S 1581 —APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Bun I D:NG-ELECTRICAL PES IT N0. 1581 w
•• BUILDING DIVISION APPIJCATION/PERMIT PLUMBING.-MECHANICAL V` L58
BUILDING PROJECT 1DEN'IIF'ICA'1'ION
I BUILDING AUDREgS - � SANIMNY NO. APPLICATION S��UyyRMU'I'AL DATDATEZ e n Jno')-c C , er tiro .
OWNER'S Al PHO : ls� CONIRACf :SNAM13: IJC NO'.
e 7n��eod 52 / V z (0 6, NIC CONTROLO
R ITECT?' GINEER: LIC NO: ADDRESS: ❑
NTA ai PHONE: • HUILIJING PIiRMIT INFO
❑ Consultant Fees Paid by Applicant(initial) 1 E.ECL' PLUMB IiCu
C yb�lY7 qo Iva - ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm that 1 am licensed under.vno6kides of Chapter n commencing JOB DESCRIPTION
"Z will Seelig 7011Blof Division Jot the Bualncssand Pmkwoone Code,snit my license rs pl?ItMI't ISSUANCERESIDENTIAL:
In full mannand nice.
CWF ❑SPUWh ❑KITCHEN REMODEL
aUU License Class Lich APPLIANCES-RESIDENTIAL "lliIIIISDIATION El PLUMBING RH=PIPH
N Z 6 Dates ConlracmrI-D //'-�'
trf<h ARCHIT17CI-S UF.CLARAI'ION 1'AN13Lg MULTI-UNIT [I STRUCTURAL
Z O m Z 1 understand my plans shall be used as public record.. MODIFICATION
OZ— EP10200AMPS ❑INTERIOR ❑CHIMNEY REPAIR
rr+tA lq Licensed Prebaounal 101-1000AMPS IMpBOVEMENT C]SWIMMING POOLS
qq•.I OWNIN-BUILDER UHCLARATION
W Q 1 hereby affirm that 1 am exempt from the Courteou's License Law lin the
OV13R 100"AMPS [I 13A'I'll R13MODEL/RIiPAIIt DEMOI:I'I'ION
U following reason.(Semi..7011.5,Rminess and Pmfiosla ns Code Any city lir county SIGNS 13EC'I'RICA]. ❑OTHER
1+3'3 LL y which requim,a permit m comfort,alter,improve,demoliah,or repair any diucrare
Foto um to as issumme,.B.requires thea,dicam Brown permino file a signcdetmemem SPECIAL CIRCUH MISC.
�y that he is livemsedeur:amu th povidmus ofth Concraccou,License la (Chapter9
orournmenciagwah Sect 7"tni'Division t ductile Biomass dP f ' ns Gule)nr TEMP.MEfERORPOLEINST. //p COMMERCIAL:
d 'hut t npl dureff III basis 0 th 11 g 1 axe pt Ally vlolal on of t }f�y(.p{�'
Sermon 7031 5 by tiny applicant fm'n Permit subjects the npplrevm m e civil penalty.f POWER DEVICES
\.�t I� ❑'I'ENAtJ-I'--- I�f� IJ FOODSERVIC1i
of not mora than five hundred dollars($5001
F Z Y ( \1 OT P ENT
_Q bha�owner of 0e propeny,mmymnpluyees with wages as meirsole ntmpcmatiun, SWIMh1INO POOL❑LF.CI'RIC I lr
SFO xaid.thew.,k...d,haamauar is a.rmendedor.lrered for In Xrda.0044.Rusinesx ❑OTE OF GUNtn wXJ
a 3 °lid Pndcsai.m Code.The Commelors License Law does not apply m an owner of OITI'LFTS-SWITCHIiS-FIXTURF'_S
property who hill lir improves thereon,and who does such work himself or through
Itis own entployem,provided thin loco improvement ala not intended or offered for - N13W RESIDENTIAL ELEC1'R SQ ET
sale.IL lmw.vog lM1e building nrimprnvemem issnld within mmycm.1 rundeloa,thc SQ I'I'.FLOOR AREA SISQ,En
owner-hailder willl have l d fps gthal hadal nothild or improvefor p - -,0t;!3
),
lie of the P pony exclusively contracting ithl do A
�cn,lm the limited m(See 7044 Business d pro[ C d )ThC t t is l P
aw does.not-pplyt f pro,amr,%no build; p thereon, d QTY. PLUMBING PERMIT FEE
who coutw,fm such projects will.aunlrecmgs)bcecred punvanv.the Contractors
License I:IwoPERMIT ISSUANCE
❑ la cmpt and Seo. .R$PClnnhix rcas�
ALTER-DRAIN&VE ' - 'ATER(FA) VALUAI ION
Owner x line _ __.
WORKERSCOMPI3NSATIONDIiC1ARAT10N BACK lLOW PRDIECI'.UL
I hereby affirm under Penalty of perjury one of Ibe Ibllnwing declarations: /
I have and will nminmin a Ceniticmmmmu
fCnoseb-instim for Worker's Camps- DRAINS-FLOOR,R0011,AREA,
STORKS TYPE CONS'Bl1CTI0N
ax pmvidf v by Section 971X1 of the LaborGxl. ec for Ile perfomtnnna
this l the
wntrk for which x permit ix issued. E1,11 URLS-PERkAP ,
El I hoc and will maimnin Workers Cora mermen Inmrunce,as required by Section
37M)ofthe LaMrz Gde,forthepenimmusucia the work forwhich this permit aissued. GAS-pA.SYSTEM-1 INC.40 .E OCC.GROUP APN
My Workers Compensation Insurance planar and Policy number are:
Cameo Policy Na: IGAS-IA.SYSTEM-OVER 'AI
CERTIFICATE OFEXEMPTION FROM WORKERS'
COMPENtiATIDNINSItANCIGNInSJINDISTRIW E INTERCEI'IOR
HUILDI_NG DTVI ON FEES__
f,fie'sceli incefrotbe mplamdif the Pemtil is Intone hmdreddollurs S HxB CREASE TRAP �_
lir less.) PLANCIIIiCK PEE O �
toy anyN .the performanceoOhe wort for whichthis1.life Wikao' lops.- SEWER-SAKI RY-STORM FA.2g1 FT.
act employ any person in any m.nner.xn as t.became nuhjem mdse Worker.Cnmpen- ENERGY FEIi o
Q � cation Laws of California.Date WATER HE GR WNE UELF.CTR
7 O� ARh1mu - GRADING
G VJ NCH ICE TO APPLICANT.If,uRcr.mking this Cenificmc of Hacmption,you should WATFiYSTIiM/Tk13Nl'ING
F S heaanm
me hleet tmi
he W..art Compeaamlo.Fnsinna of IlI'm...r Code,yaa must SOILS FE'
Wfunhwith comply will such pmvisimu or this permit shall he danced revoked, WA' 'R SERVICE
CONSTRUCTION LENDING AGI3NCY tW RESIDENTIALPLhf B. SQ,FT. PAID late •Receit0
V O Ihereby affirm that them is a consimation leading agency for the perinrmw
aned P
the walk for wman his permit 3s l cued Ser.3097.Cie C)
QIando ,Name TOTAL
crs Ad :
L) I.nWil
�+ a BUILDI 'FEE
Lot 1 certify That I have rind this application and Stam IM1vt the above inl'nrnwinn is
N core".)sgree.tannply with all city and coumy oNinances and crate lawn rdafingm QTY. -MECHANICAL PERMIT FEE
V 2 building construction,and herahyauthodee represeniativesofthis citymenter upon the sdiiskuIE,FEE - B
aMrve-memimed property for inspection purposes. PERMIT ISSUANCE
(Wel agree to save,indemnify and keep hamdexs the City of Cupertino against x ELECTsn
Iichadities,judgmces,costs and upenses which may many wayacemeagainateuid CityALTER OR ADD'TfI MECII.
firm lir the gnuffrp of Phi,permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WI'fll A 1.NDN-POINT Alit HANDLING UNI'1(1010,000 CFM) MECHANICALFRE Li
SOURCP C,ULATIONS.
271' AIR HANDLING UNIT(OVF.R 10,000CPM) CONSTRUCT ION TAX
Signature fAP11i mConuarem, Dol EXHAUST HOOD(W/DUCI) HOUSING MITIGATION FN'.HAZARDOUS MATERIALS DISCLOSURE
W III the apP1'avm or fumro hullding occupant store or handle haaudous mmcrial 1113AUNG UNIT(TO 100,000 IiTU)
as defined by the Cupertino Mmurlpal Code,Chapat 9.12.Im l the He.Ith and Sufmy -
Cnle,Sada 25592(a)? I]EATING UNIT(OVER 100.000 BTU)
❑Yes [:I No VENT]LATION PAN(SI SOLE RFS ID) PAID
Data
Ravin M
Will the applicant or future building mTuparn use equipment or devices which
tit hazard oo.air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(?HI'OR 100,000 BTU) Tf ALof, :
or
byes, E:1 No BOHAR-COME I OVER 100,000 B'1'U)
Illveraufthallon ous cutworms is tinder Chapter 6,95 of the Cali- AIR CONDITIONER ISSUANCE DATE
Health& 5, i5
bumiagdoesn Safely Call,Sectionstrump.that
is91and25514.I u.dcrfy th that ifthe NEW RESIDENT(Al.MIiCH. SQ.IC
buildingdosnm whicynave aactpor o ismy uace of a iptifimteofy tbeardy.
appla
of the requimnmms which man be not poor m issuance of a Cenificae.f O"nlpancy.
Owner or loomed agent Dale I ISSUED BY:
OFFICE
elcit.v
10300 Torre Avenue
Cupertino, CA 95014
of
Upelthio, Building Division
(408)777-3333 (fax)
February 9, 1999
Homeowner
1022 Kenmore Court
Cupertino, CA 95014
SUBJECT: Permit#S1581
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
%G
Christy Akatiff, Administrative Clerk
Pnnred 01 Pm,cled Paper