30368APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Xtk {^�
CITY OF CUPERTINO BUILDING - ELECTRICAL. PERMI'I'NO, 30368 O J V H
BUILDING DIVISION APPLICATIONtPERMIT PLUMBING - MECHANICAL
BUILDING PROJECT IDENTIFICATION
FE -
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El consultant Fees Paid by Applicant (Initial)
BLDG ELF P NIECE
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❑
LICENSED CON'TRACTOR'S DECLARATION
QTY. ELECTRIC PERMIT
FEE
5
I hereby i ffum that 1 am licensed under grovidorgm of Chapter 9!commencing
7000)of
J B DESCRIPTION
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with Division 3ofthe Buramessand Professions Codc.and my license is
FOOC
in fullforce ane!
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PERMIT ISSUANCE
❑SFOWL ❑ KITCHEN REMODEL
IM�.Utt
111a�
Licen Ca.e Lic.M24—�
Due Co.o-°otor
APPLIANCES - RESIDENTIAL
❑ADDITION C1 PLUMBING RE -PIPE
V.7C
Fp>m
ARCHITECTS DECLARATION
PANELS
❑MULTLUNLT ❑STRUCTURAL.
ZOmp
ecos
I understand my plans shaft he used as public rrd
MODIFICATION
O Z
1-41-0i]
LicensW lkufessicual
UPTO 200 AMPS
[I INTERIOR ❑CHIMNEY REPAIR
20I-1000AMPS
IMPROVEMENT
,,¢y
OWNER -BUILDER DECLARATION
OVER IIXIO AMPS
❑ BATH REMODEL/REPAIR ❑ DEMOLITION
^y
I hereby affirm that 1 em exempt from the Commoner License Law far the
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following reason, (Section 7031.5, Business and Professions Cade: Any city or countySIGNS
ELECTRICAL.
❑ OTHER A
{s13IL
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which requires a I vomit m comaing , often implwe, doodixh, m mpap
ir any agrarian
_
Lw Ski-yfq
I
prior m its issunce, also requires theapplicent for such pertain, fillitagned stmemcm
SPECIALCIRCUIT/MISC.
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that he is licensed pursuannn Ne provisions of the Contractors License Law (Chapter 9
q0
(commencing with Section 7000) of Division 3ofthe Business and Profession, Ctde)af
TEMR METER OR POLE INST.
COMMERCIAL
4 6 n oC
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
❑ NEW BLDG/ADDITION 0 DEMOLITION
Section 7031.5 by by .,,[Ivan, for a permit subjects the applicant to a civil penalty of
POWER DEVICES
TENANT CC1 FOOD SERVICE
I.. p.
not mora Nan five hundred dollars ($500).
IMPROVEMENT
I SG
I, as owner of the property. sleirmle
pip y,lir my with
SWIMMING POOL
a G[j
will do the work, and the structure is not intended oro!&red for sale (SIN. ]t4.1, Business
for 04m1,Bsiness
THER
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and Professions Code: The Contractors License Law Nos not apply to an owner of
ODTLIETS- SWITCHES - FIXTURES
property who builds or improves themnn, and who does such work himself or through
his own employees, provided that such im,rovemems are not intended or af&red for
NEW RESIDENTIAL ELT: SQ FT.
sale. IL however, the building or improvement is sold within oneymr ofwmpletion,the
SQ. FT FLOOR AREA
$/SQ. PT.
owner -builder will hove the bun len of proving that he did nut build or improve for put.
pont of sale
El 1, as ownerof the property, am exclusively contracting with licensed contractors to
TOTAL:
a,yI,
comsat the ,meal (Sec. 7044, Business and Professions Code, The Conor...... h6
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«nee Law does not apply to an owner of property who builds or improves thereon,and
who contracts far such, with.contractor(, licensed moment to the Contractors
)ens
QTY. PLIJMBING PERMIT
FEE
HG +1• 19(10
�
O(7
License Law.
PERMIT ISSUANCE
❑ I am exempt underSer. .B& PC for this reason
LUN�r
ALTER -DRMN&VENT- WATER (EA)
lin 1
Owner - Dam
VALUATION
WORKER'S COMPENSATION DECLARATION
BACK 11 -OW PROTECT. DEVICE
1 hereby affirm under penalty of perjury one of the following declarations:
Q I have and will maintain a Cenifiwta of Consent to self -insure far Workers Compete
DRAINS- FLOOR, ROOF, AREA, COND.
'IBUCI'DON
satin, as pboula l for by Section 3700 of the [arbor Cale, for the pefformance of the
STORIES
TYPli CONS
w kforwhichthispetmitisissued.
FIXTURES - PER TRAP
I baveanA will maintain Workers Compensation Insurance, as acquired by Session
3700.1 the Labor Codefor the pofanimse of the work for wwhhiich this permit is issued,
GAS -EA. SYSTEM -1 INC. OUTLETS
OCC.GHOUP
'DPN
orkrysrjyIDrygsauot_ r.Ar and Policy n"t<�Q�!0
Cyn A,once
Policy No,
GAS -EA. SYSTEM -OVER
CER'TLFICATF. OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASIVINDUSTRL WASTE INTERCEPTOR
(This section need not heccmpleted none permit is gaining, hundreddol[ars($100)
BUILDING DIVISION FEES
or less.)
GREASETRAP
I'LANCI IECK PER
I certify that in theperformance of the work for which Nis Permit is issued, I shall
SEWER -SANITARY -STORM EA. 200 FT.
nut employ any person in any manner so as to become subject t0 the Workers' Compen-
ENERGY FEE
Z
,.tion Laws of California. Dam
WATER HEAT ER WNENT/ELECTR
4 O
ApplicantGRADING
FEE
y
NOTICE TO APPLICANT. If, after making this Cert fate of Exemption, you should
WATER SYSTEM/TREATING
F-;
become subject to the Workers Compensation provisions of the Labor Code, you must
SOILS LLE
fnnhwith comply with such provisions or thispermit shall to deemed mccoaA.
WATER SERVICE
GtGI
72e
CONSTRUCTION LENDING AG12NCY
NEW RESIDENTIAL PLMB. SQ, FT.
PAID
V O
Ihereb,.T.. ohm there isaumswdion lending agency fnnhe,erPorm.nce of
Data Receipt
V., r
the work for which this permit is issued (Sec. 3097, Cie C)
Lenders Name
O U
TOTAL:
TOTAL:
Lenders Address
1 certify that I have read his application and .Or that the above information is
BUILDING FEE
tZtt
correct. l agree to comply with all city and county ordinances and stage laws penning to
QTY. MECHANICAL PERMIT
FEE
U
builditi,amutmetlon, and hereby amhorize repmsentativesofthiscity menterupon the
SEISMIC IEE
.hove -mentioned property for impectian or,ows I
PERMIT ISSUANCE
(We) agree t use, indemnify and k p wren a the City of Cu,edlno against
ELECTRIC FEE
liabilltiee,judgm cousandexpensesw ch may in anyway accrue against said City
ALTER OR ADDTO MECH,
consequence its gmmin,.f thi,per u.
PLUMBING FEE
APPLICA ON ERSTANDSA / PLY WITH ALL NON -POINT
AIR HANDLING UNIT (TO 10,1010 CFM)
SOURCE :G ATIONS,
MECHANICAL IEE
r /e
AIR I IANDLING UNIT (OVER 10,000 CFM)
CONSTRUCTION TAX
nature of ApplicarguiLmtraemr Data
C•%HAUS'!HOOD (W'/DUCO
HAZARDOUS MATERIALS DISCLOSURE
HOUSING MITIGATION FCC
Will No applicant or future building occupant store or handle hazardous material
HEATING UNIT (TO 100,000 BTU)
as defined by the Cupertino Municipal Cade, Chapter 9.12, and the Health and Safety
Gale, Section 25532(.)7
HEATING UNIT (OVER 100,000 BTU)
Fl YO, 7 N
VENTILATION PAN (SINGLE RFSID)
PAID
or furore building use co which
Will the air
Date Receipt
comm by the B Air a lily Maces
mitrict ons air nrmaminnnts its defined by the tray, Arco Air Quality M.nngemem
ROLLER -COMP (JHP OR I W,IXN113TU)
District �
TOTAL:
❑Yee ❑No
BOILER -COMP (OVER 100,pp ETU)
I have read the h cam1m, materials requimmemeunder Chapter 6.95 0l the Call.
AIR CONDITIONER
-
ISSUANCE DATE
funis Health & Safety Code, Sections 25505, 25533 and 25534. I undersmnJ that tinge
NEW RESIDENTIAL. MECIL. SQ. FT.
building does not currently have a tenant. that it is my rw, msibility to notify the occupant
of the requirentehts which most be met prior to issuance of a Crichicam of Occupancy,
Owner or.hmhonzed agent Data
TOTAL:
ISSUED BY'
OFFICE
f.
10300 Torre Avenue
Cupertino, CA 95014
C.lpertuio Building Division
(408)777-3228
(408)777-3333 (fax)
April 3, 1997
Homeowner
10454 Plum Tree Lane
Cupertino, CA 95014
SUBJECT Permit #30368
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
Primea on Fec•. sled Paper