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30389 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. ^(}/'S[QQ BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. 3O3VV BUILDING PROJECT TDFNTDICAI'ION BUILDING ADDRP_55: I'�� 0� ,I SANITARY NO. APPLICATION SUBMITTAL DATE pr Ctvp OWNI' 'S NAME, PHO E: �^(�/ CONTRACTOR'S NAME LIC NO: NIC CONTROhM R4_ IT'ECT7ENGINEER: LIC NO'. ADDRESS: ❑ f CONTACT: PHONE_ BUILDING PERMIT INFO ❑ Consultant Fm Paid by Applicant(Initial) / ELECT PLUMB MECH t ❑ ❑ ❑ IJCItNSEDCONIod TORmcar I,nHoom of CON QTY ELECTRIC PERMIT FEE 1 hereby.)of metl alit<c Buinnerrrn.id�...nr cMrtttv(omm�,ttKing JOB DESCRIPTION aZ with Senion]Ot effic Dvision3 of the Bu.ina's and lhufl7uons Gtbe,enJ my li«nw lx RESIDENTIAL 00 wn PERMIT ISSUANCE in full Rrce vd effect. Y�F CRFDWL CKITCHEN REMODEL QI..UU Licauc Chis I.k.♦ NQW Data—Contr'ttm APPLIANCES-RESIDENTIAL ❑ADDITION E)PLUMBING RE-PIPE Fly ARCHITECT'S DECLARATION ❑MULTI-UNIT CSTRUCTURAL ANIHS Z O ZJo 1 mdcrwM my plans soli he uwi ns public rcnttW MODIFICATION O0N�u1 UPTO200AMPS E)INTERIOR C1 CHIMNEY REPAIR l.icemdl NofassimW 3f11-LBW AMPS IMPROVEMENT C'1; OWNER-BUILDER DECLARATION OVER 1"AMPS BATH RENODEI/RFPAIR CDE\fOLfDON 3:00< I hereby.Rrm foo1 am cxcmp from the C... &,License law for the x a V following«awn.(Section 7031.5.Dusinus and 1'mfcolocs Gde:Any city or county SIGNS ELECTRICAL C OTHER Yl LL �11 which rcyuira a Pennit to construct,idler.'Impove,denxtluh,or rtrur my rrvclure C4 Prim to io it.a.alwncquims the afrpicant f«such permluo Rkesig«d smmnKnt SPECIAL CIRCUP"'NUSC. ��. Jut he is licrnsedp ..to aK gaovisiomofthe Caawetrc,license aw(Chepter9 �CpO (i,mmerring with Saban]JOB)of DiAocro 3 of JK HvimKs and Pmfeuitxis Codd or TEMP.METE OR POLE S'L 'Lyx o C man he is exemp melnfrnm vM the Iii fm the alleged cianptim.Any violation of M'QO�THER ION C DEMOLITION Ra m Scnion A13L5 by any vppliwntl-npomit.whjcots the epplicanuo a civil penally of POWER DEVICES ❑FOODSERVICE tZOnot mm nae Fiva mi dtcn dollars(35DE C T,a owntt a to pepttty,or my erinflo es with w.ges as thi sWe eorrion >tian, SWIMMING LELECTRIC will da the woh,.ad JK umcmre i.not imendM or oflened for Vila(Sec.]BW,B-__ R .nd Pmfcssiam Cori:TW Cantnamis Licenxe law Ger d.eptly to rn owm of Of1T1 -SWITCHES-FlX'NRFS W Ogen)wW WCoor impnna IWnenn,enJ wWGKx svehot a himna«tErutgM1 his own employes,pnrvrt that xxh improvements eR not intended or offered for NEW IDEM'IAL ELECT SU FT ,ala. Ww<vtt.thc WidinB«impmvertKm is sdJ within ane yeuofmmplevon,the .FLOORAREA LSQ.FT. xr-Wilder will have the burden d poving NUI a did rot Wild or improve f«pe- ❑p'•e ^� I,s nwrcs of the rnT+cny,em cadusivdy comrocling wiN Ikunwvl cunvannnTu:,� TOTAL: 7� onstr«t the projcot ISA.71114.Bado.v and Profoi-w Colic: Pc Contracude lijc y y oxnae law dop w.ppY m sn owrKr tri gopnty w W Wilds«impmvr_s Jrmean.SM•' i't'�ti1- 11p�r` i G:P- IT FEE wWc.Law.fm such pmjccu wish.conuecttK(s)liamsed pumuant to tlK Cadrac1Io. T /} Liccn.naa lis 'P M[rIt51SUANCE 9� ❑Lem exc tp P . ,tl&PCT«this - - ( w A191?R-DRAIN&.VBNT-W'LER(E) VALUATION v W RKER'SCOMPENSATIONDECERATION��{ n BACK FLOW PROTECT.DEVICE I iKrebY affirm under Otani)of Mrjury ona of Abe following dcclvratiauR�^• CIh.ve and will meimain.Certifcmc ofCoan eno mlf irom vfor Worker's ComNn. ''DRAINS _RQQF,A HA OND. saiiun,u rc,ol 1 for by Sic, n 391p of the Labor Cede,forp+ m the formae ot'thc STORIES TYPE CONSTRUCTION work for which This permit is issued. FIXNRFS-PER'1'RA ❑1 have eM will maintain Worker's Cconp .tilt In imi es retained by Scotian 37BBaf Jte labor CMe.Inc tW pa .ntt of JK wok fur which this Permit is iuucd. GAS-E.SYSTEM- C O S OCC.GROUP AM My W«kcYs Corryewtion Insurantt carni orb Ihrlby number.rc: Grticr. Polity Nn: CAS-E.SYSTEM-O R4( CERNFICATEOPEXEMPTIONI'RO RKERS' COMPENSATION SURA E CREASFIINDUST WASlE1 R (Thts.coal.berom iftha thf h Jon ISI11) BUILDING DrvIS1UN FEES «Icu7 GREASE TRAP PInNCHECK FEE Icrnify that In the ped ac nfthe ich thi rs .LAwll nmcmplo any Perwninw SEWER-S ITARY-STORM FT. y ynunor w oMw theWo"ia. onnpero ENERGY FEE O Z scum laws of CaOforni..Date WATER TGR WNENT)II r Z Applicant GR ING FEE ay NOTICETOAP ,hie WorkaNM r,.oatenslE gthu Crnifutc of Labor om,you uWum WATER SYSIEMMEATING ; bcoome euhjm to the WmkNs Cmnprnmtion provisions of the Ichor Cadc,you man SOILS fanhwah om,ly wi11,w,ch foc im rrr or mix Omni Shull he dccmcJ o tked. WATER SERVICE a � CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ,FT. PAID V I for which e,agcacy f«Ne perf«rom..e of D.te ReccipM � U thewmk for which Gisfmnit i.iswed(Sco.3BT],Civ.C.1 [U Fa LaniY Nvmc TOTAL LeMa'x AdJnexi TOTAL: L I'miry Jut 1 harc tend this alglic.tion noxi wa Jut Ne vhwe inforrratitm ix BUILD^NG�Tl ina� UIA cdra4.l egrcemcomylywim all ciry.M tvumy«JinanKcs mamma laws dWingm QTy. MECHANICALPERMIl' FEE r Z Wilding cuuvuaion,anW hemhY.uthtviee mryecnteuvn of Wscity to cera spm the S�ISg11C F� ahovementionrW PegKny for inspcctkm Purptus. PERMIT ISSUANCE. fWe)agrca m mvc,iMcmnify a d keep hmnJar(hit Chy of CuNr ino ugron,r ELECTRIC FLB ;-,...•nom liahilitia,jtdgmentr,cow and expenses which troy in any w.y ecxrue againm said City in axuequnrce of BK Bening a this permit. ALTER OR ADD TO MECH. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO H."CFM) MECHANICAL FEE SOURCE REGULATIONS. /Y q /� �jn�I /-''j y-.•9 AIR HANDLING UNIT(OV-RIII,I11q CTM) CONSTRUCTION TAX Signa)su .ppliranyCnnuactor Ni, l Da¢ EXHAUST HOOD(WTD CT) HOUSING MRIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the.pplicantor fortune Wilding occupant uoreorheMle ba,omIras nuteri.l HETING UNIT R IM BTU) u dcfncl by the Cupeiru Mmicilral Code,Ceapmr 9.13,and the Ifeulth and S.feD Co,r.Swm.25592(.)1 IDEATINGUNIT )V1MIW.101BTU) - CYs No VEhOTLAT1 FAN(SINGLERESID) PAID Will theDee Rcaip♦ epplie.nt m futum Wilding by mic are equipment m brace.which ROIL ER OMP OULP OR Ifin'")BTU) .mit araJ.ws air cmtaminwts as Jcfned by the Bay Am Ar Qunlily Maoegcr«nt AL: Dmrctf BOIL[ -COMI'(OVER IOO.gp BTU) ❑Ya I'r/rvo I lave rd JK lbao w m«•ninds".imrKds unvlenr Chep,6.95 of Ne Citi- ALR CONODIONER ISSUANCE DATE Tamm Hullh&Seftty Cock.Section,35505.25533 sod 25534.1 mdcrgnM tat if me NEW RESIDENTIAL MECH. SQ.IT. building d._.t.M.,onlly avc a nnatiL lat it ie my na Poo,mility to rally We noxupum Of la mrylRrtKna which mum be met prior t0 issuanc<of u C[nIFKm[If(Scvpancy. f _ OwtKrm wthorisd.gem I Date TOTAL ISSUED BY: OFFICE &Ci 10300 Torre Avenue oI, Cupertino, CA 95014 Cupert�l0 Building Division (408)777-3228 (408) 777-3333 (fan) April 3, 1997 Homeowner 7645 Dumas Drive Cupertino, CA 95014 SUBJECT Permit#30389 Dear Homeowner: We have been going through our files in the Building Department, and contacting those people with permits remaining "open". AAccording to our inspection records, the subject permit has not been fmaled. 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 permit card shows the final sign-off, would you please contact us so we may complete our records? If the permit is not signed off, 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 Pnnred on Recycled Pnoo,