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8972 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO �► .� INSPECTION DIVISI N JOB INSPECTION R ORD PERMIT.EXPIRATION JOB ADD S� `' T# PERMIT EXPIRES IF WORK r owNEH CONT ACTOR CIM14 IS NOT STARTED WITHIN INSPECTI DATE I INSPE-CT-0-R-1 INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION AELECT. PLG� ON. UFER PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL MEC.. MECHANICAL 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING I� MECHANICAL FERMI TO ELECTRICAL FRAMING S IES TYPECONSTR INSULATION OCG GROUP RES.UNITS PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT,F400EAREATOTAL CREAGE ROOFIAPHRAGM BES INOther APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDAS EO. ROUGH PLUMBING / TRACT­NO PARCELNO. GAS TEST i MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMINGldGrl y. _ SAN # G.SITE NO. INEION PLUMBING ZONING EN GAS =FIRE E"C. MECHANICAL - Y ❑ N[] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING waD zorvE L.LATH—INTERIOR p`y,Z,n — ELECTRICALLATH—EXTERIOR FIRE DEPT. Y N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK F � GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN REPOINT PEN ONLY C)TY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. ^^�k BUILDING DIVISION - APPLECwTloi3li ILary},j+lil PLUMBING-MECHANICAL L 9�9 VJ l8J ..naNtt vsanwrT iuNTiFlCATION UILDINGADDRESS: - SANITARYNO. APPLICATION SUBMITTAL DATE ,22q-pyo c-�p�--[��►a �(�p.. u� --f I�o . ' C C� `3.6 WN`[R'$��MEt l�Dd2ll��lD PHONE'" CONTRACTOR'S NAME: LIC NO: � ` NIC CONTROL g" W=W -L �11��0!^ A DRIiSS: ❑ )DA Lt oNTACT. PHONE: IC/ BUILDING PERMIT INFO y r �� ^ L. • ' ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT[ PLUgM�B. MECH ' LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby ellirm thm 1 em IicensM under provisions of Chapter 9(commencing AL- DESCRIPTION 400 withllmocni000)ecO. sionJufthe BusinessanJ ProfessionsCWe,and mylicenxe is RESIDENTIAL dO L - Pf:RA11T ISSUANCE rycpDWL [I KITCHEN REMODEL � `[E-{ m full force and cffccL �rMtf` FVZ License Class Cama APPLIANCES=RESIDENTIAL DDfrION [I PLUMBING RE-PIPE ND Dare Camara -ARCHITECTS DECLARATION ❑MULTI-UNIT �1 ❑STRUCTURAL F.Oy PANELS /f p ZO 4 lumlerntend my plans shall he used as public recorJs g'„ p ��-MODIFICATION OZ-0 UPT02WAMPS ❑INTERIO [I CHIMNEY REPAIR r,4 LicrnsNProfesxionel 201400oAMPS IMPRO op OWNER-BUILDER DECLARATION OVER 1000 AMPS ,❑BATH EISR, 9INICLITION O U 1 hereby affirm thm I nm exempt tram the Contrnctor'r License Law for the ❑OTHERy O LiyS 6 following mason.(Section 7031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL sn 31r,F which requires a permit a cotuwct,alter,improve,demulim,or repair any xtmcam, I"'�y prior in its issuance,also repairer me applicant for such permit..file a signed statement SPECIAL CIRCUIT/MISC. "'n IIVU �yap, that he is licensed purnmed to the provisions of the Contractor's License Law(Chapterr) W CSO (Comma.....wllh.ec..]_ofDivixion3ofthe Business and Professions Code)or TEMP.METER OR POLE INST. COMMERCIAL 6 that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION + Nnot more Non Five hundred dollen($5W). Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES ANT ❑ E FOODSERVIC [-Z 7' IMPROVEMENT 6 ❑hasownmoftheda kite,myemntended withwagesosueir sole compensation, SWIMMING POOL ELECTRIC O and Pr fie sions Com: Connector's not intended..Law dos not apply:]044,Business OTHER. and Professions Cale:The Conwanr'e Littnse Lew does not apply to as owner of OUTLETS-SWITCHES-FIXTURES pmpcny who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvementsarc not anot intrndW or offered for NEW RESIDENTIAL ELECTR SQ ET. sale.If.however the building.,improvement is sold within one year ofcompletion,the .,rte �O SQ.FI'.FLOG REA SQ.pI'. owner-builder will have the burden ofproving that he did not build or improve for par- {/Q,J 6,+0 ��y�17 poo fssW I owner of the property,em exclusively rontmcting with licensed contmc'tors to f swn the project(Sec.](44,Business erd Professions Cale:)The C.nmeclnr'r Li- - cnuLaw does not apply to an owner ofpropany who bull&or improvev human,and QTY PLUMBING PERMIT FEE who tomenta forsuch projects with a Contractors)licensed pursuant m the Commemes License Law. PERMIT ISSUANCE ❑1 am eapnpt under Sec. .B&P C for thin reason ALTER-DRAIN&VENT-WATER(EA) VALUATION Own Date ��� 'e WORKER'S COMPENSATION DECLARATION PACK PLOW PROTECT.DEVICE I hereby affirm utMtt penalty ofperjuryone of the following declarations: —Worker's Conlon- o ❑Ihzve andwill maintainaCion 3700 ofConeentLab relf-insure Worker's Comp the DRAINS-FLOOR,EDGE,AREA,COND. STORIES TYPCCONSTRUCf10N smlon,as hick this for by Section 3]1X1 of Ne labor Code,for d¢perfontumce of the work for which ill permitis issued. FiXTURF.S-PER TRAP ❑1 have and will mar,for Worlat pert. Compensation work (a,which as required by Section 37M.MyWo the LobosCnsationthe surance cancer and Poli. fnumbir sm; permit is issued, GAS-EA.SYSTF.Md INCA OUTLETS OCC.GROUP APN My Worker's Compensation Insurance artier and Policy number are: Carrier Policy N..: GAS-FA.SYSTEM-OVER 4(EA) , CERTIFICATE OF EXEMPTION FROM WOR KERS' .. CONIPFNSAT ON INSURANCE GRPASE/INDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES I (This union need not he completed if the permit isfmone hundred Jolla..lSl(q) GREASE TRAP or mca) PLANCHECK FEE Ioy any person in in any of the becoork me for which this permime ixirs Cour en.all SEWER-SANITARY-STORM L'A.3W P1'. not employ ony person in any..more,so m m become subjem to the Workers'Compen. ENERGY FEE �e Zsation Lawsof Cmifomia.Dam WATER HEATER WNENT/ELECTR Q Applicant GRADING FRE y NOTICE TO APPLICANT:If,after making Nis Cenilicate of Exemption,you should WATER SYSTEM?REATING SOILS FEE a [ become subject m the Worker's Compensation provisions of the labor Code,you must - � ry forthwith comply withruch provisions or this permit shall be deemN rcvokW. WATER SERVICE Zz CONSTRUCTION ON LENDINGAGENCY NEW RESIDENTIAL PLMH. SQ.FTI D V I for rwhich rte thatmen1 isaced(See ionlrnding agency for the performance of Dat eceiptX D. the work for which this permit is issued(Seco Jfl9],Civ.C.) Lender's Name TOTAL WLeader's Address L lcertify thm,l have read this application erM sere that the above information is ILDING L V) c.rtect.l agree....mpiywiffidleityandcounryordi....atandsmm laws relating m QTY. MECHANICAL PERMIT O V Z building rensmeti.n.and hereby authorize expreumatives ofthis city to enter upon am SMIC ti above mentioned property for inspection purposes. We)agree to rove,indemnify and keep homeless the City of Cupertino against PERMIT ISSUANCE - ELECTRIC FEE imbilitiex,judgments,emetoid expenses which may loan,way accmeag.mit said City ALTER ORADD TO MECH.' in consequence of the granting of this permit. UMBING FEE APPLICANT,UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,WO CFM) SOURCE REGULATIONS. CHANICALF E AIR HANDLING UNIT(OVER 10,1X%1 CPM) NSTRUCTIO TAX Signamreof Applicant Commmor Date EXHAUST HOOD(WNULT7 USING MITIGATION FE - HAZARDOUS MATERIALS DISCLOSURE Williheupitheantnr future buildimgoccupamamreorhandle hazardous rnmedal HEATING UNIT(TO 100,000 BTU) , u defined by the Cupertino Municipal Code,Chapter 9.12,and Ne Health and Safety Code,Section 85320)P HEATING UNIT(OVER 100.01)BTU) ❑Ycs Fl No VENTILATION FAN(SINGLE RESID) PAID Data Receipt X Will me applicamor future building oceupzm use equipment or devices which mit hazardous air contaminants as def BOILER-COME(3HP OR IW,IXNI BTU)red by the Bay Area Air Quality Management TOTAL: District ❑Yes ❑Nn BOILER-COME(OVER 100.0,Y)BTU) ' I have reel the hazvJous materials mquirtmems under Chapter 6.95 of the Cali AIR CONDITIONER ISSUANCE DATE (curia Health&Safety Cade.Section,25505,25533 it 25534,1 underxmnd that if the NEW RESIDENTIAL MECH. SQ.ET, building doer me eurrendy have o terent,that n is my responsibility morally the oca phat of the equirtmenu which must be met prior In issuance ofit Certificate of 0ccupmemy. Owner or authorized agent Date O' �' ISSUED BY: 17,60 OFFICE 10300 Torte Avenue of, Cupertino,CA 95014 Cupel tino Building Division (408)777-3228 (408)777-3333 (fax) March 24, 1997 Homeowner 22430 Cupertino Road Cupertino, CA 95014 SUBJECT Permit#29998 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,the subject permit has not 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 Printed on Recycled Paper APPLICANTTO FILL IN INFORMATION WITHIN RED LINES •USE BALL POINT PEN ONLY ,CITY OF CUPERTINO BUILDING,ELECTRICAL. PERKHTND. BUILDING DIVISION APPLICATIONIPERMIT PL,uNIxrnC..a,MECHANICAL L S 0145 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE as 3aI 15 .4 OWNER' AME: PHON': CONTRACTOR'S NAME: LIC NO: NIC CONTROL# AIT (ENGINEER: LIC NO'. ADDRESS. ❑ CONTACT: PHONE: BUILDING PERMIT INFO ash �� ❑ COnsBltant Fees Paid by Applicant(Initial) 91.DG ELECT PLUMB MECH ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEC )OED CRIPTION I hereby Affirm that 1 am licenud under provisions of Chapter 9(commencing Oz Z with Seainn]110!11 of pivision3of the Business and PrnfessinnsCode,and my lirenm is RESIDENTIAL: (—I- infullfo.eandelfect. PERMIT ISSUANCE IF ❑SFDWL O KITCHEN REMODEL �UUU License Class Ur. APPLIANCES—RESIDENTIAL, ❑ADDITION [I PLUMBING Frn W0. PIPE Date C ❑MULTIUNIT ❑STRUCTURAL ARCHITECTS DECLARATION F.7 y PANELS MODIFICATION 'ZOnz lundernund my plans shall he used in,public records UI1102AMPS ❑ pZ�,� WINTERIOR [I CHIMNEY REPAIR r 0E- Licensed Professional 201-1000AMPS IMPROVEMENT C]SWIMMING POOLS OWNER-BUILDER DECLARATION OVER W00AMPS O BATH REMODEUREPAIR GDEMOLITION ac 1 hereby eBinn that 1 em exempt from the Comment',License Lawlor the x�x d U following rmeon.(Section]NI 5,Business and Professions Code:Any city or county SIGNS ELECTRICAL OTHER W D F which requires A permit m consuuct,Ale,improve,demnlish,or.pair any anotme �- priortoinissuance,also requires the applicant for such permit to file a signedstatman SPECIAL CIRCUIDMISC. i ray that he is Iisciawd parmanun the provisions of the Contractor's License law(Chaper9 COMMERCIAL p�'O0 (commencing with Section 7")of Division 3 of the Business and Professions Code)or TEMP.METER OR MILL INST. A. mC that he is exempt therefrom and the basis far the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION h Section by any applicant far a perran subjects the applicant to a civil penalty of POWER DEVICES ❑TIiNANT [I FOOD SERVICE tQnm more than five hundred dollars(S500). IMPROVEMENT 1,a,owner of the ro norm employees with waesaetheir,are tom tion, SWIMMING POOL ELECTRIC ❑ t pe Y Yemp y g pens ❑OTHER II dome work,end the ammo.is nm intended n Law discs isconsole(Sec.]Urn,Business�'� and Professions Code:The Cnnvucmr'x License Low does not apply m an owner of OIITLITS—SWITCHES—FIXTURES 4i propeny who builds or improves maroon,and who dues such work himself or through his own employees,provided that such improvements em not intended or offered for NEW RESIDENTIAL.ELEC R Q sale.If.however,the building or improvement is sold within one year ofcnmpletion,the SQ.FT.FLOOR ARCA S/SQ.FT. ter-builder will have the burden of proving that he did not build or improve for W r- p ce of sale.). D 0 L,As owner of the property,am exclusively emaciating with licensed contractors to IAL' construct the project(Sec.7044,Business and Profession,Code:)The Cnmracmr's Li q cense Law does not apply to an owner of property who builds or improves thereon,and QTY, PLUMBING PERMIT FEE flit I���� who contracts for such projects with a contractors)licensed pursuant to the Conaamm's License law. PERMIT ISSUANCE ❑Ins emplu ,ea &P C for this reason vV _ ALTER—DRAIN&VENT—WATER(EA) V IBN ORKER'S C( PENSATION 1 ,ARATION BACK FLOW PROTECT.DEVICE kb 1NSPfC t he alfim under Penalty of perjury one I& foll wing declarvlions: - veendwillmninminACertificateofConscnua set(-insure To.Werkee.Compen- DRAINS—FLOOR,ROOF AREA,COND. O 1. xt TYPECONS'fRUCION stolen,As provided for by Section 37M of the labor Code,for the perfamonce of the 1 �PFRrINIO J�'ENr work for which this permit is issued. I:I XTURES—PER TRAP 0 I have and will maintain Workees Compensation Insurance,as required by Section 37M of the Labor Cade.for the perfornamee of the work for which this loom is issued. GAS—EA.SYSTEM-I INC.4OM,ITS (N]C.GROUP APN My Wooster Compensation Insurance carrier and Policy number am: Carrier: Policy No.: GAS—EA.SYSTEM-OVER 4(RA) CERTIFICATE OF EXEMPTION FROM WORKERSGRF.ASEBNDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES (This sectinm need Am be cmadered if be permit is forme hundred dollars(SI00) GREASETRAP or less) PLANCIIECK FEE I rectify that in the performance of the work for which this permit is issued,l shall SEWER—SANITARY—STORM EA,200 FIR not employ any person in any manner sn As m lett come subjeeo the Workers'Compen- ENERGY FEE union Lows of California.Dale WATER HEATER WNENTIELECTR GRADING FEE Z O Applicant y NOTICE TO APPLICANT:If,after making this Cenilicate of Exemption,you should WATER SYS'TEMITREATING become subject to the Worker's Compensation previsions of the Lallo Code,you must SOILS ITE forthwith comply with such provisions or this permit shall be deemed.voked. WATER SERVICE 0 CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLM9. SQ.IT. PAID pare Receipt p L)0 thereby affirm than them is a construction lendingagcwy,for the performance of UL F' the work for which this permit is issued(Sec.309],Civ.C,I 0Lendeis Name TOTAL. {U2a TOTAL Lenders Address y 1 cenify that I have read this application and state that the above information is BUILDING TEE rp comet.I agree to comply with all city and county onduances end state laws relating to QTY, MECHANICAL PERMIT FEE SEISMIC FEE C„) ,Z building construction,and hereby authorize representatives of this city to eater upon the above-mentioned property for inspection purposes. PERMIT ISSUANCE ELECTRIC FEE (We)agree to save,indemnify end keep harmless the City of Cupertino against Iiabihoes.judgmems,costs and expenses which may in any way Accrue against said City ALTER OR ADD TO MECIL PLUMBING FEE in consequence of Ne granting of this permit. - APPLICANTUNDERSTANDSANDWILLCOMPLYWITHALLNON-POINT AIR HANDLING UNI'(TO I(h0(a CFM) MRCHANICALFEE SOURCE REGULATIONS, AIR HANDLING UNI'T(OVER 10,000 CFM) CONSTRUCTION TAX Signature of ApplicanVContmear Dam EXHAUST HOOD(WIDUC) HOUSING MIT'IGATI 'L HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occuporstem or handle hazanious material HEATING UNIT LTO I W,000 BTU) as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 255320)] HEATING UNIT(OVER 100.001ir BTU) O Yes F7 No VENTILATION PAN(SINGLE RESID) PAID Date ReceiptM Will the applicant or future building occupant use equipment or devices which BOILER-COMP(3HP OR 1001 l BTU) emit hmardous air contaminants as defined by the Bay Area Air Quality Management TOTAL: DommV BOILER—COMP(OVER I(I()AW BTU) GYes ❑No I Mae tend the haxardnus materials noN.Aarramde s unr Chapter A95of to Cali- AIRCONDITIONER ISSUANCE,DATE forma liealm&Safety Code,Sections 25505,25533 and 25531 I understand that if the NEW RESIDENTIAL MECH, SQ.IT. buildingdtes not currently have a temmt,that it is my mapmsibllity to notify Ne occupant of Ne requiremnts which must W nwt prior to issuance of A Certificate of Occupmtcy. Owner or authorized agent Date TOTAL: j1SSU:r.DB!Y. OFFICE