29597 APPLICANTTO.FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CITYpF CUPERTINO RUILDING.ELECT RICA],- PERMIT NO,
nuiLDINC DIVISION . APPI.ICATION/PF,RMIT PLUMBING.MECHANICAL. ., n [] G f�7.
BUILDING PROJECTIDENTIFICATION L J J J 1
BUILDINGADDRESS: ' .. SANITARY NO. AT LICATIONSUBMITTALDATE
ru9z3 StIJCsC� 1446 Gl_' .�_�
OWNER'S NAME: PHONIi: CONTRACTORS NA LICNO:
/ NIC CONTROL k
i�CHI I PC 17UNOINEER: LIC NO: AI>1)RESSo T l' ❑ ..
6 0`
CONTACT' o^: Q ❑ BUILDING Consultant Fees Paid by Applicant(Initial) BLDG PERMIT INTO
ELECT
MECH
` ❑ ❑ ❑
LICI NSED CON licensed
of OR S DFCI ARATION
r QTY. ELECTRIC PERMIT FFC
I hereby Ir that I am 1 anaea m J p f Chapter 9(cmmme c g " - JOB DESCRIPTION 3
{C{�00 wins a 70(10) fDvsion 3.Une BusinessH I 'Cede;and my license RESIDENTIAL:.
.wr nfullborecand fff¢1 O PERMIT ISSUANCE
-U Linens C ss 3 V G"Lie # 3 , ❑SFDWL ❑KITCHEN REMODEL
I- -W
I>ure fr a Contt nn - APPLIANCES-RESIDENTIAL , []ADDITION ❑PLUMBING RE-PIPE'
F-Orn ARCHITEcUs DECLARATION _ PANELS
- []MULTI-UNIT ❑STRUCTURAL `
z O t�7J 1 understand my plans shall housed as public records . MODIFICATION
-4 UPDO 200AMPS s ''
QZF.p ❑INTERIOR~ ' ''f ❑CHIMNEY REPAIR
Imo..iN,,.F,aJ Lsensed Pmfeommel 201.IWf1AMPS - - IMPROVEMEN
OWNER-BUILDER DCCT ARAl DON OVER lgppMPS
W ❑BATH " DEUREPAIR El DEMOLITION
y O W U I hereby affirm that I m exempt from the C m ao -License La for the
p(a follo g r (S t 7111 5 lhoires.ind Profit C 1 'A y city in county .. SIGNS ELECTRICAL R
YI xh¢h tcyu res lemwt c n.war alcor impr e d n 1'h pa y.t cture
��� priori Lrc I- equ thevppintf Contractor,
a flea gw(Chater9 SI'[CIAh CIRCUIT/MISC.
y (hath I enwit parsuau the prmvisioi,imw toneeBusness n ProelaxlCnodl or '
`sCHg (commencing with Senion7(XIO).f Division Sof the Business and Professions Cmdel or TEMP.METER OR POLE INST COMMERCIAL: ' `
oaL 1 1 he Is exempt merebro nod the basis lot me alleged exemption.Any violation of ❑NEW HI.DG/ADDITION ❑DEMOLITION
pyo m LLm Section 7031.5 by any applicam for a Permit subjects the applicant to a civil Penally of POWER DEVICES W^ - ❑ PV' ^ ❑FOOD SERVICE
ar
not me than flue hundred dollars ISSWIMPROVEMENT).� �: .- IMPROVEMENT +
=Q ❑Las owner of Ne property,or my employees with wages vtheir sole n,mpensatinn, 571##1 LELECTRIC
will do the work,and the structure is not intended oroffered fmrsale(Sec.701 Business []OTHER
aim Professions Code:no Commcmrs License law fres non apply m an owner nl OUTLErS S IT IE -FIXTURES,
Property who builds or improves thereon,and who does such work himself or through -
his own employees,Innvidnl that such improvementsare nm intended or offered for N17W RESIDENTIAL lib. 'R SQ FII
sale.IL howeve,me huildingor improvement is sold within one year of comp.......,the a SQ.top FLOOR AREA S/SQ.FE
er-builder will have the burden of proving that he did not builds improve for.par- '
Eric made.). - - -
❑ 1;as owner of the n AI" .P A 9 ® i
property,am exclusively contracting with licensed cnractors i-
mae La the Profen(Secapply
mars
ars Business and Py who
ds or i The Contractors Li-
come
J- -
aelawdm,ersuchpytoaaownerof commoners)
who buildsrs improves Contractoroils
QT'y. PL •RMIT FEE 3630 fk 1f(
License rads for such projects wish acmnvunm(.1licemN pursuant the Gmwemrs ' - �Ov 919
License law. PERMIT ISSUANCIi
❑ lana exempt under Sec. ,B&P C for this reason r
' -
OwnerDate AIDER-DRAIN&VENT-WATEI E W"'tyUJI�NNIuuU
- -- L
WORKER'S COMPENSATION DECLARATION - HACK FLOW PROTECT.DEVICE
I mrchy affirm under penally oF'perjury one of the following declarations:
I have and will maintain a Coni Bente ofComentto arlGinsu ,for Workers Carrion.. DRAINS-FLOOR,R(>OF AREA,COND, STORIES TYPE CONSTRUCDIO.
nation,as provided lair by Section 3701 of the Lobar Code,for the perl'ormancic of me I ,
work for which this permit is issued. 'FIXTURES-PER TRAP -
❑1 have and will maintain Worker's Cmnpenamion Imonstice,.n required by Semina
3700ofthe LaMnC,Je.for lheperformaacc ofthe work forwhich mispeatit is issued. GAS-I SA.SYS 119,14 INC.4 OU'TLET'S UCC.GROUT' APN
,My Workeyy'gCnm�pet ti Tier and Policy n�u'y�/
Cartier.=;pc olicy No.:A �,S7y�Zd1� GAS-I SA,SYSTEM-OVER 4(BA)
CERTIFICATE OF EXEMI'1'ION FROM WORKERS'
COMP17NSA'I'ION INSURANCE GREASPIINDUSTRI.WASTE.INTERCEPTOR
Obis veonctineed not be completed Ban,permit isforms,hundred diihim($100) BUILDING DIVISION FENS
is,less.) GR BASE TRAP PLANCH[CK FEE
I certify maim he performonceofrhe work for which this permit is issued,l'nhdt SEWER-SANITARY-S7URM PA.2001'x. t,
not employ any person in any manners...m become suhject nt the Worker:Coapen- E ERGY FEE
O Z. smion Low,of California:Dane WA'1'F.R 1{GA'TIiR W/VEN'1'IIiLEC'I'R O
7
O
Applicant - GRADING FEE
P. VI NOTICE TO Al to the
H,art" skits this Cemoidmaxm in f"how io dc, aham, WADER SYSTEM/DREATING
f become suhjeo to the Nuch ro Cmm�s., is Permit
ion.mine hLHr Code,you muv SOILS FEE
fmnhwith comply with such provisions or this permit shall be deemed invoked. WATER SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FE PAID
U 0 - Ih,mhyaffrm that there iso cmn.anctum lutdia,agency for thcperfornamcrf Date Receipt#
D. E'+ the work for which This Permit is issued(Sec.301 Ci,C.)
Lender's Nam. TOTAL:
rLU Finders Address - "1'O'I'AL:
ffrr - I certify her 1 have road this application and state that the above information is BUILDING FEE
. Ln correct.i agree to comply with all city and countyorainmtcesnail into lawsrelatinylo QTY. MECHANICAL PERMIT FEE
V Z huilmo,combectinn.and herebyauthorizerepresenmtives mflhiscity locator upon the SEISMIC PEE
nlnwemteminncd property for hopenioopamswe, ...7 II ISSUANCE
(We)agr.e b sore,indemnify and keep hmmlesx the City of Cup.ninn against RMFEE' ^
Iivhllities,judgments,costs and expenses which may in airy way accrue against said City ALTERORADDTOMECH. eC
PLUMBING FEE l eU
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO 10,000 CFM)
' SOURCE REOULA'TIONS. �. MECHANICAL IrEE
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIONTAX
Signature of Applicint/Cmanommr Date "' EXHAUST HOOD(W/DUC1) HOUSING MI'T'IGATION PEI: '
HAZARDOUS MATERIALS DISCLOSURE
Will the vp,licam or hums building occupum sbn,or boodle hnunlaun mnmrivl I IEA'I'INC UNIT('TO 100,000 BTU)
as defined by the Cupertino Municipal Gyle,Chapter 9.12,and the Health and Safety
Code,Section 25532(.)7 HEATING UNIT(OVER 100,0010 BTU)
' ❑Yc., ❑Nd VL•N RATION FAN(SINGLE RESID) PAID
_ Dam '- aeipt p
Will the applicant or Oils a building occupant y A equipment Qul tat.M res which - BOILER=COMP(5HP OR 100,(X10 RTU) -
n hazaNnus air contaminants as defined by the Bay Area Air Qwlity,Management TOTAL:
isaict7 '
lew
i ❑Yes No , BOILER-COME(OVER OI,OWBTUI
❑ '
NR CONDITIONER
k
' Iheve read the havNous aneteriak requirements under Chapter 6.95 nl Ore Call- ISSUANCE DATE' '
brain Health&Safety Cede,section,25505.25533 and 25534.1 undcrsmny'that if the NEW RESIDENTIAL MECH. SQ.FD.
nuilding d, .t cunea0r haveatant,m=ti�v my renrytnnin111tym nnnry/Ile ncenppum:
of them a Ict pnono�:uance aha CcniBcaN,,(�u,park"a .
O er or mmdzeJ.gem Dot TOTAL: ISSUED BY: _
2 ,
'_ OFFICE"
I ® a
10300 Torre Avenue
• Cupertino,CA 95014
City
of,
C.ipertulo Building Division
(408)777-3228
(408)777-3333 (fax)
June 18, 1997
Homeowner
10923 Sweet Oak
Cupertino, CA 95014
SUBJECT Permit#29597
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 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
•
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