30051 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE.BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMU NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING.MECHANICAL. �O O 5
BUILDING PROJECT IDENTIFICATION V
BUILDING ADDRESS: \ SANITARY NO. APPLICATION SUBMITTAL DATE
Iti c Q\ �Oti
OW ERS NA Mfi PHONE: C UAW R'S NA l ^ LI(:NO'.
\ S } NIC CONTROL
a ARCHIlBGDENGINEEW UC NO AD ESS: ❑
CONTACp - PHONE: BUILDING PERMIT INFO
SS
El Consultant Fees Paid by Applicant(ItfihW) HIDG ELECT MUUM�B MEECH
0 /� ❑
LICENSED CONIRACIUR'C DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby iMm tura I,m licensednsvs uer provisinof Clapter 9(ccs mrencine. JOB DESCRIPTION
O�Z whb Sceian'1000)oHNvisheu Cam.:.,.
m3ortnc Busind ProGde.arm my license is
rtiv
1tyy O O
Fes_ ie full foe and of PERMIT ISSUANCE RESIDENTIAL
C F ❑SFDWL ❑KITCHEN RGMODEI.
a w Lic Q_ Lich APPLIANCRESIDEIAL
W Dmc Cpu.cmr ES- RI' ❑ADDITION El PLUMBING RE-PIPE
ZO`=tol.win,ol..
I undcmmm myplaARCHITECI•SUECo1JOtXHON ❑MULTI-UN1T ❑STRUCTURAL
nssnall heed u blusur records PANELS MODIFICATION
OZ— UPTOXOAMPS ❑ NT
IERIOR ❑ IM
CHIMNEY REPAIR
icensed PmfesucnJ
OWNER-BUILDITR DECLARATION3U1-1(XXIAMPS IMPROVEMENT
I h reby affirm chatI um eaemp f.the Cmaractar's Licenselaw fmthe OVER 1000 AMPS ❑BATH RFMODEURFPAIR ElDEMOLITION
(fiction 7031,5,Business and Pnde,snionx Cada:Any city ur..maty SIGNS L11-[crjMEL ❑OTHER AJ
which rtquires a Fermir to cswhuch der,imi dcmofush,or repeiT uny ssrvc um
f O purroro its itrwrec,also oC,E.msde.11fcan,for such permit to Me asignedsatcmcoa SPECIAL CIRCGI
QF tMt Wis lfcenscd pursuena lothe pnrvaumx of the Cnntrm7or's LRensc law(Chwp 9
dJ (CommeecingwiWSaum'Rp0)a DivisiomJoft Ruieessud Pmfeuk sCode)or TEMP.METER 1
dO Wet k it exempt alertfTum end Uro 6esis fm the alleged cacmm,im.Any violuiun of
5Satinn]UJLS by uny eppliamm finepemtit subjects the epplrcam uiaclvil lertdry of POWER DEVICES ❑NEW RLDG/ADDITION ❑DEMOLITION
m ❑TENANT ❑FOOD SERVICE
FZY .snore than five hung 1 bUan(5.500).QIMPROVEMENT
❑ re
I.uowrof t o pm y,army employees with wagceas Ncir rope
le cnmnmtiun, SWLMMINGMIOLEI RIC _
wdl do the wvk,uW Ne umeture a.1 imenkd orulTertd for.wto(Sec.]DLt.Bus'orss ❑OTHER
W a sod Pmf.ione Costs:The Ccmractnra License Law doer WE.sF,to w owm+N OUTLETS-SWITCH -Fl RES
pmpcny who huikls or tmprovu,s Wwon,and who dies soch work himself w Nruugh
his own employ.,pii that such impovemcns arc Cot intended or oferM for NEW RESIDENTIAL E OFT
We.If.howsvef.Ne Witdingorimprorcnema is sold widrin Cane yearnfcomplctim,be, SQ.FT FLOOR AREA vs Q.EI'.
wr.:r.Ini will h o,e the hurdcn of .,in,,lon hC did not Wild to improve fie star- p
you of Wo). .`1 I4 6
❑I,as owner of the pmpcnY.am exclusivelyContracting with Ibscd cncomranors to TAL
momma de,staect(Sco 97 L.Ii.i.,ors]Pmfia ns Code:)The Cmmicoar'n Li-
QT2 1996
nose iswdoce rur.pply m.n owner of fageny woo Wilt'orimprove lhacvn,Cara Y. PLUMBING PERMIT FEE JUN 1
wM1u amtmets(onuch projtan with a cuntrecug(s)Ihcn.cU pu.E m Ile Cum—ow.
Ucm.•Law' PERMIT ISSUANCE.
❑Luo eaemprMSec. —,
aaT B&PCfnnrt
his nson LI I T Vf: vurrn I BVI
Owry Date ALTER-GRAIN&VENT-WATER(EA) YVALUAGON
WORKP.R:S COAMPF.NS ATION DECLARATION HACK FLOW PROTECT.DEVICE
m �O
1.. ay affna ludo penuhy of perjury ane Caf the fnuowimg declarations: V
❑Ih.ve Cad will maintain.Cmifcue of Cmuem to sell-imore fro Worker'Common- DRAINS-FLOOR RODE AREA.COND. STORIES TYPECONSTRUCrION
ration,u provided fur by Seuion 3900 of the Lahr'Gds for the a fmtwmoc of ted
work for which this pemut 6 usuN. FIXTURES-PER TRAP
1 have end will.amain War-Icer"Canpensation Immorace,as regairW by Section -
3700ofthe robmC dc.for w momccof the,work fm which,his permit is ivaCtl GAS-EA SYSTEMI INC.a OUTLETS OCC.GROUP APN
My Wvrk �'�^[a sora ars n euricr.nd Policy
Curicr:�Miq NGAS-EA.SYSTEM-OVERC(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' ,
COMPENSATION INSURANCE GREASMNDUSTRL WASTE,NOBJICEPIOR
Ini,vection navl nm W u.nplmW if the permit is for arc hundml dolous(S 100) BUILDING DIVISION EF.ES
an kr..) GREASE?TRAP PLANCHECK FEE
I cenify that in the perfamunce of the wMfor which this permit is i sited,I that] SEWER-SANITARY-STORM EA.200 IT.
act employ any Peron in any manwr.so as to become Cboct to are Workers'Con,en- ENERGY FEE
OZWinn CaLawn d'CaIJ uD�c
Z WATER HEATER WIVENTBILECIR
Dpit - GRADING FEE
NOTICE TO APPLICANT:If,tiller making Thu Certificate of Faempdon,you should WATER SYSTEMITREATING
F become,abject to the Warkcfs ComMw
lion provisions of the IsM1or Codm e,you norSOUS TEP,
fos hwilh comply with such prso,kinns ,his Ecru,.,shall M deemed invoked. WATER SERVICE
= z CONSTRUCTION is. oNLENDINGA, one, NEW RESIDENTIAL PCMB. $Q.FT. PAID
GO Ilertwhithy im,peorertisvard!( c.-WO.ding agency Murtha pttfomarcc of Doc Rettipt♦
� � be,wixt f«which,tlis permit is icauN]sec.309'1.Civ.C.)
O F-' Lrnler'.NomeTOTAL:
Leader's Addme+ TOTAL: g
6. I crnify that I MrcW U .pp
reus licuise.W nate tiushoot,natt thshoot, mwi
infonn it 2 BUILDINGFEE / g
y n+Tay,I egra m cmtvly with all city and nuti,y tNinwas end ame Iuw.relating m QTY MECHANICAL PERMIT FEE
U Z Wilding common ins.and hereby vudmriee BToeSecmmvesof Nis city wentnupon are SEISMIC FEE g
v TnmBo ed propnY for irmpection fwrmous.
y p pmino against PERMIT ISSUANCE .�
agree to otic,iMcmnif attl kn hannks.the City of Cu � ELECTRIC FEE L✓
liabiluin,' oto cogs Cad eapmsea whkh vuY in mY wtYemue apairut vid Cay ALTERORADDTOMECH.
consequmtt the ting ofhis tpermit/ PLI1MtlIN0IEE ,
APPLICANT UN ER TANIS NO WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFSO
SOURCE REGIf1A'10 S. MECHANICAL FEL
AIR HANDLING UNIT OVER I0.000 CFM) CONSTRUCTION TAX
esnu'Cwtrxm Dino EXHAUST HOOD(WIDUCr) HOUSING MITIGATION FEE
HAZARDOUS MAfERIAIS DISCLOSURE
Will the.pplic.ntorfmmc building upug store or haMkM1vudour mwcd,i HEATING UNE'(TO 100.000 HN)
u ci by the Corcrtino Municipal Code,Chrocr 9.13,aM the Ilealth and Safety
Code.Section 25532(0'! HEATING UNIT(OVER 1W."BTU)
C3 Yes, ❑No
VI:NTILA'1'ION PAN(SINGLE BESIDE PAID
Will the haat or future,Wiwi occo Date, Receipt 0
app ng pot use e.Air
saviors which
mitb.rnrdous aircmaamiranU as def and by the Bey Mca Air Quairy M.ragemrna BOILER-COMP(JHP OR 100.1X10 BTU)
Diwicaf TOTAL
E3 Yes No BOILER-COMP(OVER IW.IXI(i BTU)
I hove read the t..,ardC,,mas als Colin rcux under CTagv 6.95 M do Cdi- AIR CONDITIONER
ISSUANCE DATE
firmaWoldi ,thisFlo ,n Safny ly Sectimnr 25303.is XEDmy end 25511.1 m.bsnW Uw if ane NEW RESIDENTIAL MECU SQ.EI'.
r Wilding Jtcs mt namn,ly lawaacnam.,lato isusnespunsih sir..ifytho,Nari
dthe rtyuvmta,o which rrvua W rb prior m Issum a of a Ccnifgae mf Ompncy.
Owren Caraudmria lsgem Date TOTAL: ISSUED BY:
OFFICE
}1
10300 Torre Avenue
Cupertino, CA 95014
( ilv �I
C1pert1110 Building Division
408)777-3228
(408)777-3333 (fax)
January 15, 1996
Homeowner
10711 Farallone Drive
Cupertino, California 95014
SUBJECT Permit: #30051
Dear Homeowner:
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 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 records show the
subject permit as fmaled, 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, Adm inistrative1lerk
0