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S 0777 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY.JF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT Pl.unwwc McC"ANIGAL. Q 0 7 7 7 BUILDING PROJECT IDENTIFICATION J I BUILDING ADDRESS: SANITARY NR APPLICATION SURMITTAI.DAPI OW F:R' NAME: �PyJ�isic Cl ACTOR NAME: ^ LIC NO: NIC COlVTR0L# 73 0 6M CHI'I'EC'UEN liliN: LIC NO: ADDRESS: _a[ ❑ Z CONTACT: PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUh MECH 3— S z ❑ ❑ ❑ LICENSED CO ACTO 'S UI:CLARATION ()TV ELECTRIC PERMIT PEE 1 hereby aRrm that[.it,licensed under pmviouriv of Chapter 9(commencing JOB DESCRIPTION OIYz, with Section 7001 afDivi&4m 3 ofthe Business and Prafssions Cash.and my license is RESIDENTIAL IH O PERMIT'ISSUANCE F�� in lull force Inde ce ❑SPUWL ❑KI'FCH17N REMODEL. aUU License Cl ss — Llcn APPLIANCES-RF'_SIUIiN'DAI. ❑ADDITION ❑PLUMBINGRE-PIPIT LLLL�77 Uat Cnnwa; AHCIIITGC FS UF:C. It ❑MUhTI-0NIT ❑STNl1CfURAL 'D y PANELS Zp ay lundcrstlmd my phos xhull be used as public records UP T021XIAMPS OZ�O [I INTERIOR ❑SWCHIMNEY MING POOL AIR W Licenmd Professional 201d(XX[AMPS IMI'ROVP:MF:MI' E3DE OLINGPOOIS OWNEC thatIa exempt m CLARA'OGN C�Q 1 heathy affirm Ihnl I ora exempt from the Contractor's License Law for the OVER I0X1AMP5 ❑NATE RIiMODEL/RIiPAIR �DIiM01.1'I'ION 0,U U followin m(Section]IDI 5,Itusineas and Professions Cnde:An t un( ❑OfIII:R iy( following Yciynrcn y SIGNS ld.I.Cl'RICA), W!;W F which regnirte a elds.m core,Im,alter,imp,we,demolish, i repair any evunure � prlono,fiem,di,also requireslitenxiono for.mchpermitmlileo,Law(stmmnem SPECIALCIRCUIT/MISC. Ihm meta ,withSectio 70(XhofDoffic isionsnfd¢Cnmmemr'el.icemclaw(Chadedor �IYOp pter 9 that he is exempt pt therefrom and MDiasis for alleged exempt Professions Cade)or T'F.MI'.MITIiR OR POLE(NST. COMMERCIAL: 116 a that he is exempt therefrom and the basis for lite alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION WM $emion](DI.S by any applicant tura permit suhjecn lM1e appllcammacivil penalty of ('OWER DEVICES of mrc than five hundrMdallias($5W). ❑TENANT El FOOD SERVICE >. a ❑1.as owner of the propeny,ormy, employev with wages as(neir vale compeasalion. SWIMMING POOL ELECT RIC IMI'NOVEMEN'I' will do the work,and the unable isnm imendedorofiered fo...1.(Site.7044.Basin... ( ❑OTIIIiN ad 3 and Pre iota Code The Contractor's License Law does not apply to an owner of OUTLETS-SWITCHES pri who builds or improves thcreom and who d;cs such work himself or through his own employees, ore ded that such improvements arc not intended or offered fit, NEW IA i1. R aIle.If.however,the building or improvemen6%%old within one year oRompdetiom the SQ.IT.FLOOR AREA $/SQ.F1. er-huilder will have the bnrdcn of proving Lha(he did not build or Improve f F� point of nuleJ, ') I ❑Las,weerofthe pmpmy,ranexclusively Pfc,oing with licensed cora elsm tfo conmmm the prnjec[(Sec]IW4,Pwiness and Professions C,de:)The Contrac 's 1' TALTER censelawJresnotapplymunownerofpmllenywhobuildsorimprovesthere TY. LUMBI P MIT PEE who contracts for such projects with recmmetor(O licensed pureanno the Cana or's Licen.vc Law, ISSUANCE IumexelnplanderSec, ,B&I'Chuchism rZ DRAIN&VENT-WATER(ITA) VALUATION Owner DamWORKERS COMPENSATION DECLARATION LOW PROT ECF.DEVICE I hereby affirm under penalty of perjury ane of the following dcdamtiane: (have oral will maintain aCenlficateof Cmtsem m self-insure forWrkcr's Cmnpcm -FLOOR.ROO['.AREA,GOND, STORIES 'TYPECONS'rRUCI]ON satlom,as provided for by Seclina 37M of(he Lamm Code,for( e perliarm recol'the k for whicli tis permit is issud. ES-PER TRAP I have and will maintain Worker's Cnmprnva(ion Insurance,as acquired by Section 3700of the LaMar Code,far the perfonnanceaf the work far which this permit is issued. GAS-ITA.SYSTEM-I INC.4 OUT.HTS OCC.GROUT' APN My War r'sC tyleutinn}paura cc cameroli Policy n�� !14342 � 7— GAS-PA.SYSTEMOVER 4(EA) Cartier. CHRTI tISP� Policy No.: WORKC CI:RTIPI COMPENSATION SATION'IINN PROM WORK(:ItS' COMPENSATION INSUItANCG GRI?ASI%INIIDSTNI.WASTE IN'1liliCEl"ION BUILDING DIVISION FEE'S(Thissectionneednb otecumpleed ifthe permit is hu nehuodmddollars($HX) oalessJ GREASE TRAP PfANCHECK FEE I cenify that in the serformnnce of(he work forwhich this Perini[is issued,l shall SEWER-SANITARY-S'IORM EA.NXI F`L ' not employ any pemon in any romantic so as m become subject to(he Workers'Cannata ENERGY FEE zi Ration Laws of California Dam WAIF HR I(EATER WNI:N'1'IELECTR &Q ZQ Applicata 1 GRADING FEE F ; NOTICE TO APPLICANT:If,mm,making this Cerificam of Emnalalon,you should WAFER SYSTEMUREATING beano,sobject o the Worker's Compensation Provisions of the lata Code,you most SOH-S IEE forthwith comply with such provisionxnnhispermi(shallbedeemcd invoked. WATER SERVICE s � CONS'I'RUCTION LENDING AGENCY NEW RESIDENTIAL PILMB. SQ.FF. PAID Up I hereby affirm that(hcrclx a conga inn lendia,morcy farlhcperfonnmac of Date H«'IFI [he work for which this permit is issued(Sec.3097.Civ.C.) Lendce,Name TAI,: V Levdves Address 'TOTAL: I cenify that 1 have read this application and stale that the above information is - BUILDING FEE LFi f70 correct I agree to comply with all city and county ordinances and state laws reducing to QTY. MECHANICAL PERMIT FE U Z buildingcom1... iii,, SEISMUFFE aboveamenlioned property for inspection purposes. PitNMI'I'ISSUANCE (Wil)agree to save,indemnify and keep hunnless the City of Cupertino against ELECTRIC FEE liabilities,judgments.costs and expenses which may in any way accrue against said City ALTERORADDTOMECH. JD 7 in neegaence of the granting of this permit PLUNKING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING ON]F('IO W CFM) MECHANICAL FEG SOURCE REGULATIONS, a. AIR HANDLING ON]](OVER I0,000 CFM) CONS'I'RUC'HON'i'AX Signature of Applicant/Contrumor Date EXHAUST[FOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE: Will the applicant or future building occupant score or handle baeaN,us material HEATING UNIT(TO 100,00)BTU) as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(8)9 HEATING UNIT(OVER 100,000 IFI E3 Y" 2PTln VENTIIATION FAN(SINGLE RESTED PAID '- Date Receipt X Will the applicant or future building by the B use ct Ail Qu or devices which emir bar rdnus air cnnuminant as def red by the Buy Area Air Quality Management BOILER-COMP(311P OR 100,000 BTU) Dis(rim'r TOTAL: ❑Yea E:1 No BOILIiH-COMP(OVI?R 11X),(XE)BTU) AIN CONDITIONER I have mad the h ode.Se tions 2ls 5.M533 na under Chapterul,695 of the Cai ISSUANCE DATE building Health&Safety Crile.ea Sections 23505,is try and 23531.1 understand Net if the NEW RE.SIDLNTIAL MECB. SQ.FT. building dvcznm currently have tenant,that it is my responsibility mnotify[he occupant C./' ✓F� of Ne •m le whits W tifi of.cercmcnf Occupancy. Owner ora r teed aflem Dote TOTAL: Swill)BY OFFICE ��Y .; C1tC of ,cc, '�'b® 10300 Torre Avenue Cupertino, CA 95014 Cupertino Building Division (408)777-3228 (408)777-3333 (fax) February 9, 1999 Homeowner 20655 Scofield Dr Cupertino, CA 95014 SUBJECT: Permit#50777 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 • Printed an Pecycled Paper