29871 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO BUILDING-ELECTRICAL. PERMIT'NO.
BUII,DINGDIVISION APPLICATION/PFRMITPLUMBING-MECHANICAL 29871�oO ��
ItUI1.HING PROJECT IDENTIFICATION
BUILDING ADDRESS: {- SANITARY NO. APPLICATION SUBMITTAL ONE
�� Q Dill
OWNER'S NAMEPHONE: CONTRACTOR'S NAME: LIC NO:
L .AA W'A41 ! YL, TFZ—/ )Ar c£J4-w. .[ice 6 v616996 N!C CONTROL»
•sRCHTTF,Cf/ENGINEER: LIC NO: ADDRESS: �dL Jb �T ❑
C
6
CONTACT: � PHONE: BUILDING PERMIT INFO
DA" A.)1r L 1S 3—)3 4ficPt ❑ Consultant Fees Paid by Applicant(Initial) HLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
Q tY Z 1 M1creM1y utlirm Lha I am IivemcJ under provisions of Chapter 9(commencing JOB DESCRIPTION
mth Scmr70TXhaf D,x xion3ofthe Buninecsund l'rofroamr,Code.and my license is !SO RESIDENTIAL:
1+100 . PERMIT ISSUANCE .7
Fes— ❑SFDWL El KITCHEN REMODEL
t_u Lt...Class Lich APPLIANCES-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE
Na W Date Cunlrrom,
Fly ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL.
Z p y Z I understand my plans shall he coed as public records / ^ MODIFICATION
❑
OZ=- I UPT02MAMPS / INTERIOR ❑CHIMNEY REPAIR
r an I- Licensed Professional 201-I000AMPS IMPROVEMENT
OWNER-HUILDER DECLARATION OVER Him)AMPS ❑BATA REMODEUREPAIR ElDEMOLITION
C Q 1 hereby.(firm aha 1 L5 exempt from @c Contramor's License Law for the
x6x06 V following mneme(Section]OILS.Business improve,
de inns Code:Any coy in county SIGNS ELECTRICAL ❑OTHER
W LL y which requires u permit ac constme,alcor,improve•demolish,nr repair any swaurc
Od'
prior mits cenedpoalso acquires e thevisionso for Contractor's
EleaeLow( mmmnn SPECIAL G[RGDITIMISG.
}'4 (emormslicemW position,to 7")Of Division
of the Contrine,s License L.wlChapter9
6100 (c°mntencing with S¢tion]000)of Division Sof the Busincss.nJ Prafn>ions Code)ar TEMP.METER OR POLE INST. COMMERCIAL:
lea Lha he is exempt therefrom and the basis for the.Ilegcd exemption.Any violation of ElNEW BLDG/ADDITION [IDEMOLITION
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty m POWER DEVICES ❑TENANT ElFOOD SERVICE
FZ o, .mare Nun five hundred dollars($50(h. IMPROVEMENT
=6 Q Las owner ofthe progen,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
O will do the work,and the suucmre isnot intendedoroffemd for.sale(Sce.7(AL,Business ❑OTHER
W 3 and Professiero Cate:The Contractors License law doer not apply to.n owner of OUTLETS-SWITCHES-FIXTURES
T" property who builds or improves thereon,and who Dees such work himself or through
his Awn employees,provided that such impmvemcros art not intended nr offered for NEW RESIDENTIAL HLECTR SQ ten
odc.If.however.the building or improvement is sold within one year ofcnmpl......he SQ.FT.FLOOR AREA $ISO.n'm
owner milder will have the burden of proving that he did not build or improve for pur- a
pose oGale')' TOI'nL:
1.as owner of the progeny,am exclusively contracting with licensed contractors to I J 9
construct the pmjett(Sec.]BW.Business and Professions CAM:)The Contractors I.I. pppp pp 1996
Ase Law does not apply to an owner of progeny who builds or improves therm . QTY. PLUMBING PERMIT FEE MAy
who convects liar such projects with o mmmelons)licensed pursuant to the Contractors
License law. PERMIT ISSUANCEI11\X)
[DI am exempt under Sec. ,B as
&P C for his Mason I a (^ sqn U
ALTER-DRAIN&VENT-WATER(LA) VALUATION
•Owner Dam
WORKF.RTSCOMPENSAT10N DECLARATION BACK FLOW PROTECT'.DEVICE
I Mnd will
under pembyof te ofCoueneofthefnllowingWorkerions:
❑havepro,idd forbyetion Certificate ofConssmmCode,for
rthe Woderace of In- DRAINS-FLOOR.ROOHAREA,CONED. STORIES TYPE CONSTRUCTION
union,as provided for by Sermon PINI of the Labor Code,tin,the performance o[the
work for which this permit is i mkeO FIXTURES-1'ER TRAP
17 I have and will ode,far Worker's ante (thew work
whinsumnes.ch
as required by Section
1700.fthe Labor Code,for the performance of the work for xMich this Mrmit is issued. GAS-FA.SYSTEMA INC.40UTLETS OCC GROUP APN
My Worker's Compensation Insurance reoricr and Policy number are: 01
Carrie[ Policy Na.: I GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION PROM WORKERS' GREASUINDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES
(This section need not be completed ifthe permit is forome hundred dollars($Its)) CREASE.TRAP �
nr less.) -P CHECK PF,F.
I certify that in the Nrfunnancmfthe work(a,which thispemol is issued.I shell SEWER-SANITARY-STORM EA.2W FT.
not employ any person in any manner so as in became subject to the Workers'Compen. ENERGY FEE
01Z salmon Laws of California.Dae WATER HEATER WNENT(ELECTR GRADING FEE
Applicant
Z = NOTICE TO APPLICANT:If,aver smkmng this Cenificme of Exemption,you should WATER SYSTEMORIATING
(•' berms,subject m the Worker's Com tion fine labor Code,you must SOILS FEE
pens. provisions o
forthwith,amply with such pmvixiona or this permit shall be deemed revoked. WATER SERVICE
Q
=s CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ,FT. PAID
V O (hems,aff Ill.,there i..... ucli nlending agency for the perfmmaric of Dare Recciptp
H the work for which this permr is issued(Sec 3097.Civ.C.)
U" Lender's Numt TOTAL:
O W Lender's Address FEE
sx TOTAL:
a. 1 clarify that I have mad this application and stere that the above information is
F VT correctI g.a.comply with all city and county ordinances andsute laws minting In QTY. MECHANICAL PERMIT FEE
V buildingar,loinlos,.ndhth
orny auodaem,m.,caallvesnl th
this city to enter upon e SEISMIC FEB
alcove-mentioned pmpeny Liar impectlon pan"orc. PERMIT ISSUANCE �f�a
(We)agree m save,inclemarify..it keep harmless the City of Catania.against ELECTRIC FEIi b V
Iiabilith,judgmems,coon,and expenses which may in say way carve against said City ALTERORADDTOMECH.
PLUMBING FEE
in consequence of the granting of this pcmait
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTAIR HANDLING UNIT(To In(SIT CFM) MECHANICAL FEE
SOURCE RE'
'CATIONS. o/
51_J O AIR HANDLING UNIT'(OVER IT."CFM) CONSTRUCTION TAX
Signaturenl App manllCanlmcla0.r" �� hale EXHAUST HOOD(WIDUCT) HOUSING MITIGATION FI?E
HAZARDOUS MAT IAL S DISCLOSURE
Will the applicant or future building execution store or handle hafardous material HEATING UNIT(TO 100.001)BTU)
as defined by the Cupertino Municipal Cale.Chapter 9.12,and the Hcalth and Safety
Coda,Section 25532(a)'I I[EATING UNIT(OVER I W.OW BTU)
Yes No� � VENTILATION FAN(SINGLE.RESID) PAIN Dam RccciptX
Will the applicant or future building sxcup..I use equipment of devices which _
1,hueardou.s air comm�tinums us defined by the[toy Arca Air Quality Muwgentenl BOILER-COMP(SHP OR 100,001)BTU) TOTAL:
District?
❑Yes 0No HOLLER-GQMP(DYIiR IW,INNI BTU)
I have read the haesrdous noterials requirements under Chapter 6.95 of the Cali- AIRCONDIT[ONER ISSUANCE DATE
forma Health&Safety Code,Sections 25505.25573 and 25534.1 undersi nd that'd the NEW RESIDENTIAL.MUCH. SQ.PT.
building does not currently have a Tenant,thug it is my responsibility to notify the occupant
nithe requimmems which must he net 16.1te issuance-(a CeftiGcate of Occupancy.
Owner or aahoriud agent Dae TOTAL: ISSUED BY,
OFFICE
ocilvol,
10300 Torre Avenue
Cupertino,CA 95014
Cupertino Building Division
(408)777-3228
(408) 777-3333 (fax)
January 22, 1996
Homeowner
1086 November Drive
Cupertino, California 95014
SUBJECT Permit: #29871
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
I0