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
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