30981 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY '
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 30981
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING I'ROIF.CI'IDENTIFICATION
BUILDINGADDRESS: SANITARY NO APPLICATION SWIMI ITAL DATE
2
OWNER'S 1 ` PHO': Z / CON'I'R (1N'S NAMP - LIC NO: N/C CONTROLp
RCHITECT/E GINEE v LICNOP ADDRESS:
vl
CONTACT. - � HONK: - BUILDING PF:I2 INFO
, I�/ ❑ Consultant Fm Paid by Applicant(Initial) ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARAI'IO VN QTY ELECTRIC PERMIT FEE ql )G
I hereby M.that I am licensed under previsions of Chapter 9(commencing JOB DESCRIPTION
�,Z with Seaion]OINq nfDivision3ofthe Business and Professions Cale,andm licen.e is
OO Y PERMIT ISSUANCE RESIDENTIAL: -
�.. Lifullfarce dnA effect. -
V U License Class Lie.N SFDWL �KITCHEN RP:MODEI.
I Zul Dam Contractor APPLIANCES-RF E I AA . ITION ❑PLUMBING RE-PIPE
ARCHITECTS DECLARATION 0 TI-UNIT ❑STRUCTURAL
H K I uadcrxtand an hall be used us utile records PANF.1 S
Z, .y� YPOtns.s F MODIFICATION
C)z4 UPT021NIA '
f=[? u�1 Licensed Professional 19 AJ El INTERIOR ❑CHIMNIEY REPAIR
J 201-I(NNl P IMPROVEMENT' '
¢y.
OWNER-BUILDER DECLARATION OVER XZ MPS
h^a 6 1 hereby affirm that I am exempt freta the Contractor's License Law for the ❑BATH REMODEI/RIIIja DEMOLITION
ip5,O0.V following remr,n.(Section]0315,Business nnsl Pn,fcssian,Code:Any city ser cation, SIGNS ELECTRIC ❑OTHER Pe /{ D
it.a It.F which requires a permit to c monall,alter,improve,demolish,or repair any orucum
�� prior to itsissuance,also requires the applicant for such penniuonleasiland stmemm
eSPECIAL CIRCUIT/MI C.
$., 0 Nat he is licensed pursuam 1.he provisions ofthe Connector's License Law(Chapter 9 �AN) a!!A
rr OO (c°mmeadng with 5ec[ion]OlXq of Divislon9 ofthe Nusincas onJ l'rnfessinns Code)or TEMP.METERO t ,� ti COMMERCIAL: V III&"
dqi5 n y that he is exempt therefrom and the hasis liar the alleged exemption.Any violwlon of ❑NEW NL /l'sU�1TION ❑DEMOLl9'ION
Way Section 7031.5 by any applicant for permit subjects the aPPlicannoacivil penahy of POWER DEVICES ❑TENANT f�(- yy��,{,p
Fs nm more had five hundred dollars($500). � Uttgkf�ffARFeRVICE
O ❑ Las owner oftheproperty,or my employees with wages as theiesole compensation, SWIMMING POOL ELE IC IMPROVEMENT �r�t'NfVV
will do the work,and the saocture is not intended or offered for sale(Sec.]044,Easiness ❑OTHER
m and Professions Code:The Contmmors License Law does not apply to an owner of OUT L1!TS—SWI TCUES—FIXTURES
property who builds or imprves thereon,and who does such work himself or through
his own employees,provided that such improvement;are not intended or offered for NEW RESIDENTIAL ELECTR SQ ET.
stile.If,howevcf.the heildi ng or improvement is sold within one yudi of completion,the SQ.FT.FLOOR AREA $/SQ.EF.
ownerM10 o).e will have the harden of proving that he did not buil]or improve for par- �lot-lot-o dw1ld
11,
es owner of the property,am exclusively contracting with licensed carnrs
memto ot
vs um the project(Sec 70,14,Business and Professions Carl The Contractor.,Li-
cnseLaw does not apply it)an owner of properly who haild.ter Improves m.,eon,and QTY. MBING PERMIT FEE
who convects for such pmjmis with a contractors)licensed punume to the Contractors
License Law. PERMITI NCE r
lam exemptundSec. ,B&P C minreason
ALTER-DRA -W 'fN f[a) VALUA'I ION
water Dale
WOTUKER'9 COMPENSATION DECLARATION BACK FLOW P CCI'. CE
I hereby affirm under pcnalry of peapary one of the following declarnme:
13Ihuve and will malntuinn Certificate of Consennnself-insure far Worku's Camper- DRAINS-FLOOR,RO ARCA, D.
fail on,as provided for by Section 3704)al )at labor Code,for the performance of the _ STORIES TYPE CONSTRUCTION
work for which this perht is issued. FIXTURES-PER'FRAP It `
I have and will maintain Workers Compensation Insurance,as required by Section x
3700of[he Labor Code,for the performance of[he work for which this Permit is issued. GAS-EA.SYSTFM4 INC.4 OUTLETS OCC.GROUP APN
My Worker's Cf lismsntin i I nsurance carrier Old Policy number aro:
Carrier: Policy No.: GAS-1!A.SYS'I'HWOVER 4(HA) '
CERTIFICATE OF EXEMPTION FROM W ORKBRS'
COMPENSATION INSURANCE GREASFANDUSTRL WASTE INTERCEPTOR
,(This.wcdnn nerd oat be complcmdifthepennit isfonkhd $IfNp HU LDIN IVISIONPP.erGRI!ASIiTRAPI certify that in Ne Performance little work for which lIshall PLANCHECKF SEWEN-SANITARY-STORM EA.200 LT.nut employ any persn in any manner sa as[o hecome su 'el.,.- ENERGY FEE
z sat am Laws of California Date WATER IfFBTF.R WNENTIIiLF.CTR
yQ O Applicant _ GRADING FEE
q y NOTICE TO APPLICANT.IL after making this Cmific x ,9�. ,you s s W SYSTEM/IREATING
become subject to the Worker's Compensation pmvisionsofth ,abmyCaw-eTyou t SOILS FEB.
Wti forthwith comply with such provisions onhis cennit shallbe eemeeAAreLucyl. �s ER SERVICE.
Q 1
zz CONSTRUCTION LENDING AGENCYNb RESIDENTIAL PLMB. SQ.FT. PAID
V O Ihertby affirm thauhere ise romwaion lending agency fm the primmest f De eceipis
44 r the work for which this permit is issued(Sec.3097,Ci,C.)
O U Lender's Name TOTAL:
Lender's Address 'I
1 certify that I have read this application and slate that the above information is BUIL FE
V) correct.l agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE
V building construction,and hereby authorize representatives of this city to enter upon the SETS C 'E
,nova-Nemlmned property far inspection purposes.
(We)agree to of indemnify and keep hornless the Cary of Cupendo against PERMIT ISSUANCE ELEC'I'RI FEE
1!abilities,judgmems.costs and expenses which may in any way accme against said City ALTI!R OR ADD TO MECH.
in consequence of the gemming of this per it. PLUMB GFEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(T01O.MOCFM)
SOURCE. ILATIf NS. MECH NICALFRE
AIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUCT TA%
Signature pphour/ noucm, Date EXHAUSTHOOD(W/DUCD HOUSING MITIGA'ION FEE
H no— MATERIALS DISCLOSURI!
Will theapplacant or future building occupant semem handle hazardous material HEA'T'ING UNIT(TO 100.000 BI'U)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)?. HEATING UNIT(OVER 100.000 BTU) -
❑Yes DNa PAID
VENTILATION PAN(SINGLI!RC$ID) pam
RecciptM
LWill the applicant or futurebuilding occupant use equipment or devices which BOILER-COMP(3HPOR 100.000 BTU)
.nit hazarduux air containmentss ans defined by the Bay Arta Air Quality Management TOTAL:
District?
❑Yes 7 N BOILER-COMP(OVER lit BTU)
Ihave read the hazardous materials requirements under Chapter 6.95 ofthe Cali- AIR CONDITIONER
ISSUANCE DATE
(urate Health&Safety Code.Sections 25505,25533 and 25534,I understand that if me NEW RESIDENTIAL MECfI. SQ.FT.
building docs oat currently hoc ti tenant,that it Is my re,l onsahilhy,,notify the occupant
of the requirtments which must be met Prior to issunncc of a Certificate of Occupancy. '
r
Owner or authorized ager Oar TOA ISSUED ItY
OFFICE
® 10300 Torre Avenue
Cupertino,CA 95014
cu per t,1 1.0 Building Division
1 (408)777-3228
(408)777-3333 (fax)
September 30, 1997
Homeowner
721 Stendhal Lane yl
Cupertino, CA 95014 b 1�
SUBJECT Permit #30981
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 Geld, 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
I
Christy Akatiff, Administrative Clerk
J
Pnnled nn Rnryrind P;gmr