31309 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY-OF CUPERTINO BUILDING-ELECTRICAL PIiRMIT NO. O
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING PROJI!CIIDENTIFICATION
.�MIILUING AUUH655: SANITARY NO. APPLICATION SUBMITTAL DATE
I tong
NCR' NAME: PIIONii: CONTRACTOR'S NAMLICLIC NO:
1 1k\\.,t}�atiiia.� NIC CONTROL
#
ARCHITECTIENGINEER: LIC NO: ADDRESS: - ❑
ONTACT: PHONE: 6UILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) HLLDD{G E PLUMB MECH
/�J_7� I 1/T ❑ ❑
I.ICHNSHDCON'fRAC'IY)H:SDECLARATION QTY ELECTRIC PERMIT FEE
I hereby uRrm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
O d'Z PERMIT ISSUANCEwith Sectinn]IXH))nf Divisum 3ofthe Businecstnd Professions Com.snd my llcenseis RESIDENTIAL:
¢
aFad. infull eClass efl'av ❑shUWL ❑KITCHEN REMODEL
UV License Class Lic.N APPLIANCES—RESIDENTIAL C1 ADDITION [I PLUMBING RE-PIPIT
P-Z W Date Contncmr
ARCHITECI'SDECLARATION ❑Ak_uri-UNIT ❑STRUCTURAL.
F H Z I undersand my plus shall be used as public records PANELS MODIFICATION
ZOZ_C UP TO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
F--NFW Licensed Professional 201-1000AMPS IMPROVEMENT
agsj E; OWNER-BUILDER DECLARATIONOVER IOW AMPS ❑BATH REMODEUREPA1R ❑DEMOLITION
K C Q I hereby affirm mat I am exempt from Ne Curri czar's License Law for the
{axj3 elU following reason.(Section 703 L5.Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
y
y which requires u permit to construct,alter,improve,demolish,or repair any suucture
E"LL'O I prior to its issuance,also requires the applicant for such Femtiuo file a signed statement SPECIAL CIRCUITIMISC.
f y�Y that he is licensed pursuant to the re
provisions of the Cnmcmr's License Law(Chaper9
0 (commencing with Section7000)of Division J of the Business and Professions Code)or TEMP.METHR OR POLE INS,. COMMERCIAL:
0.TA..n f� that he is exempt therefrom and the basis for the alleged exengninn.Any vinlution of ❑NEW 91,DG/ADDITION El DEMOLITION
cc=n Section 9131.5 by any applicant for a permit subjects the applicantto a civil perodyof POWER DEVICES
cit ore thu Eva hunlmildolh¢s(S50(O. ❑'IMPRO ' [I FOOD SERVICP,
F Z IMI'ROVykF;NT
` Q s nil the WnpenY,or my employees whh wages its their sole contpennmins, SWIMMING I'OOh GLLCI'RIC ���� F
LX' will Jnt wwork,u^Jthestrvd...is nmmended moffered far sale(Sri.7(1 ,Business C1 OTHER Q—c
0.3 and Pndcs.Inns GNe:The Convucmr's License taw Dues nal apply m an owner of QUITE IS—SWITCHES—PI%T
progeny who hold,or improves thereon,and who docs such work himself or through
his own employes.,provided that such improvements arc nm imuded nr offered for NEW RHSNGNTIAL[LECTR
.sale.If,however the huddingorimprovement is sold within ane year of enmplction,me SQ.IT.FLOOR AR A S/SQ.II'.
mer-builder will have the burden of proving that he did not build or improve fur pur-
pose of via). TOTAL:Y
❑I,as miner of the progeny,an enchoiveiy continuing with licensed contractors no 1P'R
onarua the prsjem(Sec.]oto.Buxiness and Profex irons Code:)The Contncmr's Li- P D
c w Law does not applym uowner of pm obuilJs or improves Nemon.and Q17. PLUMBING PERMIT
whorontrseafo s ec ithaco s) sensed pursunnuu the Commnur's Oq�
License Law PERMIT ISSUANCE ` 1 f7
❑lame ,H&PC funhis a _ill yr` r,I
VALUATIFIR
WOR 'R'SCOMPENSATIONDECLARATION{ BACK FLOW PROTECT.DEVICE R(HA) UfGUN�HONO
I hereby affirm under penalty or perjury one of the follow ing Jeclaratione V
I hove acid is ill maintains CurNcatu nrConsent to self-insure for Worker's Cniopen- DRAINS—IT,OOR,ROOF ARM,CONT. STORIES TYPE CONS]RUCTION
sudnn,to pnwldad for by Section 3900 of the Labor Gale,forme perliamnmec of the
wnck lin which this permit ix Issued. FIXTURES—PER*1 RAP
0 1 have and will maintain Wmkcr's Compensation Inwmnce,as required by Section
3](100(the paMx Axle,far he performance urine work fol. ..In this gems;(is issued. GAS—EA.SYSTEM-I INC.4 OUTLE'rs OCC.GROUP APN
My WI Compensation Insurance carter and Policy ampler am:
Curler. Policy No.: OAS—EA.SYSTEM-OVfiR 4(EA)
CHR`KATE OF EXEMPTION FROM WORKERS' GREASE/INDUSTRL WASI'f:INTEHCEPI'OR
COMPENSATION INSURANCEBUILDING tIVISION FE
(This sectimnneednmt be rompleted face permit is for..hurulred dollars(SIOn GRGSE TRAP
or less.) PLANCHECK FEE
Icenifythat uride,ofienmmescifthe workforwhich Nispermit sincerest.[,hall SEWER—SANITARY—Sl'OHM EA.200 Flo.
not employ any Persian in my manner so as to become subject to the Worker'Compen. ENERGY FEE
Z cation Laws of Cullman..Duce, WATER HEATER WAGENTA LEC R
ZApplicant Q GRADING FEE
NOTICE TO APPLICANT:If,after making this Certificate of F,xemption,you should WATER SYSTENI/TREATING
F became subject to the Workers Compensation provisions of the Winn Cure,you must SOILS 17EE
forthwith comply with such provisions or this permit shall he deemed revoked. WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RLSIDIiNTIAl.1'LMIi, SQ.FT. ('AID
I hereby office that hem is a construction lending agency lira the performunce of Receipt#
pthe work for whidt this Ienotn isolated(Sec 3097,Cie C.)
0 Ixndcr's Name TOTAL:
U
Lk1 Lender's AJOress TOTAL:
1 certify that 1 have maid this application ud sae that the absve information is BUILDING FEE
F' V0.) awma.l agmen comply with all city and county collimates and some laws mloan,1. QTY, MECHANICAL PERMIT FEE
U Z building construction,and hereby substancepr
reeveratives me SEISMIC city to enter upon mSCISMIC FEE
cause-mentioned pmpeny for inspection purposes. PERMIT ISSUANCE
(we)agree rt save,indemnify and keep h rvidess the City of Copeman against ELF:CI'RIC FF
liabilities.judgments.costs and expenses which may in any way secure against said City ALTERORADDTOMECH.
in asequence of the gaming of this permit. PLUMNINC T:E
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM)
MEC({p•CAL FEL
SOURCE REGULATIONS.
AIR HANDLING UNIT LOVER 10.001)CFM) CONSTHUCI'10 X
Spgnmureof ApplicanuCommcmr Dole EXHAUST HOOD(W/DUC ) HOUSING MITIGATIO 'EE
HAZARDOUS MATERIALS DISCLOSURE
Willunit, camnr fnumauddingoecupant smrcrnhaudle hanardous mmcrial BEATING UNG(To IWIHHI H'rU)
as MHned by the Cupertino Municipal Cute.Chapter 9.12,and the Hcahh and Safety
Code,Sestina 25E2(a)P HEATING ON]](OVER 1(0.011011'IV)
Ye, No� � VENTILATION CAN(SINCI.Ii RES ID) LAID Dom Receipt#
Will the applicant or future building occupant use equipment or devices which BOILER—COM('fJHi'OR 1 W.IHO RTU)
it harnNous air contaminants as defined by the Bay Area Air Qualify Management 'Jb AL.
^met!
E]Yes 100.000BOILER—COMP(OVER 100. n BTU)
I have leaf the havvdous materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
[1,.Uag..,dms
ix Realm&Safety Cute.Scums 25505.M533 and 255}1.1 understood that if the NEW RESIDENTIAL.MECH. SQ.FT.
utea city haveamoot,mat it is my respoasihilhy mnmify the acuput reuiemcna which must be met pror to issumee of a Certifcam of Occupancy.
ner r authnrirtJ agent Dee TOTAL: ISSUED BY:
OFFICE
r�
;�r* 10300 Torre Avenue
• v "' CiLv oC Cupertino, CA 95014
CupEr,]no Building Division
(408)777-3228
(408)777-3333 (fax)
June 18, 1997 ��(l
Homeowner G`
10677 Par Three Dr
Cupertino, CA 95014
SUBJECT Permit#31309
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 Fecvr"ied Paper