31500 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUIIAING-ELECTRICAL. PERMITNO. 31500 J1 C O O
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL J
BUILDING PROJECF IDENTIFICATION
BUILDING ADDRESS: _ SANITARY NO. I APPLICATION SUBMITTAL DATE
OWNER'S NAME: I ON"E�3L�O� COWRACfOR'S NAML': LIC NO: NIC COWROLM
d rTCALF S�'�ills 44$334/7
ARC CUENGINEER: LIC NO: ADDRESS: E3J—J-7 / IQ /•
CONTACT: PHONE - BUILDING PF,RMI'P INFO
$10.
SQ 0372 El Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
M qLF ' ❑ ❑ ❑
LICENSED CONTRACT'OR'S DECLARAHON 'Q'T'Y ELECTRIC PERMIT FEE
❑=Z
1 hereby affirm N
at 1 am licensed under partitions of Chapter 9(commencing JOB DESCRIPTION
with Scotian 7BBB)nf Uivision3af the Business and Professions Code,end mylittnse is
�00 i PERMIT ISSUANCE, RESIDENTIAL
n full force and effect.
VUR Live so Class I.it.a ❑SFDWL [I KITCHEN REMODEL
OR�ntc ' Contractor APPLIANCES-RESIDENTIAL, � ❑ADDITION [:3 PLUMBING RE-PIPE
FOy ARCHITECTS DECLARATION I]MUITI-UNIT ❑STRUCTURAL
PANELS
Z O �j I undersand my plans shall be used as public records MODIFICATION
OZl UPT0200 AMPS
❑ - ❑INTERIOR [1 CHIMNEY REPAIR
F H X ty l`LicenuA Prof toiowl OWNER-BUILDER DECLARATION 201-1000 AMPS .IMPROVEMENT
O '1
�V lr 1 hereby affirm thct 1 am exempt farm the Contmnor's License Ices for the OVER IOW AMPS CI BATH REMODEUREPAIR [I DEMOLITION
a following reason.(Section 7031.5,Business and Professions Calc:Any city or county SIGNS ELECTRICAL. � C1OTHER
C G .which requires u permit m construct,alcor,improve,demolish,or repair any structure
prionoits issuance,alsorequires the applicant forsuchpemtina file a signed steamer, SPECIAL CIRCUIT/MISC.
thnt he is licensed putsuantto she pnoislons of the Contractor's License Us.(Cl a see,9
no (commencing with Section 7")of Division 3 of the Business and Professions Code)or TEMP.tiETER OR POLE INST. COMMERCIAL,
IllNat he is exempt themfmm and Ne basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
z} Scotian 703 L5 by any applicant fora pennitsubjeco,the applicant tact civil penalty of POWER DEVICES EITENANT ❑FOOD SERVICE
not more than Eve hundred dollars($500). IMPROVEMENT
C ❑Las owner ofthe property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
5Fp will do the work,and the structure is not intended or offered for sale(Sec.7044,Business BOTHER
and Parfessiom Code:The Contractor's License Law does naa apply to an owner of OUTLETS-SWITCHES-FIXTURES
A' .. pmpeny 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 ELEM SQ ET.
sale.If.however.the building or improvement is sold within one yemofcompiether the SQ.FI'.FLOOR AREA $/SQ,Er.
owner-builder will have the burden of proving that he did not build ser improve for par- A
you of sale.). l iY
❑ 1,as owner of the property,am exclusively contracting with licensed contractors to
ensue(the project(Sec.7044,Business and Professions Com,,TTe Gmtrannr'e Li- Q Nov 2 U aw 1996
sense Law docs not apply m.an owner of property who builds or lmponex thereon,and T'Y. PLUMBING PERMIT' FEE
who contracts for such projects with a corrosions)licensed pursuanua the Contractor's �x
License Law. PERMIT ISSUANCE C
❑l an exempt under Sec. ,B&PC for this reason Uh VVrCItIBy
ALTER-DRAIN&VENT-WATER(CA) VALUATION
Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEV
I hersby eflirm under penalty of perjury one of the following declarmads:
Owner -
IhaveandwillmaimainaCertifiecteofConscrunself-insore for Worker's Compen- DRAINS-IPI�(�I7H STORIES - '1'YYE CONSTRUCI'I(lN
salon,as Provided for by Section 37(X1 of the Labor Code,for the perl'onnadce of the ,
work far which this mand is is sued. FIXTURE.S�PIBFIZ7P
❑1 have and will maintain Worket's Compensation Insurance,as required by Section
37M of th- Woe Labor Code,for the
�pperrf�foorqrm�annprce+ooff�the work forwhich this Permit is issued, GAS-EA.SYSTEM-T INC.4 OUTLETS s OCC.GROUP APN
Ce cirk
a�Alll6 t�NOGN1A1 po)cy Nu.YSi+s GAS-FA.SYSTEM-OVER4(EA)
CERTIFICATE OF EXEMPT )N FROM WORKERS'
COMPENSATION INSURANCE GREASOINDUSTRL WASTE INTERCEPTOR
Tble seminn OeW not becompleted ifahe permitis foronehundred Jolters($100) �' BUILDING DIVISION PEES�> ..
or less.) GREASE TRAP PLANCHECK FEC
I cenify Nat in the performance of the work for which this permit is issued,l shall SEWER-SANITARY-STORM EA.2W IT..
not employ any person in any manner so as to become subject to the Workem'Compen- ENERGY FEE
OZ satins LarsufCalifomia.Date WATER HEALER WNENTMLECfR
0 Applicant GRADING FEE
fA NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should WATER SYSTENUTREATING
['! Income subject to the Worker's Compensation provisions of the labor Code,you mush SOILS PER
Li�1y
45 forthwith comply withmeh provisions or this permit shall be deemed rooked. WATERSERVICII
�Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FI'. PAID
I hereby afErm that Here isarnnstmnion leoding agency for the performance of Dote Receipt
the work for which this permit is issued(See.3097,Co.C.)
Lender's Name TOTAL.:
AWL Lender's Address TOTAL:
a I minify that 1 have read this application and state that the above information is BUILDING FEE
r0 correct l agree to comply with all city and county ordinances and state lows relating it) QPY. MECHANICAL PERMIT 17EE
huiliingcon(invon.and hereby auNorFzerepresen...orsofdiscity to enactment the SEISMIC ITS
above-mentioned property for ma maian purposes, PERMIT ISSUANCE
(We)agree to mte,indemnify and keep harmless the City of Cupertino against ELECTRIC FHE
liabilitice,udgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH.
in consequence of the granting of this permit. PLUMBING HE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,(100 CPM)
SOU [E EGU`LA-TIOork` - MECHANICAL FEE
it. 0 c` AIR HANDLING UNIT(OVER 10,q)OCFM) CONSTRUCTION TAX
Sigrtame of Applic��rJaaNN✓C✓✓o✓[mmtt++a14Z ��' Date l EXHAUST HOOD OVMUCI) HOUSING MITIGATION FEE
HAZARDOUS ATF-RIAIS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material HEATINGUNIT(TOIOLo00BTIH
as defined by the Cupertino Municipal Code,Chapter 9,12,and the Health and Safety
Code,Section 25532609 HEATING UNIT(OVER 100,000 BTU)
I]Yes VENTILATION PAN(SINGLE RESID) PAID
Wirdas
Will the applicant or furore buimlding occupant use equipment or devices which Date Reccipt 9
'thnnous air malmaironts defined by the Bay Area Air Quality Mmi onnena BOILER'-COMPOR 100.100 BTU) -
istdn? (3HP TOTAL:
EJ Yea .IA. BOILER-COMP(OVER I00,000BTU)
I have read the hmardous materials requirements under Chapter 6,95 of Ne Cali- AIR CONDITIONER ISSUANCE DATE
fomib Health&Safety Cade,Sections 25505,25533 and 25534.1 undcom s!that if the NEW REST UENTIAL MECH. SQ.EL
maldingdoesnmca 0y huv aman, hall ie nay responsibilitym nalfy the cecvpam
ofth p�tlpematl mich mu. mea pri m iesuonre oft Cenifeme of Occupancy,
Owner or authnn dagent Dam TOTAL: ISSUEDB
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:MlR70YYNt1EOgSIONCORP. J FO6f LOC�C@i• ,�L .tet
'o STOREFRONT SIDE SIGN ELEVATION20690 CREEK BLVD a a»47&O r RZ7
STEVENS
. w e
CUPERTiNO, CA.
OFFICE COPY
® ,04 10300 Torre Avenue
(',ilv it Cupertino,CA 95014
Cl p rti.110 Building Division
(408)777-3228
(408)777-3333 (fax)
September 30, 1997
Footlocker
20690 Stevens Creek BI
Cupertino, CA 95014
SUBJECT Permit#31500, sign permit
Dear Business Owner:
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 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
ChristyAkatiff, Administra ive Clerk
Pinlrtl nrr l4n,:ycled('nprr