S 0338 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
cfTY OF CUPFRTINO BUILDING-F.I.F.C'FRICAL P194ITNO. O^ ^ /N
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING.MECHANICAL J 33 VH
BUILDING PROJFICI'IDI NI'IFICATION
B LNG ADDRESS: EIA,NI,IAR2NOAPPIATION SUBMITTAL DATE
55 To In/ �e�fif no CA �1��0 OWNER'SNAM : f ` ONE:— INRAC :S NAME: ��LIC NO:.�'�I✓1' rhovied /f 611t�L ONTROLp
/ARCHITECT/ENGINEER: LIC NO: A SDR.SS: AI Zp / -�E t/yE 'I I
CONTACT. PHONE: '
V l• V/� BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLD Ed _CT i PLUMB _ MECH�
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FLEE
I 1 hereby offireith.,t I..licensed under provlsioma of Chapter 9(ammmentgng JOB DESCRIPTION
{Oy�O with Section]f00)of Uiviv' n Ohe Business and Professions Craft,and my license is PF:RMITIS5UANCF.
Fly in full force anJ ertect. � �S� 2 FDWL ❑KITCHFN REMODEL
CZE License Clva3 y Llc.p APPLIANCES-RESIDIENT[Al. EI ADDITION ❑PLUMBING RE-PIPE
Date glJ—Commcmr ❑MULTI-UNIT ❑STRUCTURAL.
fpfn ARCHITECI'S DECLARATION PANELS MODIITCATION
ZO rn 7J. I understand my plans shall be axed ax public records
OZ-� UPT02MAMPS ❑INTERIOR [3 CHIMNEY REPAIR
,F.W Licensed Prol'easional 201.100AMPS IMPROVEMENT E]SWIMMING POOLS
Yk , NER-BUILDER DECLARA'I'[ON OVER I"AMPS ❑BATA REMODELIREPAIR ❑DF.MOI.ITION
C 6 1 hereby affirm that oro exempt from the Comrecmrs License Lew for the
O a U following reason.(Section](I. S,Business and Professions Coda Any city or count0 SIGNS ELECDtIGAI. El 01
O F- which regaircs a permit m cons c6 alter,improve,demolish,or repair any structure
E17prior m its issuance,also nation , applicant for such Permit file asigned.amement SPFCIALCIRCl11T/MISC.
that he is licensed pursuannothepro si ns of the Comrannrs License Law(Chepter9 COMMFRCIAI:
� (commencing with Section]0X01 of llt cion 3 of the Business and Pinfitmions Codelor 'TEMP.METER OR I'OLF.INST.
Lx c y that he is exempt therefrom and the bau for the alleged exemption.Any violation of ❑NEW BLDG/AUDITION ❑DEMOLITION
1n-4y Secti.n703i.5hyanyapplicntforaper 't subjects the applicant o civil penalty of POWER DEVICES ❑TTENANT ❑FOOD SERVICE
st mom than five hundred dollars($500). IMPROVEMENT
❑ Lusnwnernfthepmpeny,nrmyemploy swim wag..as theirsolecnmpensation, SWIMMING POOL ELECTRIC
will do the work,and the structure is not imende ter unified for ode(See 7044,Business ❑is
OTHER
end Professions Cade:TTe o" 'one
Llcens Law does not apply to..,,.act of OU'I'LII:S—SWITCHES-FIXTURES
proPeny who builds m improves thereon,voJ w does such work himself or through01
his own employees,proviJed shot such improve mu are not intended or offered for NEW RESIDENTIAL.ELEC R SQ FT.
sale.If.however,the huilding Lir improvement issa withinnneyearofcomplenoathe SQ,F .FLOOR AREA LSQ.F1'.
erhuilder will have the burden of proving that did not build or improve for pur-
ple of.16.).
1,as owner of the property,am exclusively contracting with licensed commoners to TOTAL: s
construct the project(Sec.7111,Business and Professions Coco)Phe Contmdor's Li-
eLawro
doesnotapplytoanownerofppenywhobuildsorimprovesthemon.and QTY. PLUMBING PERMIT FEE
who amaacts for such projects with.cmatr ctur(s)licensed putsvemt to the Contmetors
License Low. PERMIT'ISSUANCE O
E3I am exempt under Sec. .B&P C units reason
ALTER-DRAIN&VENT-WATER IEA) VALUATION
Owner Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTIECC DEVICE
I hereby aff rat Linder penalty of perjury one of the following declarations:
❑ I henmal will onimmm a Cenificatenf Corwritmsclainsure for Wmkcrs Campcn- DRAINS-FLOOR,ROOF,AREA,COND' STORE TYPE CONSTRIICHON
sation,as provided for by Section 3110 of the Labor Code.for the Performance of the
work for which this permit Is isstmd. FIX'I'URIS-PER TRAP
VEl I have and will maintain Workers Compensation Insurance,as required by Section a
3700mf are Lahr Code,for the peAomwnceof the work far whichthis peman is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OC P AIN
Cm Worker nsaf nhts ro cartieiund y+ttsNllayyl'�hc�,�,a�a�o GAS-IEA,SYSTEM-OVER4(BA)
Currier. C'N�
CER,TIFICATE OF EXEMPT ION FROM WORKERS' IIVV
CGMPIEN9ATION INSURANCE: GRHASEANDUSI RL WAST'13 INTERCEPTOR BUILDING DIVISION PERS
(TTis section n\nm� placd if the permit is'mane M1unJml dnlhtrs lSIM)) ORIEASF.TRAP
or less.) PLANCHECK FEE
I ccnify that ince of the work lor which this Permit is issued,l shunSEWIEN-SANITARY-STORM M.2M1 PT.not emnlny any persoerso os m twerme xobjectto the Wurkcri Contpen- ENERGY PEE
`G aon Lwa of CalifoWATERHEATERWNENT/IEhF.CTR
z 0 Applicum t GRADING FEE
NOTICE TO APPLICANT.If,she king this Certificate of Iixemption,yon should WAFER SYtiI'FiMlfREATINC
SOILS PEE
I-' become subject m the Workets Comp atinn pmvisinns of the Lvhor Code.you must
forthwith comply with such provisions this permit shall hedeemed revoked. WATER SERVICE
a
7 CtJF STRUCfION LENDING AGENCY NEW RP.SIDGNTIAI.PLA1B. SQ.PI'. PAID
L) I hereby affirm thmt •refs aconstruction lending agency for the permrrance of Date ceiptq
:r the work for which this permis issued(Sea 3(19],Clv.C.)
ULender's Namc - TOTAL:
Lenders Address TOTAL' t
I ccnify them I hove read this%'h'. mf
n and store that the alswe information is ARM
Fi
corte<t.l agree to comply with all cmy ordinances and sm¢laws elating in QTY, MECHANICAL PERMIT FEE
L) Z building canstmdian,and hereby uurcunMtivesnfthiscity mentor upon the
above-mentioned pmpeny for insp uses. PERMIT ISSUANCE /^l
We)agree to save,indemnify and keep harness the City of Cupertino against S../Iiabilitics,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECII.nce of the +APPLICANT INDERSTANDSANDWI L COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 11,00OCFM) E RI' ILATIONS.
AIR HANDLING UNIT(OVER111,lXX)CFAI) ON 'AX
SI arc o'Applicanl/Commctor Xte EXHAUST FOOD(W/DUCT) HOUSING MITICAI]ON FEB
- HAZARDOUS MATERIALS DISCLOSURE
Will theapplicautorfamre building cecupatnnoreorhandle hazado
rus materiel HEATING UNIT(TO 100,M01{TU)
14 V
as defined by the Cupertino Municipal Code,Chapter 9.12,amt the Health and Safety it
Gni,,Section 255320)? 111EA'I ING UNIT(OVER 10000)B'TUI
C]Yes Ip No VENI'IIAFION FANS INGLFE RESID) PAID
Date Receipt p
Will the applieent or(uum building occupant use egolpmem Lir devices which
emit hmmdnus air comm n nams as defrad by the Be,Are.,Air Quality Manogement BOILER-COMP OOP OR 100,001 BTU) TOTAL:ITP U
District! at, BOILER-COMP(OVER I m),000 If 1'U)
❑Ycx
I have read the hezmdous materials recparments under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE.
fomia Heald fiery Cale,Sections 255115,25533 and 25534.1 understand them if the NEW RESIDEM'IAL MECH. SQ,FT.
building doe' o oncndy haveamna mi my 'PmsihilitymnnbfyJJ11 c nm 23�
Orth naw i�uxt t 'on cc c 'mmuy�Qg7
01514,ar nuthnrixed ugcm /F/�✓s/ate // f I I U1 ISSUED BY: 0
OFFICE
OCi(,%,
10300 Torre AvenueCutinoper , CA 95014
of,
Cupertino Building Division
Cupertino
(408)777-3228
(408)777-3333 (fax)
March 20, 1998
Homeowner
1455 Poppy Way
Cupertino, CA 95014
SUBJECT: Permit# 50338, air conditioner
Dear Homeowner:
We have been going through our files in the Building Department, and contacting tho
people with permits remaining "open".
• According to our inspection records, this permit has not been finaled 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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recvoeo Paver