30729 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLYx1j7 Q'
CITY OF CUPERTINO BUILDING ELECTRICAL ' FERMI NO, 30729 3 O 1 Z V
BUI LING DIVISION APPLICATION/PERNI T PLOMBINC MECHANICAL
BUILDING PROJECT IDENTIF'ICA'TION
In IIDINGADURESS: 'I s - - _ SANITARY NO. APPLICATION SUBMITTAL DAD
Wo
OWNF. 'S NAME: 'il „ PI10NE: —�L Opt^� g A Fr ]; LIC NOa�� NIC CON'fROI.N
ICHI'I ELT/f NliliR: I6 LIC NO' AK//DCID•RtI+�Sa/LY!/ 7//�''to ❑ e
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CONTACT: PHONE: BUILDING PERMIT INFO
/�(�/ ^�����/ ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
G
LICENSED CONTRACTOR'S DECLARATION . QTY. ELECTRIC PERMIT FEE
I hereby dfnm that Into licensed under Provisions of Chepmr 9lcommeucing LOB DESCRIPTION
'osZ with Section7")ofDivision3oftheBusinessmalProfestoonsCode,andmylicenseis RESIDENTIAL:
0 0 PERMIT ISSUANCE.
u �. mlull form anti cffea6 & ❑SFDWL t KITCHEN REMODEL
lUU Licenu Clas I:ic.p APPLIANCES-RESIDENTIAL
-F�W DmcComwctor ❑ADDITION ❑ UMBING RE-PIPE
d' ARCHITECTS DECLARATIONElMULTI-UNIT .C1STRUCTURAL
Z p t"5/J Z I understand my pDns shall be used as public retarPANELS ds - MODII°KATION
.0'Z 0 UPT02MAMPS - C1 INTERIOR ❑CHIMNEY REPAIR
(-4 f'W Licensed Professional '- 201-1100AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION
ON
a 1 herehy affirm that I ten exempt from the Contractors License Law lo, he OVER 10(If1AMPi El BATH REMODEUREPAIR ❑DEMOLITION
�y(OG V following reason.(Section)031.5,Business and Professions Cale:Any city or musty SIGNS ELECTRICAL ❑OTHER
W'3 W ye which rcqulres u Formic to a isaam,alma improve,demolish, a repair any poucmre - -
�`HJ priormnsissuance.mso rigoimstbe applicam for such permino file esigned statement SPECIAL CIRCUIT/MISC, -
pEp�d that he is licensed punuant to the proWsmas of the Contractors License Law(Chapter 9
Ia2a00 (commencing with Seclinn]101pof Division]of the Business and Professions Codc)o, TEMP.METER OR POLE INST, COMMERCIAL:
L y o y that he is exempt Nerefmm and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
�4C1 LL,
� See,!on 70111 by any opplinmt torn permit subject the applicen ,,a ci vil penally of POWERDEVICES []TENANT ❑FOOD SERVICE
} nut more than five bundrrd dollars($5011). - IMPROVEMENT '
SD01,as owner of the property,or my employeas with wages as their sole compensation, SWIMMING POO[.ELECT RIC
1•Fsm will do the work,and the slmcmrc is not lmenk,d or offered for sole St 7(94.Business I ❑OTHER
S�na and Professions Cale:The Contractors License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who hui Ids or improves thereon,anti who dues such work himself or through
his own employees,provided that such imprevemctnn are not intended or offered for NCW RESI)ENGALELECTR S T.
sole.IL however,the building or improvement is sold within one year ofcompletion.the SQ.Ff.FLOOR AREA S/SQ.FT.
owner-builder will have the burden of proving that he did not build m improve for par. 1'R� 1
poseof sale.). -
I] 1,es owner of the pmpeny,oat exnlusively commcting with licensed cnnwcmrs m .TOTAL: -
amnmct the project(Sec.70W,Business slid Professions Coda:)The Contractors Li-
cease
i- JAN
•'., -
c se Law,does not apply to an owner ofpmpeny who builds or improves thereon,and QTY, PLUMBING FERMI PE /� .7 RfC�
who conuacts fsu
or ch project with u commemrD)licensed parsuanud
o the Comruor'n f,
License Lew. PERMIT ISSUANCE
❑ Iamcsempiunderlice. - :B&PCRudU,rcasan Ur `'Ur
ALTER-DRAIN&VENT-WATER(HA) ALUATION
Owner m Da1I �+
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE L '. •
I hereby uMO.undo,pera,yofperjury one oftbe following declarations LL ��rVV
.I have and will mention a Carficam of Consentm self-insure for Worker's Cnmpen. DRAINS-FLOOR.ROOF.AREA.C
uCoda,
OND. STORIES TYPE CONST RUCTION
on,as provided for by Section 3]10 od
of the Lobar Ca,for the performance of the
Zw -for which this permit is issued. - FIXTURES-PER TRAP
I hav and will maintain W'orker's Compensation Insurance,its required by Section '
3700 ofthe Labor Csde,for the performance of the work for which this plant iss d. GAS-FA.SYSTEM-1 INC.4 OUTLET OCC GROUP - APN
My Worked C p nxml 'tear ,o faltenand policy n p n:� -
Carier. Policy No.: 1 GAS-EA.SYSTHM-OVER 4(EA)..
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPCNSATION INSURANCE 1 1 . GRF:ASUINDUETRL WASTE INTERCEPTOR. BUILDING DIVISION EEL'S
(This section need not he completed if the permhu
it is(or one ndred Jo11an1S100)
or It,,.) i GRF.ASETRAP - PLANCHECK PPE
I certify that in the perf rromeoafthe work(or which this permit is issued,ishill SEWER-SANITARY-
nm employ any Person in any manner so as to become subject to the Workers'Com _ STORM EA.2q1 FT.
union Laws
V) NOTICE TO APPLICANT:ITL arc,makingthis Ciulifiane of Exert t an WAHiR SYSTEMOREAl INE ENERGY FEC
O WATER HEATER WNF.NLHLECTR
❑❑❑7 O Applicant FET:
GRADING
a -s Labor tot,you U Must - SOILS FEE
becomeh comps it Wmkere Compensaliis provisions of charmed Coke,you must _
forthwith comply with such provisions or this permit shall he deemed revokedr WATER SIiHVICE.
4
COthe.i.Cf10N LIiNDINGAGENCY NEW RESIDENT IAL PCMB. SQ,FT. PAID
V 0 Ilte,whichthi thanherc iixmsd(ec.30 lending agency for purfnnuunce of _ Dam Receiptgits -
(~ the work for which this pemsit is issued(Sec.309],Ci,C.)
Lenders Name TOTAL:
;a, W Itndere Address ' s TOTAL:
I cenify that I have read this application and nam that the shove information is - BUILDING FEF.
sF, va) correct.I ngroe to comply with all city and county ordinances and nam laws inhaling to QT�y. MECHANICAL PERMIT FRE -
V ,7Z. building emnrucdon,and hereby minimize represemmives of this city m enter spm the SEISMIC FEE .
uMsve-mentioned property for inspection purposes. - PERMIT ISSUANCE
(We)agree m dove,indemnify and keep hnfmless the City of Cupeninn against ELECTRIC FEE
liabilities,judgments,costs and expenses which may in any way acerae against said City ALTER OR ADD'TO MECH.
in consequence of me gmming of this pt,runt, PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT AIR HANDLING UNIT ITO 10.(00 CFM)
SOUR RI.)ULATIONS. /J 1 MECHANICAL.FEE
�� � /-7-97 AIR HANDLING UNIT(OVER I0.000 CFM) CONSTRUCTION TAX
Signammof AuAAreorf AApplicant/Contactor +�^-•-� - .Dale EXI[AUSTHOOD(W/DUCT)
HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store lir handle torturous material HEATING UNIT(10 100,000 BTU) •
as defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Seaton 25532(x)? HEATING UNIT(OVER 100,010 BTU)
❑Yee „ F)NO VENTILATION FAN(SINGLE RESID) PAID'
Date Receipt g
Will the air comm of future huilding occupant use er Air u or devices which
1 hazallous air cnmamiwnts os defined by the Bay Area Air Quality Management BOILER-COMP(JHP ON IIX1,100 B'TUJ -
)Inrict'f —I\
❑Yes F1 NO BOILER-COMP(OVP,R I WOUN)BT(1)
I hove rata the,amnionsmated.],matrivenents muter Cbuperfi95 of the CxliAIR CONDITIONER ISSUANCEDATE
fomiu Ilcalth&Safety Code,Sections 25505.25533 and 25534.1 undemmrd that if me NEW RESIDENTIAL MECH. SQ.FT.
huilding does not cumntly have a tenon,that it is my responsibility to notify the necupam
of the requirements which mum be met prions issuance of a Cerilicars of Occupancy.
Owner lir authorized agent Date - ,TOTAL I ISSUED BY:
OFFICE
�� Qa 2
Ck
JAN 71997 Ma Oa
13WG.INSPE v
C1N OFf CUPERT' - O
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IL2 O
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S�au�a �ri ut �Pl1S �a
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10300 Torre Avenue
Cupertino, CA 95014
{-� l its ul
C11p rtil:10 Building Division
(408)777-3228
(408) 777-3333 (fax)
November 3, 1997 �f
Homeowner
7634 Kirwin Lane
Cupertino, CA 95014
SUBJECT Permit #30729
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, 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 Clerk