S 1766ArPLICA7 TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
N'1:-MECIIAOCAL
CITY OF CUPERTINO PLUM
IBHI,DINC DIVISION APPLICATIONt'PERMIT 1'hUMIIINI:->14:CIIANICAh
BUII,I)INC PRSJIF,CT IDP\TIFIG'I'IUS
PERadIT "°. 1766
I /11.OING ADDRL5S:
ZI IZS jahow �z. ��JPI�nrT�o �5o I'i
SANII'A0.Y NO.
AI'//LICAI'IUN SUBMI'TT'AL DATI!
1
sWN ME: �2— 1'IIONONB:z`
CO ACTOR NAME LIC NO:
NIC
El
CUNIROLx
CE, :CIIIIJGINEER: LIC NO
v
ADDRESS
CONTACT: PHONE ;
BU ILDINCI PERMIT INFO
❑ Cntavullanl Fars Paid by AppllOunf (Initial)
PLUG ELECT PLUMB MUCH
El El 0
LICENSED CONI'RACH)RS DECI^RATION
I henchy affirm Thu I am Iice,ued under �oecsr, of Chale, 9 (commencing
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
PERMIT ISSUANCE
with Sseliim ]tMU) of Divi:i0) 3 Mthe Busin_,%amt Pmfmin, CuJc, endmy limu a is
in full force mad eOcc,.
RFSIDEN I IAI.:
❑SnOw'I. ❑KI'I'CHFIJ REMODEL
APPLIANCES- RFSIDFNIIAL
Li.<nvc Class Lica
Date Cmtvcun
❑ADDITION ❑PLUMBING RE -PIPE
❑STRUCNRAI.
MODIFICATION
❑INTERIOR Ll CHIMNEY REPAIR
IMPROVEMENT 0SWIMMING POOLS
ARCHITECTS DPCLARxUoN❑MULTI-UNIT
I unck.IoM my plme mull Is, used w'o ie Inv7nl.,
PANGIS
UP'CO2MAMPS
Liccmed l4wcrsional
20I-1000AMPS
OWNER -BUILDER DECLARATION Chet ON
law for he
I hcrcby a(Erm Inns 1 1 cecmp, o-mn ton Ctninn, Co a: An,
Tobe. hat mlwia ereaivn Y)313. Itmue, uJ Pmfdentoa Code: Any sty on amnry
which
he a • ceesat,, m cauuuca cher, ,for i, demMlfK «rtlnir any vructurt
❑BATH NPMO F1 ErAIR I}'IyDFMOLl9'IOh
❑ OIHI!N I,"p10 G.. /Z
OVER I(M)()AMIS
SIGNS ELECTRICAL
itsienoed alm,eyuima,hcapnes(Gst
its
La,v(mlcmrnl
SPECIAL.CINf.UIT/MISC.
tlilfio Conocnnitmflcas
CostOr9-
ocovon ineng, sedlrvwnm 70 000) of Droinen 3 dKCommcess ProfIsw,
fanucandngwiN ersefto],Xd ofUvlawU the al Bed!eamtx Pn. AnyICndc)m
Thu k is tlrrtfrom and the hems funk alleged efflica t any 0)7 M
11?XII METER OR POLI!INST.
COMMERCIAL:
❑NEW BLIX'JADDITION ❑ LTTON
,,
it pco
Smim]0?t SM1y any apPlinnl lurafrrmil wM1jcc„Nc applicmnn ,civil pcwlty of
31-1 h
IroWILR DEVICI?S
FOOD SERVICE
❑'11iNANT El FOOD SEHVICI!
net nnom, lion Pvc hundrnl dollues (5510).
y. or my emphryeea whh wages their compeuaion.
n I, as tr of the pnpena N
wvrc
will Jt the L. a,d the vmtturc is mw intended n offence! far he ISec. 7l . Muss—
IMPROVEAII AT
❑ OTI IF.R
SWIMMING RK)L F.LIiCfRIC
and Professions Code, 'IM Cm,ni License law Jura not apply to an owner ed
OUTLETS - SW ITCHES -IIXT RIES
N17W RESIDIWI'IAl, ELECTR SQ IT.
,.,' y no build, or ....M)s,s Ilenvn, and who doe, .h wurk himself one Through
Ina own cnlPltrym, poosteA that such imlmrvci menu we not intended m offered fa
ale.If.hwxvcr.IhchilJing arimprw'rnrnT isanldwilhinme)vcMrnmpletito.the
Aider will have dK burvan el proving dwt he JIJ nm build or irri for Pur-
SV FT. t•1_IgRARTA
C
SISQ, FT
�J
p (^'l II
perb
s,id,cic').
0 1, as awnef m the p,sspeny, am eaelusiod, contracting with lift •nl contract, to
<
PAI D
` a I h/� TOTAL:
connrvct the projem(See.]OYL Pusirrss and Prefessiom Csde:) TFr Cawrntur.+l,i-
c wlos does 0)t applylomo.rc,oflmgeny whet mild, mimpno,, merrtw, and
wleteoetmets torxuch lxno:cuwi7hue0nmmle(s) 1,,se.vd pursuamlo,he Cmnno, s
�JUP! 5 AMI)
1 tl y
Q'I'Y. 'I P.LUMBEQG .HBII ITE
5
PERMDF ISSUANCE
law.
❑1 . cacmlau rStt. .P.l P C Re thixraaon
ALTER-DRAIN&VENT-WATIR(I'll
.�
IJNAlaMlll y
r -o
,may III
WORKS 1 PEIJSATIUN DECLARATION
shy affirmu I,y M Pefjury arc of Ne folk 'ng declamantm:
BACK FLOW I'ROIECT. DEVICE
ul will main Cenlfame of Cnnsem In sdf inmrt fn Wn3er', Compen-
wit us pmvidd for y Sec em 3]1X1 of the Idnr Calc, fu the perfom0unce of he
DRAINS - FLOOR, R(A)P, ARCA. COND.
STORIES
'I'Y VE CONOR UCTON
work fee which Nis permit is rowed.
FTKTURE - PER TRAP
❑ 1 have and will maintain Workers ComIcroalion Insurancx, as required by Section
3700o,hcichorCnle,Ee the Nailermuoacof 7M wast fur which T his Pcmtit is i—ed.
OCC, GROUP
APN
GAS - ISA. SYSIT;M-1 INC.4 OLC LITS
My Workers Csmpenaminn Insurance tamer and Pie icy number arc:
Camel. Policy Na:
GAS- FA, SYSTEM -0V I!R 4 (EA)
GHIiAst%INDUS'1'RL WASTEINTERCEPTORCOMPENSATION
CERN FICATE OF 1-KEMPDON FROM WORKERS'
INSURANCE
BUILDING DIVISION FFE9
(Thissectionnml nxtr minMnal iD)r Fcnndh GrunchundnJ dulWrs($100)
on Lev.)
GREASETRAP
PLkNCHECK FTE
I,enifyihm inlRlcrfomtansc of Newark rorwhich Nispermi, is is .I shall
unyn �uwrmu.m bcc...,n ,,no the Won,—
no,ntploy any aCo
SEWER - SANITARY - STORM EA. 31X1 FT.
ITURGY FEE
WATER HEATER WAIENIIF.LEC R
GRADING EFF
G
vats.. Laws of csllfomiu Daren
I Applin,
NOTICE to APPLICANII If, after,eko,,his Ccnifcar of E,ate nice. on should
Nec, ,unfatit to ILK Wtvkcra Coni :m niml o nflhe U,hoc Code, yea mLL+l
WATER SYS'p!M/TREATING
SOILS I L'E
WATER SERVICE
tmhwiN,imply with such Presi.vort or Nim pcmdt s0ull be Jcerecd rooked.
CONSTRUCTION IJINUPCAGENCY
� Iheuhyuffimoather,isa cmnwclla0lenJing agencyfor Thv'pednmrvmeof
NEW HISIOIMIAL ILMOSV IT.
PAID
Umc resp
Ibe work fine which Nis fermis ie sated (Sec. 3097. Co. C.I
Lc,7Acrs Na„r
l ,cover, AM ess
TOTAL
DYTAl,:
EE
I cenify Nm I have 0 A this aFflica,ion and stun tUl ,he cNee infcnneawn is
i <ntreca lagrte tommply wiN.11c'ny and county mdlm,KcseM aura laws alaingm
huilding ewaaucdon. aM henaby oulhnnan mI, cren,wim M this city'. e...... k
QTY, MECHANICAL PERMIT FEE
PI?RMIT ISSUANCE
FIHi
u„e-mcminmed frefe"y f r m, eclian Pu"os,
I Wel a oc, m save, indemnify and keep hnmdeas the City of Cupcento ugnina
AUTER OR ADD TO MSCI I.
PLUMBING FE
MCON.WRU=ONTAX\
IiabilitiesyuJgmm,.cons, and saFemes wTich may in any way acme again. said City
in rnnsesucnce of Ne enming of Nis Pentyl.
AIH HANDLING UNIT CTO In IMXICFM)
AL
APPLICANT UNDERSTANDS AND WE I COMPLY WITH AI.I, NON -POINT
SOURCE REI” LAI IONS C �j
f�/lf�- ONS . s�L/V 7:'p
AIR HANDLING UNIT IVtlXI CFAD
IIONTAhSignu
-eI Applicau-CDe",
EXHAUST H,1D(wmucrf
ITI;NI'ION4 i
H DOES MATERIALS DISCLUSUR17
HLAI'INGUNITfTOI00.00 BTU)
WIIIFr appli tufu,urt building tecupm, slue mhardJehvardaystratend
Cnk.k. by Ice Cupcni,m Municipal Calc, CTaptm H.12 and the IIca1N and Safny
Sc SCCTiun 25532(,)!
HEATING UNI T (OVER I00,IXM1131V1
0 y El No
Will ,le applicant m future lei uccupnn use equipment on deice, which
adws hi, ,vto jnunu:wdafmd by the Bay Amo Air Qnali,Mowgmmn0
VENTILATION FAN (SINGLE RLSIU)
PAID
Dae Receipt x
BOILI!R-CUMI'(JHP OR IfX1,gX111'IV)
TOTAL
BOILER-COMP(OVER 100,000HIU)
Dn 'nY
❑Yea ON.
AIR CONDITIONER
I lwvc mld do lwlwdwn 77anenuh o ninen.t, udr Clofcr 6.95 of the Cull-
ISSUANCE DX[ H,
NEW HESIDESOIAL MECIL SQ. IT.
ftxnio HmIN n Safety Costs, SecE. 25505, 25533 and 25534. 1 un4ramd tht if chic
hudding do nom curroly have a,amata Nat i, H my,mP"IvIdY to notify,hc mcwlant
ofhit ".4emmn which matt IN, mat Pnor In isstmccofa CaUdiiazmof(kcup cy
ISSUEDBY:
I TOTAL
Owr7m or outtonud agent Date
OFFICE
10300 Torre Avenue
Cupertino, CA 95014
of
Cupertino Building Division
(408)777-3333 (fax)
February 9, 1999
Homeowner
21125 Freedom Dr
Cupertino, CA 95014
SUBJECT: Permit #S 1766
Dear Homeowner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open".
soAccording to our inspection records, this permit has not been signed off by the Buildine
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.
0_11.
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
Printed an Rec cted Pnper _ �i