S 0511 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
OF CUPERTINO BUILDING-FUl!Cl FISC,AI.
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"BUILDING DIVISION APPLICATION/PERMIT —- PLUMRBJO-IMECIIANICAL Cs 0511
: i•• 'BUILDING PROJECT'IDENTIF'ICA'I']US,L4' " �J
BIIILDINGADDRESS: SANI'IA14Y NO! APPLICATION SIIBMI'TI'AI,UA'I'I
9� a s7'�AJBkI �'c . �hS�C7
OWNER'SN MF.: PIIf1NF.: CONIKACTOR'SNAMME p, 1•IC N(1:
N/C CON'IA(ILp
ARCHITECT/ENCINF.F.R: LIC NO. ADDRESS: ❑
IGN'TACT: - PHONE: •.i ' !'BUILDING PERMITINFO
JU�F V LOL (S 3�6=67`D O ❑ Consultant Fees Paid by Applicant(Initial) DC Ii� PLUMB MECH
IICFNSEDCONTRACTORS DECLARATION - QTY. t CLGCTRIC PERMIT + ' ; PEE'rs
I hereby It 'm that lu licensed d p fC1pt 9( n 'g { ' .'•.et a ' a' n _ LOB DESCRIPTION
WOZ with5 [ 7000) tD Division 3 of the Buvme.�.amt Professrn.ewe and my licenses El SHOWS,
WOO PERMIT ISSUANCE.
F1- in fall force and dicer '` ❑SPUWI. ❑KI'TCIII:N k1iMOUliI.
�UU Licerne CJa-s'r_9� Lio.M �'VB pPP1.IANCES-RESIDLN'I'IAI. ❑ADDITION ❑PLUMHINGRIiI'll'li
F Z W Un1e�R—.—�--;—Cnntmcmr
m¢y ❑MULTI-UNIT' ❑S•1'RUCTURAL
ARCHITECT'S DECLARATION
•F7m PANELS MODII9CATION
Z ltndersWnJ my plans shall he used as public records
UP*1'02N)AMPS
❑INTEk10R El CHIMNEY REPAIR
W Licensed Professional ' 201-1000AMPS ROVfivU NT E]SWIMMING POOLS
�a� , OWNER-BUILDER DECLARATION IlRENIZEUREPAIR ❑DEMOI.RION
J . OVER I000AMPS
%C¢ I hereby from that 1 am exempt from the Comracmr's License Law for the
following reason.(Section 7031.5,Business nnJ Professions CnJe:Any airy nr county SIGNS ELECTRICAL fYI'HER
F O which requires a permit to construct,alar,improve,demolish,or repair any structure
Por d t also q ithern,plUianf th Morka,file.ridowdotoomian, SPECIAL CIRCUTUMISC.
�1!{p.
that licensed pursu pursuant thep :ion. fth Contractor's 1 L (Chapter9 COMMERCIAL:
�jap0 (tom e g lM1 Seel ]0(10) 1D tai 3 [th B est JP f. ' .CNet nr TEMP.METER OR POLE INST ,
0.y m y shut he is exempt thereGom routine basis for the olleged uxampuon.Any violation of ❑NEW BLDG/AUDITION EIDE hIOL[PION
W m Section 70315 by any applicant for a permit subjects the applicant ❑TIiNA
o a civil acridly of POWER DEVICES NT ❑TODD SERVICE
not more than 0vo hundred dollars(S500). IMPROVI:MF.NT
SO ❑ I,as owner of the property,or my employees with wages as their sole cumpensation, SWIMMING POOL ELEC'1'HIC
F
will do the work.and the sua
uere is not intended oroffered for sale(Sce.]044,Business ❑0'I'HI?R
L 3 and Professionor
Professions Cale:The Conduct 's License Law does not apply to sea owner of OUTLETS-SWITCHES-FIXTURES '
property who builds or improves thereon,and who does.such work himself or through
his own employees,provided that such improvemems are not intended m offered for NEW RPSIDENTIAI.ELECTR SQ FIC
sola.If,however the building or improvement is sold within one year ofcompletion.(ba 9�f�PIF]OR AREA SJSQ,Fr,
comer-builder will have the burden of proving that he did not build or improve torpor
l4//
Sin, Lalc) 9TYIA1•: IlI�
El I f Ne progeny.art exclusively commmmg with licensed contractors to
constract the paid(Sec.7OM1 Bias' and Professions Code)The Contractors Li-
mn
: I• - 'r f/ 'NWFI/shi
mare Law does nor apply to arn rwneralpropeny who builds or improves theared and ?TY, 1 ' " PLUMBING PERMIT FEFCIr {/
who contracts rsmnContact.,cts 6usuch projects with a commands)licensed puno the Contctor's , r ' .1Uf
License Law. PERMIT'ISSUANCE Ur✓;k l Zhu
I am exempt under Sec. .B&PCfor this reason
ALTER-DRAIN&VENT'-WATER(VA) VALUATION
Owner Date
WORKER'S COMPENSATION DECLARATION _ BACK FLOW PROTECT.DEVICE I N.
Ihereby affirm under Malty of perjury one of the following declaration: K w
I have and will maintain a Certificate of Consent to self-Insure for Worker's Compen- DRAINS-FLOOR,ROOF,AREA,COND. STORIA 'I'YPI!CONS'I'RUCTIOC
Ilan,as provided for by Section 3700 of the Labor Code,for'he perfmmanm of the
work for which this permit is issued. _ FIX'IGRES-PER*1'RAP
1 have and will maintain Worker's Compensation Insurance,as require)by Section GAS-F.A.SYS'TIiM-I INC.1 DO[LETS J] ofthe labor Code, heperformanceof the work for which trchis permil is issued. OCC.GROUP APN,
- CarYW dec kert ypt typ ins any ePal Policy Noy anO�6— 9B GAS-EA.SYSTEM OVER 4(EA)
] CERTIFICATE OF EXEMPT ION FROM WORKERS' GREASE]INDUSTRL WAS I'I.INTERCEPTOR
COMPENSATION INSURANCE BUILDI . D ISION PEES _
(Thisetion need not hecompleted ifthepemtit islbrone handreddollars(Stun) GREASE'I RAP
or less) - PLANCIiIiCK IEE
I certify that in the performance oOhe work forwhich this permit is issued,]shall SEWER-SANITARY-STORM EA.21X0 Fr.
not employ any percnn in any manner so as to hecnme subjenmthe Workers'Coinpen- IiNIiIS: FP
,Z satin laws of California.Date WATER HEATER W/VENUELECTR
zApplicant I GRAD
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should WATER SYSTEM)TREATING
W"Its, MV
became subject to the Worker's Compensation Sims cions of the IaMr Code,you must SOILS
fanhwith comply wabsorb provisions tor his Mail shall be deemed revoked. WATER SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,EL. PAID Dal, ec Sita
U O Iherebyaffdrm thin them is a construction lending agency far the performance of
I3. H rhe work for which this pemtil is issued(Sec.4097,Civ.C.) TOTAL:
0 U Lenders Name
TOTAL:
Lenders Address
�•' d 1 certify that I have mad this application and slam that the above information is I BUILDING IEE
F �o comet lagree mcomply with all city and county ordinances and suite laws relaivg nr QTY;- MECHANICAL,plE T� FEF,.1i
U•2$ building construction,and hereby authorize representatives of this city to enter upon the ; •i SEISM1IIC FEE
'-' above-mentioned property for Inspection purposes. PERMIT ISSUANCE: ELECTRIC FEE
(We)agree to save,indemnify and keep hernless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADDTO MECH. PLUMBING PI7.
in asequence of She granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 11.001OCFM) MF.CHANICAI
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER 10,000 CFM) CONS"I RUCTION TAX
Signature of Applicarm Conuecmr- Due EXHAUST HOOD(WIDUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle horniness material HEATING UNIT(TO 100,000 SITU)
as defined by the Cupertino Municipal Code.Chaplet,9.12,and the Health and Safety
Code,Section 25532(0)]' HEATING UNIT(OVEN IM."BTU)
0 Ye: El No VENTILATION FAN(SINGLE RISIO) PAID
[)am Receipt N
Will the applicant or furore building acugam use equipment or devices which BOILER-COMP OITP OR 100.100 BTU)
t
Induction;air commandants as defined by the Bay Area Air Quality Management TOTAL:
e)isvict? . . BOILER-COMP(OVER 100.000 BTU)
❑Yes Fl No
I have read he hmanlous mammals requirements under Chapter 6.95 of the Cab- AIR CONDITIONER ISSUANCE DATE
Lb.ildr.,
d Health&Safety Cade,Sections 8505.25533 and 25534.1 understand that if the NEW RF'_51DF.NTIAL MECH. SQ.ET.
does net Imnally have tenant Nat it is my respnnsibiliry to notify the aeupml
e reqiremems which orm net pd.r m{wumce of a Certifimm of Oce.paid,
erorauthnrize4agent ( Dao
TOTAL, ISSUED ff Y:
OFFICE
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10300 Torre Avenue
Cupertino, CA 95014
Cite of
Cuperthio 13uildin.- Division
777-3228
(408) 777-3333 (fax)
February 4, 1999
Homeowner
22920 Stonebridge
Cupertino, CA 95014
SUBJECT: Permit# 50511
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, 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
Printed on Pecycled Paper