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27648 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUIL DI G-EI.F.C'1'RICAL PERMff NO. APPLICATION/PERMIT PLUMB NI:-MECHANICAL 27648 BUILDING DIVISION illl[,DISH ECT PROJ ][)ENTiFICATION BUILDINGADDRESS: © C�.,_ r�� SANII'ARYNO. APPLICATION SUBMITTAL DATE �•.rl�yJyk`Ilapr�� 14 ulvn'w I.oTa OWNERS NAME: ga/Cr PHONE: CONTRACTOR'S NAME: LICNO: ­NICCONTROL# �.RCHGLCryENGINEER: LIC NO: ADDRESS:I-looll ''`` ❑ V Se CA�,,, e r PH NIL 4 BUILDING PERMIT INFO 1 .I.s���ppv0'f Y �.� Yy QTY, ELECTRIC PERMIT FEE KCL' BLDG ELECT PLUMB MECII P Vx.C� 151 PERMIT ISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDP.NUAL 1W DLSCRIpTION O=Z I hereby affirm that l am licensed underprovisions of Chapter9bcomencingwilh G1Q , 00[ Section 70(som'Divisma3 refine Business and Professions Code,and ON license ism PANELS �r(„ '^�'-� lessOJ In forceandeffect. (Lapalr FZ(y License Cl as Lic.. 14a filo UPT0200AMPS ROdf— 1/NY, ({rJ m6y Dae Comtacna kt§?nCU 201-10(10 AMPS ZOZHK R HI'IECTS DFCLARATION OVER IUfX1AMP5 SQ.PT.FLOOR AREA EISQ,TT. CZ-0 I understand my plans shall be used u public eeamds. Pti L' SIGNS ELECTRICAL Q Licensed Poifiessi...I ax�d'Q OWNER-BUILDER DECLARATION SPVCIALCIRCUIT/MI . W C'uI hereby air.than I am exempt from the Comments License Law for the LL,VVi fnllnwm ingrtoa(Seeeon 7031.5,Bminanm esad Professions Code:Any city coumy TEMP.M1iTER0 POLI;INST. .] which requires a peanut to construct,once,improve,demolish,or repair any structure �Y:: prior to its isrmaice'alsorequires lho applicmn folatch permhtn Ne asignetivalcomm POWER BIZ<CFS y�j�Q O that he is licensed pursuant to the Provisions of the Convactor.a License Law(Chapter aaoE4 9(commencing with Section 7008 of Division 3 ofthe Business and Professions Cede) SWIMMING POOL ELECTRIC VALUATION K'^^' or shat he is exempt therefrom and the basis far the alleged exem li n.An WYin 703 P B rmI Yl Finally of OUTLETS-SWITCHES-FIXTURES I 75a, 00 F.Za TimmSeen. re than56ya hundred dollar, $permit subjecuthe applicant toocivil penilty of O7 O nm mare than five hundred dollars(S5B0). NEW RESIDENTIAL ELECIR _SQ.FT. yB:2 ❑ Lmown#rnfrhepropeny,ormyd amended comffwngesustheirwle compensation, TORIES 'I'YPB CONSTRUCTION 3� will doth#wink,end theswnum isnm imendW oruffered forsale(SmA044,Business ' and Professions Cede:The Contractors License Law does not apply to an owner of property whobuildsorimpraves themen,and whodoes such wnrkhimselt orthrough his OCC.GROUT' RES.UNITS own employees,provided that such improvements are not intended otmffered for sale.If, however,the huddingor improvement is sold within one yearofcompletion,the owner. TA L: builder will have the burden of proving that he did nor build or improve far purpose of . salt.). CII,asownernfibepmperty,amexclusivelyontracting with l eensWcamractnrsto QTY; _ PLUMBING PERMIT - FEC ILOODZONE APN construct the project(Sec.7094,Business and Professions Code:)The Convector's Lieeme Law doesnot apply toanownerofproperty whobuildscrimprovesthereon,and PERMIT ISSUANCE whormaruca forsuch projects with a conrrwrods)Iicened patterns tothe Convector's ALTER EA License Law. (' ) PEI?SUMMARY ❑ 1 am eiu mpt under See. ,B&P C for this reason BACK FLOW PROTECT'.DEVICE UTSIDH FEES SANITARY Y N Owner Date I?CRECEIPT p DRAINS-FLOOR,ROOF.AREA.CONU. WORKMAN COMPENSATIONDTARATION SCHOOL TAX YN_ ❑ lhmbero'Co affirm ton Inamence Or ifemeof copythmof(insum,m Lab C.)which RECEIPT'# Wmker%Compensation lnaumnce ore<ertifiW copy thereof(Sec.7B00,Lab CJ which FI%TURCS-PF.R P PARK FEE Y N covers all emplIs it ibi`pyr,i^ /,, GAS-EA.SYSTI s- C. TLE'f5 RECIAPF# Policy.—t�1ZM—Y�'TFS r4 BUILDING DIVISION FEES Clumam"�'>.TII1++-1� -�-r-I-r-r� GAS-EA.SYSTF.M- VL 4(EA) PIANCHECK FEE ❑ Certified copy is hereby famished. ❑ CenifiW copy is filed with the city inspection division. GREASEpNDUS'IRL ASTE INTERCEPTOR GRADING ITH! CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (This section need not hecompleted lfthe permit is formolondlW dollars($100) SEWER-SANITARY-STORM TA.MOM ENERGY FEE or less.) I certify that in the performance mfthe work(01 which this permit is issued,l shall WATER HEATER W/VHNT/ELECfR not employ any Iverson in any n t as m om bocm subject In the Workers' PAID Compensation Lawsof Califomia. Dates WATER SYSTEM/fREATING Use Rcceiptp Z Applicant z C) NOTICE T'O APPLICANT:If,after making this Certificate of Exemption,you should NEW RES]DEN'IIAL PLMB. SQ.11'. TO'T'AL: f•-' (4 become subject o the Workers Compensation provision of the labor Code,you must � ; forthwith comply with such provisions or this permit shall be decreed revoked. BUILDING F'EE aQ CONSTRUCTION LENDING AGENCY SEISMIC FEE Vz I hereby affirm that there is a cnngrumion lending agency for the performance of O the work for which this permit is issued(Sec.3097,Civ.C.) TOTAL: ELECTRIC FEE Lenders Name O U Lender's Address Q17, y MECHANICAL PERMIT -- FEE PLUMBING FEE 1 certify that 1 have read this application and state that the above information is a agree to core with all cit and ordinances and amt,laws to PERMIT ISSUANCE. MF,CHANICAh PEE correct.la comply PYwi yon rya g building consvarduri,and heresy authorise representatives of this city(reenter upon the CONSTRUCTION TAX U Z aWvemcproperty ned property for inspection purposes. ALTER OR ADD TO MECH. (We)agree m save,indemnify and keep harmless the City of Cuperino against Iiabilities,jWgmeins,costs and expenes which may in any way accrue against said Ci ty AIR HANDLING UNT 110,000 FM) in consequence of the graining of this permit. AIR HANDLING (O 10,000 CFM) SiBnamre of Applic..VCon.rr Data EXHAUST HOOD CT) PAID HAZARDOUS MATERIALS DISCLOSURE HEA'FINr 91T(TO IW.00f1 BTU) Dam Receipt. Will the applicant or future building occupant store or handle hamrdoaa materiel as defined by the Cupeninn Munici pal Code,Chapter 9.12,and the l Ealth and Safety HI?ATING UNIT(OVER 100,000 BTU) T TAU Coda Section❑Yet, �j No VliM AI'ION PAN(SINGLE RESID) .�, n n tas, Will rheepplicanmr fmurebuildingaccupanr uxequipmemnrdwiceswhich emit BOILER-COIMPQHP OR 100,000 BTU) r -ISSUANCE DATE hazardous air comaminanrs as della#-by the Bay Area Air Quality Management BOILER-COMP(OVER 10(1,000 BTU) JAN 2 3 199E District? ❑Yes �. 'o NEW RESIDENTIAL MECIL SQ.IT, /spp 1 have rind the hamrdous materials requm ireems under Chapter fi 95 of the CI I i yr V V r CF4 111w California Health&Safety Code,Section 25505,25533 and 25534. I understand that if the bolting does not currently have a rental,that it is my respomibility to natify the necupam of the rectimmonta which mast be ren.doe to iuuance of Certificate of Occupancy, s Owner or authmiudil — - ate TOTAL: ISSUED BY: V v OFFICE 10300 Torre Avenue Cupertino, CA 95014 Cil:� of Cupertlllo Building Division (408)777-3228 (408) 777-3333 (fax) November 12, 1996 Homeowner: 10422 Scenic Circle Cupertino, California 95014 SUBJECT Chimney repair, permit: #27648 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 Printed on Remled Paper