30143 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. O"3^ a
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL" 43
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI'ITAI.DAI
OLRD ter C5Fhr 9t 7 ¢ 60.WNE "NAME PHONE: NTRACTOR'S NAME: LIC NO:
WI� o eAt 73 at`74 N/C CONTNOLN
RC,ITECDENGINEER: LIC NO: ADDRESS: ❑
CONTACT PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) ELECT PLUMB MECH
LICENSED CON'LRACI'OR'S DECLARA'T'ION 1QTY ELECTRIC PERMIT FEE El
1 hereby affirm that I am licensed under provisions of Chapter 9(
1 commencing JOB DESCRIPTION
wowith Section 700())of Division 3 of the Basin',and Profession,Code.md my license is RESIDENTIAL
F O n full force and effect PERMIT ISSUANCE
QI�..UI'" License Class Lic.4 CSFDWL ElKITCHEN REMODEL
Va QL Dale Coal.,.r APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
ARCHITECTS DECLARATION PANELS []MULTI-UNIT ❑STRUCTURAL
-zor z l undemond my plan,shell be used as public remnls MODIFICATION
OZ=p UPTO 2W AMPS ❑INTIiRIOR C1 CHIMNEY REPAIR
4: Life nse)l'rofeasinnal
OWNER-BUILDER DECLARATION 201-1100AMPS IMPROVEMENT
�Y•4j
:Y C Q I hereby affirm that I am exempt from the Contractors License Law for the OVER LIMO pMP$ ❑BATH REMO �REPAIR DEMOLITION
31 F folkowing reason(Section 7031.5,Business and professions Codc:Any city m county SIGNS ELECTRICAL C OTHER �IDE�Up.L r
a ns which requires a permit to constmct,alter,improve,demolish,or repair any someone
prior,.its issuance.it so requires the upplicmIfor such permit to file ani,edmatem,nt SPECIAL CIRCUIT/MISC.
that he is licensed pursuant o the provision'of lie Contractor's License Law(Chapter 9
(commencing with Section 700))of Division 3 ofthe Business and Professions Code)or 'TIEMP.MEiR OR MULE INST. COMMERCIAL'
a a e C that he i,exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION C DEMOLITION
14 LL Section 703 IS by any applicant for a permit subjects the applicant o a civil penalty of POWER DEVICES
tr' not y...i,I h,.five hundred dollar.,($510). ❑TENANT ❑FOODSERVICE
C1,as owner of the propcny,or my employees wird wages as their sale compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
F- will doth w.,k,.ad lmanaty a is not iatendedoroffered forsal,(Site AIM,Business ❑OTHER
W m and Professions Code:The Contractor's License Law does not apply to An owner of OUTLETS-SW'IT HES-FIXTURES
property who builds of improves thereon,and who does such work himself or through
hi,own employees,powidcd Na,such improvements are not intended or offered for NEW RESIDENTI CTR SQ ET.
sale.If,however.the building in improvement is sold within one year ofcompletion.the SQ.FT.FLOOR AREA $/SQ.FT.
owner-builder will have the burden of proving that he did not build or Improve for par,
po m of sale.). p
Cl,as owner of the property,um exclusively contracting with licensed contractor In TOTAL: L•a I)�
construct the project(Sec.7044,Bu,ines,and Professions Code:)The Contractor's Li-
cse Law does no[apply to an owner ofprnnerrywhobuildsorimprovesthemon,and QTY. PLUMBIN IT FEE
pl g96
who contracts for such projects with d contructoGs)licensed pursuant m the Contractor%
License La, P[RMIT ISSUANCE
C l am exempt under Sec. ,B&P C iia this reason
tee. r..6 is"
41's act
Dao
ALTER-DRAIN&VENT-WATERI u v VH IVALUATION LI 1111 VW
WOR ifi CGMPENSA9ION DECLARATIO BACK FLOW PROTEGE DEVICE -
I hereM1y affirm under penally,(perjury one of ohc following dedmalions: g�
Ihaeennd will mainf.in aCertificafc of Connem muff-imine for Workers Coalwa- DRAINS-FLUOR,ROOF,AREA,COND. TORTES TYPE CONSTRUCTIO
sation.as provided for by Section 37W of the LFor Code,for the performance of the
work for which obis pemdl is k,ned FIXTURES-PER TRAP [
i] 1 have and will maintain Worker's Compensation Insurance,as required by Secllnn CI I Y Ur I,/UIV
Lpa I II\L:
3700o1ftbe Labor Cade.far the performance of By,work for which this Permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC GROUP APN
My Worker'.,Compn ensmi. Imumyce currier and Policy number arc:
Carrie' Policy N., GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE GREASFJINDUSTRL WASTE INTERCEPTOR
(This satin eed moo he,cnmpleediRhe permit is foray,hundred delta,($100) _ BUILDING DIVISION FEES
or le".)
O 1certify Nainthe performance of Nework which W'Permit i,issued,Ishall
GREASE'RAP
PLANCHFCK
ITE
� natemploy any in anyinunerso a,mbecome'uhjscunthe Workers Compcn- SEWER-SANITARY-STORM EA.200 IT ENERGY FEE
ration Incas of Califomi..Dale WATER HEATER WNENT/ELECTR
O
z Applicant NOTIC
to E'10 APPLICANT:If,al¢r making this Cenifcam of Exemption,you should GRADING TEE
WATER SYSTIEM/IRF,ATING
a ; become h .. o the Wodero Compensation provisions tithe Labor CoFEEe,you muco SOILS FE
� forthwith....
. p
forthwith comply with such provisions in thi'(smtit'hall h+deemed revoked WATER SERVICIi.
S n
.0 z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLM,. SQ.FT. PAID
U 0 Ihercby affirm that there is aconswclion lending agency for Ne performance of Doc RccciptM
U. F the work for which this permit is iswed(Sec 3W0,Civ.CJ .
L) Lenders Name
Lenders Address ,TOTAL TOTAL:
p, I eci ify that I have rend this applicvtion and.cute that the above information is BUILDING FEE
N correct.l agree to comply with all city and county ordinances and state laws relating to QTY MECHANICAL PERMIT FEB
UZ, building construction,and herebyauthorim reporwyead,c,fedi,fly,u,m,,upon the SEISMIC FEE
abwe-mentioned property for mspeclion pugmses.
(We)agree to save,indemnify and keep hyrolese the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE
Iiabilities,judgments.costs and expenses which may in any way accrue against said City ALTER OR ADDTO MF.CH.
in consequence of the granting of thus permit PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(To 10.IXq CFM)
SOURCE REGULATIONS. - MECHANICAL FEE
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TAX
Signature m ApplicnndCantrector Dam EXHAUST HOOD(W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE
Will he appliccomor future building accupant,mre or handle accordant matenal HEATING UNIT(TO 1(10,0(10 BTU)
as defined by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(.)? HEATING UNIT(OVER 100.000 BTU)
❑Yes E3 No
VENTILATION PAN(SINGLE RESID) PAID
Will the applicant or inna,a building occupantusc yAcocitiquaresto
Quordeviceswhich Dam ReceiptM
nit hazardous air ammininants as&,tined by the Buy Arca Air Quality Management BOILER-COMP(3HP OR I 00.00d BTU)
isvict? TOTAL:
❑Yes []No BOILER-COMP(OVER I00,000 BTU)
I have read the havardro s materials AIR CONDITIONER ISSUANCE DATE
X25533 an under ,1 understood
rsto of Ne Cal,
Healthdoes&Safety Code,a aacou t.thin.is my and 25514.1 umdmsy th that if the NEW RESIDENTIAL A1F,CFi SQ.FT.
building don rot t,whiccurrently have a tenant that.i'...c ofazCeray es notify the occupant
of the requimmmts which man be met prior to issuance nfa Cenifr mnf Occupancy. -
Owner nr amhonzal agent Dam TOTAL: ISSUED BY:
OFFICE
f; i
• ®' 10300 Torre Avenue
Cupertino,CA 95014
CiU pit
cupel't1110 Building Division
(408)777-3228
(408)777-3333 (fax)
April 3, 1997
Homeowner
10620 East Estates Drive
Cupertino, CA 95014
SUBJECT Permit#30143, Patio Enclosure
Dear Business 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, the subject permit has not 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 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
1
Christy Akatiff, Administrative Cler
Printed on Recvded Paper
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