31536 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. �S
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL J1 `53l6
flUIRIANG PROJECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
OWNE 'S AVE:' PHONE: C A R'SN ME: }ICN
411111111111111 / .h - '�h+t: JRE0�54y 0 Zq1 ( ) N/c CONTROL«
R HITS NGINEER: LIC NO: ADI V G:�J 'Q_n x � ; ��I
CONTACT: PHONE: U/O rvl BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE AL
1 hereby afR that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
X00 with Sation]1100)of Division 3 ofthe Business and Professions Cade,and my licenseis 0 . RESIDENTIAL:
00 in full foreeandefcat PERMIT ISSUANCE
p;W I WL ❑KITCHEN REMODEL
aV License Cl Contractor
APPLIANCES-RESIDENTIAL ITION ❑PLUMBING RE-PIPE
Dote Commctor
k P ARCHITECTS DECLARATION _ ppNLLS MULTI-UNIT CFTORALusedt� 1 understand my plane shall he used as public records MODIFICATION
OZ.S-f UPT0200AMPS ❑INTERIOR f� p a CHIMNEY REPAIR
'rM Licensed Professional - 201-1"AMPS IMPROVEMRNT%
IN
OWNER-BUILDER DECLARATION Conv ON OVER I"AMPS ❑BATHp MODEL/REPAIR ODEMOLITION
CC I hereby affirm on 1 am exempt from the Cantrns Co License Law for the ❑O��
36V followingreason. emits ]onstru Business and Professions Cods:Any city or county SIGNS ELECTRICAL
LL which requites o permit m construct,alma improve,h permit t m retia,any swnum 1ang}
I-IA kpdonoiocensed abmart to a re Novisiosofesid far mchmwes License Laand w
SPECIAL CIRCUIT/MISC.
} that he is licensed pursuenno are provisions of the Commnors License lawfChapmr9 CC`
p�q (commencing with Smtion]000)of Division7a(the Businassand Pafessionx Codc)or TEMP METER OR POLE INS r`1i! Af(�
a. e W the,be is exempt therefrom and the basis far the alleged exemption.Any violation of 0 NEW BLDG/ADDITION /T?GEMOLITION
Is• by sayapplicam far u permit ermit subjects Neapplicantto a civil penalty of
pPOWER DEVICES
.n y 0 TENANT 0 FOOD SERVICE
Section]
not more then five hundred dollars Wall.
qQ O I,us owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
!!^y?^y?r will Jo the work,and the structure is not intended proffered for sale(Sec.]M4,Business OOTHER
end Pmfexsim,Code:The Coatrrean's License Law does at apply m nn owner of OUTLETS-SWITCHES-MIXTURES
-. property who builds or improves thereon,mid who does such work himself or through
his own employees,provided that such improvements an,not intended or offered for NEW RESIDENTIAL.ELECI'R SQ PT.
sale.If.however,the building or Improvement is sold within one year of completion,the SQ.PT.FLOOR AREA SISQ.PT.
owner-builder will have are burden of proving that he did not build or improve for pur-
0 of waled. �- �� f ~) `
❑I,as owner of the property,am exclusively cnmraming with I)The
comma,', i. L.(. (Jr�
consumer the project(Sec.]004,Business and Professions Code:)The Canlruanrs Li-
came Law does not apply to an owner of property who bmI&or improves theircon,add QTY, PLUMBINGPERMIT FEE
who contracts for such projeats with u commctods)licensed pursuant o the Connector a
License Law. PERMIT ISSUANCE
O l um exempt under Sec. ,B&PCforthis reason
Owner 'Dam ALTER-DRAIN&VONT-WATER DIA) VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby o ism under Penalty of perjury one of the following declarations: �I Jar /I���
(have and will meintaina Cenifimte of Conunl to xlf-insure for Woder'e Compcn- DRAINS-FLUOR,ROOF,AREA,COND.
and nn,as provided for by Section 37W of he Labor Cade,far the performance of the _ STORIES TYPE CONSTRUCTION
work for which this pemtii is issued. FIXTURES-PER TRAP
O 1 have and will command Workers Compensation Insurance,a required by Section -
01, 11
37M of the labor Cade,for the pcifowaace of the work for which this permit is issued GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROU APN
My Workers Compensemin Insurance carrier unit Policy number are:
Carrier. Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM W KERS'
COM�BNSATifHf+ NC GREASF/INDUSTRL WASTE INTERCEPTOR kLTft4bG DIVISION FEES
(This secdonnead not r" etedifthe pant is emndrcddollars($10(b GREASETRAP Liteor less.) / - PLANCHEC P l Y
lociify Natintheveif ce the kf w c Tsps 'ssued,lshall SEWER-SANITARY-STORM EA.200 FT.
not employanyperours any er eras�u he Imthe )m Compen. ENERGY
,anon Laws of Califon a.
OVj WATER HEATER W/VETMLETR
GADI EApplicat
NOTCC
TO AP ANT.If,after making this Cc xemptom,you should WATER SYST IMURRATING
a ; neeonm suM1jeet m th Workers Compensation pmvis' s df Is,labor Cade,you must SOILS Fly
forthwith comply wi such provisions or Nis Pewit shall be deemed revoked. WATER SERVICE
0s CONSTRUCTION LENDING AGENCY NEWRESIDENTIALPIAN SQ.IT PAID
C.)0 Iberehynffirm that there iso conswninn lendingagency for the pcdbman.,d` Dm ReeciptN
w 0 the work for which this permit is issued(See.TOO,Cie C.)
0 {kI Lender's Name TOTAL:
Lender's Addmas
I curtly that 1 have read Nin applicmion and state that the ulxwe information is BUILDING HE �
lZ) correct.I agree to comply with all city and county amlinences and wrote laws reaming to QTY. MECHANICALPERMIT FEE
V building conswninn,and hereby euthnrix rcpmxnmtiven of Nis city to cater upon Ne SEISMIC
id nve-mentioned property for inspection purposes. PERMIT ISSUANCE(We)agree to save,indemnify and keep harmless the City of Cupertino against ELECTRIC FFIE
liabiliti"InMmwhirl yin any way attme against said CityALTERORADDTOMECH.xqueNis permitPLUMBING FEia ju OMPL H ALL NON-POINT pIR HANDLING UNIT(TO 10,(gOCFM) MECHANICAL E
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION %
Signora ofAppliwnVContractor Date EXHAUST HOOD(W/DUCT) HOUSING MITIGAT NPEE
HAZARDOUSMQTRR . DISCLOSURE
Has,applicant or future building occupant store orhandle filtrations material HEATING UNIT(TO 100,000 BTU) _
as Je0 by the Cupertino Municipal Cale,Chapter 9.12,and the Health and Safety
Cade,Seedad 25532nd? HEATING UNIT(OVER Ifp,000 HUM
'0Yes Otho VENTILATION PAN(SINGLE RFSID) PAID
Will the applicant or future building menton ma e,mpteem or desiees which Data eecl
thazeribusaircimarinnnIs as defined by the Bay Area Air Quality ManagemU)em BOILER-COMP(311P OR 100,0011 BT14
District? TOTAL:
Oyer ON. BOILER-COMP(OVER U10,000BTM
I have read the hemrdooe matedule myuisments under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCEDATE
funds Health&Safety Code,Sections 25505,25533 and 25534.I undersand Nal h the NEW RESIDENTIAL MECH. SQ.PT.
building dces not currently have a tenant,that it is my responsibility to amity the tccupnnt
of the mquirements which must be met prior to issuance of a Certificate of Oacupancy.
Owner ds authorized agent Data L: ISSUED BY:
OFFICE
. 10300 Torre Avenue
Cilc nl
Cupertino, CA 95014
Caper tll10 Building Division
(408)777-3228
(408) 777-3333 (fax)
September 30, 1997
Homeowner ✓�
7565 Tiptoe Lane
Cupertino, CA 95014
SUBJECT Permit#31536 '
5'
Dear Homeowner: f
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 F CUPERTINO
Christy Akatiff, Administrative Clerk
•
Ponied un Recycia0 Pcoer