S 0857 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BDB,DENa:-ELECTRICAL PERMIT NO
BUILDING DIVISION APPLICATIOWPERMIT
PLUMBING UT MECHANICAL S 0857 8 5 7
BUILDING PGOJE:CT wiisrIFICATION v 1
BUILDING ADDRMS: *0: A SANITARY NO. APPLICATION SUI4M111pTfAL DAIQ / c, — L -Q'0OWNS . NAME: 10 NMN G N
NIC CONTROLIF
CIDIECDNGINEK: LI}yCC N* H O / / ❑
CONTACT: �/JII/ BUILDING E:] Consultant Fees Paid by APPli=t Unidasl✓l)) BLDG IW
DPGRNFO
EING FILuMHF .0
LICENSED CONTRACTOR'S DECIARATLON QT-Y ELECTRIC PERMIT FEE
I W mhy affirm Incl 1 oral licenwd unkr pmvirian of Cbaper 9lcomnelamg JOB DESCRIPTION
�"O ZO wish SCed�n]IXMU of UivirianJnitW Buaitlas cad Prnfcc rum Code,ard tyl' nwir PERMIT ISSUANCE R -NIR D 'f1Al.:
�, in foil fmre vrm,R ❑SFT)W'1, ❑KI'rCI1FN REMODIiI.
a�G lac me a, s.a APPLIANCES-REMDENHAL ❑ADDITION ❑PLUMBING RE-PIPE
a a Dam Comlr.etnr
RCHUDICTS DEC ❑MULTI-UNIT ❑STRCC1URAL
PANIB S MODIFICATION
Zonz Iroden'unl my plans dull be ural m,Public neurals
OZ�' UPTO200AMPS [I INTERIOR El CHIMNEY REPAIR
r4-w License)ltnfe.siunul 2014000AMPS [MPROVF,MI:NT C]SWIMMING RX)IS
���� OWNIiR.HUILD[R DICCIARnIION OVER I"AMPS ❑BATH REMODHIAEPAIR ❑DEMOLIION
C Q I hereby nfRnn that I vat esempt from the Gmftscoma Licenw Law fnr the
X 36 U follow in,naam.(Semon 70115,Hminsi cad Pmfe.caims Gefe:Any city m,maty SIGNS ELECl'RICAL ❑OT IER
W LL� whkh ICgYu6 a perttdt to cmlXnKl.after.Impose,demdish,m retanlr any so-uaurc
F ujy�a pn.rto its iuumce,abo myuncs rise applicant for such perodt to file a signal sta 1 TSPECIALCIRCUT/MISC.
45l 217 Aff, Is
9gW� ilalhe is(ranted pursuant to Use provers,of the Cmvacrmfs Uccntt Law(CWpter9
IY�� (<ommereing with Suwm)IXXO of Uiviaion3ofde llusiaaa and lholcssions Qak)n TEMP.METER OR POLO INST.
Ly C that he is excmM Ihcrcfrmm eN rhe basis forx the alleged astmir an-Any violation or C)NEW BLDGIADDITION [I DEMOLITION
o
uX] la• Section 7031.5 by any elplieam fnr a permit whjecn rM uppliamr ma civil penalty of POWER DEVICES 0�NpNT El FOOD SIiRVICIi
FZT
not mac than rhe WmltM oWlan($500), IMPROVEMENT'
6 pl.¢s mvler.(Ihe pruscny,amY,mplgm with wagcsn Neireok cwrmcn.sarion. SWIMMING POOL F,LECIRIC
will do the work.and the, la rot inlemkd m ofeml fa sale(Sec.703 .Busircss ❑OTHER
L 3� and pros isiaV Code:ITe Co rmtrus-License Law ki hit apply to an owner of OUTLETS-SWITCHES-FIXTURES
Pop:ny who Wild.rr intpmvas rlrrv.n,and wW des such w.h himself or ftmi
his own enployces,provided chat such imM.vcments my nut intended or mfemd for NEW RESIDENTIAL ELECIR SQ Fr.
svle.If.ttwvv,ftftc buildingor impmvanam its-Id within ataycm cfcuinpednn.IM SOFT-Fl-GOR AREA LSO.FL
nsr lts deer will lure the Iorsden N solving that he did nN Wild m improve for pur-
pose M sai
1.¢s owrcr of Ifo fvrg
s,fem,am esclmdsely coracting will Ikon.1 cnmracmn ho TOTAL: �y
atom,du pojaet(Sm.7041,Bntircsa and Ibafeasimo Codv:)The,Co .'s Lt-
an Law does not apply manmwm7 of pr.pcny who huilds orimpoves damns.and QTY, PLUMBING PERMIT FEE
wtn"mutat'"fnr suchpn'ts"with a..mwemi Iieenvcl Imrtm,,WCommemrs
Lie.Imv. PERMIT ISSUANCE
1 um eacmp urdes Sac. .B R P C for this ft.'an
ALTER-DRAIN&VENO-WAI ER(EA VALUATION
Owner
DWlcr Date A104V< VV
WORKERS Co,oI NSATIUN of DECLARATION NAC (WFR(IIECT.DEVICP, ll//
{nerany art I.ander lerady nrpvtJaD na.n W r.u.wir,g drdrad�as.
Jlbevcvnd will lrsinmina CcnifcwcnfCnmenunrclf-insum[ur Warkcr's Conrlx'n- URn 5- F, / SfORICS E
jNff
I,for wllicbtbis Peamit is usncd.1 Lovestd will main VinWakesC.Frm don Inwrva'e,as rcovaly Section I.Fits,I.ab rCode,rathe edonsama Tris,wvtfa wfiich thispmnit is iasud. GASS , I- T OCC.GROUP
My tip ati.I u e erre PNlrymGAS-EA.SYSIYJ.t-OVER JBEA)
Coerce Ibl'cy No.'.�E-Y1CJ—
CERTIPICA 17 OF, TION ON INSURANCE
WOTKERS' GREASP/INDUSTRL WASTE INTERCEPIUR
COMPENSATION INSt1RANCE BI111.UING DIVISION I'FJLS
(This section need wbecouni iflW Peruilk fame homlrN dollar,($100) GREASCTRAP
a Ecu) PIANCHECK FEL'
I cerafy lhvin the pff.mcrufthc worl,forwhiclt this permit is iuuN,I shall SEWER-SANITARY-STORM EA.200 FE
not employ any Pecan in any ttamer so w to beaatte subject to the Worba"Camper,- ENERGY FEE
O Z .,.an Laws or California Date WATER HUATER WNEi ,TLECTR GRADING IEE
z 0 APm
plka
y
NOTICE:TO APPLICANT If,after making this Ceniticare til Esempion.You should WATER S5'S h`TREATING
P , Iccome wbject 1.the Worker's Compensation smvNia s.r IW Iadnr Code,you muss SOILS FEE
{J7 fonhw'irh comply with such rovisiors nipemoit shall be diverted r,vad. WATER SERVICE
z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PI LAR. SQ, AID Dam Race
U O Ihcrehy alli four tM1m cisarnw
rucd.n lending agrncy for theperfmmmee of
the work fa which Thil pcmrit is issued LSA.1(w7,Civ.C.) JCTAn1,
Qv1<rd:Is Name TU'1'A L:
Irnde/s Acklt
BUILDING F1
a I certify that I jr.,read this a aPica ion end.some that the above information is
FTA correct.Lgrze tO rnmply wiNellcityvim mwryordinaxecvnJ state lawsreladng to QTY, MECHANICAL PERMIT FEE
U Z Wilding rnmruction.and hereby sathmiu rtpnsentmlves of this city to enter upon rhe SEIS LIC nli
aMrvamcmiu ed popcny fvs imp,avar purpm. PERMITISSUANCE.
(We)agree In save,indetnnily anal kesp harmless tW City of Cupenito against FLP 1
habilitiesjudgmii costs end cspanscs which may in anyway accrue agamu sad City ALTERORADDTOMECI ,GUFF
n oomac t ehr e.f the,renting cr this pertnir.
APPLICANT U9DERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT ITO 10,000 CFLE ME IATR ICpIJEP,•s s t
SOURCE REGULATIONS. e
AIR IIANDhING UNIT[OVER III.gIII CEM) CONSIRUCTON TAX
Sigwtum of Applicanl/Gnwetor Date EXHAUST HOOD(WMUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will lhcapplinnt orrumre Wildingoccuporr aaeox Wndle naemLms material HEATING UNIT(TO 100.000 HT1H O�
as defined by rhe Cupenim,Markak.@aper 9.12 and do IImi mv!Sun,
Cade,$Kll.a 25532(x)7 / HEATING UNIT(OVER I Oftf( I HTU)
�Ye. V ,D IIATION FAN RCSID) pal)
E1
V Ilmc Rarip M
W II rhe applicant m futum Iwlding nrupanr use cyuipmed a device%which
ith'e_N uw airrnnlemiNnu as deftwl by Em Buy Mea Au Quality Motagemenl BOILER-COMPUHPUR IIXLIXXI N'N)
TOT
Tsrnao1 BOILER-COMP(OVER IOLOOBBTU)
❑,
AIR CONDITIONER
I lave t®d rhe Mavdaus natcddx mapircneaa under Chal^cr 6 vS.f Ile Cali ISSUANCE DATE
rumW H j N N: fey Cole.Sect .5)$.25533 W 25533.I undoas rd dot If rte N17W RESIDE- HAL MI;CIL SQ,ET.
Wildi nl25
I Z a=L Wul it is my .y mpnsibility de avfwM
w 'hn he nwt piamLwmttof �J(J�'
>w wuauthaerrN agent aue TOTAL: ISSUED BY: `� O�
OFFICE
®�- of 10300 Torre Avenue
Cupertino, CA 95014
CiCc
Cl1perthio Building Division
(408)777-3333 (fax)
February 9, 1999
Homeowner aC C
10505 Foothill Blvd
Cupertino, CA 95014
SUBJECT: Permit #S0857
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
•
Primed on Recycled Pager