29020APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
eITY OF CUPERTINO RMLDING - ELECTRICAL
"'""NO
'""NO.
BUILDING DIVISION APPLICATIONMERAUT PLUMBING -MECHANICAL
GJ
29020 9 O L O
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS:
SANITARY NO.
APPLICATIONSUBMITTALDATE
--
2 7 o -r i L c G.0 D
It -I" 5
OWNERS NAML L YHONE
E
CO ACOR'SN ,LIC NO:
NIC
❑
CON9'ROLx
ARCHITECr/EN 'INFER: LIC NO:
ADDRESS:
CONTACT: PHONE
BUILDING PERMIT INFO
l ��0
❑ Cmuultant Fees Paid by Applicant (Initial)
BLDG li PLUMB MECH
❑ ❑ ❑
LICENSED CONI NACIUR'S DECLARATION
I hmeby afTum dont 1 tin licemied utdcf pmvisials 4 Cha ren 9 (cmuncocing
wi Scti 7")of Division Jofi eBu.yin¢s d M)fcuinnaCN ,ZaM lylkCnreis
in full force ad effect.
liceme CLu Lica
Dam Contractor
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
R SIF DFNTIAL
❑SFDWL [I KITCHEN REMODEL
[]ADDITION ❑PLUMBING RE -PIPE
❑MULTI -UNIT []STRUCTURAL
MODIFICATION
pERA1IT ISSUANCE
APPLIANCES- RESIDENTIAL
ARCHITECTS DECLARATION
LUNawM my Plans shall reused it, public recants
PANELS
/
UP TO 3W AMPS
❑INTERIOR El CHIMNEY REPAIR
IMPROVEMENT
OD' FP
❑ BATH R [I OLITION
IV«med Pmfaakmal
OWNER -BUILDER DE CLARATION
1 hereby affirm Not I amp, from 0uLo
e ComrR:s License w for de
NII-1000AMPS -
OVER 10)(MAMPS
SIGNS ELECTRICAL
folbwing reawL (Seminar ]0315, Business ars! Pmfasiom Code: Ary city wmormy
which mryimi a permit to cautmm, alta, impmve, ilmrohsh, or ncTi m, any stn time
❑ OTHER
prim bio iuuwce, ulw rtyoirt. the ti,licam for such peoWuo file n.igned vuterent
Ihw he is IicemN par.., -" to Nc Positions M the Comnnor. Usama law (Chapter 9
SPBCIALCIRCUITIMLSC.
r
TEMP. METER OR POLL' INST
COMMERCIAL
from .ng wird Satio.9(XM)MUivisiun Iof Jon nosiness and Pmfsaaions Codc)ue
That be R exempt Nmmfmm and be bmis for rhe alleged esemption. Any violation of
am«
Section by any appiicafa permit the applicam to a civil penalty 4
owl ac than five M1UMrtdrhJlun f5500),
r ofth, pmy,«my em«xan m
wJl mw«pm pkry. wird gtheir able conpensati«r.
Work aM the stnsmrtia reainmMN «oRcred Tor ala (Scc.)014,Bmv«sa
[I NEW BIDG/ADDTIION 0DEMOLTf10N
❑TENANT ❑ FWD SERVICE
IMPROVEMENT
El OTHER
POWER DEVICES
SHIMMING POOL ELECTRIC
n It et.
and Professions Code: The Cmaox m'- Ucense law dome' MI apply In anowner of
OUTLETS- SWITCHES - FIXTURESsj'Z
s.'ho builds «imptnvm loich erd who dna s«h
hi, mon
his ow" empinym, provided IMI such impmvencna are not immrJed «o@red for
imi filed or
NP,W RESIDEM'IAL EL[LTR SQ FT.
.ek.IL Mwever, Ne huildine «improvcnent is sblJ wiNino«tar of rompinirn, Ne
SQ. Ijj(f EA
S/sQ. FT.
-bolos sai111u.s the Foden rfproving that he did not build«improve for pro-
laV YR40l
���
pone rf sale),
❑ I, m owrcr of the pmpcny, w e.clmivelY cmvactirlg wird Bc<maed ctNram«] m
a
CII Y
'
TOTAL:
C. tin, project (sec. T(IW, Busi. and Pmfesuaes Gds:) The Contract« a Li-
nnlrpplyloanoxnerrfpropenywht) rildn«inyanvnn-reon,wid
Who comixons for such mijcts wird. coartribbit') Piccmd pun. as de Contractors
u,emwl.aw&l LUYtF(�IN(I
QTY, PLUMBING PERMIT I FEE
PERMrr lssuANCe
Lsce a exe
❑ ns a erScc. ,BAPCf«Nis reason
AL,'I ,DRPes'& FM'-WAT3R(EA)'
Due
VALUATION
BACK FLOW PROTECT. DEVICE
WORKERS PEI' NDECLARATION
I hencbyafr order pewty of perjury one ofte fellwiog 4cluuivas:
kIhuve
DRAINS- FLOOR, RWP, AREA, COND,
rend will muimuin.Cenificeh ofConsrnnoeelf-inaumfu WrNcr'xCmrpcn-
.anon, as rovitl 1 for by Section 3700 of the Labor Cale, for do, Performance, of Ne
STORIES
TYPE CONCTRUCI'ION
FIXTURES - PER TRAP
wort f« which Nu permit is issued.
❑ I have and will rwirtain Wmtcrs Compenutinn I.. , as reyuirtd by Se loon
3700n1fdle Labor Crde.for Ne pcafwmvwe of the wok f« which NisµmWt is iawwl.
My Wod:ers Cumlemwim lmuraree aurin and Policy numher tie:
GAS - EA. SYSTEM -P INC.4 OUTLETS
OCC. GROUP
APN
Carrier: Policy No.:
GAS - FA. SYSTEM-0VER 4 (FA)
CERTIFICATE OF E)(EMPf10N FROM WORKERS'
COMPENSATION INSURANCE
(Dries cation recd. be complged fifth, permit is for acne Mmfied "Fab, (s 100)
or Ins.)
1 amity iM1m in tnyGxnunce of Thr wort tar which Thi. permit is Isauedshall
.l I
o a
scat enaLa.yperesm in any rt..aoumhcmrrc subjclmNe Wortm.'Crmirn
A .
liso taw. of CNifornial DeeA,11
cal
GREASMNDUSTRL WASTE INTERCEPTOR
BUILDING IVISION FFFS
GRI:ASETRAP ,
PLANCHECK EFF.
'
SEWER -SANITARY -STORM FA(10 3FT
FfIERGY FM
RA li
WATER IIISTER WNENTF.ECIR
NOTICE TO APPLICANT: IT after making Nu CExemptior.
become, swNpm In NeWMNx Cunenmivmvi,i.n,oflhcLabor Cd, y,,uma.
WATER SYSTEM[ORFATNG
S ILS FEE
fuNwiN contort wird such pmvision.0 Nis permit Wil he deemed rtvotN.
WATER SERVICE
CONSTRUCTION LBNDING AGENCY
I hereby Wfrm amt there is a construction Ismixtng agency for de perfmvmae of
PAID
Date R.,0
NEW RESIDENTIAL PLMB, SQ. FT.
the wort for wNch this permit is used (Sec. YN7, Ci, C.)
Lsodcr's N.
TOTAL:
lagkrs Ad mass
TOTAL:
1 ex,m y Nat L have read this appticetioo and .tete Net Nm above information i.
BUILDING FEE
QTY. MECHANICAL PERMIT FEE
mmn.I spree wcorrplywith all cityami coumyordinancesoarswe law. mWingm
building cmuvuc0om arld hcrtby awhoriee repcsrnutiva of Ihia city to. upon the
SEISMIC FEE
above-Inentiued propcny for im crion pmry;cs.
(We) agmen to save, inkmniy mal keep hanNeu Ne City ofCoWroo r agaiml
PBRMITISSUANCE
ELECTRIC FEE
Iiabilitia,jWgrrcds, mous cad ci,xmi which may in any way acme aryma said City
in cone mceof tiegmmingof this permit.
ALTER OR ADD TU MECH.
PLUMBINGFEE
AIR HANDLING UNIT 10.800 CFM)
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT.
SOURCE REf TONS
MECHANICAL FEE
AIR HANDLING UNIT(OVER IO.fI00 CFM)
CONSTRUCIIONTA%
g of ApplicanUCrnaan« -. _ i,L 'Dat
HAZARDOUS MATERIALS DISCLOSURE ,'
STW
EXIIAUHD(IMMUCT)
HOUSING MITIGATION FEE
HEATNG UNIT (70 100,000 BTU)
Will Neapplicant«future building mvpaet slum or heMle hnvidrus ocelenal
as defined by the Cupertino Municipal Cade, Cha,cr 9.13, and the Heelo and Safny
Code, Section 25533(a)'t
HEATING UNIT (OVER 100,000 PTU)
PAID
Doc Receipt
❑Ta C)No
Will the applicom«Rome laildingoccupant use equi,scrit or dcvicns;Eich
I hasvdmla air contaminants as definer by the Bay Aro Air Qmm
lity Managcnt
VBNTILATON FAN (SINGLE RESID)
BOILER-COF1PfJHP OR 101" BTU)
ai'ma'!
TOTAL'
BOILER-COMP(OVER I00,nob BTU)
CYa FIN.
AIR CONDITIONER
1 love real du harandows muCriWsreyuirtmmu umler Chapter M1 95 of lat if ax
Tania HcsIN A Safety Code, Sa obaw ]5505, 25531 aN 255.11. I mm.ify lhet 0Nc
J«s nd mm1rkh hove a mawnh ihat it is my rcryusibility m.reify Ila recuP4m
ISSUANCE DATE
NEW RESIDENTIAL. MECH SQ. FT
a too, res
od rte reaairtmenls whkh mast be oral psi«m nwenec afar Certifewe uf(kvvlwcy.
ISSUED BY:
Ow«r«emhrnud spam Dote
TOTAL
OFFICE
of"
10300 Torre Avenue
Cupertino, CA 95014
Cupertiuo Building Division
(408)717-3228
(408) 777-3333 (fax)
September 25, 1996
Gary Hall
10227 Foothill Blvd.
Cupertino, California 95014
SUBJECT Elect, panel change Permit #29020
Dear Homeowner:
We have been cleaning out our files in the Building Department, and contacting those
people with permits which have remained "open".
IsAccording to our inspection records, the subject permit has never 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 records show the
subject permit as finaled, 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
Cl
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, Administrative Clerk
Printed w Recycled Paper