S 0878 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY-OF CUPERTINO - BUILDING-ELECTRICAL Vpx lPNO. o878
BUILDING DIVISION APPLICATION/PF,RMIT PLUMBING-bIECIAmCAI' SlJ
HUII.DINGPITOJECT.IIII')NITFTCAI'ION I/ ��i i
BUILDINGADDRI35: SANITARY NO. APPLICATION SUBMI'PI'AL DAI'ii
i deo ro cis "ON't
OWNUIVSNAMIl PIIONIi'. CON'I'ItACTOR'S NAME', LIC NO'.
NIC CON I'ROI,b
ARCHFLECTFNGINEEC - LIC NO: ADDRESS: ❑
ON'IACT: 'PHONE: - - f';.;f+= 7;' -'+13UILDING PRRMIT INFO + '
❑ Consultant Fees Paid by.Applicant(Initial) BLDG I;[HCl' PLUMB ME; it
A6ovE ,, ❑ ❑ ❑
hICINSED CONTRACTORS DECLARATION QTYI1 'ELECTRIC" st PERMIT FEL
{ E "Is
I herenytrfrn nail it,fiterned undarpr"v a...af Cloqua,9fanian,in, JOB DESCRIPTION
O�Z wSection in,S7W)of D' i.ion 3 at theulu
Bins and Professions Cade and any license PERMIT ISSUANCE. RESIDENTIAL �-
a100 I
Fq� in full intersect affect
❑SIUWI. [I KITCHEN RIiAfODEI.'.
6UU License Class- Lie.bAPPLIANCIS-RESIDIiNT1AL El ADDITION
❑PLUMBING RE-PIPE
F Z W Dam- Constrictor
vi6y - - - ❑MUCI'1-UNIT ❑STRUCTUTAL
ARC({I'11iCPS DECLAMATION
p.,pm PANELS MOUIFICA'IION
Z O r-.Z. I undemmnJ my plums Shull be u.ed as public records UP TO ME AMPS ,����P
OZ�� LxTIN'PROVR ❑CHIMNEYREPOIL
LiauscJ Pmressi-nal 2111-I10X1AMP5 IMI'NOVEMF.N'1' OSWIMM1fING POOLS
OWNF,N-BUILDER DECLARATION OVER INS AMPS ❑BA'1'11 RHMODHIJREPAIR ❑DEMOLITION
6 1 hereby afflnn
0.' .bat I ant exempt front the Contract Llan,,Law,liar the
iqyxS O L U following reason.(Section 7031.5.Business and Professions Cade:Any city n,county SIGNS ELECTRICAL ❑Ol'I{lila
which squire,a .it to consancor,
u ,alimro
pve,demolish,or repair say saucmre -
F. g poor tip its issuance,aLw requires the applicant for such gamin In rile a signed statement SPECIAL Cl RCUTUMISC.
that he is licensed pursuant ver the provisions of the Contractor's License Llw(Chapmr9
CO (A ariencingwhh Selo ion 700(0o1'Id,Wou3ol'The Businua and lsn+fessions Cada)", TEMP.MIi'I'IiR OR POLI3INST. IA
dqx C that he is exempt therefrom and.he basis far the alleged esempliun.Any violation of - N ABLDO/ADDITION ❑DBh1OLITIQN
W�rn Section 7031.5 by anyapplicant Luo peritsubject,the applicant toacivil penalty-f POWER DFVIM- �LTHNA(NT ❑FOODSERVICE
t more than Bve hundred dollars(3500). VEMENTzOI...ownarefam pmperlorny employees with wages as'halls.lee-mpersntion, SWIMMING POOL ELECfRIC11 domowork,uralme,muquma,n-I inerndwloroffamd ln.sale(Sec.7044,BnsincsP R
and I'mfe,sicns Cade:The Contractile,License law Jou not apply to cot owner of ORTUX I'S-SWITCI IHS-FIXI Falls 0
propc0y who builds or improves(here,,and who dans such work himself nr mhnmg
his own employees,provided that such improvements are nal amended or affcmd fill NEW RESIDENTIAL ELECTR SQ FT.
sale.If,however,the building or impmvmm
e - issuld withinone year ofcomplc.ion:the SQ LOON AREA SISV.IY I'.
ct-halide,will Lave the bagden of pmving.huI In did not build of improve in roar-
' Poo of sole.). -
1,as owner of the property,am exclusively contracting with I claed contractors to I
construct the project(See.7014 Business and Professions Cale.)The Contract r:L- -
Law does nm apply to owner ff perry hn bold: - p thereon,and ?TY".
t„++ PLUMBINCpE MIT I '1 7)1.1 FEE +
who un nrct,La,a,l.pnajects wdh a contact ill' cnw, noun To The Cnnl t
Li,,ran l.are _ PERM I'FISSIJANCH
❑Iamexempt 1 B&PC Barad
mo -
ALTE R-D IN&V T W' A) VALUATION
Owner Data
WORKER'. IMPENSATION LARAHON BACK FILO P '- 'T s ICL -
1 herehy af0rnm under penalty of perjury nn of the following declarations: - / O
I
over. will mainmina Cenifcme of Consent to ulf-insure for W-,kers C-open- DRAINS-1408R.ROOF.ARE .COND. STORIES 'TYPE CONSTRUCTION
tion,a provided far by Section 3701 of the LaMar Code,for the perf-ranar of the
ark far which his peil is issued. FIXTURES-PER TRA('
r
1 have and will anaintain Worker's Coinpcn.atlon Insurance,as required by Section '
30(X1 ofthe Labor Calc,for the ped'urnmance ofthe work for which this pornin is issued. GAS-EA.SYSTEM-I INC.4OD'I'i,li'TS OCC.GROUP AI'N
My Wmkees Compensation Insurance carrier and Policy number are: - -
Carrier: Policy No.: GAS-13A.SYSTEM OVER 4(FA)
CERTIFICATE OF EXEM PITON FROM WOR KERS' GREASI%INOUSTHI.WAS TE INTERCEPTOR
COMPFNSA'1'ION INSURANCEB .1 NO DIVISION FEES
(This section need notbecompleted lobo permit isforamehundred doliariFilan, GRFASI'.'I'RAI'
or lea,) LANE CK FH
r Icerafy that in the perfnrance ofthe work for which this permit is issued.i shall SEWER-SANITARY-STORM PA.21X1 FT
.at TniN.,any pend in any mann.,an as to become subject to the W-,ken'C-rupeo- ENERG li
�
'a7.a cillo..Laws of Cali hands.Data IR
0 WATER II LATER W/VENTIELECTApplicant I AI
NOTICE TO APPLICANT:If,aiier making this Certificate of Iimuntri-n,you should WATER SYSTEM/I'RIiATING SOILS itiEtV
(•' hecome subject to the Worker.Compensation provisions of the Calm-r Cola
e,you mst
W � forthwith comply with such provisions or this perit shall be deemed acloarJ. WATER SERVICE
Q
CONSTRUCT i1CTIONLENUINGAGENCY NEW HISIDGN TIAL I'IA1N. SQ.PT.
U O Iherehy afflnn that there is.construction lending agency fonhe perfonuance of 7111MBIN111
ReceiPtb
f2 the weak for which this permit,is issued(Sec.3097,Civ.C.)
OU (milds Name '101'AL:
foe J .Add :, ro m.'s I , �._ cot 1 nfy Tht lhavc reeJOi.w pPl 't J:II roll( M I -tit t. 1 I f gt Q'fY. MECHANICAL'PFRMI9 1, FEF 'budding consutcton.and hereby author rep sentatives ofthis city to a ter upon the above-mentioned property for inspection pure ses. PERMIT'ISSUANCE.(Wer)rg,ceuasave,Indenmifyand keep hnnnlass the CityofCupertinoagtiretIiuhilitiesjudgmens,eossunJ expcnves which may inany way locate agaln.l said City ALTHRORADD'TO MECH. ”
in
APPLICANT
Nthe gaming S this peril.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT AIR HANDLING UNI'I'(TO III,(AM)CI'M1)
MF.CHANI L ItiE
SOURCE REGULATIONS.
AIR IIANOLINC UNI'I'(OVER 111,01X1 CPM) CONSTIXUCT N'IAX
Signature of ApFlicanVCommror Data: EXIIAUS'1'1{OOD(WIDUC'0 HOUSING MI'I IGAIION FEE
HAZARDOUS MAITR1A1 S DISCLOSE—
Will theapplicantarfrom building aacatend,rare nr handle bazarlous mamfial HEATING UNIT!1011X1,(00 BTU)
au defined by the Capenino Municipal Code,Chaplet 9.12,and the Health and Safety - -
Club,Section 255t2(a)I HP.ATING UNI'1'(OVEIt 1011,000 HT U) -
❑ `'Yes pp No VENTILATION FAN(SI NGLE RPS ID) PAID
Data Bernina IT
Will the applicant or future building aactpant use equipment ce devices which 601LIiR-COMP(3HP OR I W 111%111!11)
con bwaidous air comnatur 1,as defined by the Bay Arca Air Quality Managenment (TIAL.
isvicfl BOILIiR-COMPfOV13H 1110,(00 H'lV)
❑Yes )(Nn
I have read the bamtdots andrialN rcquiremens under Chapter 6,95 of the Cali- AIR CONDITIONER ISSUANCE DATE
fnmiu Health&Salary Code,Sections 25505,25539 and 25534.1 undersmnd mm If the NEW It Ii.SIDENTIAL MECIL SQ.FL
building does ou,nrrcntly haveamnce,that las my ruponaibiloy rurality lheocmtpaln •/A
of r.quiremntM
es which must met prior to issuance of a Cenificam of Occupancy. 6
Owner or aumnrircJ agent Date - TOTAL: ISSUED BY:
OFFICE a
R146 r
_ 10300 Torre Avenue
Cupertino, CA 95014
City of
all e1`tll10 Building Division
(408)777-3333 (fax)
March 5, 1999
Homeowner
10400 Stokes Avenue
Cupertino, CA 95014
SUBJECT: Permit # 50878
Dear Property 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, 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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