30659 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY IF CUPERTINO BUILING-ELERICAL PRMITNO.``
30659
BUII,NN' PLUMBING-MECHANICAL
BUILDING PROJECTIDENTIPCATiON
BUI IINGADDRESS: - SANI'I'ARYNO. APPLICA'TI SUB TI'ALDA'IT
3 m� S-r� v�Ns t r k.
OWN A��Nt G` P 4E:je3r CONTRACTOR'S NAME: LIC NO:
GG 11MMSS DD NIC CONTROL#
1 HIFIC f/ NGINEER: �l LIC N ��, IDDR17SS:
b1� . N`sit .
ONTA�41 ^ PHONE: BUILDING PERMIT INFO
C ❑ Consultant Fecs Paid by Applicant(Initial) ELEC7 PIX B E
LICENSED CONTRACTORS DECLARATION - QTY. ELECTRIC PERMIT FEE1 hereby unlimited;.m licensed under provisions of Chapter 9(commencing JOS DESCRIPTION
O0Z
� wide Scaion7")ofDivisimn 3ofthe Business and Professions Code,andmns
y license is PERMIT ISSUANCE RESIDENTIAL,
W r
full force and ellen. ❑
�UV License Class Lic.# SFDWI. ❑KITCHP.N REMODEL
��RN PANELS ❑
Dam Comrumor APPLIANCES-RESIDENTIAL DADDITION ❑PLUMBING RE-PIPE
re ARCHITECTS DIiCLARATION MULTI ❑ CT
UNIT STRUURA[.
ZOt�2 lundersmnd my plana shall be used as public records - MODIFICATION
UPT0200 AMPS
OZ—O - ❑INTERIOR C1 CHIMNEY REPAIR
F�.#'.,W Licensed Professional 20I-1000AMPSIMPROVEMENT�d OWNER-BUILDER DECLARATION -•-
C�� I hereby affirm that 1 rat exempt from the Contrunar'x license Law Inn the OVER]"AMPS El BATH REMODELUREPAIR El DEMOLITION
�•O 0.V following rcamn.(Section 7031.5,Business and Professions Cede:Any city or county SIGNS ELECTRICAL ❑OTHER
u.WF which requires a permit m alter,improve.aimprove,de.Nidt,or repair any nmic are
�`y prior to its is.+umm%elm requires the applaud for such pconitto file a signed statement SI'IiCIAL CIRCUIT/MISC.
that he is licensed pursuant a the provisions of the Contractors License Law(Chapter 9
qp0 (commer<ing with Section 7oo(B of Division 3 ofthe Business and I'm fessions Cale)or TIiMP.METER OR POLE INSq'. COMMERCIAL'
6 e' that he is exempt therefrom unit the basis for the alleged exemption.Any violation of
o ❑N WBLDO/ADDITION ❑DEMOLITION
m or,name th n le hundred
d.fl for apennit nubjeos the applicum mucivil penalty of POWER DEVICES ENANT
not more than five hundred dollars(5500). El FOOD SERVICE
F Q ❑h,as owneroflhe pmpeny,or my employees with wages as theirs ole compensation, SWIMMING POOL ELECTRIC I.MPROVEMENT /
will do the work,and the structure is not intended mattered for sale ES 7044,B []OTHER OTHER
se and Professions Cade:The Centimeter's License Law does not apply man..net
of )UTLETS-SWITCHES-FIXTURES i/O
property who builds or improves thereon,and who dors such work himself or through
his own employees,provided that such improvements are not amended or offered for N17W RESIDENTIAL.ELECTR SQ Pn
sale.If,however.thebuildinger impmvemeni scold within oncyearafcompletion,the SQ.IT.FLOOR AREA S/sQ.FI'.
monobuilder will have the burden of proving that he did not build or improve for pun- 9/
pas e
1.asaten. 41Z "At
TOTAL: _Qk
❑ 1,as owner of the property,oat exclusively contracting with licensed contractors to
eoonmcwWprojectpplyonn wnerosstrod Professionsds or i The Cmtmamr, Li
cerise l.uw does not apply man owner of Oropcny who builds or improves thereon,and QTY ° IN ERMrr FEE
who conar5 for such pmjecrs with a centmanons)licensed purutant to the Contractors
License Li. PHRMITIs UAN
C I..exempt under Sec. ,B&P C for this reason
Owner Date ALTER-DRAIN EN "TER(EA) , 'y`ALUA�1'IOON
WORKER'S COMPENSA'T'ION DECLARATION HACK FLOW PR(l'IE(.T. E Z �+ S
1 hereby union under penalty of perjury one of the following declarations
10
I have and will maintain a Certificate of Consent to self-insum for Worker's Camper- DRAINS-FLOOR,ROOF,AREA,GOND. STORIES' TYPECONSTRUCIGON
tion,rs provided for by Section 37M of the Labor Code,for the Performance of the
work for which this permit is issued. FIXTURES-PER TRAP
❑ I have and will maintain Worker's Companaatlao Insurance,as required by Section
3700 oftheLahor Code,for the performance of the work for which this permit is issued OAS-IiA.SYS'I'IiM-f INC.40UTLETS APN
My Workera,Co.pene diem Insurance carrier and Policy marcher me:
Cannel: Policy No.: GAS-EA.SYSTEM-OVER 4(RA)
CERTIFICATE.OF EXEMPDON FROM WORKERS' -
COMPENSATION INSURANCE GREASIVINDUSTR1,WASTE INTERCEPTOR
('Ibis section need not he completed if the pemeit is for one hundred dollars is1W) 1 3&PEES
orlc,s.) GREASETRAP PLANCHErK FEC
leenify lhahme perfnrmunce of thework far whichthispermit isi.,med,l shall SEWER-SANITARY-STORM IiA.210 FT.
not employ eny perm.in any manner so as to hecome subject to the Worker'Camper- ENE M E
O Z smim laws of Califomi..Date WATER HEATER W/VENT/ELECTR
7 Q Applicant GRADING FILE
G y NOTICE TO APPLICANT:If,after making this Certificate mf Exemption,you should WRIER SYSI HMfI BEATING
a �^ become subject to the Workces Compensation provisions myths Lubar Code;you must SOILS FEE -
[S7 G forthwith comply with such provisions or this permit shall hedecmed revoked. WATER SERVIC17 -
7
CONSTRUCTION LENDINGAGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID Z Ihertby affrm that is omi.n lending agency for the performae of Dam eceipt#
WP the work(or which this permh iv issued(Sce.3097,Cie C.)
Q F" Lenders Name TOTAL:
WLenders Address TOTAL:
Iy 1 ccrafy that 1 have read this application and nam that the Niceuinformation infoation is BUILDING FEE ,0
A correct.l agree to comply with all city and county ordinances and state laws mining no QTY. MECHANICAL PERMIT FEE •2/
V 4 building construction,and hembyauthonze represemativesofthis city merrerupn the SEISMIC FEE ##77
above-mentioned properly for inspection pugawes. . I'GRMIT ISSUANCE(We)agree to Savo,indemnify and kcap harmless the City or Cupertino against ELECTRIC FIB: •'f 0
liabilities,judgments,costs and expenses which may in any wry avcme ageinn said City ALTER OR ADDTO MECH. �S.•7/�
11
in onmquence of Ne got t as of thi melt. PLUMBING FEE
APPLICANT UNDERS NDS W .f OMPLY WITH ALL NON-POINT AIR HANDLING UNIT GQ I0,000 CFM)
SOIIRC 0 TI MECHANICAL.FEE 7. •lO
Z-�Z-� AIR HANDLING UNIT(OVER 10,gOCFM) CONSTRUCHONTAX-
Sign re of Applin noDae EXHAUST HOOD ONMUCT)
H S MATERIALS DISCLOSURE HOUSING MITIGATION FEB
Willtheapplcamtoto,.e
building cccupam store.,handle hacaNmus material (HEATING UNIT(10 100.0013 BTU)
as defined by the Cupertino Municipal Cole,Chapter 9.12,and the Health and Safety
Coda,Section 25532(.)' HEATING UNIT(OVER 100,000 BTU)
,pees 0 N -
VENTILATION PAN(SINGLE RI?SIU) PAID
AN, Air Quality
Management Date Receipt#
Wrll the applicant m furore building occupant use equipment Mana which BOILER-COMP DHP OR 100,(011 BTU)
nit hazuTOTAL:
refinementsas defined by the Bay Arca m
Wa'! ds air co
El Yet r)No, II<IILER-COMP(OVER 10fl,(KKI BTU) ,
I have mad the hazy a enols ,uimmen'&under Chapter 6.95 of the Cali- A I R CONDIq'ION ER ISSUANCE DATE
forma Health&Safe C c ns 2330,23533 and 255:14.1 understand that if the NEW RESIDENTIAL MECH. SQ.FT.
buildi eit seaut it is my responsihilirymnotify the cecupunt
art a I'd metprimmis,amnm Ufa Cedxj,c
liver onWil a Date TOTAL: ISSUED BY:
OFFICE
r®•
10300 Torre Avenue
Cupertino, CA 95014
�11��'1` ll1.0 Building Division
(408)777-3228
(408) 777-3333 (fax)
November 3, 1997
Business Owner
20300 Stevens Creek Bl
Cupertino, CA 95014
SUBJECT Permit#30659
To Whom It May Concern:
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. We
. are missing our records from February 5, 1997 and we believe this was the date you were
scheduled for your final. 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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
P;mtetl nn Recvrletl Psper
l