28926 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CIT OF CUPF.RTINO - BulLnlrvc-ELEc'ra1cAL PERMIT No. ^ ^ ^
BUILDING DIVISION APPLICATION/PERMIT PLUMBINO.MECHANICAL L y b
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: - - SANITARY NO. APPLICATIONSUBMITTAL DATE
2-2-4W ClYPERmillo Pb.
Ow. PR'S NAME. PH&N CONT CT :5 A LIC NO:
\NIA 4SM N/C CONTROL#
RCHO]ICTIENGINBER: LIC NO: ADDRESS: ❑
CONTACT: PHONE: . - BUILDING PERMIT INFO
_ ❑ Consultant Fees Paid by Applicant(Initial) B ELECT PLUMB, "MECH
LICENSED CONTRACTORS DECLARATION Q• Y1 ELECTRIC PERMIT FEE
I hereby affirtn that 1 on licemal under provisions of Chapter 9(commencing I JOB DESCRIPTION
OCz with Section 7000)of Division 3 of the Business and Professions Code,and my license is t RESIDENTIAL:
�00 wt PERMIT ISSUANCE
F In full force and affect. ❑SFDWL ❑KITCHEN REMODEL
E.ZW License Close Contractor
APPLIANCES-RESIDENT' 0ADDITION ❑PLUMBING RE-PIPE
<L Date CnntDECL
ARCHITECTS DBCLARATIONPANELS ❑MULTI-UNIT El STRUCTURAL
Z p-7J- I understand my plum all ho used as public recordr MODIFICATION
OZDip M2W AMPS 01 ❑INTERIOR ❑CHIMNEY REPAIR
p4kLicensed Prnfnismand 2-01-1000AMP$ IMPROVEMENT
OWNER-BUILDER DECLARATION OVER10110AMPS BATH RE P/�• DEMOLITION
S 1 hereby affirm Net I nm exempt from the CommcmYs License Law for the 8
�C.U fallowing reason.(Section 7031.5,Business and Pmfeasions Cabo:Any city or county SIGNS ELECTRICAL THER
3 O F which requires a permit to construct,stmt,improve,demolish.or repair any someone
prior to its issuance,also requires the applicant for such Permit file a signed statement SPECIAL CIRCUIT/MI5
2 Y.� that he is licensed p...matlothap...kinds of the Commcim's Lima.low(Cloutier 9
6W C<p0 (commencing with Section 7001)of Division 3 of the Business and Professions Code)or THEIR.METER OR POLE' T.
a that he is eaemin therefrom and the basis for the alleged exemption.Any violation of ONcLuBLDGIADDITION O DEMOLITION
0
Smion 7031.5 by any applicamfore pcnniumbjats the epplicemmecivil pcnuhy of POWER DEVICES � O NANT OFOOD SERVICE
�.y>. not mom Nan five hundred dollars(E50b. PROVEMENT
❑❑< pl,as owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
C will do the work,and the structure is not intended or offered for sale(Sm.9W4,Business _ OTHER
and Professions Code:The Convectors License Law does no apply to an owner of OUTLETS-SWITCHES-FIXTURES
3 r progeny who builds or improves Hawn,end who does such work himself or through ,
_ his own employees,provided that such improvements the na intended or offered for NEW RESIDENTIAL B SQ FT.
sale.If,however.the building or improvement is sold within one ycarofcomplaion.the SQ.FT.FLOOR AREA $/SQ.ET.
owner-builder will have the burden of proving that he did not build or improve for pur-
p;FrsowsJ. -
!�I roe the property, exclusively trach with licensed cnnvunnrsm a TOTAL'
P� Y d Professions
ro ng wi r T
comtruddproject(Sec.o an Businessandrty wh i builds
or
Thoes the on.Li- fl./
whoInce dos not apply m an owner of mormaly who builds or improves thereon.and QTY PLUMBING PERIv1l( PEE
License masforsuchprojectswiNacanvvcmrts)licensedpursuanttatNeCommcmr's _ Oer.2 A
LicenaeLaw. PERMIT ISSUANCE OCT,24 199,►
I run exnmps under Sec. ,B&P C for this mason
ALTER-GRAIN&VENT-WATER(EA) ' LIJI VALUATION
saner Dam VI' k ,LUrizil
ATI111V11
WORKER'S CG6AEMyqSAGON DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby affatn under penally of perjury one of the following declarations:
I have and will maintain aCenificate of Consent to self-ireame for Workees Camper. DRAINS-FLOOR.ROOR AREA,COND, STORIFS TYPE CONSTRUCTION
cation,as provided for by Section 37M of the Labor Code,for Ne Performance of the
work for which this permit is issued. FIXTURES-PER TRAP
O 1 have and will maintain Worker's Compensation Insurance,as required by Section
37M of the labor Code,for the Performance of Ne work for which this Permit is issuak GAS-EA.SYSTEM-I INC.4 OUTLFTS OCC.GROUP APN
My Worker's Compensation Insurance carrier mrd Policy number are'.
Carrier. Policy No.: GAS-EA.SYSTEM-OVER 4(EA) ;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASIVINDUSTRL WASTE INTERCEPTOR
BUILDING I3IV )N
(This worst need not be completed ifine permit is for hundred Mllam($100) GRGSETRAP
or less) � _ PLANCHECK PEE
I cenify that indoperfmmanceofthe work fnvehiah this permit is issued,I shut[ SEWER-SANITARY-STORM EA.200fT
not employ any person in any manna sous to Become subject m the Workers'Compeer- ENERGY FEE
OZ satimn Laws of Califomla.Date WATER HEATER W/VENT/ELECfR - GRADING FEE
77 C) Applicant
NOTICE TO APPLICANT:If,after making this Cerilicale of Exemption,you should WATER SYSTEM?REATING
abecome subject to the Worker's Compensation provisions of the labor Code,you must SOILS FEE
W foMwith comply with such provisions or this Permit shall be deemed revoked. WATER SERVICR
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT.
PAID
� 'z' IhercM1y affirm that Nem is econsometion lending agency fonhe performance D Receipt)
L) the work for which this Permit is issued(Sao 3097.Co.C.)
fender's Name - TOTAL:
L) Denotes Address - - TOTAL:
I certify that I have read this application and state that the above information is
BUILDING HE
f0 cortecLl egrceocnmply wish all airy amt county onlimmces mrd stem laws mlmingm QTY. MECHANICAL PERMIT FEE
LJ Z building cnnstmction,ind heob,midurmotposcoundwesofthis city to anlm.pon the SEISMIC FEC
abuvememiomed property for inspection purposea
(We) Sam to save,indemnify and keep modes,the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE
limbilitteajudgmcnts,costs and expenses which may in any way accrue against said City ALTER ORADDTO MECH.
in consequence of the granting of this Noun. PLUMBING
APPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT OD 140011 CFM) MECHANIC FEE
SOURCE REGULATIONS.
�Z p AIR HANDLING UNIT(OV-R 10,0110 CFM) CONSTRU TA%
Sig acre of Applicunt/Conwc DateEXHAUST HOOD(W/DUCT) HOUSING MRIGA NFEE
HA2lAR US MATERIALS DISCLOSURE
Will the epplicmtnrfuture building occupant store or handle Incautious material HEATING UNIT(TO 100,000 BTU)
as defined by Ne Cupertino Municipul Cnde,Chapter,9.12,end the Health and Safety
Code.Section 25532(a)7 HEATING UNIT(OVER 100,000 BN)
❑Yes ON.. VENTILATION FAN(SINGLE RESID) • PAID
Dam Re ipt#
Will the ircnapplicant to furore building by the Bt use ea Air a or devices which
emit haznrtlous air cpnwninants as defined by the Bay Area Air Quality Managemrnt BOILER-COMP(3HP OR D00,(Il10 BTU) T(YI'AL
District?
s ❑Yes ONo BOILER-COMP(OVER 104(100 BTU)
I have mol Ne unninlous materials encs under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE AT
reg2553
fomia HwIN no Safety Code,Sationx 25505,25577 and ns534.1 to notify
th Nat ff Ne NEW RESIDENTIAL MECH. S0.FT.
building does a is whit ybase a mount,prim
o is ua responsibility ca notify the occupant
of ton requiremems which must he ma prim o issuance of a Certificate of Occupancy.
Owner m amhndzed agent I3me TOTAL: ISSUED BY:
OFFICE . /
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Ad.
ecitv
10300 Torre Avenue
ie
Cupertino,CA 95014 of,
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
November 12, 1996
Homeowner
• 22450 Cupertino Road
Cupertino, California 95014
SUBJECT Patio cover: Permit#28926
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
Pored an Pocvsled Paper '