29444 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.-ELECTRICAL. PERMITNO. ^� p p p
BURRING DIVISION APPLICATION/PF.RMIT PLUMBING-MRCIIANICAI: L 4 4 4
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
3 o it, S f 'S 6
OWNP 'S NAME: PHONE: CONTRA R'SNAME LICNO:
Pq � LO/jqW N/C CONTROL g
Ck J I1TECT/ENGINEER: LIC NO: q^^p ESS:? S -�. ❑
�
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
' 5 ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMPT FEE
I Immoy affirm that 1 am 1 tensed under pmvisions ol'Chapter 9(commencing JOB DESCRIPTION
aZ with Section VlXg)of Division 3oflhc Busies and Professions Csdeardny lcenxeix
O O PERMIT ISSUANCE RESIDENTIAL:
in full(ores anJ n
GUZE' Licen In. SZZSgZ - ❑SFDWL ❑KITCHEN REMODEL
h6G Dare Cumrpc a.Mg .0 If ABpL1ANCFS-RESIDENTIAL ❑ADDITION C1 PLUMBING RE-PIPE.
F.Oym CHD
AREC......ARATION PANELS ❑MULTLUNIT ❑STRUCTURAL
Z O:J Z I undorsund my plans shall be usedpublic records MODIFICATION
ar
0zO UPTO200AMPS ❑INTERIOR El CHIMNEY REPAIR
Licensed Professional 201-1,0100AMPS IMPROVEMENT
MOP
OWNER-BUILDER exemptDF.CLAementeRATION OVER I000AMPS ❑BATH REO. E EPAIR ❑DEMOLITION
OOGG I hereby unitarian,1 am exempt Pram the Comms Co License law for the
MOP 6 F following¢aeon.(Section 0031.5,Business and C,demolish,
h,or Any city or county SIGNS F:LECPItICAI. ❑OTHER
aJ LLO which requires a permn r1.e toren,aper,imp..e,demolish,ore a sig any secure
that heor its cense moan myope the appnsfiftheant for such Contractors
Blea xLaw(ned Chain,9 SPECIALCIRCUTUMISC. Iy Ie�tknt��j�T
00 y that paiscingwid pnrmrn 7")of Diviomnfof t eBusiness License Law(Chapmr9
(commencing with Section]pB%of Division3 of the Nosiness and Professions Code)or TEMP.METER OR POLE(NST COMMERCIAL-
that he is exempt therefrom and the basin for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
�y
Section 7031.5 hyanympplicam fora penndrobjecatheapplicunt uncivil penaltyof POWER DEVICES ❑TIiNANT ❑FOODSERVICE
} e
I mmthan live hundred dollars($50d. -G IMPROVEMENT
[� I,us owner a[the propuny,our my empinyeex wish wagon us their sola rnngensmlan. SWIMMING POOL ELECTRIC
dl do the work,and in.structure is net imended moffered for sole(Seo.VM4,Boniness ❑OTHER
and Professions Code:The Contractor's License Law dies not apply a at owner pf OUTLETS-SWITCHES-FIXTURES
a' property who builds or improves thereon,and who does such work hinnsclf or through
his own employees,provided that such improvements arc not intended or offered for NEW RESIDENTIAL.ELECI'R SQ IT.
sale.If.however the building of improvement is cold within one yesrof Completion,the SQ.FT.FLOOR AREA S/SQ.F-n
owner-builder will have the burden of proving that he did not build or improve for pur-
pose of tele.).
1,as owner of the pmpenY•em exclusively commeting with IicenuJ commdtns m . TOTAL:
construct the pmjact(Sec.7044,Business and Professions Cock:)no Contractors Li-
censeLawdoesnotapplytoanownero(property who builds or improves tareom and QTY. PLUMBING PERMIT FEE
whocontraas forsuchprojects witacnntr oKU licensed punuanno the Cnntmctors
License Lewis PERMIT ISSUANCE
❑ I am exempt under Sec. ,B&P C for this remon
Owner Dom ALTER-DRAIN is VENT-WATER(EA) VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.D17VICF
I hereby affirm under penalty of pepury marof the fallowing declonrions:
x]L have unit will maintain a CodlHcate of Consent to set f-insure four Worker's Comfier- DRAINS-FLOOR.BOOR AREA,CON D. STORIES TYPE CONSTRUCTION
sution,us provided for by Section 3]1X1 of the Labor Cade,Iia the poramnance of Ind
war
'or which this permit is is.med. FIXTURES-PCR'I'RAP
hove and will maintain he perf's Compensationce ofthw Insurance,h f ip permit
by Section
My of the Labor Code.for teperformancarand policy
for ywlhai`ch ti.e permit ie issQned. GAS-GA.SYSTEM-1 INC.4011TLEfs OCC. ,ROUP APE
Ca Wurgfy" G`t9Pcy l Zln��c.R rand
No.Y -�4 ��Y06 GAS-FA.SYSTEM OVER 4(EA)
Cartier.ICllN:1L a{[
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFIINDUSTRL WASTE INTERCEPTOR IL NG DIVISION ISIS
OTisscc0apnecd net be completed if the penpal is feature hundred dollata(I LW) GREASETRAP
or less.) PLANC11 . FF.F.
Ic<nify to ante performance ofthe work for which this permit is ixsued,lshall SEWER-SANITARY-STORM FA.2W Ff.
nu employ any person in any manner sou az to become subjca In the Wnrkcn'Campcn- CNERIR1Rilis000I,
anion laws of California.Dam
O z WATER HEATER W/VENT/EI.ECfR
Applicant GRA 1
NOT(
NOTICE TO APPLICANT:If,ager making this provisions
cue of Labor ioac you should WATER SYSTEM/1'REA'1'ING
a become subject cond oche Workers Coons or tis provisions of tomedrCode.you must SOILS �'E
forthwith comply with such provisions or this permit shall he JcemcA revoked. WATER SF.RVICP.
z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT, 411 .E
.0 (hereby affirm that is a conamorion lending agency for life performance of ceiplg
the work for which this recruit is issucit(See.3097,Cie.CJ
0jv-f� LtndefsNunn TOTAL:
Lender's Address TOTAL:
CL. 1 comfy that I have read this application and state that the above information is �+[A cnren.l agree ucontply wit ell city and rounty oNinuncex and surto lows rcletingm QTy, MECHANICAL PERMIT FEE z building Conswction,and hereby termi u representatives of this city to enter upon to above mentioned property for inspection uni ons. PERMIT ISSUANCE(We)egret m son.indemnify and keep harless the City of Cupminaagainst
liahilities,judgmenu,case and expenses which may irony way sccrueeguirmt and City ALTER OR ADD TO MECH.in consequence ofthn g..Iin,.f this pemm. PLUM 1 FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNU'(TO 10,000 CFM)
SOURrE REGUI \TIONS. MECHANICALMI
- � l4 //O� AIR HANDLINGUNIT(OVER IO,fX)O CFM) CONSTRUCTION X
Signawrcn Applicanb/Contrucmr Q [I [)are EXHAUST HGOD(W/DUCT) HOUSING MITIC ON FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hamtdous material HEATING UNIT(TO I00,000 BTU)
as defined by the Cupenina Municipal Ede,Chapter 9.12,and the Health and Safety
Calc,Section 25,532(a)'1 �/ HEATING UNIT(OVER 100,000 II'I'U) ��
F7 Yes ZiNu
I VF.NTILA'OON FAN(SINGLE RESID) PAID v
Will In,applicant or future building occupant use equipment our devices which - � Data Raceipl N
nn harardnm air canuderam outs es defined b to Ba Are.Air BOILER-COMP(3HP OR IOLODO BTU C/ `I t V vs I. 1 s
y y Quality Management ) 4
txma? BOILER-COMP(OVER IDo BTU) TOTAL:
LbuTldjngdc�
ead the houradous maurials p AIR CONDITIONER ISSUANCE DATE
requirements under Chapter 6.95 of the Cali-
Safety Code.eations 255at i 25531 end 23534.1 understand tat if the NEW RESIDENTIAL MECH. SQ.Fr.
ntly haveatenanb,dot itixmyresponsiiliryu bifythe tmapanltbs which must be mer prior to issuance ofe Cnifneb f cuParty/ '%y gnxed agent •—� Dae TOTAL: ISSUEUBY:
OFFICE
�.•! '�'®• 10300 Torte Avenue
Cupertino, CA 95014
cupci-` illo Building Division
(408)777-3228
(408)777-3333 (fax)
January 22, 1996
+ Homeowner
19320 Pruneridge
Cupertino, California 95014
SUBJECT Permit: #29444
Dear Homeowner:
We have been cleaning out our files in the Building Department, and contacting those
people with permits which have remained "open".
• According to our inspection records, the subject permit has never 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 records show the
subject permit as finaled, would you please contact us so we may complete our records?
If the permit is not signed off your permit can be reactivated and 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