S 1659 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUI'ER'fINO
BUILDING-ELECTRICAL "Pt I'T N(1.
dUu,mNC DIVISION APPLICATION/PF,RAl17• rLualxlsr.-ho-:cnANTCAI. J 1659
IniudIING 1'BOJb:NIT IDEN"1'IFICATION
BUILDINGADDKESS,, SANITARY NO. APPLICA'HON SUBMIFIAI, lA'I'H
8 K ✓t 14 fir q �
OWNER'S NAME: I'1'{(1NI3: CONT RAC I ORS NAME LIC NO
y co / NIC CON BxDl.a
"
RC TECI/IiNGINIiI' LIC NO: ADU ISS: ❑
: Ii{ONI!: dU1LDING PEI2M1'I'INFO
❑ Co.S.1 amt 17Ue9 Paid by Appllcan((Initial) BLDG BLECf PI M #LCI
LICIiNSLU CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEIi
1 hereby affirm that 1 ant licensed under provision,of chapter 9( mme
cordng JOB DESCRIPTION
Oz'L withSeni.n AXlol of Uivixinn l.fthe Husinevs and lhvfcssions Clde,unJ mvlieen.wiz RESIDENTIAL:
WOO PERMIT ISSUANCI.
PTT,- in full force and vfbd,. O SFOWL ❑KITCHEN REMODEL
CU F` I.icenm Claw Lic.#
Q V APPLIANCIiS-RIiSIDI,NTIAL ❑AUDI TION ❑PLUMBING R17 FEET
4 Dan Cnmmam
ARCHII'EC'I"S UIiCLARAI'ION PANELS MODIFICATION CIS'TRUCI'QRAI,
Z I understood n0,plans shall be used us public rccardx MODIFICATION
vn
OZ-
,, UP TO 100 AMPS ❑INTERIOR OCHLMNEY REPAIR
F.'/_rFW Licensed professional 201-I000AMl'g IMPROVEMENT 0SWIMMING PCOIS
C C 1 hemi ltirm that Ilam ednmt Gam the Contru�nr's License Law for the OVER 1000AMPS ❑PKI'll RIiMODEL/REPAIR (1 UPMOLITION
6 yu
OyU following reason,Section 00313.Bovinesand Pmfcssicns Calc:Any city or county SIGNS ELECTRICAL ❑OTHIER l
fA'3 W h [,I'll requires 1,permit v+eunelruel,dmr,impmvc.demolish,nr tepwr any,radars
F I'..�< pie I I I: 4 II p1l' II hTenon t II A J:Tmncn SPECIAL CIH('tll'1IM15C.
}� dTo he I,I Ip.,.an' 'be P n'be C t' t I I (Cl vptcr9
V 00 Icnm etang wrh Sul 1.,.1Dvsi l.1 be Havre, II f Code)or 'I EMP MIiTI!R OR POLE INS'I' V3,N
d
a a C thm he is exempt thercfram and thv basis for the allegN cxempunn.Any siolnt nn of ADDITION O ivmo (THEN
0
W l w Section 7031.5 by any applicand for a permit objects the ap,licmn m a diva pewhy of POWER DEVICES O FOOD SF:RVICIi
F Z} o rrood Nan liw hu aims dolls s UE10II, INT
b- F1Lvsowncndthe pmpeny nr my en+pinyccs wish wngesmthcirsnle compcnxaeon, SWIMMING INXH ELECTRIC
1.. w 01 Jmhewnrk,ard rmstmdnre i,notl teu)Ili dried farnale(See 7044,Pusineea
IW and Ptnfessin I,Codd: I'he Comordia, Jcw+se Law does not apply In an.wncrol' OUTLIHS-SWITCHES-FIXTURIdi
property who build,or improves themon,and what docs such work und,clf or Ihmuglt
his own employees.proviJN that.such improvements am not intended or offered for NEW BESIDES I[A].ELECFR ,S
sale.IL hovi the building or impmvemmnt is%old within one Year ofcompletion.the SV FI'.I FLUOR AREA SISQ.14.
ovornerbuilder will have the burden of proving that he did not build or improve for par
Pose of vele.).
O 1,as owner of the Prnpcny am d,clo,vcly rintmadi.,with licensed contmemrs or - 'AL: p ^
m.aud me project(Sec.9041 Buxincs,; I Prolc,sians Cod,:)'Dm Con¢acmr",Li- PAI I N
mLowdoe utlupplymnnnwncr oil......Gly he beildsntimpme,dumoo,and QTY. PI
who cont a tx for such pmleet,with a cunlrocmr(x)licensed pursuunno the Contmanr's
Licence law. pE h. N MAY 1 r
I am exempt under Sec. .B&P C for this ma,ob
ER- 'T-WA 1 VALUA' ON
tlwner Imm crry ur (i(f1-
WORKER'S COMPENSATI(IN DECLARA9'ION PA FEE 'CI. ;VICI! CI1111VkJ
I hereby utlirm under penuhy of Perjury one of the following IF I ,iiillal
ki unA will muinmina CertiGcam nl Cunmm mcelf-inxum ha Wer nimn- .t DRAI -FLOUR, Ip.AREA,CON D. S'HIRIES 'I YPI?CONS'IRUC I'ION
To provided for by Section 3900 at Im Ismor Code,for the perfillariscal tin .y,
work for which this alissued. . 11 I R ]']ill'[RAP
1 have and will maintain Workers Compero,minn h mretmc,as re pared FIrigelefim
3700.1'the labor Code for the performance of the work for which this permit - a1. GAS-EA.SYSTEM-I INC.40UTLISIS OCC.GROUP APN
'My Work Is C.teen in naumnc camermd Policyfiu berare: _
I Policy No.: ) LS GAS-
EA.SYSTEbf-OVER 4(EA)
a roilCHRI'I IICAI'OF EXEMI'I'ION FROM W(R B S' \' GREASIVINDUSTRI,WASTE INN HRCHPOR
CONIVENSM ION INSURANCE BUILDING DIVISION PEES _
('ThiN action nculnnl be cnmplewdd the Fauna ix fur and hundred dollars IS 100) GR EASE'IRAI'
or Ic,s.l PLANCIIIiCK FEE _
I cerifydid Ohe petfnrmantenfthework forwhichdisperunt is k,red.l shall SEWER-SANITARY-STORM EA.200 IT.
not employ any penun in any manner eo as,u+beeome subject Wallets'.the WalleWallets'Calliper- ENERGY 19:1;
z vtion Laws nfcalifnmia.Date WATER HENT iR WNEN'I/F,LECTR GRADING FEE
C) O Applicant
NO-HCI:10 APPLICANT:If,after making this Cenilicme of Eadrrldinn.You should WATER SYS'GiM/IRIiA'1'ING
N SOILS THE
F hccrnnc xuhjcd u+me W.rIt m Comb,,,don,,len jns of the Luba Code around
linthwith enntply with seep prnvivinn,ur this Imnnil n1uJl tw Jcmnal revakcd. WAFER SEKVICI?
Q
7z CONSTRUCTION LENDING AGENCY NEW RF.SIDIiN1'IALPI h1B. tiV FT PAID Ome Receipt#
U O Ihemilyohrnthat them is a c...handim,lendiel agency for the performance of
the work for which his pea is issued(Sec.3097.Civ.C.)
O Leader',Name ,l 1
W Leapa's Address n
BUILDING
} S I laity mat I have read Ih'o:gq+IlenBnn bad sane mal Thu nMwe iafomtmio I ix Plili
oH. (Z) cornet.lagrccIIcmnply with ell city and nnnnyordinances:+.+J snm lawsrtlaBvgm F2'I'Y. MIiCl IANICAL TERM I'F FEE
UIL Nordin,cnrstri,ram.and hercbymnhorieenprccenmevcs of this city to cuter upon the SEISMICITT.
d.we-mentioned property IT impedion pmrv+ces. PERMIT ISSUANCE ELECTRIC FEE
(We)agrde in save,indemrifY and keep harmless the City of Cuperinn,against
liabilities.judgment%.matsmdcxpcnws which may in anywayacemc agmmt said City ALTER OH ADD TO h1[CH. PLUMBING EEE
nsequencenfthemmingnfthixpernto
APPLICAN"r . STANDS nND WILL C0 WITH ALL NON POINT
SOURCE AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL ;E
IIINS.
J+� AIRHANDLINl11lNl'r(OVER 10,I11XICl'M) CONSTRUCT IN'IAX
I cure+Appian rmcmr Dam EXHAUST'I IOOD(W/DUCT) HOUSING MI' TION FEE
HA9ARDOUS MATERIALS DISCLOSURE
Will he applicant or forum building occupant store or bundle hazvNam material HEATING UNI F('IO I W."PTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cale,Section 25532L4t HEATING UNIT(OVER 100.000 B'1 UI
L]Yes ❑Nn PAID
VEN9lLATIONI'AN(SINGLE RE.SID) hale Rcmipt®
WE,die applicant nr fumm hadding u,,apum use d ...,rot nr device,which rBOILER-COMP(31111 OR 100,000 I{'Ill)
9Jnns air ummminams as defined by he Bay Arta Air Quality Management dYYI'AL:
I�Ycn Otho BOILER-COMP(OVER 100,000 BTU)
I have ruin the mouredons materials requirements under Chapter 6.95 of the Cali AIR CONDIT IONIiR ISSUANCE DATE
famia Ifealm&Safety Ede,Section,25515,25533 and 25534.1 undcr,LmJ Ilmt if the NEW RESIDUN'HAL MECH. SQ.FL
ho'ddam Joe,bat uurmnly ha— tana.,had it Is my respal,dullty onndymenccupmn
oI the iccone an,will,must he amt prior lu lobe e,of a Ccnil lane of(kcm,snaq.
Owner or a ithaved agent Dote I 'TOTAL: ISSUED BY:
OFFICE
®> 10300 Torre Avenue
Cupertino, CA 95014
Cite of
Cupertino Building Division
777-3228
(408)777-3333 (fax)
February 9, 1999
Homeowner
8127 Park Villa Circle
Cupertino, CA 95014
SUBJECT: Permit#S 1659
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 signed off 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 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 remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Pecypled Paper