S 2099 —APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECfRICAI, PES IT ND. a�O
BUILDING DIVISION APPLICATIONMERMIT PLUMBING.MECHANICAL J C
BUILD]NG PROJECT IDENTIFICATION
99
BUILDING ADDRESS: SANITARY NO. APPLICATION SUIIMITTAI.DATI
00 -- _ -�
OW R'S NAME: PHONE:
CONTRACTOR N 1E: LIC NO:
NIC CON'I'ROLM
^HGMTfl lGINEER: LIC Na A15DRaS' ❑
1
CONTACT: PHONE: BUILDING PERMITINFO
k�r LL ❑ Consultant Fees Paid by Applicant(Initial) BI ELECT PLUMB/
MECH
Aer ❑ CS ❑
I.ICENMIDCONTRACTOR'SDECI.ARAI'ION QTY ELECTRIC PERMIT FEE
1 hereby alBw that 1 am licenxed under provisions of Chapter 9(commencing JOB DESCRIPTION
Q raIZ with Seolinm]B(I(pnf DlvixinnJmhM1,Buxlncss ane Pmfcsainnr Gale,and myliccnseis R -ID NTIA
W O PERMIT ISSUANC17
ESB in full fora andel 1. ❑SFDWL ❑KTTCH1iN REMODEL
6UV License Class ` Lic.M APVLIANC[.S—RIiSIDENTIAL []ADDITION ❑PLUMBING RE-PIPE
F�LLI Date Cnntlaalnr -
y ❑ [IM FUNIT ❑STRUCTURAL.
❑m ARCHITECTS DECI-ARATION PANELS
Z p n Z I understand my plans shall he used as public records MODIFICATION
oz— UP T020 AMPS El INTERIOR [I CHIMNEY RITA1R
W Licensed Professional 201-1000AMPS IMPROVEMENT EJSWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IfgX)AMPS ❑BATH REMODEIIREPAIR [I DEMOLITION
CG Cm 1 hereby affirthat 1 am exempt from the Contractor's License Law for the
�t�1(06 U following reason.(Section 703 1.5,Business and Professions Calc:Any city or county SIGNS ELECTRICAL. [I O'PTIIiR
413 L4 N which require,a pewit or emonneq.1ar,impnrve,demohxa or repair any xVactare
1�0..}< Pat n.was issance,aN,te,dirextheapplicom for tach perminm lileanigred,htlement SPECIAL CIRCUI I'/MISC.
that he is licensed pursuant to the provisions of the Commodes License Law(Chapter 9
�0murmuring with Srotion 700mof D......a 3mr the Business and P,ofaysiomsCsi TEMP.METER OR POLE INST. OMM R IAL'
a t m a that he is exempt Nerefmm and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
{+X1
Section 7031.1 by any applicantfor a Permit subjects the applicant to a civil penalty of POZI DEVICES [ITENANT ❑FOOD SERVICE.
F=Qm ammorethan Five hundreddW1urx($500).
E)I,as owncrof the prnpcny,nr my employees with wages as their sole compcnsmion, SWIMMING POOL ELECT RIC IMPROVEMENT
will do the work,and the structure is not intended oraH'ered for sale(Sol.704A,Bmainess ❑OTHER
m and Rofessinw Code:The Contractor's License Law does not apply to an owner of OUTLETS—SWITCHES—FIXTURES
property who builds or improves tbemnn,and who does such work himself or though
his own employees.provided thin such improvements ore nm intended or offered rnr NEW RESIDENNpIA ECLR SQ FT.
sale.If.howevee the brikhr, rimprovemens is mldwalam one year ofcnmplction.the SQ.FI'.FLOOR ARRA SISQ,FT.
tesnerTuilder will have the burden of proving that he did not build or improve torpor
pose ofsaler,
❑I,a mane,of the property.am exclusively commuting with licensed emoname,In TOTAL:
construct the project(See.7044,Business and Professions Ctxle:)The Convectors Li.
wLawdoes not apply to on owner of properly who buildxmlmpovcs direnn,tmd QTY. tPERMIFEE
TIT
who contracts for such projects with a enntmemys)licensed pursuant it)the Contractors
Liccnsc Law. FERMI UANC.
1 ant exempt under Sec. .B&PC for this reassm
AI:I'ER—URAL VENT VALUATION
Owner [)at,
WORKER'S COMPENSATION DECLARATION BACK ELOWP H' F,VICIi
I hereby nllirm under pewlry of perjury one of the falhmving declarations:
Ibavemdwillmaintaina Cenificatenf ConsenO(isell'-insurcfor Worker,Comlxn- DRAINS—FLOG )EA COND. STORIES TYMCONSTRUCTIOI
nation,as provided for by Section 3700 of the Labor Cade,for the po frmaine of the
work rnr which(his permit is issual. Hl X'I'UR[S—PER'rRAP
❑ 1 have and will maintain Worker's Compensation Insurance,as otcmired by Semina
370 afthe Labor Ctrle,for the performance ofthe work for which this pewit ix issued. GAS-EA.$Y$IIiM-I INCA OCC.GROUP APN
My Wor c 9s,I ripnlluy�numher
arc
: -
/N`P' Cartier: mkt` `mance carrietl'olicyl n, GAS—EA.SYSTEM-OVER4(EA)
CERTIFICATE OF EXEMPTION PR M WORKERS' GREASFJINDUS'1'RL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION HEIS
('Ibixsenion need not hecompletcd if the pewit ix Torose hondreddullao($1uq GREASEIRAP - _—
or loo'.) PLANCI3ECK FEE
I madly that in the pofnwaincofthe work for wbiab Otis permitla iewed,Ishall SEWER—SANITARY—ST ORM HA,200 Fr.
nm employ any person in any manner so as m become subject to the Workers'Co span- ENERGY Flit
Q z aatian Laws of California.Date WArER HEATER WNENTIF.LIiCTR GRADING ITB
Applicant I
rA NOTICH TO APPLICANT:If,after making Nix Cenircme mf Exemption,you should WATER SYSTEM/TREATING
f^ ; become subject to the Worker's Compensation provisiore of the Labor Cod
Carlo,you arms, SOILS IEE
{aZl lud ith comply with.such provisions or this permit shall he domed wmked. WATER SHRVICL
�z CONS'TRUCT'ION LENDING AGENCY NI?W RCSIUENTIAL PLMB. SQ Er.
PAID Dale ceipt9
1 hereby aBiw That there is a conswmion lending agency for Ne pednwance nl
ILOthe work firwhich thispvrmit isissued(Sec.709],Cie Cd
O U Lenders Name TOTAL:
Lk1 Leadcr.s Address TA
y 1 cervi I"hot 1 have read this application and nate Not the above inhnmalitin is EMECHANTCAL
V) correct.l ameem comply with all city and county ordinances and slate laws relating to QTY. MECHANICAL PERMIT FEF.Zbuilding connmetion,and hereby minnow,repre...drives of this city to enter upon theabovo-mentimad property rnr impoem.purposes. PERMIT'ISSUANCL(Wc)agree to save,indemnify and keep harmless the City of Cupertino againstI iabilides,judgments,costsand expenses which may In any wry accrue against said City ALTER OR ADD TO MECH. ('in conseuence of the granting of this pewit. x
APPLICANT UN ER AN ND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO HITCO CFM) FEE
SOUR' IiC NS
AIR HANDLING UNIT(OVER BLNX)CFM) CONSTRUCTION TAX
ali-a ofApplicadr,CondflyctDate EXHAUST HOOD(WIDUC) HOUSING MITIGATION ME
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fimem building occupant store or handle harallous material HEATING UNIT(TO 100,000 H'DD
as defined by the Cupertino Municipal Cotte.Chapter 9.12,and the IleWlh and Safety ,
Calc,Section 25532dd? HEATING UNIT(OVER 10(h1gg)BTU)
El Yes ❑Nn PAID
VINTI
i1.ArION IAN(SINGLE HBSIDI Data Heceipl M
Will the applicant or future building occupant use equipment or devices which BOILER—COMP(3HP OR 11N1,fKK1 BrU)
n harallous air comaminants as defined by the Bay Arca Ai,Quality Management T It
tstnor? BOILER—COMP(OVER 10,000 BTU)
❑Yam ❑No
I have mad the hadevers materials ramdompent under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE� .�
fnmia Health&Safely Coh,Sexa mas 25505.25533 road 25534.1 understand that it the NEW RESIDENTIAL MECH. SQ.Fr.
buildingdoes nmca en0y have.mmmL that it ix my responsibility In mdfy the occupant
of the requiremenw which mot be nut prior to issuance ofd Condone of Cccupancy.
TOTAL:
Owner Or amhorizaJ agent Date ISSUED BY:
OFFICE
eci
10300 Torre Avenue
Cupertino, CA 95014
„ ty or,
Cupel h, o Building Division
N
(408)777-3333 (fax)
March 5, 1999
n
Property Owner
10700 De Anza BI
Cupertino, CA 95014
SUBJECT: Permit# 52099
Dear Property Owner:
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 ouncomputer.
Thank you for your assistance.
Sincerely,
2TY F UPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recycled Paper