28698 APPLICANT TO,FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY' �,;
CITY OF CUPERTINO BUILDING-ELECTRICAL - PERMIT NO. 28698 8 6 w aw
BUu.gING DIVISION APPLICATION/PERMIT PLUMBING MF.CIIANICAi. L yl(7 ks,.,J�yV(
BUILDING YROJBCT IDENTIF'ICA'TION
• BUILDING ADDRESS: w _ - SANITARY NO. APPLICATION SUBMITTALDATE
L)���yyOW��NNIHVS NAME: ,P,j10eN'�_7 NTRACTOR:S NAME: LICNO:
OA/ TO 1 0 '�� (���»� �Y{ CA F.p I o N/c coNTROI.x
1RCHI'THLT/CNGINEER: 'LIC NO: DDRGSS �
CONTACT:i' . 'PHONE: - BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSEDCONTRACTOR'SDECLARATION QTY ELECTRIC PERMIT FEE ❑ C1I hereby affire mai I ten limosed under provisions of Chapter 9(commencing JOB DESCRIPTION
WOO withS troop 00),f Division3of the Business and Nofessions Code,end my licensers RESIDENTIAL:
O PERMIT ISSUANCE
F in full farce and effect. '
IOZU License Class Lica CSFDWL 1 [I KITCHEN REMODEL„
�QR Dam " Contractor APPLIANCES—kESI0fNT1AL "[]ADDITION D PLUMBING RGPIPE
�' •ARCIH rpC`FSDECLARAHON s,
F�r� PANELS - ❑MUL'DANIT ❑STRUCTURAI,
,x O '� 1 undnsmnd y I x shall 1a a os P.b •rcc s �' MODIFICATION
CZ s� UP TO 20fi AMPS'
LicemeJ Profeml
ssional. - [I INTERIOR ❑CHIMNEY REPAIR
201- 000AMPti IMPROVEMENT
sit OWNER-BUILDER DECLARATION OVER 1000 AMPS TH REMODEUREPAIR [I DEMOLITION
a 1 hereby affirm mat 1 am asent"from Lhe Cm,.... a's License Law(or the _
?CC?5Stt OyU following rescue.Section 7031.5,Business;and Professions Cale:Any city or county OTHER
u+3 0 f"' SIGNS ELECTRICAL
which requires v permit a construct.alter,improve,demolish,at repair any structure
ins priortn its isomme.also requires the applica t for such Permit filevsignedstaent temSPECIAL CIRCUIT/MISC.
} that he is licancripasoain mdr,pmvisinnsof the Commcmrs License Law(Chapter 9
a0 (commencing with Section 7")ofDivi.sion 3 of the Buiiness and Professions Code)or TEMP.M ETL:
ER OR POLE INST. COMMERCIALq o eG His(he i.c exempt therefrom and the basis Hix the alleged exemption.Any violation of - ' 's" D NEW BLDG/ADDITION. D DEMOLITION .
pWC li
Section 70315 by snyappl' urnf applicant pcntmhjccts the applicano acvil penalty of POWER DEVICES TENANT CFOOD SERVICE
s4 un 1, than T h d II y ciopl - F
❑ 1 owner of pr pe nY Y pl yees wnh wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
C
will do the work.andthe t a t intended or offered for sale(See,7614,BusinessDOTH R
and Profnuons Code The Comrmuus License law does nm apply to an owner of OUTLETS SWITCHES—FIXTURES
�'3 Propeny who builds m improves thermn, it who does such work himself or through
ILI-
his own employees,provided]mm such impmvemenu are not intended or offered for NEW RESIDENTIAL ELEC 11 SQ FT
tele.If,however,the building or impmvemenL is eaid within one year of completion the Q.IT.FLOOR AREA $/SQ.I.T.
ownenbuilder will have the burden of proving that he did not build or improve for pup • h- d D
IU6a of Bale.). -
Q'I,as owner of the pmpeny,oro exdusively commcting with IiccnsW commdas m 'TOTAL: IA10,
p1 '1
nmstmet the project(Sec.]044,Easiness unit Rnfessions Cade:)The Cnmrunor's Li Q Y•aOV. j 1995
cense law does not apply to an owner of property who builds or improves(hereon,and TY. PLUMBING PERMITp6 FEE Yr �J
who contracts lbrsuch projects with ucantrtelor(s)licensed pursmom m t be Coomatio, CI. r Ur 1r' _
Li.mcl.aw' PERMIT ISSUANCE 6 • V �UrLU
❑ Imaeaemptonder Sec I ,B&P C for this reason `t 1�INC
AhTF.R—DRAIN&VENT—WATER(EA) VALUATION
caner, Uam
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
1 hereby.M.under penalty of perjury one of the fallowing deciamtian:
Fl I have and will maintain a Cenificate ofComent to calf-insure for Workers Cumpen- DRAINS—FLOOR,ROOF,AREA,COND. STORIES, TYPE CONSTRUCTION
ration,as provided for by Section 300 of the Labor Code,for the performance of the
work for which this permit is issued, FIXTURPS—PER THAT -
D 1 have and will maintain Worker's Compensation Insurance,as required by Section -
3700of the Labor Code,Turtle performanLce of the work for which this permit is issue d. GAS—EA.SYSTEM-I INC 4 OUTLETS •OCC.GROUP. AI'N
My Work�r�C�� J�nlr Ve�Lel nliey Noy u@ty� g ,k ., ,•
/
Cromer: rr 1T�— U Lal—'9� •I L4;' CAS—LA.SYSTEM OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASUINDUSTRL WASTE IN9'ERCEPTOR
(This section need not be comple"Hurt permit is for one hundred dnuour(511X)) BUILDING DIVISION FEtS
ai less.l GRF.ASP.'1 RAP PLANCHECKIFE
I verify that in the performance of the work for which this permit is issued,l shall SEWER—SANITARY—STORM EA.200tH'.
not employ any person in any manner w as to become subject m the Workers'Compete ENERGY FEE
O Z satin,laws of Califon ia.Date WATER HEATER WNENT/F.LECTR
Applicant GRADING FEE
y NOTICE TO APPLICANT:If,vfter making this Cenifimle df Exemption,you should WATER SYSTHMffREATING
a ^ become mbjen to the Worker's ComPemitlion provisions of the Lvhnr Code,you must _ SOILS 17EL '
I'y forthwith comply with such provisions ter this permit shall he deemed mvakad. WAIER SH BY ICE I
Q
LL CONSTRUCTIONLHNDINGAGHNCY NEW RISIUBN'1'IAL PIMB. SQ.IL r PAID u )
V•Q I for which this
that i issromtmct30 len ding agency for the performance of .Dam Receipt If
O
the work for which this permit is issued(Sec.J(IYZ Cie CJ
u's U' Lender's Name TOTAL:
lenders Address
A. I certify that 1 have read this application and state that the above infammion is _ BUILDING FEE
V) comm.I agree to comply with all cityand...aq.rdinancesandnntelawauditimgm QTY. MECHANICAL PERMIT FEE
L).Z building construction.and hereby vuthodre representatives of oris city to enter upon the SEISMIC FEE
uhove-mentioned property for inspection purpose,. PERMIT ISSUANCE'
(We)agreendem
to once,inify and keep harmless the City of Cupenim against ELECTRIC PEB
hahilities,judgmena,costs and expenses whichnay in any wayuccrucmguinst sold City ALIHR OR ADD TO MECH,
segncnce of the granting of this Permit. PLUMBING FEE
I JZ
APPLICAN NDERSTANITSS/AND ILL COMPLY WITH ALL NON�POIN'I' AIR HANDLING UNIT(TO 10,000 CFS.1)*�� F, HANICAL FEE
SOUin , LATIpVts / l ... i
/���• , AIR IIANOLING UNIT TOHR IQBBOCFM) g
I CONSTRUCTION TAX
Signature o.pplien ur/ onuac Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will thcapplicaramfortune building acupamnom ufhe,dle hawdoms mdentil HEATING UNIT(To 100000 BTU) -
uv defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety — -
Code,Section 255320i)? HEATING UNIT(OVER-01),000 BTU) assist
❑Yes ❑N PAID \1/•••
LC
I VENTILATION PAN ISIINGLE RESID) a
Will me applicant future balding occupant use egnipmem or devices which ReceiPtx
— �n
:mit huaunlous air contaminant .d lined by the Boy Area Ar BOILER COMP(3HP OR 100,001 BTU)
Quality Monagentent' • -
DistncL^ s - TOTAL: - -
❑Yes CNo BOILER—COMP(OVER 110,000 BTU)
I have read the heradous material; F AIR CONDITIONER
Iran. DATE
requirtmena under Chapter 6 95 of the Cvi-
(omia Nealth&Safety Gide,Sections 25505,8533 and 25534.1 understand mat if the NEW RESIDENTIAL MECH. SQIT
building docs not currently have a tenan6 that it is my responsibility m n .otify theoecupam C.Y
of the requirements which must Ise met prior to isuanm of Ccnificate of Occupore,
Ownermlood iud agent Date .TOTAL: ISSUED BY:
OFFICE i..
® 10300 Torre Avenue
Cupertino,CA 95014
Ci V nl'
Clpertano Building Division
(408)771-3228
(408)777-3333 (fax)
September 25, 1996
Donato Dimonte �
22540 Kinst Court
Cupertino, California 95014
SUBJECT Bath remodel/repair Permit#28698
Dear Homeowner: ( �\
We have been cleaning out 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 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 Clerk
•
Pmrtea on Pecvcled Pone,