Loading...
S 0106 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PE MIT NO. (� BUILDING DIVISION APPLICATIONMERMIT PLUMBING-MECRANICAL 0106 BUILDING PROJECT IDF,N'FIFICA71'ION BUILDING ADDRESS: SANITARY NO. APP (CATION SUBMITTAL DATE 7S r o ie . CG OWNER'S NAME: PHONE: CONTRA C�R'S Nr�'1?: LICNOOxg .7 li �{•� NIC CON'I'ROLp l'HII ECT/ENGINEER: - LIC NO: ADDRESS: ❑ )14,--ae Cr qW CONTACT: PHONE: BUILDING PERMIT INFO E� ❑ Consultant Fees Paid 6y Applicant(Initial) DG ELECT PLUMB MIECII at1� 9 d- 12/ LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm Nat 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION OZO eidt Section700(B of Division 3 of the nosiness and Professions Code.and my license is PERMIT ISSUANCE RESIDENTIAL, Iy� lull force and a QOt..pSdo7 ❑SFDWI. CHI3N REMODEL Littnnc hic.N APPLIANCHS-RESIDENTIAL []ADDITION PLUMBING RE PIPE rFWM Ihne s Cnmrn� X . V, PANELS ARCHITECTS DECLARATION ❑MUUfIANIT SI'RUCI'ORA[ y pn p v1 TJ. I understand uaW ux ersnd my plans shall public records CATION C y,v,JO � UP TO 2(XtAMPS [I INTERIOR ❑CHIMNCHIMNIiY kEPAIk Licensed Professional 201-10MAMPS IMPROVEMENT C]SWIMMING POOLS OWNER-BUILDER DECLARATION OVER IMOAMPS ❑BATH REMODEUREPAIR ❑DE.MOLITION I hereby M.that I am exempt from the Contractor's License Use for the 56 6 V following memo.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL 0 MITER 1+13 LL fNQ" which requires is permit m construct,alter,improve,derrmb,b,or mpoir any structure � o� m.i prim to its issuance,also mquims the applicant for such permit to file u signed statement SPECIAL CIRCUIT/MISC. p G� that he is licensed pursuant to the provisions mile,Contractors License Law(Chapter 9 'p� a (commencing with Section 700(f)of Division 3 of the lhsineu and Professions Code)or TIME METER OR POLE.INST. COMMERCIAL: S e WNut he is exempt Nerefmm and the basis for the alleged exemption.Any violation of ElNEW BLDG/ADDITION [II?M DOI.TION N tea, S110,11 71111-1 by any applicant far a permit subjects he applicanuo it civil pemdl,ol POWER DEVICES ❑TENANT ❑FOOD SIikVICE y not more than five hundred dollars(S500).M ❑ I,as owner of the pmpeny,m my employees with wages as their sole cmnpensminn. SWIMMING POOL ELECT IMPHOVI3MF.NT wilido Cheworksaadthe structure is not intendedoro(feral formle(Sm.)044,Business ❑OTHER LLL3 and Prnfe.m.Code:The Cnntmea.e.License law does not apply man owner of OUTLETS-$WITCHES- UR 01 property who builds or improves theater,and who does such work himxlf nr through his own employers,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELF.CTR aide.If.Wei the building or improvement is sold within one year ofcompletionJhe SQ.FT.FLOOR AREA 5/SQ.r ownerbuilder will have the burden of pmeing that he did not build or improve for,ar- p�0 10 l poo of Me.). 11 ❑1,as owner of Ne property,am cxclusiscly rims iam,with licensed comranmx to as AI^ CX N construct the project(Sec.]INq Business and Professions Codep The Convector's Li- �FAf ur�H�1"O cense Law does not apply to an owner of property who builds or i reproves t heram,and TY PLUMBING PERMIT PEE !`''n L)r V who contracts I'or such projects with a contractor(a)contranr(s)licensed pursuanto the Contractor x V License Law. PERMIT ISSUANCE 1 am exempt under Sec. .B&P C for this reason 0sol0" ALTER-DRAIN&VENT-WATE.R(EA) VALUATION Owner Dem WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE (61 TY_. I hereby affirm under penalty of perjury one of the following declarations: ��••(,�� I have and will maintain a Certificate ofConsem to elf-insure for Workers Compen- DRAINS-FLOOR,ROOF.AREA,COND. STORIES TYPE CONSTRUCTION ion,as provided for by Section 3]W of the labor Caie,for the performance u(Ne e work for which this permit is issued. FIXTURES-PER TRAP have and will maintain Workers Compenmtion Insurance,as required by Section R, jr,)ofthe Labm Code,for the performance of the work for which this permit is issued. / GAS-EA.SYS9'I?M-1 INC 40OCC GROUP AI'N Mp Wnrker'n��Com�pe��ns�oJJrPPn IndjY�'��e��uPP'sur and Policy nut Carrm,lis— 1TLL Policy Nr.: S GAS-EA.SYSTEM-OVER 4EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASE%ININS'1'HL WASTE IMfERCEI'I'OH BUILDING DIVISION FIRS flhissectionneeloat be completed if the permit is foronehundoll dsdlan(SIM) GREASE TRAP or Ices) PLANCHECK ITiE Loy any pershatom in pertarrioanymannce ro the astolark comesuich jisnthis o Perthe it Wi.ern'Co ,encsL SEWER-SANITARY-STORM EA.2W IT,• no employ any permnin any manner so as mhecome suhjanott¢Workenx'Cnmpem ENERGY ETF. Z nation Laws of California.Data WATER HHA1 IR WNENTMLECFR Applicant 1 GRADING FEE F7 NOI'ICL TO APPLICANT:If,one,making this Certificate of Exemption,you should WATER Sys'O?M?REATING �f~ become subject to the Wnrker'a Cnialconiom provisions of the Labor Cato,you most SOILS FEE !� forthwith comply with such provisions or this Permit shall be deemed revoked, WATER SERVICE W Q CONSTRUCTION LENDING AGENCY NEW RPSIDIiN'1'IA1.PLMB. SQ,ff. PAID L) 0 l h erebywhichithi Nm Nem issued(Sec.31YUlending agency for the Performance of Date Receiptp the work for which this parotin is issue)(Sea 3WI,Civ.CJ W. I"' haters Name AL: CL. I comityIanderAddress 'TOTAL.: comity Net 1 have read this application and state Nat the above information is BUILDING IEE V0.) correct,l agree to comply with all city and county oninances and state laws relating to QTY, MECHANICAL PERMIT FEE U 71 building constmetion.and hembliodmrice repmomatives of Chiscity to enterupon the SEISMIC ITE above-mentioned pmNny for inspection purposes. PERMITISSUANCE (We)agree to save,indentnily and keep harmless the City of Cupertino against ELECTRIC FEE liuhilitie.,judgments,rnsu and expenses whlchmay inany way uccmeagainxCsaid Illy AITHR OR ADD'I'O MECH. in nxcqucnce of Che granting of Chin permit. PLUMBING FEE APPLICANTVIGO— UNDERSTANDS ANO WI .1.COMPLY WITH AL1,NON-POINT AIR HANDLING UNIT(TO 10,01(1 CFM) SOURCE?R GULATIO�J MECHANICAL FEF. 31 , /` �6N� AIR HANDLING UNIT(OVER I0.IMO CFM) CONSTRUCTION TAX Signature of Applillcam/Contactor Date / EXHAUST HOOD(W/DUC) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE. Will the applicant or future building occupant store or handle larrdous material HEATING UNIT CFO IM."BTU) us defined by the Cupertino Municipal Code,Chapter 9.12,snit the Health and Safety Code,Section 25532(ap HEATING UNIT(OVER I ft"Bill) ❑Yes Fl No PAID VEN'I'lLA'I')ON PAN(SINGLE N1351U) Dulc Recdpt X Will the applicant or(marc building occupant use equipment or devisee which BOILER-COMP UHP OR IIX),Ogl BTU) t1111111 it Weandous air contaminants as defined by the Bay Area Air Quality Management TOTAL: tatu01] BOILER-COMP(OVER If,"BTU) ❑Yes ❑No I have mad the leararlu.s materials requirements under Chaper 6,95 of the Cali. AIR CONDITIONER ISSUANCE DATE famia Health&Safcty Code,Sectinn.25505.25533 aod 25534.1 um arum id that if the NEW RESIDI:. IAL MECH. SQ.p1'. buiWingdnes not currently have a tenant,that it is my responsibility to notify the mcup in of the n;uhemems which must he met prior m issuance safe Certificate of Qcupncy. WC Owner or authorised agent Dole T(yTAL: ISSUED BY: OFFICE 11— 847 12 58 N (D O C/) x W D � � x n� m o X U) -- D D v 0 cn W © OD D v ° 0- ° O" N W N W f- � � cn � OM -- O z C m x G) (=D Y m p vDi V a O0 U Z IT � m _ � v CID 4 p cn 45 71 -17� r 123 0(cltvof 10300 Torre Avenue WN Cupertino,CA 95014 Cupertlll0 Building Division (408)777-3228 (408)717-3333 (fax) January 30, 1998 4✓� Homeowner '� v 6375 Myrtlewood Dr Cupertino, CA 95014 U SUBJECT: Permit# 50106, Kitchen remodel 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 finaled 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 fmal 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 • Pnnted on PeCvded Paper