28949 APPLMANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY INCUPERTINO BUILDING-ELECTRICAL. - PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMRING-MECHANICAL. 28949
BUILDING PROJECT'IDENTIFICATION v v
BUILDING ADDRESS: - SANITARY NO. APPLICATION SUBMJWA�WTI
OWN 'S NAME: - PHO . CONT CTOR'SNAME: LIC NO:
3 O N/C CONTROL#
-RC 1 /ENGINEE . LIC O,- ORFS ❑
/o r �3a /C 0
CACT: PHONE: BUILDING PERMIT INFO
v,{� ❑ Consultant Fecs Paid by Applicant(Initial) By DAG ELECT - PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby eRms that I vm licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
aO with Section lWO)of Uivision3of the Bu`- ass onAP Iesxions Cnde,and mylicensu is PERMIT ISSUANCE
O RP.RIDF_NTIpL+ `
n full fame and ^ ^� p
—CUU ' C. d 7 ❑SFDWL ❑PLUMBIKITCHENREMODEL
aUV Licrns 1 Lic.# APPLIANCES-RESIDENTIAL ❑ADDITION C1 PLUMBING RE-PIPE
GDem Conmac
y ARCHITECTS DEC TI(N ❑MULTI-UNIT ❑STRUCTURAL
Zpry, lundersmnd my Ilons,ludl lx:used as publicattsrds PANELS r MODIFICATION
Oa�.ZuUPT0200AMPS' C3 INTERIOR [I CHIMNEY REPAIR
t-M Licensed Put anal 201d000AMPS IMPROVEMENT'
..I OWNER-BUILDER DECLARATION OVER 1000AMP5 ❑BATHREMODEDREPAIR ❑DEMOLITION
K W 6 I hereby affirm that I am exempt from the Contractors License Lw for she
04 U following reason.(Section 7031.5,Business mut Professions Code:Any city or county SIGNS ELECTRICAL []OTHER
Rze
a which recruits,a permit to constrvn,alit,,improve,demolish,or repair any ntmcture _14_-;%
prior to its issuance,vise requires the applicasn far such pnuuo lileasigned.,near SPECTALCIRCUITNISC. '
g} that he is licrnad portion, the provisions of Ne Comructors License,Law(Chapter 9
�a (commencing with Section]000)of Division 3 of the Business and Professions Collator TEMP.M ROR 9LEINSL COMMERCIAL:
that he is exempt themment and the bust.for am alloyed exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Sectinv 91131.5 by any applicant for a permit subjects the applicant to u civil penalty of POWER DE S
Fey not more then Use hundred dollars($500). [:1 TENANT FOOD SERVICE
0 1]1,as owner of the property,or my employas with wages as their sale compensation, SWIMMINGPODL ELE IC IMPROVEMENT
will do the wok,and the nrvcure is not intendedorolTcred far sale ISa.9614,Business' ❑OTHER
Yl a and Professions Code:The Connector's License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTU
G property who builds or Improves thereon,and who does such work himself or through
his own employees,provided that such improvements arc not intended or offered for N17W RESIDENTIAL ELECTR "'•
sale.ILhowever,the building or improvement is sold within one year ofcomplelmo,the SQ.IT,FLUOR AREA 5/SQ.Ff.
owner-builder will have the burden of proving that he did not build or improve for par- n
poseofsowne TOTAL: try 2O
s,uct the
,(See.ert,W.Booam lmi veld contracting%Cow,th )Theedconascnoem u T7 f1(I�
came La tha project(See.70,W.an c Business and Pndesni but ds or
The improve,them is U. 99
propictur whobuilds
uant.,hthC.. end QTY. PLUMBING PERMIT FEE IiIIr `I -
whonseLaw for such projam withammacmrts)liecnsed puauum to the Convecmrs I�
01am Law. PERMIT ISSUANCE"
LU�Orff�j;•i7
❑1 am exempt under Sec. ,H&P C for this reason - _ r
ALTER-DRAIN&VENT'-w•ao.a—,� J VALUATION
Owner Data
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
I hereby affirm under penalty of perjury one of the following decimations
❑I have and will mainum a Certificate of Consenuo self-insure for Worker's Compete DRAINS-FLOOR,ROOF.AREA,COND.
svtion,us provided for by Section 3900 of the Labor Code,for the Imb m)nnce of the STORIES TYPECONSTRUCDON
work for which thio permit is issued FIXTURES-PER TRAP
I have and will maintain Worker's Compensation Insurance,as mquhed by Section
DO of dm LaborCode.for Ne perfemunre ofthe work for which this permit is i...edr GAS-EA.SYSTEM-I WC.40uIrL OCC.GROUP APN
My Wm1w xCompema'oeim rmicrearrie'am Policy um GAS-EA.SYSTEM-O ER4(EA
Carrie r:�(4Q_.QQ} _Policy Nu.� - Y
ER'fIFIC m OF COMPENSATION
INN PROM WOR FIRS' Q GREASMNDUSI'RL WA TERC R
COMcom SATION INSURANCB BUILDING DIVISION FEES
(Thissation tined not la,completed if the permit isfmone huntlreddallms(SI W7 GREASETRAP
Or less.) PLANCHECK FEE
I certify that in the performance ofthe work for which this permit is issued,l shall SLWER,_SANITARY-
not employ any person m
in any manner so as to becoe subjectto the Workers' 2 �' .RGY FEE -
Z 'T-s senor Lows of California.Date WATER HEATER W/VENT/ELECTR
O Applicant ADING FEE
FN-t NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should WATER SYSTEM/TREATING
become subject to the Workers Compensation provisions of the Labor Code,you most SOILS FEE
[Ta forthwith comply with such provisions or this permit shall he deemed revoked. WATER SERVICE
As 0
=)z CONSTRUCTION LENDING AGENCY NEW RESIDENTIALPLMB. Q FT. PAID m acted#
V OI hereby affirm that there is a construction lending agency for the performance of
the work far which this Permit is issued(Scc.3091,Civ.C.)
Q17" Leaders Name - TOTAL: . .
U.1 Lender's Address
1 certify that I have reed NIS application and sum the the above information is BUIL
C y reenact.I agree m comply sated all ciry unci county cNi...mi and nate laws relating m QTY MECHANICAL PERMIT FEE
V z building construction.and hereby mthorike representatives ofthis city to enter upon the SETS C F.
WE
above-mentioned property for inspection purposes. '
(We)agree uo serve,indemnify and keep hamlcss the City of Cupertino against PERMIT ISSUANCE. ELF. E
liabilities.judgments,costs and expenses which may in any way accrue against said City ALTER ORADDTO MECH.
in asequence of the gaming ofthi.permit. ING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1,NON-POINT AIR HANDLING UNIT(TO 10,o00CFM) ME ANICAL FE
SOURCE REGULATIONS.
t AIR HANDLING UNIT(OVER 10,aW GPM) CONSTRUCTI(IN AX '.
Signature of ApplicunUCenuacmr Dam EXHAUST HOOD(W/DUCT) HOUSING MITIG TION FE.E
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicam or future building mcupantnore m handle hazardous mumnal HEATING UNIT GO 100,(IIXI BTU)
as defined by Ne Cupertino Municipal Code.Chapter 9,12,and the Health and Safety -
Code,Setion25532(0)1 s - HEATING UNIT(OVER Il .(g0BTU
[I Yes �No ' PAID
VENTILATION PAN(SINGLE RPSID) Data Receipt
Will the applicant or future building occupant use equipment or devices which BOILER-COMP(3HP OR 100.000 BTU)
mit huzurdous air contaminants as defined by the Bay Area Air Quality Management TOTAL:
District Y Yes 1Py� //I1No BOILER-COMP(OVER 100,000 BTU)
'
I have read the Incautious mumnalrAIR CONDITIONER
requirttanm under Chagcr,6.95 of the Cali- ISSUAN
forma H.IN&Safety Code,Sections 25505,25533 and 25534.1.sok tand that if the - NEW RESIDENTIAL MECH. SQ.FT.
buildi dceenotcurrcntl vera tenant that itis my responsibility m airily occupant ..
oftgoiremevmwhi v"son ri uance ofa Qn't �panry. ,
Diolaffleffhahah-nallagent I Dam' TOTAL: ISSUED BY:
OFFICE
I 6
• ® 10300 Torre Avenue
Cupertino,CA 95014
Gila nl'
Cupertuio Building Division
(408)777-3228
(408)777-3333 (fax)
September 25, 1996
Byers Properties 9l3
O/
10562 S. De Anna Blvd !Q�
Cupertino, California 95014
SUBJECT Pre-cast wall# 28949
To Whom it may Concern:
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
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Printed on Recycled Poper