S 0743 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUILZINC-ELECIVICAI, PERMIT NO.
i" BUILDING DIVISION APPLICATIONA'ERMIT PLUMING-MECHANICAL
BUILDING PROJECT IpwrIFICATION 0743
BUILDING ADDRFSS: SANITARY NO. APPLICATION SUBMITIAL DATE
OVINEElpf NAME: PHONE: CO OkS N P,: LIC NO:
Ned n o (0-8 llfQ ers 04(g S9 3 WE CONT ltOl.p
RCHITECT/EN (NEER: LIC NO', A�DD•RESS: r 4y_ ❑
k:J k f �' b I 9901
ONTACII PHONE: BUILDING PERMIT IYO
❑ Consultant Fees Paid by Applicant(Initial) BLDO ELEC.'I' PLUM Sniqla
❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELIiCTNIC PERMIT FEIi
1 hereby affirm mel 1 um licensed under provisions or Chapter 9(commencing J06 DESCRIPTION
G�'Z Ih Suss..."'p of Divininn3of the l3usinwsand l'ndcsxlons Codo,and any llcenm is RPSIIJPNTIAI'
IIa��OO wi PPRMI'1'ISSUANCIi
F+�.. n full force and et t. -414 _ ❑SFDWL ❑KI I'CHEN REMODIEI,
IUM(� Data Cl `c 1-ic,# J 3� ( APPLIANCES-RILSIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
F Z eI Data 1.- - c'a' L1Kt�,
'I.Q a• ARCHITECI-S DECL R I'ON ❑MULTI-UNIT ❑MODSTRIFI Al IO
I.O rn UPIO2 MODIPICA9'ION
ZOy�j lunderstond my plans shall he used us public records
OZ�4p UI'TO 2(I(IAMPE ❑IN]'PRIOR [:1 CHIMNEY REPAIR
W Licensed Professional 201 ES00AMPS IMPROVEMENT [DSWIMMING POOLS
OWNER-BUILOERDECLARAI ION pyF.RIBBAMPS ❑BAfIIREMODEIJNEPAIR ❑UEh10LIT10N
cem Q I hereby affirm that I am exempt from the Conleclors License Law for the
)0.,)!,06 U El OTHERfollowing reason.(Section 9031.5,Businessland sl
nd Profcsuns Code:Any city or county SIGNS ELECTRICAL
I�W WO E' which onfores a permit In tarnslmcL olio.,improve,demolish,or renal,any almalma
LyIy... prior par its Issuance,also requires the applicant for such prouttofit asignd Imentrt SPECIAL CIRCU I17 ISC
that he is licensed purunit to the provisions of me Convectors License law(Chapter 9
0OWCCy_.p0 (commencing with Section 7")(if Division 3 of the Business and Professions Code)or TEMP.METER N. COMMERCIAL;
0.y o C
that he is exempt mereliom and the hams for me alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
%^W Seclion71D1.5byanyapplicanlforapermitaubjeclsmeapplfennunaelvil penally of P(IW ER VI ❑TI?NAN'I' El FOOD SERVICE
a� rot m pat than rive hundred dollars($5010.
TR IMPROVEMENT
EMIEM'
Q ❑ 1.tux owner Dime Prupeny,armyennployeea with wages as their sole compensation,
P=.O will do the work.and the saucure is not intended or offered include(Sec.7M4.Business ❑OTIIIER
6'3 and Professions Code:The Conference,License Law does not apply man owner of 1'L[T 5 I —PIXY S
propeny who builds or improves thereon,.pad who does such work himself or th
his own employees,provided that.such Improvements are not intendeal er NEv :SIDENTI '.L R SQ FT.
sale.IT however,the building or improvement is,sold within oneywrnf- n.the SQ.FT.FLOOR AREA $,SQ.FII
owner will have the burden of proving that he did not build par i ve for par- /
nese of sale.).
❑ 1,m owner mthe propeny,see exclusively commit with licensed co TOTAL:
construct me project(Sec.76,t4,Business and Professions Codej Tilt Conlr. is Li- -
moseLawdoesnotapplytoSoownerofpropertywhobuildsurimprovesthat and PLUMBING PERMIT FEE
who contracts for such projects with a commissions)licensed pursuant m the Contr
Liceme Law. PCRMI"T ISSUANCE
1 am exempt under Sea .B&1'C for this reason
' AUTER—DRAINV!,
F. t;WA'I'IER(EA) VALUATION
O n Dale
WORKER'S COMPENSATION DECLARATION BACK FLOW PRr . T.DHVICL
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Worked Compm- DRAINS—FLOG ROOF.AREA,CONDSTORIES TYI'Ii CONSTRUCDOh
is.s provided for by Section 3700 of the Tabor Code.for the-.fans....¢¢of the y T:80
work for which Ihis Permit is ismd. FIX'FORES—PER TRAP
El I have and will maintain Worker's Cnnrpemsallon Insurance,as retailed by Secdcn
3700 of the labor Code.for performance ufthe work for which this Permit is issued. GAS—IEA.SYSTEM-1 INC.4 OUT1.ElS OCC.GROUT' APN
My Warms, m 1penmljpn Insurance examined Policy nWWrRl p��� -
Canicr. Policy No.: AJ `Y-f'N3�1 GAS—F.A.SYST13hb(IVER4(LA)
CEITTIIIC E OP EXIEMFGON FROM WORKERS' GRCASIIINDUSTItL WASTE IM'IENCF.1'TOR
COMPENSATION INSURANCE -BUILDING DIVISION ITHS
Obisseculn need nal becamplemd res,parent is Intone hundred dnllam($I(N) GREASETRAP
or less.) PhANCI{ECK FEE
Imnifymalinthe pariomnance ofthe work for whichmispennit EsiswW,1,IIA SEWER—SANITARY—STORM P.A.2111)FT.
not employ any person in any manner so as to because subject to the Workers'Comperl ENERGY PER
Oz cation Las,of Calif..ria Dam WAI'lilt HEATER W/VIENPELIECI'It D
z O Applicant ` GRADING FEE
F^ NOT ICE TO APPLICANT If,after making this Cenilicme of Exemption,you shimW WATLR SYSTEM/TRIEATING SOILS FIFE
Weume subject time Workers Compensation pension.,of the labor Code.you ams,
forthwith comply with such provisions or his permit shall he deemed revoked WADER SERVICE /$
Q ^ !1//
z C(INSTRUC'I']ON LENDING A017NCY NEW RESIDENTIAL.PLMR. SQ.IT PAID D.Ic V} N
U l for which nn mut there is sued(See.307.Celeading ugrncy lar the Perfo......f recipe
kLI Fthe wort for which this Permit is issue)(See.309).Civ.C.)
Landes Name _ TOTAL:
V Lender's Address TOTAL:
� BUILDINIFF,E
[... certify that 1 have read thirty land coup and drum that the show informationwing is
N currecl.l agree to comply with all city and county urJltmnees and xmm lows mining In QTY. MECHANICAL PERMIT FET,
(� z building nmamction,anJ hereby amhrtize repmsemmives of this city menta.upon the SEISMIC PF.F.
r alxrveneserimed property far inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep harmless me City of Cupertino against ELECTRIC PGE
Iiabilities,judgmenls,costs and expenses which may in any way accme against said City ALTIER OR ADD TO MLCH.
PLUMBING PEE
in consequence of the g tour g sl su nit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING(INTI'(TO 10AX)CFM) MECHANICAL ME
SOURCE REGULATIONS.
AIR HANDLING ON]T(OVER 10.000 CFM) CONS'1'RUCTION TAX
Slgnmureof Applieam/Cmetmemr Dale EXI IAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant of future building occupant stare or handle havardaus material HEA'T'ING UNIT(TO 100,010 BTU)
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safely
Code,Section 25532(.)7 HEATING UNIT(OVER 100,00)BTU)
❑Yes ❑Nn PAID
VEN'I'l1.ATI0N FAN(SINGLE Itlist D) Date Receipt If
Will the applicant or fuwrc M1uilJing oecupam use equipment par devices which BOILER—COMP(?HP OR IIXL(Xl(1 BTU)
fluctuations an cmuman en,au defined by the Bay Arca Air Quality Management TOrA{
ret)
❑Yea ❑Nn BOILIER—COMP(OVER I(NI,IMN)B'T'U)
AIR CONDITIONER ��(I(]]]��akT))
1 have read the heele. a tionsard2 5 5.25533 a under .I and rsta of the ifthe ISSUANCE; l:
facia flcailh&SafetyCode,Sections 25505,255??anJ 8511.I understand mm if the NEW RFSIDEN'I'IAL MECH. SQ.FT. i
building does no currently have a tenant.that it is my to ponsibflily m notify the necup:mt
off c rcyuiremenls whit be,mel p bI m issuance of a CenlBe tent kcu cy.
t
' �r I'hurtzd nnycn C�G�� sjs TOTAL: ISSUEDEY:
OFFICE
s.
w
®; 10300 Torre Avenue
Cupertino, CA 95014
Ciiaof
Cupertino Building Division
(408) 777-3333 (fax)
February 4, 1999
Homeowner
10549 San Felipe Road
Cupertino, CA 95014
SUBJECT: Permit 4S0743
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.
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
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