S 1777 APPLICANT TO RLL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
'ERTINO BUILDING LDING
CITY OF CUI -ELECTRICAL PEIS1IT NO.
HUI1)ING DIVISION APPLICATIONI'ERMIT PLUMBING-AtECIIA BICAL �J 1777
BUILDING PROJECT IDENTIFICATION
RUILDINGADDRFSS,, SANITARY No. APPLICATION SUHMITIAL DAIE
`y N'l!�1,li: D PHONE./N CONTRACTOR'S NAME: I,IC NO:
■NI NIC CONTROL
qlv" 1 CIIENGINEER: LIC NO ADDRESS: ❑
CONTACT. PHONE: BUILDING PERAfIT INFO
❑ C.,Paitant Fca Paid by Applicant(Initial) BLDG ELECF PLUMB MECH
LICIiNSHI)COMIRACIORS UIiCLARAHON @TY ELECTRIC PERMIT FEE
o Z I thereby alum Inv 1 tar Iiem„dl under pmviuoms of cbapin 9 letmagpems JOB DF-SCRIPTION
�
�� full force and clrnft> PERMIT ISSUANCE ❑SI
ivirim3nflMllusinca<mW 14o4,rNitmr Ode,vnd:ny licumc:s RF-SIDF,NTIAI,:
W O w SI-DWI. ❑KITCHEN RI;MODi:I,
QUU Lia.Our Lich
a a APPI.IANCI3-RESIDENTIAL []ADDITION El PLUMBING RE-PIPIT
A
F� Dule Drlw
VVII RCHFILLTNTS DECLARATION ❑S1UhTbUNFf ❑SUtUCNRAI.
PANI:I ti
Z O rn Z I wdcnwnd or,plvns Jmll W u.cJ vs plM1lic rtctNs MODIFICATION
OZ=� UP T021p AMP5 E]INTERIOR ❑CI{IMNIiI'RF.PAIR
(a-r?�"41,,ed Pmf6'iovl g)1-I0(M1AMPS IMPROVEMIWl' E]SWIMN ING WK)LS
OWNER-BUILDER DECLARATION OVER IgM AMPS E)BATH Rf MODI' REPAIR ElDEMOLITION
6 1 bereby alErm that I am exemp from IW ContorOmlx License Isw,for the
K O W p ❑0THER
3 EdLrwmp rcval.Isaelnv 9OJ LS,ILwl r:ew:std Irorvrlmi.CsWm'.Any oily or county SIGNS eLECFRICAL
LLa which mymrts u permit to mvnUucL alter,irnpove,tkmMisn,or repair my awnuac
prhrr u, iuuarcealut reymn,,Ole vpplicmd fonuch pemtilm GW a sigrcdstatmrnnlENEWP"RFSIDFfFD`1AI
RCUITAII • ��
$�y Eva he is licenvJ putwanl to lW provisions uftW Contractors Leef,e law(Chaper)
WEE C Ietnmrlcin Ih Semimnnan)ofuivimtm3of Bte Busircxs"t ferdtarrcme COMMERCIAL:
gxi lmR OR .fa
L C Ih:e le is cecmp d...oar::W Or lads tar the ulkgcd cxcntpim.Any violalinn of ❑NEW BLDG/ADDITION ❑DEMOLITION
Seetion]031.5 by any applicant f«v pertul Nm FMt%one vpplc.nl In a civil pointy OfVICES
a H ❑IMPROV ❑FOOD SERVICE
y dR.than o c Wmdmd chloro yT$500)
cmpl
�SQp Lnx orwttcr n)thepmp<my,mmy employer.wile wugamtMir wlc campcnvrion, POOL ELF;CTRI OTHER FMFXF
roll do Ih<xrark,vM Ik!lN[lurt is m inrcmhd m nRmerl for ole(Scc.'114J.Bwirress ❑OTHER
IWil r mud Pmtusdme Coclo '1 M1c CmlmcuMs Lkcnrc 1.1w doer aN apply tow:Avntt u1SWI'ICIIES-FIK'rUR.,
popeny,who build.or Improves therefor,and wdm docs such word,hirmelf oc through
n-own mnpmy es,lmwtded til such improve mnu am not imcMcd tx aBcred forINTIAI.HT I CIR NuI.
'Ie1f.wevcntha Niklingmrimpnwcmcntiss Wwithlnorcy< rofc,) pioim.lhc SQ.FT.FLUOR AREA SbQ.FT
owns-W IR,r will havc the W rden of proving dial he did mw W iW or imProve for Pur-
ptmofede.). r A 1 n
❑ h u mm of the ptryerry,ver culudvcly(9rllraeling with IiccrEN caxractta.m TOTAL
c mvmcl the prn cul IS,714.1,Bwln 5s ono Pndcrsionn C:.kU'1he Cmnrxvdr hi�ern m ��
c sc laved n applyu,.owoof Pnxe.ny veno builds or impovn lhctmaril n. QTY. PLUMBING PISRMIT FEE p
Dwbmcomrxlsfm.uchpn7emswithamm.18� OG]IiaerrccJ Punuvntmlhc Ctrmtamor'e /�
Listener law. a PERMIT ISSUANCE S,a/�' {/
` ❑Imo s< tun�lcr Sec. III for thi.resrm fit-
(A
t"-X7LYX
AL'I ITR-URAIN&VENT-WATER G Oy
WORK12R'S COMPENSATION DECGRATIO. BACK R-OW ' x' );-.,"I. Its
I larehy intima under Knolly of perjury ume of the Io lowing declurwimns:
,-J there:artl will maintain a CernfispOe ofConsenl to self-imam,LV WorkcYs CoOmen DRAINS-FL .RIX)F,ARU'8 I S'IGRIES TYPIi CONSTRUCTION
.moon,no provided for by SRlinn 391g1 ofrlm IaMu Calc,fm 11w pcdtm:amc aF1W r
work for which thin permit is i.vuerl. FIMURIS-PI AP \ J
O 1 havc and will maintain Workers Com emim m Insvnme,as required by`+'trim
37011ol the laWr Cao,fwtW pcdimmmc,.Fnu,work forwimbdr,prod is iOomed GAS-G.SYSTEM-1 INC.d OUTLETS OCC GROUP APN
No
.
CCWarkcrs Conycwrim Inaurmrcc cemricrmWI' numbs art:
micc I'oGcy .o GAS-G.SVSFEM-0VHR 4(1iA)
CERTIFICATE OF EKIiSIFI'ION FROM WORKERS'
CONIPENSATION INSURANCE GREASEANDUSTRL WASTE INIERC)R
BUILDING DIVISION IFES
(HO._Omo nerd.hex nmOecl ifthe permit is fur a a hotWw ol!u(S 1011) GRGSETRAP
m k,") 1'IANCI{IiCK IFP.
toy an.yln: in mvmmncco astobNprrn wTds*h Lr the
lel 'Chldmll SEWER-SANITARY-STORM G.Mp 1?.
marl empu)vnY lcrvn in ay mower aerators subject to tW W'dleri Cmmprn- ENERGYItiE
Zz. 'tion taws mf Cvllfmm,Date WA PER HEATER WNIL'I/ LECIR
Q Alpl.pon I GRADING FL'H
.Na
NOTICE'FO AP%KANDE If,after making this Ccmifcarc of Enempim,you eMauW WATER SVSTENIGRP,AfINO
forth.th comp ur o Wmkcr'osimnpen.r thi,Permit
ha,l of rhe tpeci r f-k,you moat SOILS IEE
rtmnxiln comply wim.uten l.mvirion.«mi.pemdr.l,all be,d«mcd revoked, x'Anm slxvl(.li
a0
7 Z CONSTRUCTION LENDING AGENCY NEW RESIUFt.I'IAL NMB. SQ.FT PAID
V work
fdh thv ohne (Se,
3 7,Cis, agcrcy 4nthe pcR:marcwf Dere eipN
Ne work far whiell chis pemilt is i_rrucd(,Sec 3(191.Civ.CJ
pF' Irrak+'s Name TOTAL
U4 Imdur.Adlc u
F1 I arufy dim I have read this applicwim and Nate tow the elnve information is BUILDING
N carzl,l agrtcm comply xbb.1161y.nd,onlyordramcr wWsmm law,rtl.ting ,, QTY MECHANICAL PERMIT FEE
V z building<nnrbrKlimq arW hcrehyvodavieemepm.nbm,estd lhiscjtylmcntnupmdre SEISMIC
aWvemsentiurcd PmpnO,for iraseclion potoNs. PERMIT ISSUANCE
Twm ngrca m veva,irdenmHy and keep molest rbc G1,of Capenlw nsvinst ELECIItIC FE
liubiliucs,jtbilmem,O.natW expsn.anxheh may in anywayue.,Trirta vW City ALTER OR ADD TO MECH. PLUMBING FE
in cmcsfae 'c of the emoting of this pmmut.
AVPLIC'. UNUERS'TANDS NU Wil COMPLYWITH ALL NON-POINT AIRIIANDLINGUNII'(101o,000CFS1)
SOU RC F IUI,nT10N5 MECHANIC E
�Wl..[A�I/r- AIR HANDLING UNIT(OVER IO.IMp CFM) CONSTRUCTION TA.
Si,rcmeofAfppIi,.nVConmmc1or Umc EXHAUST HOOD(WMUCT) HOUSING MITIGATION II:'
IIALARIx)US MATERIALS UISCI,OSURE
Will IW applifant a future Wilding Yuprit store or handle ha.ardws material HEATING UNIT(TO 100,M)BTU)
as clamed by the Cupni err Mmdcpul Cock.Clapton 9.12,aW the Health and Sufny
Code,Section 25532(.)7 HEATING UNIT(OVER 100110 BTU)
❑Y's No PAID
VFNFILATIO!J IAN SINGLE RISIDI Date Recejpl
�° hWill de aflAw.l or furore Wilding occant upme PiPrs,"a des,which
pil
.dan airmnmmimnu ur tk:BneA by the thy Am Air QuuBly Mvwgcment BOILER-COMP LULL OR IM).000 BI'UI
C
TO yfAl:
0Yea ON. BOILER-COMP(OVER 100,00)HTUI
ATR CONDITIONEk
I have rtxlthe herardoua tatniab,opii,ri en.maker O p'695 of one Cali- r ISSUANCE LATE
fontix fknith k Safety Code.S tionr:55U5.25533 mW 235:U.I under M dal it the NEW RESIDENFIAL MECH. SQ.ET.
Wildingtkays Ord nu 1,Wvev tcrom.shat it is my rnpondMl'oy to notify IW occupanr
of me meyuimmrcms which 11a1 M norm pilar w inwmcc of a CcmBicmc of Okcvancy.
Purer or vwMirW.gent Dmc TOTAL: ISSUED HY:
OFFICE
10300 Torre Avenue
µ
Cupertino, CA 95014
Cite of
Cupertino Building Division
(408) 777-3333 (Fax)
February 9, 1999
Homeowner
10215 S. Foothill BI
Cupertino, CA 95014
SUBJECT: Permit#S1777
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
•
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