28778 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL - PERMIT NO. ^ �a a.a
BUILDING DIVISION APPLICATIONIPE2187RMIT PLUMBING-MECHANICAL` y8
BUILDING PROJECT'IDENTIFICATION
BUILDINJADDRESSS� SANITARY NO. APPLICATION SUBMITTAL DATI
1l//,a.'/7/LL
r
OWCONTRACTOR'S NAME: LIC NO:
1 �We_y}I`Q F� IIll NIC CONTROL��
RCHITELT/ENGINEER: LICN2 ADDRESS: ❑
CONTACT: _ PHONE: BUILDING PERMIT INFO
/ //�� ❑ Consultant Fees Paid by Applicant(Initial) NLgG EST PLM MUCH
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
hhereby vffimr mal 1 atm brans¢]amer nra.ialoa�nr¢negro s mnn,mamaing _ JOB DESCRIPTION
FWOO with Secdcm 7000)of Division 3 of the Business and ProfesmonsCale.and my license is
�� in full forcedbd effect. , PERMIT ISSUANCE R ID NTIA n
FQ,V U License Class Lic.a ❑SFDWL El KITCHEN REMODEL
WzU Dae Contractor APPLIANCES-RESIDENTIAL ❑ADDITION C1 PLUMBING RE-PIPE
[_mow ARCHITECTS DECLARATION PANELS ❑MULTIUNIT C)STRUCTURAL
Z E)rNj:ZZ I umdemand in,plans shall be used as public send,
O Z-+ UPTO 100 AMPS MODIFICATION
D INTERIOR D CHIMNEY REPAIR
F�,f.W Licensed Professional ?011000 AMPS IMPROVEMENT
Sy sd'�� OWNER-BUILDER DECLARATION
C TY I hereby vffima mm 1 am exempt from the Cantracrnrs License Law for Ne OVER I(M AMT'S D BATH REMODEUREPAIR D DEMOLITION
K3 a. following reason.(Section 703 1,5,Business and Professions Codc:Any city or county SIGNS ELECTRICAL ❑01 HER
LLl u.yG which requires a pormin so construct,alcor,improve.demolish,ser repair any swetum
prio,mit,issuunce.alsonemine,the upplicam forsuch penman file-igncd sentiment SPECIAL CIRCUIT/MISC.
flythat he is licensed Pursuant o the provisions of the Contractors License Law(Chapter 9
1+1aa0`o (commencing with Section 7000)of Division 3 of the Business and Professions Cove)or TEMP.METER OR POLE INST. '
a q o eG Nepe is exempt therefrom sad me basis for the allege]exemption.Any violation or `EW BLDG/ADDITION C1 DEMOLITION
W^y Section 9031.5 by my applicant for a permnsubjects the applicant o a civil penalty of POWER DEVICES SANT ❑FOODSERVICE
ECSnot more than Five hundred bull.,($50(1).
❑ I.as owner of the property,or my employees with unge.s ev their sole compensation. SWIMMING POOL ELECTRIC IfII PROVEMENT
will dathewakundthestruchie isnommidedoroRercdfnrsale(Sec.]011,Business DOTHER
W m and Professions Coda:The Contractor's License Law does not apply to an owner of to )UTLETS-SWI TCHES-FIXTURES
6 3 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 offered for NEW RESIDENTIAL ELECTS SQ FT.
sale.If,however,the bmidingor lmpmvemem iswld widainoneycarof,mipletion.the — SQ.FT.FLOORAmas LSQgT
owner milder will rove me burden of proving That he did na build or improve for par- 2 gp�_ {fEA w�
posem"cle.), `�`NVIr�',o 7
. sowner of the progeny,con exclusively contracting with licensed contractors to 0 L U
caro et the project(Sec.]flea,Business and Professions Cove:)The es diedoru nd Q /tom
w hoc Law rims not apply u as an itha of pmlony,who sed p rs improves Comm. es TY PLUMBING PERMIT FEE /NI'�
whocontractsLaw for such projects withacommnor(s)licensed pursuant to the Comracmrs
License Law. PERMIT ISSUANCE
co t and ,B&P C for Thi.reason
Ik
ALTHR-DRAIN&VENT-WATER(EA) VALUATION
Own Dalt Ll \1
WOR 'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE ol
1 hared anmai gain a Penalty of x lacy one of me Followingdeclarations:
El(have and will maintain aCenific:ne of Consent to sdf-inwre Gu Worker's Cor the DRAINS-FLOOR,ROOF AREA.COPD. STORIES TYPE CONSTRUCT ION
section,as provided for by Section 3](1(1 of me Labor Code,for the performancee of the
wed
clock for which cols permit is isw . FIXTURES-PER TRAP
❑I have and will maintain Worker's Compensation Insurance,m required by Section
3700 of the Labor Code.for performance of the work for which tris permit is issued. GAS-EA.SYSTEM-I INC.,4 OUTLETS
My Worker's Compm
emm
ion Insurance carrier and Policy nuberare: ` OCC.GROUY — APN
Cartier. Policy No.: GAS-FA.SYS -OVER a IFA),,
(ERTIPICAIEOI EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUSTE INTERCEPTOR
(This section need not be completed ifine permit is Income hundred dollars(SIM) LDI VISION FEES
orltus.) I GREASE'I'R PLANCHE 2
I certify that in me perfonnanemfthe work forwhich this permit is issued.)shall SEWF;R-SA Y TORM FT
not employ any person in any manner so m to become subject to the Workers Compen- ENF.R
Z, cation Laws of California.Date
O WATER HEATER E GRADING r�
Z � Applicant
to NOTICE TO APPLICANT 11;after making this Ccnifiene of Exemption,you should WATER SYSTEM,TREATI
become wbjwt to the Workers Compensation provisions of The Lalwr Code,you most SOUS FEE
forthwith comply with such provisions or dais permit shall be deemed revoked. WATERSERVICE
Q `UO CONSTRUCHONLENDING AGENCY NEW RESIUENTIALPLMB. SQ.FT. PAID
Ihereby which thi that mere lewd construction lending agency for perfortnan<e of Dvte Rre
� Pthe work for which this permit is issue](Sec.3100].Civ.CJ
U Leveler's Name
Lender's Address T TOTAL:
D. 1 ready that 1 have read his aMli,as-and state mm the above information is it BUILDING FEE
to correct.I agree to comply with all city and county ordinances andsmte laws relating to QTY, MECHANICAL PERMIT FEE
U� building construction,and herebyauhorize representatives of this city to enter upon the SEISMIC FEE mail
abuse-mentioned progeny for inspection purposes. PERMIT ISSUANCE(we)agree m humorlessh
save,indemnify and keep humorless e City of Cupertino against ELECTRIC O
hibilaies,jud mems,ewlsoad ex which may ��
g this Pew yin any way a¢me uguinrt sail City ALTER OR ADD TO MECH. LO ga,g
in consequence NDEgranting of this D WILL COMPLY WITH ALL NON POINT
SOURCE REGULATIONS. AIR HANDLING UNIT LTO 10,0016 CFM)
MOCHA CAL FE `
AIR HANDLING UNIT(OVER 10,000CPM)' CONSTRUCTION X
Signature of Applica /Contractor Date EXHAUST HOOD(W/DUCT)
H _
AZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION F
Will meePPlicanmrfware buildingoccupam store or handleba[ardour mmend HEATING UNIT OTD 100,000 BTU)
as defined by the Cupertino Municipal Cade.Chapter 9.11,and me Health and Safety g
Code,Section 25531(u)? DNn HEATING UNIT(OVER 100.000 BTU)
DYcs D
WAIRCONDITIONER
FAN(SINGLE RFSID) PAID
Will the applicant or future build ing �arT D e R ei p
PP g necupam use equipment or Devices whichP
mit harommus air contaminants as defined by me Bay Area Air Quality ManagementPHP OR 100,000 BTU)
DisRic,? Uh f.r TAC:
❑Ycs DNo COMP 100,000 BTU)
I Health
read dac h ode, a tions 5505,25533 and 1153 1 and ommal6,95 the Cali- ERISSUANCE DATE
forma Hro1da&Safety Cade,e.hrna 8505,155]3 and 85]4.1lo nota yffi that it meIAL MECH. SQ.PT.
buildingricesnetc which havea,metp matm issea responsibility canotifyLMpancy.ntof the requimmems which must be and prinnoismanre nfu Cenifiam of Occupancy.OwnermauBmtred agent DateTO
ISSUED BY:
OFFICE
0.1—lcltv
10300 Torre Avenue
Cupertino, CA 95014
of,
C-apei t1I10 Building Division
(408)777-3228
(408)777-3333 (fax)
March 24, 1997
Siemens Components
19000 Homestead Road.
Cupertino, CA 95014
SUBJECT Permit#28778
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 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
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 C rk
Printed on Retycled Paper