B 0239 _rAPPLIC,ANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL- 1 PERMITNO 0 2 3 9
BUILDING DIVISION APPLICATIONIPERMIT PLUMBINGMECHANICALSOOO1
BUILDING I'ROJFCP IDENTIFICATION
BUILDING ADDRIiSS`. SANI'I'ANYNO. API'LICAf1ON SUBMITTALLDATI
`1-01-:1hot e k l — (, 6
OWNER'S NAMI' PHONE: CONTRACT'OR'S NAME: LIC NO: SIC CONTNOLN
a.1 LIT % ` - 60
ARCIITTF, /ENGINEER: LIC NO: ADDRESS: ❑
9 4
ONTAC9': PHONE: BUILDING PERMIT INFO
Js.+ I /Q ' I ��r .-r ^O��p ❑ Consultant Fees Paid By Applicant(Initial) BLDG ELECT PLUMB MECCH
x1111 KVLICENSED CONTRACTOR'S DECLARATION lXJ\ QTY. ELECTRIC PERMIT FEE
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
OaZ with Section]fXNBofDivialon 3ofthe Businass and Professions Code,and my lleensc is RFNIDPNTIAI'
O p PHRMIT ISSUANCE
in fu11 force and sheet ❑SFDWI, ❑KITCHEN REMODEL
�UU License Cl-ii
Lic.q APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING REPIPE
zz W Uam Contnnor
Wig I
FIGL ❑h1U1.T1-UNIT [I STRUCTURAL
ARCHITECTS DECLARATION
y p E2 Z I understand my plans shall be used as public records PANELS MODIFICATION
OZ— UPT02WAMPS F)INTERIOR [I CHIMNEY REPAIR
[C Licensed Professional 201-I000AMPS IMPROVEMENT (]SWIMMING POOLS
C6 OWNER-BUILDER DECLARATION OyliµllNM1AMP5 ❑HAITI REMOD 4•IIRF:YAI �DLMOLITICIN
yp, I hereby afrinn that 1 em exempt frmn the Cnmrunor's License Law Inv the AOT
(x/0.4f✓ f0.�C (TION
x 3 c. following....(Scab..7031.5,Business and Professions Code.Any city or county SIGNS ELECTRICAL —fir,
LLLL17 tt which inlimpi a permit to construct,a1mr,impmve,demolish,or repair any structure
prior to its issuance,also quires the applicant for such Permit Fit easignedstmemem SPECIAL CIRCUrrjkl
that he is licensed pursuant to the provisions of the Continuities License Law(Chapter 9
(commencing with Sectinn](W)uf Di vision 3 ofthe amines.and Primminns Cale)or TI?M R METER OR POLE.INST. COMMERCIAL•
L y M eL that he is exempt Ihexfrom aid Ole host.;nor the nllegcd cxemptioa Any violation of ❑NEW RLDG/ADDITION ❑DEMOLITION
�Y11 I+ySection](I3I5 by any applicant for a permit subjects the upplicanno acivil penalty of POWER DEVICES ❑TENANT ❑FOODSERVICE
nal more don.rive hundred dollars($AN)). CV
IMPROVEMENT
E�G ❑Las owner of the propeny,mmyemployas with wages os their so le cnmpenmtinn, SWIMMING POOL ELECTRIC
will do the work.and the structure is not intended or offered for sale(Sm.7044,easiness ❑OTHIiR
Wco and Professions Cade:The Contractor's License Inw does not apply to an owner of OVO.I:TS-g WITCHES-Fl FS
pmperry who hWild,or improves thereon,and who dove such work himself oT though
his on employees,provided that such improvements are not intended or offered for NI7W RESIDENTIAL FLECIR SQ
sale,IL however,he buildingor imro
pvement is sold within'Incyear ofman0cllnn,the SQ 19'.FLOORARIiA $/SQ.PI'.
ve
-builder will have the burden of proving That he did not build or improve for par-
fnsceoLawdi. RED
❑ h a owner of b property,am exclusively contracting with licensed ano acmrs m TOT
nstmct the project(Sea 7044,Business and Pro(essians Code:)The Contnctors Li-
cense Law does not apply to an owner of property who builds or improves Thereon,and QTY PLUMIIING PERMIT FE
who cmm�ms fur such projects wish n commcmr(s)IicenscJ pursuant m The Cnnvvcmrs
License Law. PERMIT ISSUANCE
❑Imarawmptmtder Sec. ,B&PCforthisrea..n
ALTER-DRAIN&VENT-WATER(EA) VALUATION
Owner Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTLCT.DEVICE
1 hardy ofRrtn under Penalty of perjury one of The following mfor de Worker's
ns:
Ihavc and will maintains Cion 37te of Ce Labor Coot,
the Worker's Compo- DRAINS-FLOOR,ROOP,ANEA,CORD' STORIES 'TYPE CONS'BUCTIOD
arkm provided for by 5ador 3]fNl of the Labor Codv,far The performance ol'the
for
have
alis permit is issued. PI%'I'URF,S-PER TRA('
Ej 1 have and will maintain Worker's Compensation Insurance, requiredby Section
l]00 of the ltuM1a Code for Ne perfnrmance of the wok for which
This pcmrit is issued. GAS-EA.SYSTEM-]INC.J OUTLET'S OCC.GROUP APN
My Warkers Compensation Insurance carrier and Policy number are: GAS-EA.SYSTEM VENJ(F.A)
C
mriee Policy Nn.: -0
CERTIFICATE OF EXEMPTION FROM WORKERS' GRF.ASFIINDUSTNL WASTE INTERCEPTORCOMPENSATION INSURANCE BUILDING DIVISION PEES
(This section revel not becoru,jemd if the permit is for ane hundred dollnn($IW) GREASETRAP
or less.) PLANCHIiCK FEL
Termly rhaunt rfurmance of the work for which this mad is i.awaL]shall SEWER-SANITARY-STORM EA.2W FT.
not employ any p: mm be
ee9� bject m the Workers
OZ action Laws of f � 7—� -Y � + WATER HEATER WNENT/LLECDt
4 O Applicant �t222��/��LLL�— — GRADING FEF
ZI NOTICE TO APPI.ICAN p:IL after making this croficam of Exemption,you should WATER SYS'TEMOKERTING
abecome subject ,,The Workers Compcnmtion provisions of the Labor Cale,you must SOILS Flili
Ila forthwith comply withsuch provisioneorthis permit shall hedeemed revoked. WATER SERVICE
Q
!L
CONSTRUCTION LENDING AGENCY NEW RFSIDENTIAI.('LMH. SQ.IT. PAID
UO (hereby af0nn that is a construction lending agency for are performance of Dm Neceiptp
tr the work far which this permit is issued(Sec.3097,Civ.C.)
QU Lender's Name TOTAL'
U Lender's Address TOTAL: '
y 1 certify That I have read this upplicataon and state that the above information is BUILDING PE
if
h cored l agree to comply with all city and county ordinances and suite laws mining to QTY. MECHANICAL PERMIT FEE
U Z building connotation.and hereby autMdre repesenwtives of This city to enter upon the SEISMIC FEE/
shove-mentioned property far intimation purposes. PERMIT ISSUANCE
(We)agree to saw.indemnify and keep heartless the City of Cupertino against ELECTRIC P:E
liabilities,judgments,cots and espcnseswhich may in anyway accme against said Cary ALTER ORADDTO MECIL
amegrenm ufthe%tuntin8 of this permit. PLUMHIN( ICP.
�APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIN HANDLING UNIT(TO W."CFM)
MECIfACAL PF:E
SOURCEREGULATIONS.
AIR HANDLING UNIT(OVER TO."CFM) CONS CION TAX
Signature of Applicant/Contracmr Dae E%IIAUST HOOD(W/DUCq HOUSI 'MITIGATION FEL
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future bulldang occupant nae or handle hazardous Tramnal BEAT ING UNIT CTO I W,IIfI(1 BTU) ,
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 2553200? IIEAHNG UNIT(OVER 100,0100 BTU)
(]Yes RNo VENTILATION FAN(SINGLE RFSID) PAID
Will the applicant or future building occupant use equipment or devices which
Date Receipt p A P7
mit hallous oar comaminams as refined by the Buy Arca Air Quality Management ❑OILER-COMP(,I"OR
Bill
'TO)
TOTAL:
1fbuilding,
dricU ROII,F.R-COMP(OVI;R 10(t(MOBTU)
El Yes Sr11No
I have rod The Waradl...materials requirementsuirements under Chapter695 of the Cali- AINCONDITIONERISSUANCCEDOE
rma Health&Salety Code,Sections 8505,25533 and 25511.1 understand that if 0tc NEW RESIDENTIAL MECH. SQ.FT.
does not currently have a tenant,That it is my mspmsihility to notify the occupant the requirements which must he met prior to issuance of a Certificate of fkcupancy. [ TZ Q
Owner.,awhorized agent Ilam TOTAL' ISSUED BY: {L
� OFFICE Ig
10300 Torre Avenue
Cite of, Cupertino, CA 95014
upertuzo Building Division
(408)777-3228
(408) 777-3333 (fax)
February 9, 1999
al/
Homeowner �!Z
20271 Pinntage Parkway
Cupertino, CA 95014
SUBJECT: Permit 4B0239
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
Primed on Recycled Paper