28788 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO:
RUILDINGIDIVISION APPLICATIONIPERMITPLUMBING-MECHANICAL 28788
BUILDING PROJECT IDEISTDTCATION
BUILDING ADDRESS: - - - SANITARY NO. APPLICATIONSUBMTITALDATI
z-sr G2 w a a -p 2
OWNER'S 'AM@, PHONE: C CIT) ME Ili N(1)
(�[� p N , NAC CONTROL♦
ARCHITECT/EIJGINEEN: UC NU: qpg " n 0 ❑
A it ux-ww DC9+— �s
CON AC. PHONE: BUILDING PERMIT INFO
❑ COnfDllanl Fen Paid by Applicant(Initial) . BLDG ELECT PLUMB MECH
❑ ❑ ❑
LICENSIIDCONTR,ltu RS DECLARATION QTY ELECTRIC PERMIT FEE
thereby )cflmet1am GcauW uMu provisions or claper9(cammercing JOB DESCRIPTION
°az hns«r mTamC1lTaCnitvni Jartne Baaire.a and Prom;morn swearer my hcerue is
�WO w PERMIT ISSUANCE RECIDFNTIAI:
ly in full farts and G� Gff 3 0 5 0 / � U SFDWL U KITCHEN REMODEL
V RJ License CI a fi lio M
¢I Dmc CmAPVI,LWCES-RFSIDEM'IAL ❑ADDITION El PLUMBING RK-PIPE
0.0. ARCIUTECTS DECLARATION MULTI-UNIT ❑SIRULTURAL
ZO�,Z„ Iunc ritmul myplomahall 4 medaspublic ru«d, PANELS MODIFICATION
OZ—Q UPT021p AMPS ❑INTERIOR ❑CHIMNEY REPAIR
I-�E" Licrn.cd Profauionel 201-1000AMPS- IMPROVEMENT
g;R OWNER-BUILDER DECLARATION OVER IWOAMPS (]BATH REMODEVREPAIR ❑DEMOLITION
= 6 I hereby effmt that 1 em warp,from the Cc ruccuce,License law for Use
X 3 W V fdlowing reae«L(Section]0J I3.Bucittas anal Ponfir"ort,Crete:Any city«scurry SIGNS ELECTRICAL ❑OTHER
DlW ablch rrgwrta.Kermit to c«tstrveL cher.Intpmve,demolish,«mlvlr any wtcNte
0 prior to its issuutce,alm rryuiinn ft eptAicwt for s«h permit to rk.sigrN vuernem SPECIAL CIRCUR/MESC
MY that le is rosd liccpursuant to the raciswmof me C.&'Licrnse Law(Chaptu9
1'QDhe rnnetcing withSemonT000)of Dhision J ofthc Bushier and Pmfp.uw Corte,or TEMP.METER OR POLE INS'. COMMERCIAL
W that he u e.uoFt tletcfrwn and the basis f«the alleged!eacnptioa.Any claimant or ❑NEW BLDGIADDITION ❑DFMOLITION
Sccuon TOJ US by any pplicem far.puna,wbjeua the applit to.civil perof POWER DEVICES
a1"rn cansltYOTFNANT ❑FOOD SERVICE
HZ} trot mac
than fsichrdrtddollenychrlden.
a, - IMPROVEMENT
Q Dl, owte,•Mthe pmpn,y.«my cmplaywith weyes ntteu sNeconyenv,ion. - SWIMMING POOL ELECTRIC
0 adlmde work,andde he,Coeia en's Lens«aRud ft hor lyto 14.owner
❑OTHER
and emty who b Craft:The Cmtractors License law mc.m apply to If owns of OUTLETS-SWITCFffS-FlXIURES
his own
whotumid,«impmvatncreon and who d«ae,n winkdledof«through
his own oweverux,provided that wen unpins cold within
not imutdd m olTud for NEW RESIDENTIAL ELECfR SQ FT.
' owclLhuwev wllehuilIMburdmpmvamntiawl he,did oct b Ywor nutuve forth- .FT FLOOR AREA 5/SQ.IcT
-W ildn will have the burden of pmvrng uW he did iW build or improve f«pur-
puic n owls, _
❑I,ans nester of the pnnpcny,vat nelusivcly mntrding with:)The Cmurtranur;r TOTAL:
eanvrmt me nrni«t(say.7U44, � w n
a,xa.in . areSaianr Culco mnur'a u.
c re Lw d e,our apply run owner afpropeny who builds or im,cmcs Oberon.ad QTY. PLUMBING PERMIT FEE
who conu.cs far Procan.with.cmtaetorO)licensed pvvuat1.Se Cmtroctoc', _ O�
L;c.", PERMIT ISSUANCE '
D 1 ann e;molit under Sec. .U&P C for this rearm
Owm Deer ALTER-DRAIN&VENT-WATER(EA) DATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
f; Iherel,Y.M.aster amahltuf Perjury o«ofrbe following dcWuiwu:
D lbevcanal will maintain.Cenif to of Consco.m self-insure fa Worker'%C«nprn- DRAINS-FLOOR,ROOF AREA.COED. STORIES TYPECONSERUMON
cation,.pnovkld for by Snuun 3700 of are Labor Code,for the peH.i,of Ole - '
which ads Permit is'...a t. FWTURES-PER TRAP
have.d will m.imrin Wmkeh Cwspervtim Lnwawc,as reafrucd by Satcn
2000.fthe Labor Coae,far the Mfornurceofthe web for which this le mut i.isaacd. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN
My W«4Kp Carpep.t 1 Mttc.rnin anal PLicy t�!aJ�e Jt�
Carrier,s,�EIL= Pdiry FROM
W=Jt� GAS-G.SYSTEN1-OVER 4(EA)
CERTIIICATE OF,SATO INN FROM W 00.KERS
COMPENSATION INSURANCE GREASF/INDUSTRL WASTE INTIJtLTPIOR
(Thiswctian ncmtl4 complaal HIS,tcrorit is f«aldel
ts hand len It lip) BUDDING DIVISION Fv:c
.
or (This
- GREASE TRAP PIANCBECK FFE
I certify that in the Perfnmtmce of tle wort for which this Permit is lewd.l shall
not cm la an SL'WCR-SANITARY-STORM EA.200 PT.
P Y Y pertain in unY manna .y ys ylb9ry9te'Flat m the Workcri Cuntpen- ENERGY FEE
Zsatinnlaw.(Wilk'nm' W-A'�Y
zO Applicant / / - WATER HEATER W/VENT/ELECTR GRADING FEE'
fn NOTICE PPLICANT:If,ef¢r rocking Chia Cenifc.Ieof laemptim,You shoald WATER SYSTNIOIZEATING
bcmre whiect In the WmkcPa Cmnpcn.ation provisions of the Leh«Cute,you muvt SOILS FEE
{7.7 fumwith comply with...h pot mint«mL,Permit shall M deenwl revoked. WATER SERVICE Cv
7z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLM]. SQ.IT. PAID
e work
I lertby.fErm abet dere is.rnnstn .lerMing agency for Neperfomturtce of Dmc Reccipt0
O thnfor which this Per issued(See.YAG,civ.C.) ..i
Lem ,N. TO
r W I< kY.MLn
h . TOTAL:
F' 0. 1 cenJy than I have red this.pplie.tim and.thv the above infommion in BUILDING FEE
In crrteLl.gr wmnMlywith.achy.ndcmaty«din.rcr "o claw mWintr QTY. MECHANICAL PERMIT FEE
C„) Z btu61irt8 svrstructian:mdhueby.trm«v rtpreseestiva of0us city wmterupon Ne SEISMICFEE
.hove-mnkaN lra(eny f«inagexa en Porlwses. .
(We).pec,u save.idemnify and keep harmless the City of Cuperntrr.g.itw PCRMITISSUANCE ELECTRIC
h.bilitin.Jwgmrn.,cewa and e;pmaeawhich may in any way accrue against raid City
ALTER OR ADD TO MECH. PLUMBING FEE
I.roaayveraa of the granting or WapermB.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT ITO 10,000 CFM)
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER ld..CFM) CONSTRUCTION TAX
Sigr.mre of AppliarroContmcmr Duh, L- HAUST HOOD(WIDUCq HOUSING MITIGATION FEE '
IIAYARDOUS MATERIALS DISCLOSURE
WJlthc.pplicenrtr furore building«cuppm stow rrz handle havutkws nwterial HEATING UNIT CTO 100'"BTU)
.s da]nd by the CuWnino Municipal Crile,Chapter 9.12,and the Health res Safcty
Gdc,S lim 25532(a)P HEATING UNIT(OVER 100,00)BTU)
❑Yat ONo PAID
VENTILATION PAN(SINGLE RMID)
Will de,agPlicent or future building orcupact use equipment«device;Which Date Receipt 0 O
althvu sairrnnununmmudfi lbyde Bey Arcs Air Quality Mamgemem BOILER-COMPCHPOR IM.00BBTU)
iatric,? TOTAL:
'DYa UNo BOILER-COW(OVER IW,"BUD -
I Ince read me harardou.materials nano.ments tads OtgBu 6.95 of the Call. AIR CONDITIONER
ISSUANCE DATE
f«tti.Hcdth&Safety Cork,Sailor 255Q5.25533 and 255N.1 utdwud tate,if the,
ti NEW RESIDENTIAL MECH. SQ.ET.
building don nor armulY luvee¢rtmLm myrnpmeiMO,yart«ifY de orog !�
of Ole aCertif y.
Q«u y.
cd.grnt Lc TOTAL ISSUED By,'
OFFICE
&CHN
10300 Torre Avenue
Cupertino, CA 95014
of
C.lpertulo Building Division
(408)777-3228
(408) 777-3333 (fax)
November 3, 1997
Homeowner
19425 Greenwood Drive
Cupertino, CA 95014
SUBJECT Permit #28788
Dear Business Owner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining"open.
According to our inspection records, the subject permit has not had a final inspection.
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 Akatiff, Administrative erk
Pnn!otl on peCvcleJ Pnner