30905 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _ Q k^�
CA Y OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO. 30905 O V O V
'BUILDING DIVISION APPLICATIONIPERMIT PLUMBING.-MECHANICAL JK
BUILDING PROJECT II)E"FICAI'[ON
BUILDINGADDRLSS: SANITARY NO. APPLICATION SUBMITTAL BAD
FDwapl
'NER'S NAME: KPH .:�3 CONTOR'S 3;qM@ LIC YO: NIC CONTROL N
CHIGDENGINEER: LIC NO ADDRESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
—7 Cl {_ 7 1 El Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
tRJI v ! [ N J I ❑ ❑ ❑ 2�
LICENSED I am ONTRACI nsedorder .skim, XI of
QTY ELECTRIC PERMIT FEE
1 nercby nrrmm mal 1 am Hansel ander provisions ar cnamer 9 aammenci"g JOB DESCRIPTION
f]02 with Section]UINDofDivision Janke Bnainessand Pmfesi Cada and Yliccnx is RESIDENTIAL
FWO . fullfnac and eIfccl PERMIT ISSUANCE '
QUV Li, Licp v0 ❑SFOWL ❑KITCH17N REMODEL.
i4ZZ Date Can coal APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING RE-PIPE
ARCHITECTS DECLARATION PANELS
F.7tn ❑MULTI-UNIT ❑STRUCTURAL
O O H Z 1 undcrntund my plans shall be used as public records MODIFICATION
O Z— UP 10 200 AMPS
F F-W Licensed Professmonal ❑INTERIOR ❑CHIMNEY REPAIR
20I-I IXXIAMPS
Sd=[�j Oar I on exempt
DECLARATION IMPROVEMENT
0 W Q I hereby affirm that 1 am exempt from me Cosmos a License Law for the OVER 100k)AMPS ❑BATH REMODEIJREPAIR El DEMOLITION
?qq?S5 D y U following reason.(Scant to ianvo Business and Professions Ca,, Any city or county SIGNS E'LEC1RICAL ❑OTHER _
m++3 LL y which requires u pamso In ca.,the uhoe impmva h Permit 1 file
repair any atmcmre
�g prinnoits issuance,also requires the applicant for such Permit Eleasigned smmmem SPECIAL CIRCUIT/MISC.
} that he is licensed pursuant to the provisions of the Contractors license Law
(Chapter 9
LLa00 (commencing with Section 7")of On,ision 3 of the Easiness and Professions Codclor TEMP.MET ER OR POLE INST. COMMERCIAL-
X0%
OMMERCIAL
d L p C mal he is exempt therefrom and the basis for the alleged exemption.Any violation of
� Section 7031.5h El NEW BLDG/ADDITION ❑DEMOLITION
y hundred dollars
subjects the applicannnndvil penalty of POWER DEVICES ❑TENANT
Z} not arson,dean Ranhundreddollarsyepl - „- ❑FOOD SERVICE
� ❑ Lo the work,
property,or myemes with wages atheinole compensation. SWIMMING POOL ELECTRIC �n/1 MGI OVEMENT
F will Bothe work,CMM:T e Con is not intended icense Law do Gaol apply to an. weer ss
of I ❑ H,R
3 m and Professions Code:Thc Conhanor's Liccnu Law las not apply to an owner of OUTLETS-SWITCHES-FIXTURES4
properly who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvemmns am not mended or offered for NEW RESIDENTIAL FLECTR SQ FT. d
sale.IL however,me building or improvement is sold within one year of completion.the SQ.FT FLOOR AREA $/SQ.II'.
owner builder will have the burden of proving that he did not build or improve for pur-
pose of sole.).
❑1,as owner of the proper,am exclusively contracting with licensed contractors to TOTAL:
consumer the project(Sao VOM,Business and Profession,Cash:)The Contractors Li-
cense Low does not apply to an owner of prolixity who builds or improves themon,and ntQTY PLUMBING PERMIT FEE P
who contracts for such projects with a comme onq licensed pursuantto the Contractors
law. PIiKMIf ISSUANCE
❑ Ium exmnpt under Sec. ,B&P C for this reason
et Doc ALTER-DRAIN&VENT_WA jum Lmlow
1
WORKER'S COMPENSATION DECLAKAPION BACK FLOW PROTEGE DEVICE
Iherebyuni under Penalty offctoryonennhefmla„ingdeclararnna: CITY Ut
i I have and will maintain a Certificate ofConunt to ulbacom mrWorkers Camper- DRAINS-FLUOR,ROOF.ARF. ND. (IDYL-fsunV
workas Provided far by Section 3700 of the Labor Code,for the perfoinaroc of the STORIES I'YPECONSTRUC ION
for which this pemtit is ismed. MKTURES-PER TRAP
❑ I have and will maintain Workers Conmpetrsatlon Insurance,as required by Section
3700 of the Labor Coale.firths,performance ofdae weak for which this permit is lsmad. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
My Workcr'af-otpPgn%uti nln int carrier Policy
sha.-nu�bfr-alc; q(ood� GAS-EA.SYSTEM-OVER Casriee policy No.MWO ERS
CIiRTIFI Arno EF-XEMPTIINN IRAN W'ORKF.RS'
COMI'ENSA'1'ION INSURANCE GREASFIINDUSTKL WASTE INTERCEPTOR
(This section need oat be completed if the permit is forma,hundred dollars 0100) BUILDING DIVISION FEES
nr IcasJ GREASE TRAP
I cent fy that in the permmmanc,of the work for which it is 't is is ai l shall P,ANCHECK FEE
oat employan perm SEWER-SANITARY-STORM P.A.2(p FT.
y person in any manner u a..to heconre suhjat m me Worker'Camper- ENERGY FEE
Z scion Laws of California.Dam
z O Applicant WATER HEATER WNENT/F.LE TR GRADING FEE
y NOTICE TO APPLICANT,IL after making this Certificate of Exemption,you should WATER SYSTEMOTEATLNG
become subjectn to the Worker's Compenamloprovisions of the Labor Code,you must SOILS FEE
W forthwith comply with such Provisions or this permit shall be deemed mvuked. WATER SERVICE
a0
Uz CONSTRUCTION LENUlend AGENCY NEW KESIUEN❑AL PLMB. SQ.FT. PAID
L) I hereby aflirm that isad(See.construction30 lending agency for the pertomunce of Umc Recetplk
C4 f� th,work for which rate permit is issued(See.3110),Civ.CJ
ULenders Name
U TOTAL
r [✓a lender's Address TOTAL:
q I certify that 1 have mad this aPPlirnion and sea¢thea the above infonnution is BUILDING FEE
V) carred.L agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE
U z buildm,,nnswau
ction,and hereby morirc represenmtives ofdi,city m m
enrupon he SEISMIC ME
move-mentioned nopcny for inspection purposes. PERMIT ISSUANCE
(We)agree hs save,indemnify and keep harmless the Cary of Crania.agmost ELECTRIC FEE
Imbilities,jud,orm,eostsand expenses which may many wayacerue against said City ACTERORADDTOMECH.
in nsequenee of the granting of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT q1µHANDLING UNIT(TO 10,110(1 CFM)
SOURCE REGULATIONS, MECHANICAL FEE
AIR HANDLING UNIT(OVEK HI001 CFM) CONSTRUCTION TAX
Signature of ApplacanVConvncmr Data EXI MUST HOOD(W/DUCT)
HAZARDOUS MA PER IALS DISCLOSURE HOUSING MITIGATION FEE
Will me applicant or future hu ilding occupant store or h:mdle bavurdaus material HEATING UNIT(TO 100,000 BTU)
as defined by the Cupertino Municipal Coale.Chapter 9.12,and the Health and Safety
Code,Semlon 2553200? HEATING UNIT(OVER IWJXp BTU)
❑Yee ❑No _�CF
VENTILATION PAN(SINGLE RFiSID) PAID Due Receipt If
Will the air contra or futuants a building by the B use Area
Air Qu or devices which COMP(3HP OR 100,000 BTU
it beauteous air dmtamiwms as defined by the Bay Arca Air Quality Management BOILER- )
mortem] TOTAL
❑Yes 11 No HOLLER-COMP(OVER 1(0,1X10 BTU)
I have mad he harardous materials o,16acmcnts under Chapter 6.95 of the Can- AIR CONDITIONER ISSUANCE DATE
forma Ilealth&Safety Curb,Sections 25505,25533 and 25534.I understand that if the NEW RESIDENTIAL MECH. SQ.FI'.
buildinyyy��Q ,lea dy haveatcna L that itismyres."nobility lm notify the acceptor
of the/allty�ti h a ma mnsuance ifs H�ifi/upall/L�ofCr
Ownermemhureedogem �t " ate TOTAL: ISSUED BY.w� ,lwl7i7
OFFICE
of
&C,tv
10300 Torre Avenue
Cupertino, CA 95014
Ctperthno Building Division
(408) 777-3333 (fax)
February 9, 1999
Homeowner
21590 Edward Way
Cupertino, CA 95014
SUBJECT: Permit 930905
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, 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 our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recycled Paper