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30665 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF.CUPERTINO BwLmnr..ELECTRICAL PERMIT NO. ® � BUILDING DIVISION, APPLICATION/PERMIT. PLUMBING.MECHANICAL BUILDING PROJECT IDENTIFICATION " 65 BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE /0 35 S,4 uE r�uo ldv-� OWNER:SNAMPHONE: C TRACTOR'SN IE' LIC NO: E: 4K ;� -725',-j +L' Q 9 r -27 NK2 CONTROL# ARCHITECT/ENGINEER:' LIC NO: ADDRESS. ❑ 'CONTACT: PHONE - ➢ PP BUILDING PERMIT INFO AeaY PA 04ea aS- 72� ❑ Consultant Fees Paid b Applicant Initial _ ( ) � { BLDG ELECT PLUMB MECH' I LICENSED CONTRACTORS DF.CLARA'I']ON ❑ ❑ ET 1 ionby nffin r that 1 am licensed under previsions mf Chavw 9(commencing QTY. ELECTRIC PERMIT FEE ]OB DESCRIPTION �0O'with Sediom]000)of Division 3 afthe Business and Professions Code,and my license is PERMIT ISSUANCE. in full force and effect. RESIDENIIAL �U�o LiceneqClassC•/o-7u'3L a93 O WL O KITCHEN REMODEL ZW /2sl�n ue.M yQy Date- - Y Contmc ,I1H ' APPLIANCES-RESIDENTIAL ' ADDITION`. El PLUMBING RE-PIPE i[ro, ARCHITECT'S DECLAkA]ION , ❑MULTI-UNIT ❑STRUCTURAL . zp 'E I understand my plans shall he used as puldemirmids PANELS MODIFICATION O Z 9 UP T0200AMPS . C1 INTERIOR [I CHIMNEY REPAIR F MFgr lad LicensedP fes.' nl 201-IOMAMPS IMPROVEMENT yA3 OatIam Uimpabut Ce CommaON OVER IWO AMPS - ❑BATH REMODELREPAIk DEMOLITION ✓ yyiS C d 1 much,so ff that 1 inn exempt from the Connacm L e : L f r the - _ _ „�J W31YFfollowing (Section 70315 r dP f Cd Any,],,'a nme SIGNS ELECTRICAL. •+ OTHER ¢,py¢ which t ts n permit t consumer,alter, mpn I h p a y mumetre y..l Comet t 'I: q ' 'Ihambientf hpe 'II tl g dswtemenl SPECIALCIRCDIT/MISC. 6 that he is licensed partner,no the provisions of the Commerce's erLicense L '(Chapter 9 dCaG (enm tg with Sati n]000) fD r'on3 ftheB ness�dP f .t na Cody or TEMP METER OR POLE IN S'T. • COMMERCIAL, p�ca that he is exempt therefrom and the basis for the alleged exemption.Any violation of Wr.�N Section 7031.5 by any applicant for a permit sublects theapplarom m'a civil penalty of POWER DEVICES ❑NEWBLDG/ADDITION El SERVICE _. [-. y norm In"' Else farmhand d II (8500). ❑TP.NANT 'Q FOOD OOD SERVICE ❑ O ❑I, finep s"id y employeeswlh g .,,hot,side courpefiLtica, SWIMMING POOL ELECTRIC - 'IMPROVEMENT y�+„) wJld (h k doh t t re-n t t nd d D df (3 .]04A B .loess ❑OTHER and P fe,s Cod The Contraor License Law does not applyt nee of OUTLETS-SWITCHES-TEXT 4i property who builds or t man vas thereon,and who does such work himself Or through his own employees,provided that such Improvements are nut intended or offered for NEW RESIDENTIAL ELECTS SQ IT. " sale.If,however the building or l amovement is sold within one year of completion,the SQ.FT.PLOOR AR EA $ISQ.FT owner-builder will have the burden of proving that he did not build or improve for par- DEC pose ofsale,.... 3199 ❑ I,as owner of the property,am exclusively contracting with licensed contractors to - TO I- onsumet the protect(Seo.704q Boston,,and Professions Codm)The Contractor's LI- senseLaw does not apply to an owner of property who builds or improver,theemm,and QTY. PLUM RING PER C�IY who contracts lot such projects with aconbacmr(s)licensed pursuant no the Cmntreclors © V Ur uurtpi'tIN License Law. PERMIT ISSUANCE ❑ I am exempt under See. - ,B&P C far this reason ALTER-DRAIN&VENT-WA'fBR(EA) • Owner pros VALUATION WORKER'S COMPENSATION DBCLARAGON T DEVICE Ihereby nffimtunder penalty of perjury no or the follrwing deelaradmmn BACK FLOW PROTEC ❑I have and will maintain a Cenificare of Consenno self-insure for Wmkers Compen- DRAINS-FLOOR.ROOF,AREA,COND, satin,as provided for by Section 3900 of the Labor Code,for the performance of the STORIES TYPE CONSTRUCTION work for which this permit is issued. FIXTURES-PER TRAP 0 I have and will maintain Worker's Compensation Insurance,as inquired by Section _ 37M of the Labor Code,for the permanence of the work for wblclithis permit is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS - My War,r's p mar inn hicatu" and PNicyry�b�e�y�� OCC.GROUP APN Crnie�,jR � >I Lerie policy N{.CK:fICllLd � CAS-EA.SYSTEM-OVER4EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEINDUSTRL WASTE INTERCEPTORBUILDING DIVISION FEES (Thissecbinuesduat heoomphoed lftbepermit is frmithomdreddred...(5100) GREASETRAP ur less) PLANCHECKPEE I employ any that in the anyfrour n r o as t wok for which this permit is issued,I pvm- nsti a lO any Catbirds an manner sn as xub'cctmthe Wdrkers:Cnm en- SF.WEk-SANITARY-STORM GA.2(Id FT. P Y Y J P ENERGY FEE Applic.owl of California.Date O A licant - WATER TEXT ER WNENT/ELECTR ' Pp GRADING FEE NOTICE TOna,the APPLICANT.If,after Compensition...immwte of Lima, odyou should WATER SYSTEMaREATING abecome comp y the Workers Croons or this provisions of the Labor Code you must SOILS FEE W forthwith comply with such provision or this permit shall he deemed revoked. WATER SERVICE - - a' A CONSTRUCTION LENDING AGENCY CBDICNG Ihemb iffirmthatthem is a construction lending agenc for the NCW RESIDENTIAL PLMB. • SQ.FT•Y y performance of Doe ReceiptNLha work for which this permit is issued(Sm.3097.Cie CJLender's NomaLenders Address - t TOTAL: TOTAL: I oenify that I hove read this application and state cher the above information is G NBCrecover.1 agree m Comply with all city and county ordinances and lose,laws relating to QTY, MECHANICAL PERMIT building conswetion,and hereby authorize representatives Ofthisdty m cammapon the FEEabove-mentioned property for inspection purposes.(Wy o res m save,indemnif PERMIT ISSUANCE - IC FEEg y end keep hamins the City Of Cupertinongainctlabilities,judgments.coils and expenses whichmay many way ucenmagainst saidCity g1TERORADDTOMECH.in wneyuwee ofthe greniing ofthis pennh. G'''APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTAIR HANUhING UNIT(TO IO,fXq CPM7SOURCE REGULATIONS. ICAL FEEAIR HANDLING UNIT(OVER ILOW CFM) 'CO TAXSignawre ofApplicanUCnntmcmr - Date EXHAUST HOOD(W/DUCT) MITIGATION FEEHAZARDOUS MATERIALS DISCLOSURE Willtheapplicantnffilar,building occupant store or handle IntrNnns armorial BEATING UNIT DO IW,000 BTU) as defined by the Cupertino Municipal Code,Chapter 9.12,and the Hudth and Safely Code.Section 25532(,)'! HEATING UNIT(OVER IOggxl$TU)El Yes EINn .. ` VEM[ILATION PAN(SINGLE RESID) Date ReceiptN Will the applicant or future building tecupent use equipme d nr devices which ILER-COMP(THP OR IIXI,OIXI BTU snit hazardous air eontaminaude ts as fined by jhe Bay Ana Air Quality ManagemBO ent ) ., District? 'TOTAL: EI ye, - FI No BOILER-COMP(OVER I W,OW ITT U) I have read(he hazardous materials requiremetns under Chapter fi.95 of Ne Cali- AIR CONDITIONER '•' ISSUANCE DATE fools Health&Safety Code,Sections 255(15.25533 and 25536.1 understand that if the NEW RESIDENTIAL MECH. SQ.F1'. building dors not currently hsventenanq that it is my responsibility to notify thenaupam requl me c must be met priono issuance o[a Cznificnte of pccupane. Ownero net urized ager Date TOTAL: ISSUED BY. OFFICE i h P 10300 Torre Avenue i Cupertino,CA 95014 clYper iflo Building Division (408)777-3228 (408)777-3333 (fax) September 30, 1997 �7 � / a//o J Homeowner l / 10435 San Fernando Ave Cupertino, CA 95014 SUBJECT Permit#30665 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 �2 Z��l Christy Akatiff, Administrative Clerk •