29264APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY'OF CUPERTINO BUILDING. ELECTRICAL PERMIT NO. 29264 9 2 ^ p
NUILDINC DIVISION APPLICATION/PERMIT PLUn1flINf.MP:CIIANFCAI' L4J L hV 4
0673
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CONTRACTOR'SNgNI]
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OFFICE
Consultant Fees Paid by Applicant (Initial)
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BLDG a PLUMB C
A 55❑
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' LICENSED CONTRACTOR'S DECLARATION - QTY. EL17CTRIC PERMIT FEE
JOB DESCRIPTION
X00
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
Sation7ME Division 3
�Ofullforce
with of of the Rosiness and Professions Cade, and my license it
y PERMIT ISSUANCE
RESIDENTIAL:
W
in effect.
❑SFDWL El KITCHEN REMODEL
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Class Contract., APPLIANCES - RESIDEMIAL
Data—
Dao Comracmr
XDDITION El PLUMBING RE -PIPE
❑MULTI -UNIT C1 STRUCTURAL
F h
ARCHTECTSDECLARATION PANELS
Z p � Z
1 undersand my plus shell beused m public records
MODIFICATION
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D
UP102WAMP$
[IF. INTERIOR ❑CHIMNEY REPAIR
FQ•�tA
Licensed Prnfesxi.nal 201-10MAMPS
IMPROVEMENT
OWNER. BUILDER DECLARATION
ON OVER IOIro AMPS
❑ BATH REMODEUREPAIR ❑DEMOLITION
U
1 hereby .(Sete that I I. exempt from the C ,mss, C's License taw for the
Coom
following reason. (Section ]011.5, floainess and Professions Cedc Any city or countySIGNS ELECTRICAL
❑OTHf.R
WO '
which requires 4 Perot no conshucL alter, improve, demolish, or repair any structurepE-sajOal
.•J7
prior to its issuance, also requires the applicant for such permit To file a signed statement SPECIAL Cl RCUI'I'/M ISC.
2, y� }
<Eq
the pvisns Of the Common's License Use (Chapters ,
that he is licensed pursuant to mio
COMMERCIAL:
(comnunMP.oing with Section of Division 3 of the llusincas and Professions Ceds)or TEMETER OR POLE INST.'3 `v�" \
a a LL
1❑
don he is exempt therefrom send the basis forme alleged exemption. Any violation of
by bjects
NEW BLDG/ADDITION ❑ DEMOLITION
^WSection]031.5
any opplicentfor is su thc.pplicamoo a civil penalty of POWI7R DEVICES
permit
[]TENANT❑FOOD SERVICE
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not morethmfivehondmd dollars
❑ Lai owner of the pmpcny, or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC y\n
IMPROVEMENT
will du the work. and the structure is not intended or offered for sale (Sa.]B}4,Bminess
ER
and Professions Code: The Contmelor's License law does not apply to an owner of OUTLETS -SWITCHES -FD., 007
property who builds or improves thereon, and who does such work himself or through
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his own employees, provided that such improvements arc not intended ser offered for NEW RESIDENTIAL ELECTR �/S�PT.
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call. ILhowever, the building arimpmvmnem is sold within one year of completi.mthe V-=
nenbuildar will have the burden of proving that he did not build", iinpmvc fur par-
FT. FL AREA Q. PI'.
Pose of vie.).
3
❑ I, m Owner of the progeny, am cxclusivcly connecting with licensed contractors to
construct the project (Sec. ]004. Business and Professions CcAeD The Contractor's Li.
cense law dans Out apply to an owner of progeny who builds or improves thereon,and QTY, PLUMBING PERMIT FEE
who contracts for such projects with a aonmactons) licensed pursuant to the Connector s
"
License Law. PERMIT ISSUANCE
'
❑under, c. & P C for this coon42
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aJ0wraer
ALIER-DRAIN&VE ATER(EA)
sed—
VALUA
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WORKER'S COMPENSATION DECLA ATIO BACK MOW PROTT: , D I
•`71
T here by uflLrm oraderpenaltyof,arduryoneofthefollowiaB Jcelaetions:'
lnq r'9 s'7•`l, raV
haveand will mainmina Cenificamol'Cnmm�uu ulGinsure for Warker'a Cumpem DRAINS - FLOOR. ROOF, AREA, CO
STORIES
TYPE CONSTRUCTION
inion, as provided for by Section 3](10 of the Lab"r Ccda, for the pe,f"mmnee of the
work for which this permit is issued. FIX 'I'ORES - PER TRAP
C] I have and will maintain WOfker's Comame,wa a Insurance, as no,mo l by Section
3700 of the Labor Code, for the performance of the work for which this permit k issued. GAS- CA. SYSTTM. I INC. 4 OUTLETS
t3CC.GROUP
qPN
My Worker'.& Compensation Insurance carrier amt Policy number are:
'
Camel Policy No.: GAS- EA. SYSTEM -OVER 4 (CA)
CERTIFICATE Olt EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE CREASIONDUSTRL WASTE INTERCEPTOR
BU .DING DTVI. ON FEES
not be completed ifthepemtit is forma hundred dollars (SIM)
PLANCHF.CK FEE
or leas) GREASBTRAP
Icenify nthe pertiny mannrce of thework for I shall'Comen.
,
pcoshat
tohemitisissued,
SEWER -SANITARY -STORM EA. 2M FT.
not employ any patron in any manner x" as to become subject ui the W'orkeru' Compete
become subch ject
ENERGY FEE O
O Z
sation Laws of California. Date WATER NEATER W/VCNT/ELCCPR
Applicam
GRADING T,
z
fA
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should WATER SYSTLMRREATING
abecome
subject to the Worker's C.mp oo ntion provisions of the Labor Code, yon must
forthwith comply with such provisions or this shall he deemed revoked.
SOILS FEB
{2J
i1
pccout WATER SERVICE
d
Uz
CONSTRUCTION LENDING AGENCY NEW RBSIDGNTIALPLMB, SQ. 1-7.
PAID
. V 0
tMt there isaca len ding agency fnnhe performance of
a Receipt is
W L•-`
work which his
the work fn, which mie permb Is Issued (Seo. 309], Ci, C.)
((aeon
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Loader's Name
TOTAL :
V
Isnder'Address TOTAL:
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certify What 1 have mad this application and stem the the above infonnminn is
FEB �a
t/3
correct. I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FE
E
U,7a.
building construction, and hereby authorize repmsentatives of this city to enter upon the
above-mentioned property I'or inspection purposes, PERMIT ISSOANCB
(We) agree ...... e, indemnify and keep harmless the City of Cupertino against
ELF, F
Iinhilides.jidgmems. costs and expenses which may in any way some against said City ALTER OR ADDTO MICH.
JHOUSINGMI�nG�All
in consequence man, Senting of this .it.
PLUMBING P.
APPLICANT' UNDERSTANDS AND WILL COMPLY WITH ALL NON•POINT AIR HANDLING UNIT (TO Iff"CFM)
'
SOURCE REGULATIONS. -
ALF
AIR HANDLING UNIT (OVER 10,000 CFM)
IONTA
Signature of ApplicanUCommem, Date EXHAUST HOOD(W/DUCT)
HAZARDOUS MAI ERIAIS DISCLOSURE?
ITIGATIO FF.E
Will theapplicam or future buildingnccupad suits., handle hiamus material HEATING UNIT CIO 100,000 WILD
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532bd? I [RATING UNIT (OVER IM," BTU)
❑Yes [3 No
R\
VF,M'l1.AT10N PAN (SINGLP. RESIU)
PAID
� Will mea applicant or furore building occupant mem or devices which
pp gre equip
Dee �pt H
a BOILER-COMP(3HP OR 100,0(10 MTU)
Lit hezallous air nmmminants as defined by the day Area Air Quality Management
Uisvim?
TAI:
❑Yes r-7 No MOILER -COMP (OVER 1(10.000 BIT Of
I have read the hazardous mammals requirements under Chapter 6.95 of the Culi- AIRCONDITIONER
ISSUANCE DATE
made Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the NEW RESIDENTIAL ME.CEI, SQIf T.
building des not y have o ¢nano the o is to ramify the
is whichua ce ofaaCeniy
Occupancy. Of the requirements which must be met prior nr issuance of n CeniOcanc of Occupwcy.
Oscar, or authorized "gent - Data
ISSUED BY:
OFFICE
.`r® 10300 Torre Avenue
j l i 1 ` Cupertino, CA 95014
Gaperti 10 Building Division
(408)777-3228
(408)777-3333 (fax)
May 14, 1997
Homeowner
10693 Pinole Court
Cupertino, CA 95014
SUBJECT Permit #29264
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 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 permit card shows the final sign -off,
would you please contact us so we may complete our records? If the permit is not signed
off, 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
Proted on Pecvcted Paper