30404 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMITPLUNUHNG-MECHANICAL. 30405
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO, APPLICATION SUBMI'PFAL DAI'
i It s,7 !3,4-,a Far P-d r S 0
CA a
OWNER$SNAM� 1 P�.—/ ' 1 CONTRACTOR'S NAME: ulA.unn1L�
\\�` N/C CONTROLO
. RCHITECT/ENGINEER: LICNO ADDRESS. ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
22 ❑ E3 ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERFEEfK
I I hereby aflrnt that 1 ant licensed under pmvislnn.,of chapter 9(commencing JOB DESCRIPTION
��Z wall Section 700O)of Division 3nfthe Business and Profession.,Code.and my license is PERMIT ISSUANCE RESIDENTIAL'
F�ty S full force and t.3 4 ❑SFDWL [I KITCHEN REMODEL
G U U License Chis Lie,.N
Dam Cmensawr APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBINGRE-PIPE
F.YY ARCHITECTS DECLARATION PANELS
z lunderlandm hll be ural ac bit.meotd., MULTI-UNIT El STRUCTURAL
ZOrn- ypanss a pu MODIFICATION
O Z UP TO 20D AMPS
F F�W LinmscJ Profmsiunal ❑INTERIOR ❑CHIMNEY REPAIR
OWNER-BUILDER DECLARATION 381-IIX111AMPS IMPROVEMENT
Q I hereby affirm that I am exempt from the Contractor's License Law for the OVER!BOB AMPS ❑BATH RE,MODEDREPAIR ❑DEMOLITION
f°' a U Selluwing reason.(Section 7831.5,Rashness and Possessions Csde:Any lily or county SIGNS ELECTRICAL []OTHER
1+1 O y which requires a permit m construct,alter,improve,demolish,or repair any sanctum
F. yg prihmimism.n,eldso re9nimstheapplicam fnmch famn, ,,file vsigned swtement SPECIALCIRCUTUMISC. gar
Z�P thathe is Imensedpursuant to file pmvnions ofthe Contractor's license Law(Chapter9
COO (commencing with Section]888)of Division 31ddic Business and Pmfesions Code)ar TEMP METER OR POLE INSI'. COMMERCIAL
d c that he isexempt therefrom and the basis for the alleged exemption.Any violation of
Section 703156 ❑NEW BLDG/AUDITION ❑DEMOLITION
m Five
sunjeco.c theapplicnm to civil Penalty of POWER DEVICES
FZT tmorc Nan❑arc hundred dollars(SSW). ❑TENANT ❑FOOD SERVICE
=a0 ❑ 1.as owner(if the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRICIMPROVEMENT
F will do the wnrk.vndthm someone is not intended or Offered for sale(See.]Bi4,Business []OTHER
W3 m and Professions Cole:The Contractor's License Law does not apply m an owner of OUTLETS-SWITCHES-FIXTURES
0. property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECfR SQ 1T.
sale.If,however,the haddingor improvement is sold within one yearofcompletion,theSQ.FT.FLOOR AREA $I$Q.14.
lir-builder will have the burden of proving that he did not build or improve for par_
Firm of sale.).
❑Las owncf of the property,am exclusively contracting with licensed contractors to TOTAL: 191996
constant W
the project(Sec.] 4,Business and Professions Call:)The Cmumctnrs Li- r.A
cense Use does not apply to an owner of property who builds or improves themm.and QTY. PLUMBING PERMIT VAI'
who contracts for such projects with a contrxmr(s)licensed pursuanno the Comractor's F E
Licloo,L.W.
I am exempt under See. ,I1&P C for this mason PERMIT ISSUANCE 1lt lli Llo;iFs`111`•I)
ALTER-DRAIN&VENT-WATER EAd
Owner Data VALUATION
WOR KBR:S COM PENSATION DECLARATION BACK FLOW PROTECT,DEVICE
1 heresy affirm under penalty of p,do,one of the following deal....i...:
J l have not will maintain a Cenificme of Consent to self-insure for Winkles Comport- DRAINS-FLOOR.ROOF,AREA.COND.
stinn,as pruvitled fur by Section J]W of Ne Lollar Cale,for the perfOrmana of the STORIES TYPE CONSTRUCTIUD
work for which this permit is issued FIXTURES-PER TRAP
❑1 have and will maintain Worker's Contpenemion Insurance,as m,dhcd by Section
37110 of the later Code,for Ne perf.homaoc of the walk for which this permit is issue d. GAS-EA.SYSTEM-I INC.4 OUTLET$ OCC.GROUP
APN
My Work "Cm di� 7e Ter and Polley numtpj in „'�! GAS-
Catricc or y Pat Ne../✓•�G. .I +� EA.SYSTEM-OVER4(EA)
CERTIFlCATIi OF EXEMPFION FROM WORKERS'
COMPENSATION INSURANCE GREASEBNDUSTRL WASTE INTERCEPTOR
(This section need moo be complated film permit is Tamm hundred dollars($100) BUILDING DIVISION 1*EES
or less) GREASE'rRAP
Icenifythd in the dormanceofthe work fn-which this PLANCHECK FEE
pe the Workers,
Comnall SEWER-SANITARY-STORM F.A.2W FT.
mot orlon arty person many manner m as to become.mnjm m the Workeds'Compcn- ENERGY FEE
O ,� smion laws of California.Doe EWATERTF,R WNEN1'/ELECTRz O ApplicantGRADING FEEEE
y NOTICE'TO APPLICANT:IL afar making this Certificate of Exemption,you should TEMIIRRATING
become subject to the Worker's Compensation provisions of the Isom Code,you must SOILS FEEforthwith comply with ouch pml,inns ur tris permit shall he deemed revoked. VICEUOCONSTRUCTION LENDING AGENCY EN'1'IAL PLMB. SQ.J
PAIDereyaimtatteresa<Onxwcdion lending vgency Nr Ne perfomtancc of Date Receipt4I. P: he workfor which Nis perm is issued(See.309].Civ.C.)
O ULetter's Name TOTAL:Lender's Address T
F0.i I eerily that 1 have read this application and Nude Nat the above information is BUILDING FEE
h comet,l agree to comply with all city and county ordinances and sum laws Maung to QTy. MECHANICAL PERMIT
U Z buildingconsmmums and herchy awbnmerep¢senmtives of Nis city memernpon the FEE SEISMIC FEE
abov>mentimad property for inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep harmless the City of Cupertino against aMITIGsrION
liabiliticiJudgmedns.cosis and expenses which may in any way accrue against mid City ALTER ORADDTOMECH.
is mruestuenm of the germing of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO.WO CFM)
SOURCE R r ,ATIONS. E
_ AIR HANDLING UNIT(OVER 10,11!1(1 CFM) TAX
algorithm of Applic macmr Date EXHAUST HOOD(W/DUCT)
f; HAZARD US MATEN IALS DISCLOSURE TION FE-E
:S
l the applicnm nrfm mhsilding occupant.slow orhandle hacershos material HEATING UNIT(TO IOL00I BTU)
as def red by die Cupertino nicipal Code,Chapter 9,12,and the Hcalth Land Surety
Code,Section 25512(x)'1 HEAPING UNIT(OVER 100,000 BTU)
❑Yes No
VENI'ILA'I'ION BAN(SIN GLE RESID) PAID
Will the applicant or dm rebuilding occupant use entrapment or devices which Dam Receipt M
nit hazardous air conumina ss defined by the Buy Area Air Quality Management BOILER-COMP(]HP OR I00,000 BT11)
Jisuict9 TOl'AL'
Dyes in BOILER_COMP(OVER IokOOOB'rU)
1 Ihave read the har,'a s meacnits requirements under Chapter 6,95 of the Cali- AIR CONDITIONER
forma Health&Safety Cale.Sections 25505,25533 and 25534.1 undersand that if the ISSUANCE DATE
Wilda not currently have a tenant,that it is my responsibility m nobly Ne occupant NEW RESIDENTIAL MECH. SQ.FF.
of s which teas od met Pon to ismance of a Certificate of Occupancy.
Usher or arra idled agent Date- TOTAL:
ISSUED BY J;:V
OFFICE
10300 Torre Avenue
•
ul, Cupertino, CA 95014
Cil.c
cupertlllo Building Division
(408)777-3228
(408)777-3333 (fax)
' April 3, 1997
Homeowner
1159 Stafford Drive
Cupertino, CA 95014
SUBJECT Permit #30405
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 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 permit card shows the final sign-off,
would you please contact us so we may complete our records?If the permit is not signed
off, 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 Qlerk
0
Pnn:ed 011 Recycled Riper