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31266 APPLICANT TO,FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. a BUILDING DIVISION APPLICATION/PERMIT PLUMPING-MECHANICAL BUILDING PROJECT IDIRATIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATI . �P/ z L, A . of OWNER'S NAME: HONE: CONTRACTOR'S# ME: C LIC NO: �� G ' NIC CONTROL# RCHITECTIENGI ER: LIC NO: ADDRESS: ./ ❑ - .. e T/loa Ed, oNTAW p1soNB: / ( �S BUILDING PERMIT INFO • ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB M�Ej�CF/j ❑ ❑ ❑ lJ LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT t FEE - - I hereby affirm that I am licensed under previsions of Chapter 9(commencing JOB DESCRIPTION 1y00 with Section]BB0)afDrshinn 3ofthe Businessand Profesmm;Carle,and my license is PERMIT IAIU �F W O in full forcLicense Class e and eBect. FDS WLL ❑KITCHEN REMODEL #. Lic.N pppL1ANCE5-RESIDENTIAL ti4Q6 Da¢ C.amer"r ❑ADDITION El PLUMBING RE-PIPE p.Drs ARCHITECT'S DECLARATION ❑MULTI-UNIT []STRUCTURAL�z O 1 understand my plans shall be used as public records PANELS P MODIFICATION OZ UP TO 200 AMPS tar wt W Lmensed pmkxsionaI El INTERIOR El CHIMNEY REPAIR OWNER-BUILDER DECLARATION 201-IIgO AMPS IMPROVEMENT ya PPCC��yy I herehy aBirm thm I am exempt Tram the Coulrecmrs Lie ense Law for the OVER IpIB AMPS �TH REMODEUREPAIR 0 DEMOLITION pea 4 FU• following reason.(Section 7031.5,Business and Professions Calc:Any city or county SIGNS ELECTRICAL. HER trl W O which requires a permit to aonstmct,alter,improve,demolish,m repair any structure0077 Ismmr�.•..,, priormiu issumtt.also rrquims the applicant far such pemminofileosigned smmmenm SPECIAL CIRCUIT/MIS.. F, } that he is licensed purauanuo the provisions ofthe Contractors License Law(Chapter 9 ffCCYY 00 (commencing with Section 700f11of Division 3ofihe Busineuand Professions Code)orTEMR METER OR POLE(NST. COMMERCINI c.p,m C that he is exempt therefrom and the basis for the alleged exemptiun.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION 4Xl W Section 7031.5 by any applicant for a permit subjects the applicant to civil penalty of POWER DEVICES 0TENANT ❑FOOD SERVICE rn aa.,more than Eve hundred dollars($500). ❑h as owner of the property,or my employees with wagesss their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT O will do the work,and the swcmn is nm in¢ndedoroRcred for sale IS..7040,Business ❑OTHER S3$ and Professions Cade:The Contractors License Law does not apply to an owner of OUTLETS-SWITCHES-M(TURES 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 ELECTR Q FT. sale.If,however the building or improvement is sold within one year of completion.the SQ.ET.FLOOR AREA D $ISQ.ff.ismer-builder will have the burden of proving that he did not build or improve for put. P /A1 Pau of sole.). ❑1,as owner of the pmpeny,a exclusively common,with m licecd contractors to construct the project(Sec.70,14,Bsiness ape Professions Cede:)The Canwcmrs Li- Q - OCT ,9 199 x law ones not apply to an owner of pmPerty who builds or improves thereon,and TY, PLUMBING PERMIT EE - who commas for such projects with a contracores)licensed pmsoant to the Convector's License Law. ❑lamesemptunder See. ,B&PCfvrdd,nason PERMIT ISSUANCE CI IY ser k,urcri 1 uv ALTBR-DRAIN&V -WATER(EA) VALUATION Owner Da ENTWORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE ' 1 hereby affirm under Penalty of perjury(me of the following decimations: I have and will maintain a Certificate of Consentto self-insure for Worker's CourPen- DRAINS-FLOOR,ROOF,AREA,GOND. ration,m provided for by Section 37W of the Labor Code,for the performance of the STORIES TYPE CONSTRUCTION work fm which Nis permit is issued. FIXTURES-PER'rRAP ❑1 have and will maintain Workers Compensation Insurance,as required by Section 37M of are Labor Code.for the Performance of the work for`which this penrdt is issued. GAS-EA.SYSTEM.I INC.4 OUTLETSMy Wo OCC.GROUP APN Carrier' amp s i alt'u gace��ucy Nn.ywbaryyff�� s /,SORA GAS-L'A.SYSTEM-OVER 0(FA) CERT •C 1 ON FROM WORKERS' COMPENSATION INSURANCE GREASEIINDUSTRL WASTE INTERCEPTOR (This section need not bocompleted Ran proton is(mane hundreddollara($IOR BUILDING DIVISION PEES or less.) GREASETRAP PLANCHECK HE Loy anythusinthe perforanyinmanceof he as workforwhich this thepermitWisissued,Isen. SEWER-SANITARY-STORM EA. FT. norompiny y Person' any manner so os m hcome subject the Workers'Compen- ENERGY FEE ' Milan Laws of fomie. Z O A licmm /[� �. WATER HEATER W/VLNT/PIECTR pp P GRADING FEB I,) NOTICE TOA PLICA# 1e free rtmLot this Cenifiam of F.sampdoa.you should WATER SYSTEM/IREATING - f'! become subject to an Worker's Compensation provisions of Ne Labor Cede,you must SOILS FEE pDJG forthwith comply with such lowisinns or this permit shall he deem ed revoked. WATER SERVICE Q CONS'BUCTIONLENDING AGENCY NEW RESIDENTIAL PLMB, SQ.FT. PAID VQ I he rebywhich thi that Nemis. sued IS..0nlendingtigewyfor the performance of Dam Receiptp lks the work fur which this Pmnit is issued(See.JW].Cr,C) O IIJ Lenders Name TOTAL: 0. Lenders Address TOTAL: yi1 1 certify That 1 have real this application anJ store that the above information is BUILDING PGG VI correct.I agree to comply with all city and county ordinances and state laws relating to QTY, MECHANICAL PERMIT FEE V building consmetion,and hereby authorize representatives of this city to enter upon the SEISMIC FEE above-mentioned property for inspection purposes. ^ (We)agree to sass,indemnify keep hatless the City of Cupertino against PERMIT ISSUANCE. ELECTRIC FEE and (abilities,judgments,costs and expenses which may in any way accme against said City AI.TERORADDTOMECH. PLUMBING FEE I.consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) MECHANICAL FEE 2 SOURCE REGULATIONS. AIR HANDLING UNIT OVER 10.001)CFM) CONSTRUCTIONTAX Signature of Apploorn(Contrawor Date EXHAUST HOOD(WNUCT) HOUSING MITIGATION FEE. s HAZARDOUS MATERIALS DISCLOSURE / Will the applicant or furore building occupant store or handle hazardous material HEATING UNIT(TO 100,1100 BTU) ss defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Section 25532(a)? HEATING UNIT(OVER 100.000 BTU) ❑Yea ❑No VENTILATION FAN(SINGLE RESID) PAID PatelReceipt# Will the applicant or Lucia building by upant the AequipmentaAivality Manages ement ant BOILER-COMP(3HPOR IOO,WO B"I'U) gmhazmJoue air contaminants as defined by the Pay Arce Air Quality Manegemcnm TOTAL ❑Yes C]No BOLI-ER-COMP(OVER 100,000 BT11) / 1 have read the hazardous mammals reyuiremcnms under Chapter 6.95 of the Cali. AIR CONDITIONER ISSUANCE DATE fomfa Health&Safety Cede,Sections 25505,25533 sad 25530.1 understand that if the NEW RESIDENTIAL.METH. $Q.FT. building does not currently have u fiction,that it is my responsibility to notify the cecupant of the requirements which must he met prior to issuance of a Cenfficale of Occupancy. Ownermimhodzet.gent Dam TOTAL SSUEDBY: OFFICE ® t tit 10300 Torre Avenue '" Cit}- of Cupertino, CA 95014 tupelrUTio' Building Division (408)777-3228 (408)777-3333 (fax) June 18, 1997 Homeowner 914 Liberty Ct. Cupertino, CA 95014 SUBJECT Permit#31266 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 Printed an Recycled Paper