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APRICA 4TTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
fCITY OF CUPERTINO Bull,NG-ELCCI'RICAI.
BUILDING DIVISION APPIACATION/PERMIT rl.umulNG-MECHANICAL
BUILDING PROJJECTIDENVIFICA'PION
I'll ITNO
1590
HU ILDI•NGADDRESR: -7 Q I+N L S'
• C.ey '�ew O -T rO% L
SANITARY NO.
APPLICATION SUBMITTAL DA'Di
NI 'SNA 13: PHONIi:
J
CO AC'f(IHti NAME: jLIC NO: C�,Qweseul%Pn
V PC COoI
NIC
❑
COMTRGLN
CHITECTlENGINEEW LIC NO:
vr
ADORES
zs o �I at -,C•
CONrACc PHONE:
BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant (Initial)
RLDG ELECT PLUMB MECII
a oA
❑ ❑ ❑ 0�—
I,ICENSI:DCONTRAC'LOR'SDI;CLARAI'ION
1 hereby affirm not 1 sunt licensed ander pr..vWor, of chapter 9 6ommcneing
QTY ELECTRIC PERMIT FEE
JOE DESCRIPTION
PERMIT ISSUANCI? J -�
3S
with Scc;inn]Ignlnf Dwi,!..n3 oDhe Husincc,and Pocks,mr, Co le,andmyliccnne hs
in tall lorce and cTfccl.•
l icer, Cl LZ �
-�-y Comb
Dam Te=�B Cnnlrvalor
ARCHITECTS DECLA ree d,
understunJ anY Plxnn slwll he usaA ns puM1lic records
RESIDENTIAL:
REMODIII.
❑ A D ITT ❑ PLUMBIKITCHENG
[]ADDITION ❑PLUMBING RE -PIPIT
❑h1U1.T1 UNIT ❑ MODIFI URAL
l ION
APPLIANCIiS- RESIDF.NTIAh
PANELS
UP To tun AMPS
CHIMNEY
❑IN'fliklOk ❑CHIMNIiY REPAIR
IMPROVEMENT E]SWIMMING POOLS
Licensed Professional
201-1000AMPS
OWNER -BUILDER DECLARATION
1 hereby alum the I ,m ewohn handle Commctor'n License Law forme
following reason. (Sect..... ]11315, B asirea, and Prnl'cnsians Coda, Any city na c a.,,
which requires a permin a, con vect, alteq improve, demolish. of repair any "nature
❑ BATH REMODEUREPAW ❑DEMOLITION
,
❑ OTHER p
A It, 0— &VOCt
OVER Host AMPS
SIGNS ELECTRICAL
SPECIAL CIRCE) 1'/MISC.
prior m its issuance. also requires the applicant for such perminn file a signedsunement
that he is liceved pursmm m the provisions of the Cnmmcmrs Liccnm law (Chapter 9
knmmencing withBxdnn]Ilggof Diviniun9nflhm llusinmas unJ Prufexaimm Cwle)nr
TEMP. MGt11R OR ('OLE (NST.
CGMMP.RCIAL:
that he is exempt therefrom and the basis liar the alleged exemption, Any violation of
❑ NEW BLDGIADDI'I ION ❑ DEMOLI'I ION
Station 7031.5 by any applicant for a pemtit subjects the applicant a civil penalty of
POWER DEVICRS
[]TENANT ❑FOOD SIikVICE
urn mare Nun live hundred dollars y carp.
❑ I, ns owner nt the prnpeny,unny enlpleyees with wages as their cote compensation.
will J..thnwon, madth
act
IMPNOVF.MEN'1'
DTIII:k
SWIMMING POOL ELLCI'RIC
jS
Liverd Lawdofonnlu(See.]1D4,n, -1
,nJ Profession, Csxlm The Cnmmnor'n License Law does not apply to an owner nl
Th,
QU'1'LII'S-SWITCHES-1�1X'I
NEW RESIDENfIAL ELECFR.npr..vcancnlhudJ
pnrpary who builds or improves thereon, and who Nes >ucB work himself nr through
his own employees, provided that such improvements are net intended or offered for
wllhin ane yearofmnaplufuq thn
SQ. FT. FLOOR AREA
$/SQ. Irl'.tosm,,builder
will base We burden ofprving that he did not build mimprove larthe,
0 1 ofsale.,.k
1, m of the property,See.704 amusiness and mntt.eting with licensedonnactors m
ILI
PA,D�
msuum Ne project (Sec. ](W4, Business end Pmferninnx Cnde:)'Ihe Cmnnmm�or, Lis
t the p
se [.ave doe,not apply m anownerofp ufaw, what builds or tprves 1111 1 ait
who cnntmets Rrt saeB projects with a cnntmcolo,O ce t,d pnrsuanuo the
License Ices
1 am exempt sunder See. . II k P C fn
PEI2 FEE
PER ISSUANCL
a
►1LS D
JUN A�7
'11
TR RAIN .NVIiNT-WATRR(EA)
CITY Ur urcYC4u°�').,
�/ S"f-.a,%
! VV
Dunc
r
PR
ffiWORKERSWORKERSCOMPENSATION DECLARATION
I herehyarm nnderpenulryofocUurymoofthe follmvingdeelaratio
BAC LOW ECT DEVICIi
j Ihaveandwill maintaineCcrtificnmofCmisem toself-insure dirt Werker's Ct
.vmion, as provided fur by Section 3)100 of the Lahx Cada for the performance the
DRAINS- FLOOR. ROOF, AREA, COND.
STORIES
TYPO CONSTRUCTION
work for which this pemtit is issued.
FlX'1'1IR13S - Plilt'I RAN
1 have amd will maintain Worker's Compensation Insurance, as required by Section
3700ofthe LaMn Code, for oho pen.... amccof life work for which this permit is issued.
OCC. GROUP
APN
GAS -1?A. SYSTEM -I INC. 4 OUTLETS
My Workcr'x Gampe ,unto.. In umncc currier anA I'ul'i y nun �SJ� (asps f�►�
Ondc[_/�Je. + Policy Nn.: �fn kTa—
,e
GAS -I?A. SYS 'I'hM-OVER 4(1iA)
GREASP/INDUSTRI. WAS G; INTIiRCIiIs10R
CIiRTIFICATEOI'' 1]IINN PROMW'ONKGRS'
COMPIiNSATONON INSURANCE
�i D��L
B1111.UING DIVISION FTs.PS
(This nvbmincednnt he complc,ed ithepennit is for tine hundred dallar,(Sl NII
The—
or Icss 7
GRIASEI RAI'
PLANCIII?CK FEE
I cenifythot in the prmarro neem the week for which this permit:, issued, Ishall
not employ any person in any manner so as to become subject to the Workers' Compen-
SEWER -SANITARY -STORM EA. 201 FE
ENERGY FEE
WKNER HEATER WIVENT/E1.ECfR
,,tion Laws of California. Date
Applic,nt
GRADING FEE
NOTICE IT) APPLICAN'p If, after making this Cenificate of Exemption, .it should
Become subject to the Worker's Compensation provisions of the LaMar Cade, you must
WATER SYSTEMUREATING
SOILS FEE
WATER SERVICE
forthwith comply with such provNin c—, this permit shall be demned revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that is a eumction lending agency dirt Ne performance of
ttnn
NEW RF,SIDEN'IIAL PLMIL SQ. FE
PAID
U.m Recei
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lender's sh le
'TOTAL:
Lender's Addrs,,
I certify that I have read this application and sum that the above information is
'ITIFAU
BUILDING FEE
Q'I'Y. MECHANICAL PERMIT FEF
SEISMICIBE
correct. I ague to comply with all city and county ardinancesand stem laws retalingm
building construction, and hereby authorize repolwr five. of this city to enterulamthe
PERMI'I'I$SUANCI; S'S'o
Ii1,P.CI'IlIC 1131?
,hove (Wellsed pro inspcmlan purposes'
(Wells. o .'Jar ify... m,awc,nnlmss Ne Chy of Cupeninn nguimt
ALTERORADD'IOMECH.
PLUMBING FEE
liabilities,j ments,cme and eapemes which may in anyway accrue against said City
in ani enc e of the g timing of this permit.
AIR HANDLING UNIT (TO 111,11011 CFM)
MECIIANICAI.1'1:1:
�� 70
APP,.1 ANT I;N STANDS AND WILL COMPLY WI 111 ALL NON -POINT
SOU Elir;(' I1 S
AIR HANDLING UNIT (OVER W." CFM(
CONSTRUCTION TAX
Cnncmr Dane
Sin.m nApplicaMva
HALA14DOUS MATERIALS DISCLOSURE
Will the applicant or future building occupatn store or handle Emeal is material
EXHAUSTHOODIW/DUCI')
HOUSING MITIGATION FEE
HEAPING UNI' I' U 0 IM,000 It fU) / Z
us defined by the Cupertino Municipal Cale, Chapter 9.12, and the Health and Safety
Cala Section 25532(.)7
❑Yes E] No
HEATING UNIT (OVER 110,000 B"1'U)
PAID �9rSlGc
Date Iteaei ut
VEN'1'ILn1'ION FAN (SINGLE RESID)
BOILER -COMP (314POR 100.000 RTU)
Will he applicem or Tumre building rccupanl use equipment or devices which
mit hazardous air contaminants as defned by the Bay Area Air Quality Management
TOTAL:
s
7
BOILER -COM11 (OVER Ig),DN1 BI'U)
)istdcl7
❑ Yes ❑ No
Alit CONDITIONER
I have readable hazardous materials requirememz under Chapter fiYS of the Cali
ISSUANCE DATE
NEW HESIDLis MECII. SQ. FT.
forma Health.F Safety Code, Sections 25505, 255understand 33 and 25534. 1 dend that if the
/yia
building docs not ca mmly have a cream, that In is illy resfairef loy m notify Ihm occupant
C/:7
oflhe rnquiremetns which mast be met prix m i ... ance of a Certificate of Occupancy.
_
ISSUED BYJ�e-
'TOTAL: ,
Owner oranthnizel'ugcut Dune
OFFICE
rj
of
Ctipertulo Building Division
1 1 _
(408) 777-3333 (fax)
10300 Torre Avenue
Cupertino, CA 95014
February 4, 1999
Homeowner
7804 Robindell
Cupertino, CA 95014
SUBJECT: Permit#S1590
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.
e•
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
Pruned on Pocvded Papel