30250 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY - '^/C
CP;Y+RkUPERTINO BUILDING-ELECTRICAL PERMIT NU. x]02,50
BUILDING DIVISION APPLICATION/PF,RMIT PLUMBING-MECHANICAL - " J
BUILDING PROJECT IDENTIFICNOON
BUILDING ADDR&SS: - - SANITARY NO. APPLICATION SUBMITTAL`DATE
OWNP.R'S NAME: . PHONE: CI/I �R Ij'e5 yA�1Ji � /` I �LI NO;44` N/C CONTROL#
ARCHITEC'UEEENN�GIINNEER: LIC NO: ADDRESS: ILK
40 Ifj{���i lr 6
LSOC ?-
CONTACT: PHONE: R3,Q g L _0-AW,-6 7- BUILDING PERMIT INFO
- ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT y{�UryH 6{FCx
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE ❑ s Ir�JJ{• I��1
1 hereby aRirm that 1 nm licensed under provisions of Chapter 9(commencing
l40z with Section]0000.fomision 3.d the Bielibl,rend Profeslimer Caue,and my live. JOB DESCRIPTION
�� imfullfmceandeRecf. ` PERMIT ISSUANCE (s1 RESIDENTIAL:
�FUZfF] License ClassLic.Y DSFDWL El KITCHEN REMODEL
N6 Date Contractor APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
'Do, ARCHITECTS DECLARATION PANELS ❑MULFTUNIT ❑STRUCTURAL
Z O Y2, 1 understand my plans shall be used as public records MODIFICATIONO Z JJ UPM 200 AMPS
p 4I:D W leaned Professional D INTERIOR D CHIMNEY REPAIR
Q SS 201-1000AMPS IMPROVEMENT
'i Y y -,j that I am OWNER-BUILDER ms the C DECLARATION OVER 1000 AMPS D BATH REMODEUREPAIR ❑DEMOLITION
yy K Q 1 hereby affirm that I am exempt from the Contrvemrs License Law for the
p(3 M F following reason.(Section 7031.5.Business and Professions Code:Any city or county, SIGNS ELECTRICAL D OTHER
LLF^Cy¢
which requires is permit to constrvcr alter,improve,Demolish,or repair any""u"
N.i prior to its issuance,also requires the applicant for such permit to file a sighed statement SPECIAL CIRCUIT/MISC. 0'
>. Nat he is licensed pursuant m the provisionsof the Cantrvetors License Law(Chapc,9
of (commrn..is thScctian]a00)of Division 3.f the Businessand Professions Cour)or❑O TEMP.METER OR POLE I COMMERCIAL:
d y M eL Secdon he is exempt Neufmm and the basis for the alleged exemption.m Any it Fouian of D NEW gLDG/ADDfT10W ❑DEMOLITION
Sceuon 7031.5byhundred
donfire a ars($S ennit subjects the epplicannon civil penalty of POWER DEVICES
not marc than five hundred dmllan(55007. EI TENANT ❑FOOD SERVICE
11 1.as owrmrof the Pomeroy,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
F will do Ne work and duinmeture is not immadednroRered for.11(Sec.]044,Business OTHER
6 3 and Ptafessiort.Cadc:The Contmcors License law Joe,not apply to on owner of OUTLETS-SWITCHES-PIXTUR
Property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements,are not intended or o0'crrd for NEW RESIDENTIAL ELELTR SQ
sale.If,however the building or improvement is sold within one yasrofmmptetim the SQ.FT.FLO(ID AREA' Q.PT.
r-builder will have the burden of proving thin he indent build or improve for Pur- vJ
D 1,res owner of the property am exclusively roniracting with licensed contractors to V O
construct the project(Sm.704,4,Business and Professions Code:)Thc Conwnars Li- np
cerise m
se law does not apply to an owner of who builds or improves thercnn,and QTY. PLUMBING PERMIT FEE - O(J
whocontracts for such projects with a comm,mr(s)licensed pursuant m the Contractors `(✓r
License Law. PERMIT ISSUANCE
D lamexemptunder Sec. ,B&PCforthisreason l
OwnerALTER-DRAIN&VENT-WATER(EA) -
Dam r VALUATION
WSCOMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby affirmm underunder penalty of perjury one Bf the following decimations
F ❑Ihaveend willmaimain eCeroificare of Consent to self-insure(nr Wnrkcr's Compen < DRAINS-FLOOR,ROOF,AREA, D.
samut.M provided far by Section 37W of the labor Cade,far the perfonnunce of the STORIES TYPE CONSTRUCTION
work for which this main is issued. FIXTURES-PER 9'RAP
D I have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Code.for the performance of the work for which this permit is issued. GAS-HA.SYSTEM.I INC.4 OUTLETS PCC GROUP APN
My Workers Compensation Insumnce came,and Policy mummer arc:
Carrier Policy No.: GAS-BA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' "
COMPENSATION INSURANCE GREASPIINDUSTRL WASTE INTERCEPTOR
(T.ucr and ifthe t is for one hundred dollan($I a0 BUILDING DIVISION FEES
permi GREASE TRAP
PLANCHECK FEB -
Icenifythetinthe n 's.ucd,lshull
\ el 'conte I SEWER-SANITARY-STORM EA.200 IT. ENERGY FEE
seri w..of Ce' hs_ ATER HEATER WIVFN IG-ECfR
GRADING PEE
TO APPLI akin,this Certificate of E tion,y 'E'ER SYS'f1iM/fREATING
become subject to the orker's Compensi .. I rule,you must SOILS FEE
forthwith comply with suchpravisionaor this permit shall be deemed revoked. WATER SERVICE
Q
� z CONSTRUCTION LENDING AGENCY NEWRESIDENTIALPLMB. SQ,PT. PAID
UO Thereby affirm that there isaconswetion lendingagency far the perfmormneenf Date Receiptp
ITr
the work work for which this permit is issued(Sec.309],Civ.C.)
U Lenders Name TOTAL:
6I Lender's Address p
1 certify that 1 have read this application and stere thin the.bull information is BUILDING FEE
Ta/1 toren.l agave m comply with all cityand county ordinances unit state laws relating to QTY, MECHANICAL PERMIT FEE
building emaboctim,and herebyauthmire represenmtivea of this city to cata,.,m the SEISMIC HE
d mperyfminspemiompurposes. PERMIT ISSUANCE C
(We)agree to s and keep harmless the City n(Cupertino against ELECTRIC FEE 7
cages,mems toss any wuy.ccrveagainstsaid City ALTER OR ADD TO MECH.
in sequence of the gaming of this permit. PLUMBING FEE LA
-' MPLY WI NON-P NT AIR HANDLING UNIT ITO 10.000 CFM) MECHANICAL FEE
' AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
ignet cof p gg�mcmr Ba EXHAUST HOOD(W/DUCf)
HA_R17A51RMi SURE HOUSING MITIGATION FEE
Will the applicant or future building occupant store or handle hazWous material HEATING UNIT 070.100.000 BTU) r
as defined by Ne Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Code,Section 25532(.)] HEATING UNIT(OVER 100.(1(10 BTU)
❑Yes ONo
VENTILATION FAN(SINGLE RESID) PAID Date -Receipt,
Will the applicant or future building allopath u¢equipment or devices which BOILER-COMP(7HP OR 10[1,0011 BTU)
mit harallous air contaminants as defined by the Bay Arts Air Quality Management
District] TOTAL
❑Yes DNo BOILER-COMP(OVER 100.000 BTU)
read the harirdous materials AIR CONDITIONER
1 have —
requirements under Chapter 6.95 of the Cali- ,� ISSUANCE D
forma Health&Safety Cade.Sections 25505.25533 and 25534.1 understand met if the NEW RESIDENTIAL MECH. SQ.FT.
building does nm currently have a tenant that if is my responsibility to notify the occupant
of the requirement.which.1 be mm prior to his..of.Certificate of Occupancy.
-76
Ownerminedonredogent DemT ISSUED BY:
OFFICE
oGitv- of
10300 Torre Avenue
Cupertino,CA 95014
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
March 18, 1997
Homeowner
7536 Hollanderry Place
Cupertino, CA 95014
SUBJECT Permit#30250
Dear Homeowner:
We have been going through our files in the Building Department, and contacting those
people with permits which have remained"open".
• According to our inspection records, the subject permit has never been fmaled. 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 fmaled, 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
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
P mwo on Recyrlen Pave,