S 0233 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELKCPRICAL PERM Tr No.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S 0233
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS'.
SANITARY No. APPLICATION SUBMITTAL DATE
ZOg46' ' '-,o 0
OWNERS NAME: I'HONI_ VeFT LY)N' RACT( 'S NAME LIC NO'.
/7I/JG� 1 �)�14Ci ��'V; 2$7-9:1161/2 A. f 1027/ rvn: CONI ROL w
1pWC111TECT-i GINEER: LICNO ADDRESS: ❑
CO ACII PHONE: BUILDING PERMIT INFO
�S/4�G�Z-1�IPi ❑ Consultant Fm Paid by Applicant(Initial) BLt� ELECT PLUMB MECI
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
1 he eby of irm Nm I am hcmtt.<a roMm provid«ns of CBWRmr 9(e«nncxing JOB DESCRIPTION
Z with Sectiom Winn)of Oivivion 3oDnc Bmiaa ns"lm Essimry Gdc,aM my Tame isIAL
WOO PERMIT ISSUANCE
=W F in full f«a amu cRea 'hUWL ❑KITCHEN REM(IDEL
Qy..UU License Clues hic'g APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMHING RE-PIPE
N<WW Date Conlmnm
F-Oy ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL.
' Z O 7j 1 undervarxl nn pions sM1011 br used o.v Ifablic tecods MODIFICATION
O UP TO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
W I.icemexi l'mr,,rimul OWNER BUILDER DECLARATION
'_'(II-IfepAMPS IMMOVEAIENT E]SWIMMINGPOOIS
C= al OVER 1000 AMPS ❑BATH RE\tODEI/RF,I'AIR (]DEMOLITION
IY Q I hcrthy affirm That I em ucmp from Ne Cmtranar,Liccnx 1«w for the
a:=
u13O tL U Iallrwing fmvm.Itieefmn]u.113,BusitLLws INA Rofeasi«Ls GtJe:Any city nr cnunly SIGNS ELECTRICAL El OTHER
LLra which regmma a permit to c«wrvcl.dim,improve,dcnatlish,or mpair any sllanme
�uv�'OJ
for,1.a.issumre.aura at,ams lite"he.,fors«M1 pemdt mfdeuxigNed Cmemmm SPECIAL CIRCUEDMISC.
fµI y teal nn it lkcmd patuwntmNe nmvird«dsarine Comfmds Lmenscwwlawpm9
W G'nO� (aonmcrcing with SmFuC]IMp)nf Divisim3ofJc BovmcxeM Pmfcaiom CMc)m TIE1,IP.MEITR ORPOLEINSI'. COMMERCIAL:
a that be is crempf fnom9Om and de basis lie me ulkgd exemption.Any violction Of ❑NEW BLDUADDRION ❑DFb10LTTION
t
Senlm 7031.5 by any apple f«a permit subjects Be applicant o a civil penalty of POWER DEVICES
-,� il ❑TENANT ❑FOOD SERVICE
F+ZY mw mem thm rive hunJtd JnlWs(g51xq.
=6 Las owner OftM o,arm th wves m ihci,-E,ot flu, SWIMMING P"d-ELECTRIC syrHERIMPROIls11iNT
❑ linNe Y Ycnipl%m xi g Ienw
W Gwill do Bit,work,ow!thetreasure rsica-tcMrd,La.doItee scarl Iv a.W.Busitr of ❑OTHER
z E-
6'3$ uMemy who
Cdu:'Duces flaha§ mc!wh Ww sus mitapplytoanaverof OVIIPIS-$WTTGHI$-T%fURlS
progeny who hoildr Of ifrgmvu Ihemrnnm r who Nes rush mtk himself«through
nix own however.
1,proviJd alit fsuchor- mentis Old
w x to iyear of m pri time.f« NL'N'RESIDENTIAL ELECfR SQ F1'.
wk.lf.M1owcvcr.IM1E huilding or impmvemcmnruld wi0in mm your of nxnplrion,Nc SQ-FT.ILOON ARBA YSQ IT.
owner-builder wall his,the burden of ryoong that Ic dW Not band«itimpmve for por- P
Pne ,Isle,.
❑I,u owrel of the mmeny,am exclusively conamning worn lken,ed contlacaxa In rOTnl I�y� 9 �(1�1
nlmN
xfref e pmjcn(Sec]Mi,Rockers ud Pmfdrlau—,Tic Comaanm's U. JUN M 7 RL{J u
cens,lalot.w cno,.,Iyman awn,rof do smy whit hulldv Or ma,mve,llcren,aM PLUMBING PERMIT FEE
nQTY.
wta caamcfs f«such projccu wiN a mmrenoHs)IiamcJ Ivrtuenf fo the CcmtmctNx
Lio.Law. IT ISSUANCE.
❑1 am esempl aMm See. .B&P C for his rmwn C I I Y ur t,�r tri I INU
Owns Dao,
AU - AIN&VENT-WATCH(EA) VALUATION
WORKER'S COMPENSATION Dfto, omvAT1ON TACK Fl. fR1iCT DEVICE
I herealBmdm
sy t o )amity of penurym nnl the lidling dmluwinnc.
❑ I have eM will maintain a Certificate of Consenuo self-incrc fsr Workers ComPcn- DRAINS.- .-00B IA,COND_ RAS OTYPE CONSTRUCTION
.cation,as Pr idd for by Seencen 37M of the,Ichor Coal f«do pmtnmurce of the
kf hichmix Pcrmifishsud, IIXI'U - RTHAP
�I llavc and will maimain Wmkn's Curyensmlon Imcia.,ax rt<ryitcd by SccliunIN RECI
3](0al die Labor Corlhene,perhxnwmce atone work for Aloch no,perostix issued. GAS-EA.S HN(-f[AIC.a OUTLETS OUP AEN'
My W'akcrr on It"rt ecameTionJPnlicy numhcr
C. - Policy No. 411 GAS-IA.SYSTEM-OVE CII I yr wrci111N
CERTIFICATE OIr EKIJNITION FROM WORKERS'
COMPENSATION INSURANCE GRIASF%INDU.STRI.WASTE L li
BULLRING DIVISION PC13
This rection icd n«Rcodmipkad iftheprnnit iv f«oma bufWnl Jdlux(5100) GRCASCTRAP
m Ras.) PIANCHLCK Ilii
Icmtif,Chu in the Perf«nwemafthe wank f«which this permit is issued.,l stall SEWER-SANITARY-SORM EA.2W PT
not employ any peman in any manner so as In rotor a subject In do,Workers'Compen- FliERGY FEE
O Z cation laws of California.Dam WATER IIEA]'ER WIVEN'diLEM I GRADING FEE
z O AfyJicanf
N
NOTICE TO APPLICANE It,Offer making Nis Ceniliaate of Excefifor.you shiadd WA[LR SYS'111M( REYDNG
F a m
beeoe subjcc tO the Worker',Cmnpe aids,provision,of Oaklabor C«k.yoo most SOILS FEAR
Leh,rh acmply with such prolia—o,Nu permit shall M icened rtvnked WAITER SERV ICE
aQ
7 z CUNSIBUCTON LENDING AGENCY NEW R151UENTIAI,I'LMH. SQ.FT. PAID Dem Receipt
V 1, ereM1Yaffirm that Chert iracce"mnicC lending egcnry fix the pcHnnnmcm of
the wart f«wltkh Nia pcnnit is i.vucd(S«.3(A7,Co.C.)
1<nJcls Name TOTAL:
V Leski Addm¢s TOTAL:
L BUILDING FEE
I«ni,e her 1 hevc mita.thin applir can yW swam Jou the oboe v,oclmtir,,,
Z mirth.I agree m cmiply with all tidy W mm�ty nrainaaaa end scam lows ealien t e QTY. MECHANICAL PERMIT FEE
U z beilLne muwefion.eM hcrthy vwhOriae mc5et-enwivex of Niscoy to cmc upon the SEISMIC IFF,
ehovc menfiond pmpe"y for Impc,a ion pmPo,e,. PERMIT ISSUANCE
(We)agmme m sate,indemnify and)keep hmmlaO the City of Cupamlmo again" ELECTRIC Hiii
liebllitim judgmcnq cmm and expn mewhich may in city was
'ares.
mmm nV aagaisaki City ALTER OR ADD TO MECH.
in comicalof fog
e aming of this permit. / �� PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TG 10.000CFAU MECHANICAL FEE
REGU ONS
AIR HANDLING UNIT(OVER 10, p CIM) CONSTRUCTION TAX
Sigoawrt n( IicanUCmtracarr i10,D00Detc EXHAUST HOOD(W,DUCT
RDOUS MATERIALS DISCLOSURE HOUSING MITIGATION
FECIV
Ill the epplk-am nr future huilding arupmdf was«hanJk lwianlnus mmcmid HEAHNG UNIT(TO 109,000 BTU)
u defitcd by the Cupctirm Municipal Code,Cldrptcr 9.121 ono the Llrnitn and Safety
Com.Sestim 26532007 HEATING UNIT(OVER 100.000 BTU)
E]Y" ❑No
VENTILATION FAN SINGLE RISID) PAID
ore H«eilx n
Will f ac ofor
pplicunf,a um luilding ccmpam rosedevices which
cyiiipnem or devicwhich
Imoit hanrdcwe air ccmWniiwns as defind by de Bay Area Air Quality Mamwgcmont MOILER-COMP OHP OR Hp,000 BTU)
TOTAL
D mit:'? '
❑Yea r7 No HOLLER-GQMP(DVEH II1l1,IXJ1I BTU)
I move rel the banrJeur maid,mlmote a under Clwpty 6.95 ef,M Cali- AIR CONDITIONER ISSUANCE DATE
forma Healn&Safery CMO.Smimn 25."5 25533 rod MY4.I cmdetmaml IMI if the NEW RESIDENTIAL MECH. SQ.FT
building Jou rd ecmendy have a R^'^ N"it E my mupeadriNliry b notify tie oveoPmat
M fM1a myuired loon mu.cue oto Ccnifiawc of(talo
z7-
OEoruu Ydagcm true TOTAL: ISSUEDBY:
OFFICE
pc
of 10300 Torre AvenueCupertino. CA 95014
Cupei to o Buildin_ Division
L (408)777-3228
(408) 777-3333 (fax)
March 20. 1998
Homeowner
20846 Fargo Drive
Cupertino, CA 95014
SUBJECT: Permit #'50233, air conditioner
Dear Homeowner:
We have been going through our files in the Building Department, and contactinu those
people with permits remaining "open".
• According to our inspection records, this permit has not been finaled 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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatif£ Administrative Clerk
Pnnlea en Avxneu Pac,••