31382 APPLICANTTn cFILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY IPyIIPR.RTINO BUILDING-F.LRCTRICAI. PERMIT NO. ('11382
RUILDINGDIVISION APPLICATIONMERMIT PLUMBING.MECHANICAL 3 3 L
BUILDING PROJECT IDENT'IFICAT'ION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
3� RosE el Dcso" l0 its q6
WNER'S NAME: PHONE: Z CONTRACTOR'S NAME: LIC NO:
VACMICK �rU�NI� f N/C CONTROL#
HCHITECDENGINEER: aV LIC NO: ADDRESS:
ONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) L IiLECT PLUMB MF,CH
ttf stiff
LICENSED COMRACTOR:S DECLARATION QTY ELECTRIC PERMIT FEC
1 hereby arm rm that I am licensed under provisions of Chapter 9 Econ mics. JOB DESCRIPTION
{O{��Z, wth section](g10)af Dlvision3onnenasinoss and Professions Cade,and anY license is
FO
—0 in full terminal effect. PERMIT ISSUANCE RESIDENTIAL, 7�s
�UV License Class Lica ❑SFDWL ep�ITCHF.N REMODEL
Z APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
<on Dam TS DECLARATION
ARCHITECT'S DECLARATION pANEIS
m ❑MULTI-UNIT ❑STRUCTURAL.
Z O!yz�� IundentanJ my plans shall he used as public recants MODIFICATION
O Z J O Licensed professional UPTO 200 AMPS El INTERIOR ❑CHIMNEY REPAIR
F�F41 201-10RAMPS
IMPROVEMENT
894 OWNCR-BUILDER DECLARATION -
-) C4 G 1 hereby affirm that I um exempt from the Contmcmr's License Law for the OVER HIMAELECIM1'S ❑BATH REMODELMEPAIR ❑DFMOLIT10N
XOLFU following reason.(Section]031.5,Business and Professions Code:Anycii,,county SIGNS ELECTRICAL ❑0'1'HM'
u3 ky which requires a Permit to construct,alter,improve,demolish,or repair any structure
�LLO prior to its issuance,also requires the applicant such pernti l m file,signed stmemcm SPECIAL GIRGDIT/MI$G.
�y thitheislicamedpursmnrrathe provsoon ofthe Ciantswnr',License Law(Chapter 9
X00 Icatomencmgwitb5eginn700(bufpivixian 3oflhe Busine,sard Prom,slnm Cot TEMP.METER OR POLE,INST. '
Q.q m m that he is exempt themomin amt the basis far the alleged exemption.Any violation of G/ADDITION ❑DEMOLITION
TENANT
i� 4. Section]II3 LS by any aapplicantfor upermit subjects the applicant toucivil penalty of POWER DEVICES oo ❑FOOD SERVICE
�3} not more than five hundred dollars(S5fi /1 ROV 1ENT
fxa0 ❑Las owner claim progeny,or my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC
will do the work,and the suucmre is not intended oroffered for sale(See.O(W4,Business H
G and I'rofasiens Com The Comment',License Law Jori not apply m an owner of OUTLETS-SWITCHES_FIXTURES �
propeny who build,or improves thereon,and who Hoes such work...moan'..through
his own employees,provided that such improvements arc not intended or offered far NEW RESIDF,NTIAL ELEGTR SQ FT. ,
side.If,however.the building or improvement is sold within ane ycarofcompletion,the SQ.FT. OR AREA S/SQ.FT,
owner-builder will have the burden of proving that he did not build or improve for par- -�
poseoftede.). - ) D
❑I,as owner of the property,a exclusively contused,with licensed conhomors to -
curlicue,the project(Sea.7044,Business and Profession,Code:)The Conant Li-
cense Law does not apply to an owner of property who builds or improves thereon,and QTY PLUMBING PERMIT FEE
who crannies for such projects with a amtmemKs)licensed pursuant to the Contractor's s( yvYiV�
License Law. PERMIT ISSUANCE
❑ sempt oder ec. Ba P C bonnie r assn
ALTER-DRAIN&VEM'-WATER(EA) LUATION
Ou ca Dae
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby affirm under pxmoRXof perjury one of thc following deelamtian,
IM1ave and will train am a Cenificale lit Consent)self-insure for Worker's Compete DRAINS_FLOOR.ROOF,AREA,COND.
ion,os provided Por by Section 37W of the Law,Cole,for the performance of the STORIES TYPE CONSTRUCTION
,,it for which this permit is issued FIXTURES-PERTRAP
I have and will mainmin Worker's Compensation Insurance,as required by Section F_ arc
3900ofthd Labor Cal,far the p marroutnceofthe work for which this permit is issued GAS-EA.SYSTEM-;INC.4 OUTLITS OCC.GROUT' APN
My Workers Compensation Insurance carrier and Policy manor are:
Carrier: Policy No.: GAS-EA.SYST12M OVER 4(EA)
CERTIFICATE OF 13XEMPTION EROM WORKIiRS'
COMPENSATION INSURANCE GRRASRnNDUSTRL WASTE INTERCEPTOR
(This section need sol be completed fdo, .In is foams hundred dollars IS I an BUILDING DIVISION FEES
or less.) GRI?ASETRAP
Icdnifythminthe peRormanceofthework fmwhlchthispermit isissued,Ishall PLANCIIECK FEE �•
not employ any person in any manner So ns to becmnesnhjeelmthe Workecr'Cmnem SEWER-SANITARY-STORM EA,200 PI',
ZZ sation Laws of C.1iminia.Data p ENIiRGY FEC
Z� Applicant WA'T'ER l(EATER W/VENT/11LECIR GRADINGFEE
NOTICE TO APPLICANT:IL after making this Campeau,of Exemption,you should WATER SYS IEMaREATING
a7 became subject m the Worker's Compensmion pm,ideas of the Labor Code,you must SOILS FEE
Lt: forthwith comply with such provisions or nispermit shall taderand invoked, WATER SERVICE '
Q
0. CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ.FT. PAID
V p (for which
anherc iso issued
3097.di,agency for the performance of Dam ceiplM -
the work for which this permit Is issued(Sec:309].Clv.CJ
O U Lenders Name
TOTAL:
Lender's Address
1 cmee thin 1 have read thirty and coup y ordinances stem the above waarmaning is BUILDING t1"
Va3 builder lagree comply and with ell city and counryivesoond stem lawsrupon the QTY. MECFIANICAI:PERMIT PEE
V � ZJ ser
building construction,and hereby authorize representatives of this city to enter upon the SEISMIC FEE If
aMve-mentioned properly for inspection purposes. PERMIT ISSUANCE
(Wp)agree to save,Indemnify and keep harmless the City of Calandra against 5CONSTRUCTIONT
E
Iinhilinesjudgmem,,ena,andex,samm,which mayinany way reente ii,amv,aid City ALTER OR ADD TO MECH,
in consequence of the granting of this Permit. ,E
APPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,WO CFM) EBL'
SOURCE REGULATIONS.
NR HANDLING UNIT(OVER W.000 CFM)SignammofApplicanUCommcmr Dam EXHAUST HOOD(W/DUC) " NFEC
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store orhandle hazardous mmenal HEATING UNIT(TO 100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(,)1 HEATING UNIT(OVER I lit RTU)
❑Yes El No VENTILATION FAN(SINGLE RESID) PAID'
ipl tl
Will the applicant m future building occupant use equipment itdevices which BOILER-COMP QHP OR 100.000 BTU)
Date 117
snit M1azurdous sir atnluminums m ddincJ by the BuyArca Alr Quality Management
TOTAL:
istriml BOILBR-COMP(OVER IW,IW BTU)
❑Yes ❑No' ,
I have ad the intended,mas requm
iments under Chapter 6.95 of the Cali- AIR CONDITIONER
reISSUANCE DATE
famia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the NEW RFSIDFJJTIAI.MECH. SQ.FT.
,ifdicngdircroad,rrentlywhich have ha metpthatil iveyrespon,ihilitylanotify lhecece,
of the requirenams which most b met prions issuance of a Cenilicam of Ucapancy. /M\n{-1•,(/
Owner or undimmed agent Data ISSUED BYME
OFFICE
i �
10300 Torre Avenue
Citi ul Cupertino,CA 95014
AL
tlperthio Building Division
(408)777-3228
(408)777-3333 (fax)
June 18, 1997
Homeowner
939 Rose Blossom Dr
Cupertino, CA 95014
SUBJECT Permit#31382
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 had a final inspection.
• 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
•
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