S 1429 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL I'Ii 1"r NO
BIJI1,0 NG DIVISION APPI,ICATION/PF.RMIT PLUM BING-MECHANICA 1, 1429
IIUILDING I-ROJNC'I Illi{N'TIFICA'I'ION
BUILDING ADDRESS: SANITARY NO. A 11PLICA'I[ON SUBMI]IAL[)ATI
� I Zv 'n5llrli Ave , d'q
M'S NAME: I'IIONI?: CONTRACT'OR'S NAME: LIC NO: i...
NIC CONRROL#
ARCH 1 6�S KY-p h O yr.� ADDRESS ❑
ON PHONE BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(initial) BLDG ELEC1' PLUMB ME It
LICENSED CONTRACIOk;S DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby Third that I ma rleenMd under provisions m Chapter 9 anmineneina JOB D17SCRIPTION
WOO win$«Tian�aNp of Division tome Dusines.and Pmfmsiomcale,andmy head,e is RESIDENTIAL
WOO P..........ANCI?
FWD in in[] Class Jtimet. ❑SFDWI. El KITCHEN RIiNOUIiL
aUV Liansc Cha.. Lice# APPLIANCES-RESIDENTIAL ❑ADDITION ❑PI.GMIHNG RI 1IPF
b-7W Drom Come"olr
ote. ❑MUCI'hUNI'I' ❑S'1 RUM URAL
ARCIII'I'IiCTS DECLARATION
~'=Z l undcrsmal m 1 h 1l be used a.public record, PAM1L1\ MODIFICATION
ZOy_ ypanssa pu UPT0200AMPS
OL�� ❑INTERIOR ❑Cfi1h1NF:Y REPAIR
IC.!n L ad Licensed Vrolo,ianul 2111-ImX)AMPS IMPROVEMENT SWIMMING POOLS
� OWNER-BUILDER DI?CLARADON OVER IIXNIAMPS ❑BATH RL'MODEIJRIiPAIR ODEh ) Ifl N
C C Q 1 herchy aflidn that I am exemp Dom the Connector's License Low for the ��
5a a V following meson.(Section"7031 S.Business and Profession%Cd,Any city or county SIGNS ELECTRICAL OTHER
LL131+-y which requites a Permit to construct,alter,improve,demolish,or repair any slmmum
`COQ prior n t I: q :TI PPIread r hp In Ed "'act]armored SPECIALC.IRCUI'1/M ISC.
zn�i F,d I dl : n are p n. l l C t 1 (Chapter) COMMERCIAL'
W�d050 Romnendng with Semon7000)of Division 3 al the Business and Pr[.. ns Code)or TEM It METER OR POLE INST.
a 6 e C that he is exempt therefrom and the basis for the alleged cumpidn.Any violation of 7 If ❑NEW BLIRi/ADDITION ❑DEMOLITION
X"y Section 903L5byany applicant forapermit subjects the applicant macivil proultyof POWIiR DEVICES QTENANT ❑FOOD SERVICIi
non nhore than five hundred dollars(SSW). IMPROVEMENT
SSD I,asowim,ol he pmpady,ormy cmploycas with wagce xs thci—elccmdpenstun, SWIMMING POOL IiLECTRIC
p., will donhewark.and nheswclum is not intended oraRemJ forsale Xce.ToW,Businco ❑OTHER
W—manal re.:- Code:The C n dr'
e ,License I Less not applyt ver of OUT LETS SWI ICUES FIXTURES
property who builds or improvesm n.anti who does sh workhimself or through
his PI y pr U 1 d h ih p c' norintended ff •J for NLW RISI[)ENTIAI.CLf;C!'R SQ
male.Ir,hu olhe bnicie,nn
rlpm est scold within t he yearnl sndplabo.tc SQ PI'.FLOOR AREA $ISQ.PI'.
nerbuilder will have The burden ofpaving that he did n I build ur improve far par-
p)sII�dR 7 D
c of soled.
❑I,as owner o1 the property,stn eaclvely contracting with licensed contractors m
unNntn the project(Sec.7044.Btwinco and professor,Code:)*Me Conlruaors Li.
aelnwdtwsnoulpplyvoanownerofpropunywhobuJJanrinhproveaherean.ane QTY. PLUMBING PERMIT FEE, GilY Ur VUr CrmtAx,l
who corimi for such projects with a ennmas'unh)hemmed Peru......the Contma n.,
License hors PERMIT ISSUANCE
ani- on under .Sec. H&P C I'll this mason At:[HR-DRAIN h VENT-WA'I'IiR LEA) VALUATION
Owner D no
W'O ;S 0' ECI
NATION O .ARAT'ION 9 BACK FLOW PROITiCE DEVICE
I hemby rlli a er pcna 1,of perjury Inc ofilm foRmt declmer inet
] I have and will coni ainaCenilimm�f Qmsennn.elf-insure l'or Worker's Comped- DRAINS-FLOOR.RUDE,AREA.COND. ( TYPE CONSTRUCTIOD
anion,us pmvidml for by semlon Too or the Labor Cn IT,Ibr the perfunmecc of tat
work ser which this permh is korld. Flx'NRIiS-PER'1'RAP
Fl 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700afthe Labor Code.forthc lwdanerve fthe work for which his .it is issued GAS-EA.SYSTEM-I INC.4 OUTLETS f G APN
My Worker's Contpcmation In amnce carrier unit Policy mother arc
Currier. Policy No: GAS-EA.SYS 117M-OVER 4(EA)
CI{RT'I FICATE OIt EXF.MPI'ION FROM WOR KERS' GHEAMUINDUSTRL WASTE:IN'TERCF.PI OR
COMPENSATION INSURANC17 BUILDING DIVISION FRES
("this union need not becompleted if the Permit is for one hundred Jnllars($IW) GREASETRAP
or Icxcl I'LANCH[CK FEE
I certify lhnl in the perfnnmace ul nhc work fuse whkh this permi reissued,l shill SEWER-SANITARY-STORM EA.201 F1'.
not anploy any person in any mu
manner so ar become subject to the Worker'Compen- ENERGY FEE
Z sminn Ivwaof Cakhomia.Dam WA"IER HEATER WIVENT/ELECIR
Z Applicant GRADING FEE
NUI ICH DO APPLICANT:If,art,,making this CenTevm of Exemption,you vbouW WNI ER SYSTENVI'BEATING
rte., SOILS FlCli
a > become nuompm the WUIh ro Comps or this provisions UI I M1e Labo r Cade,you nhusn
fnnbwinM1 comply with such provisions or this pennin shall be JeemW rcvnACJ. WATIiH SERVICE
LIJ
1 0
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLh1B, SQ.R. PAID [),,,a Receipt#
U 0 1herchy:dfirnthat there is u construction hadingugcncy for the perlimmancenf
m work fix Mittel this onn l r.insrod(Sea.3097.Co,C.)
C) Leaders Name OT'A 1,
:
WU Lender',Address TOTAL:
I Trinity That 1 have read this application and state that the above information is BUILDING FEF.
.F, to "one, I agree m con.Ed,woh all cq,and onony nNlnanecs and ebbe law,mlauns to QTY MF.CI I ANICAL PERMIT FEE SEISMIC Tai'
V Z buildin4SigmLmmot
consTmctnn4UComra,
and herahyauthuri're mpmecmeivcnl this city to enter upon me
loned pfor InsEj
rpoel. P17RMIT ISSUANCE IiL[CfRIC Plili
agme indetneep M1amdess the City of Cupertino again t
uJgn¢nand v, ich may in any wry accme against ad City AIA OR ADDI0 MECH. PLUMBING '
cncc oI'tting of" o,
'1'UNNDS ILL COMPLY WITH AL1.Nq.4.PO1NT AIR HANDLING UN, 10.0 0CFM) MECHANICALITE
E .
Z AIR HANDLING UNIT(OVER[0."CFM) CONSTRUCT ION TAX
fA racU'e I:XIIAUSTHOOD(W/DUC'T) II(IUSINGMI'I'IGATTONIa ?)URIAISDISCLOSURE
11dra. amreocuupenlanre ser handle M1azallous mmenal MEATI NG UNI I'10 IW.00011 I'UIby the s Munde,Chapter 9.12,dad IM1e Health and Safety
Calc,Scion 2553200! 1113AI'INC,ONI'I'(OVER IaAaXI BTU)
El Yes F-1 No VLN'1'ELATION FAN(SINGLE RISID) PAID
Dare 14ecipn p
Will the applicant or future building occupant use equipment or devices whicM1 BUILER_COMP(3HP OR lal,(IW BTU)
emit hazardous air contaminants as defined by the Bay Area ALT Quality Management TOTAL:
Di,Tnml BOILER-COMP(OVER Ia),0001ITUI
El Ycr ❑No
I have mad the hamdous emleriWs requimmen(s under Chapter 695 of IM1e Cali AIR CONDITIONER ISSUANCE DATE,
lomia Heal h&Sri,'y Code.Sections 25505.8533 and 25514.1 merrmnJ that if the NI?W RESIDENTIAL MECIL SQ.IT.
nodding,...mol[.treaty I,Ve a tcnrnL Iharil in my o,,avm1i,y m mthly the ncer,"m
,the cede ed,which mooWmc, or to i...raneeofa Cedifilde of Ocular y.
Owner or amhnrced agent Date TOTAL] ISSUED BY:
OFFICE
of
-y®' 10300 Torre Avenue
r
Cupertino, CA 95014
Cit:v
Cupert1u0 Building Division
(408) 777-3333 (fax)
February 9, 1999
Homeowner
10120 Peninsula Avenue
Cupertino, CA 95014
SUBJECT: Permit #51429
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 Recycled Paper