� � SANITARY NO. APPLICATION SIIRMITT�DATG
'N"SNA is PHONE 23,�� CONI'kALTOk:S NAME: LIC NO:
1 NIC COM'HULM
CI{ITECI'/IiN dNEE1t; I.IC NU'. _ ADDRESS'. ❑
Co AMP 1I // PHONE - - BU LDING PERMIT INFO
57 ._ Z3 CL/./ ElConsultant Fees Paid by Applicant(Initial) 111,I1G IiLF;CT PLUME MIICI
M
LICENSED CO 'RACTOR'S DECLARATION - QTY ELECTRIC PERMIT FEE
1 hereby main Ihat I atm licensed aader provisions of Chanel 9 onare ceding - JOB DESCRIPTION
paZ with Section 70o)o'Division 3ofthe Husincesend Professions Code,and my license is
Wr,00 PERMIT ISSUANCE
RESIDENTIAL
in full forces effect. �(
aUU 1.i¢nu Claw Lia. ❑SPDWL ❑KITCHEN Rio PIPE y4a Done Contractor APPLIANCES-RESIDEN IAL ❑gU1lITI0N [I PLUMBING RISI'IPE
T.D� ARCHITT:C TS DECLARATION PANELS
❑MUl:fl-UNIT ❑STRIICI'URAI.
Z p rn Z 1 malcontent my plans shall he died as public odamiln MODIFICATION
pZ4—a UPT0200AMPS ❑INTERIOR El CHIMNEY REPAIR
F`u,W Licensed Pmfcasinmal 201-1000AMPS IMP VEMfiN'P
�j OWNER-BUILDER DECLARATION C]SWIMMING POOLS
Q 1 hereby affirm that 1 am exempt from the Contractor's License Law for me LIVER plot AMPS `` 'H 1 EMODI?UREPAW El DEMOLITION
sea pG V following reason.(Section 7031.5.Business and Professions Cnde:Any city or county SIGNS ELECTRICAL. ❑O1111:R
W 3 W y which requires a Tamil te construct,aher,improve,demolish,or repair any structure
prior to its nhuunae,also requires thr applicant for such pemtit la file a signed smamont SPECIAL CINCUITIMISC.
�g'� that he is licensed Thrstral dothe provisions of the Cotnraaors license La.(Corona,9
IIs 200 lannmencing with Section W0)
0of Division 3 to Business and Pmfwsions Cotte)or TRMP.MIT HR OR POLI/INST. COMMERCIALa.p o C that be is escntpt thereGotn and Lha M1usin for the alleged!exemption.Any violation it ❑NEW BLDG/A DDITION ❑DEMOLITION
Station 7031.5 byany applicant for a pooh subjects the applicant at a civil penaltyolPOWER DEVICES ❑'IENANT ❑FOOD SERVICE
FZOnot mom Non f ve hundmJ dollars(SSIXp. IMPROVEMENT
01,as owner efihe propery,or my employees with wages as their sole etmgereation, SWIMMING POOL ELF:CI'RIC
will do Lha work,and the s score intact Intended oroffered Tor cele(Sec.9044,Business ER
and Pm!shins Coda:Thr Curran hiecme Law des,not apply In en owner nl cat'rLITI S-SWITCHI3\-F 1X I TIRES
pnryery who hands or improves thereon,and who does such work hile,di or di
his own employees,provided Nat such improvements are not intended our offerel four NEW RESIDHNTIAL IiLECTR SQ FT.
one.If,however,the building our improvement is sold within one year of completion,'he SQ.FT.FLOOR AREA E/SUFE
cr-builJcr w111 have the hwdrn of proving than he did nm httlId or inmmve for par.
put of sale.).
Cl 1,as owner of flue olien,am exclusively nominati ng with licensed contractors to T FAL:
consumer the project(Sec.70,14,ITu.siness and Professions Gds:)The Commedn's Li-
c• •Lawdeatnotapplyw rnownen fpmpen ho hod de oritnptoscs thcre+m.and QTY. PLUMBING PERMIT, PEE
uts�
who cnntractxfe"twin projects r tr (Ilia rxuom to the Comma 's
License Ince. PERMIT ISSUANCE
1 am exempt under Sea J_Y,[ - u.B&P C for this reason
ALI12R-DRAIN&VINT-WATER CA) VALl1A'I'ION
nor hate
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE 3/ A �-
Ihaffirm jury marcor the following d :datios:
ealnC/ -
IhnvemdwillmvimuinaCrniCa:sec dCConxrnnn Welt-insne for Worker's C man. DRAINS-I1.00R,ROOF,AREA,COND.
sotlnn,as provided for by Section 390X1ofthe Lubar Code,liarthe perlivmaneeol'the STORIES TYPHCONSTRU. ION
vital,for which this permit is issued. IB STORIES-PER TRAP
❑I base and will maintain Workers Compensation Insurance,as required by Section A 1
3900 of the Lafaar Cnde.fou'the pedonnonrr of the work for which this Oncrit in:.surd, GAS-EA.SYSTEM-I INC.4 OU MET OCC.GROUP PN
My Worker'o Compensation Insurance currier and Policy number am!
Carries Policy,Na: GAS-HA.SYSTEM OVER 4(HA) FEB 25
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEINDUSTRI.WASTE INERCEPIOR a
Ghis section need not becomplewdifthe pcnnitis fnnaentndreddelacs(SI00) BUILDING DIVISIO FH115
or Icss.) GREASH TRAP
I re....he perfmmvnceofNe work for whielthis perimit is issued,Ishdi PLA C}1�CK1f Coll
(41
not cmpin SEWER-SANITARY-STORM ETA.210 FT.
y any person in any mvnner sou as m haeme sdhju't m the Workers'Comperr ENERGY FEE I V
Zcation Lawsnl'California.Ilam WATER nFATER W/VIINTELECR is
Z O Applicant GRADINGFEE
y NOTICE TO AI'PLICAN'I:If,ager staking Nis Ceni6rom of F.xemptinn,you should WATER SYSTEMITREATING
? herons subleet to No Worker's Cnnupcnsminn provisions of the Lobar Code yon must SOILS 17EE
forthwith comply with such prnvininna or this permit shall he deatncd revoked. WATER SERVICE
a0
U2 CONSTRUCTION LENDING AGENCY NEW RFSIULNTIALPLMB. SQ.17. PAID
U 0 k for
rwhiell thi Nnnbem iso nd(Saoi30 leading agency for lwrhmmanee of Data RaeiptM
W the work lin which this pcnnit is:.sena(Sce.3119].Civ.Cd
p U Leaded Name }'OTAh:
W Lenders Addres TOTAL:
00 1 unify That 1 have read this npplicmien and state Lha the above intimation is BUILDING F f
cnratl ugru:out utmply wish all clay and county ordtnmeexnoolmerlawnrelatinem QTY. MECHANICALPERMIT PEE
U 2 huilding mnztrvctidn.and hereby ambnrizc represemmives ofth:uity nwnmr upon Nc SEISMICFE
above-mentioned progeny for inspection purpascs. PERMIT ISSUANCE:
(Wel agree m save,indemnify send keep harmless the City of Cupertino ugnina ELECTRIC F Q
liabilities,judgments.toms and esleascs windini,in any way arcmr againxthaid City ALTER OR ADD TO MECIi.
in anuquenceof Ne granting of this permit PLUMBING FBII S
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. q1µHANDLING UNIT(TO Il),IXX)CFM) O
MECHANICAL Pfi
AIR HANDLING USE I'(OVER 10,00 Clow CONS'I'RUCTION'TAX
Signature of ApplicanUContrector Date EXHAUST I OOD(W/DUCPI HOUSING MITIGATION FEE
MATERIALS DISCLOSURE
Will the applicant our future hnllding rccupwn store or handle haznnloos metrrinl I HEATING UNIT(11)100,000It 1Y1)
as de road by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
tde.Scotian 25532(s) 1X
'l - HEATING UNIT 100, 0 BTU) -
❑Ycs [IN.
VfNTILA'I'ION FAN(51NCLH HHSID) PAID Dutra Receipt#
Will the applicant Oor future building occupuase equipment or devices which
if,Eliminate.,airirwmaminan¢as defined by the Bay Area Air Quality Management BOILER-COMP IMP Ok I W.OfNI BTU)
:aria? TO'I'A
i
�Ycs ❑No H1lILER-COhIP IOVI?k 100,(X1(1 BTU) -
I have read the haaardoaa materials requirements undcr Chapter 6.95 mine Cali- AIR CON Di TIGHTER _ISSUAN DATE
fomia Health&Safety Code.Sections 25505,25531 and 25534.1 understand Na Bthe NEW kIiSIDENTIAL MECH. SQ.
bnllding Jtarx not currently hove a trnunl,that'd ix my rwporvsihillly t0 nndly IM1d nceupant
of the requirements which must he met prior to issuaneeof a Cenlfierm of Occupancy.
Ovacomawshised agent Drm TOTA ISSUED BY.
OFFICE
ON
10300 Torre Avenue
Cupertino, CA 95014
of
Cupertino Building Division
(408)777322.8
(408)777-3333 (fax)
February 4, 1999
Homeowner
10235 Creston Drive
Cupertino, CA 95014
SUBJECT: Permit#S1306
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 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 CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recycled Paper