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30836 _APPLICANTTOFILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _ - CITY Of CUPERTINO BUILDING-ELECTRICAL PERMITNO. 30836 S O ^ a�/� BUILDING DIVISION APPLICATION/PERMIT' PLUMBING-MEOHANICAL 3 lXJ Jj FVC BUILDING PROJECT IDENTIFICATION - BUanwGADDRESS: SANITARY NO. - APPLICATION SUBMITTAL DATI �r / 31-.97 WNER'S NAME: PHO C TR ACTORS 1 NnAM�E: LIC NO: Owl. Ja�-� ' It`1 + 0•'-C) /f.[. f) N/C CONTROL# ARCHITIiCT/EIJGINEER: LIC NO: ADDR l�S: �` (� Q 'l 7� J. D,_An CONTACT: pxoNG:, - BUILDING PERMIT INFO s - ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH LICENSED CONTRACT'OR'S DECLARATION ❑ 1 herehy,oflirm that 1 am licensed under provisions of Chapter 9(commencing TY ELECTRIC PERMIT FEE WOWDZ with Section 7")of Division 3 oflhe Business and Professions Code,and my license is , JOB DESCRIPTION F+�B in full force and effect. , _ PERMIT ISSUANCE - RESIDENTIAL: U V License Class Lic.# - ❑SFDWL �❑xK,ITCHEN REMODEL y0. Date Contractor APPLIANCES-RESIDENTIAL a ❑ "T ADDITION" ' LUMBING RE-PIPE ARCHITECTS DECLARATION y+O y Z I rnderatand my plans shall be used as public records - PANELS ❑MULTI-UNIT ❑STRUCTURAL O Z 4 Cl UPTO NO AMPS MODIFICATION � ty Licensed Prfessioml ❑INTERIOR ❑CHIMNEY,REPAIR OWNER-BUILDER DECLARATION 201-1000AMPS IMPROVEMENT 34FU I hereby affirm that I am exempt from the Contractor's License Law for the OVER 1000 AMPS JE BATH REMODEL/REPAIR C1 DEMOLITION pdfollowing reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER which requires a permit m construct,ahem,improve,demolish,or repair any someone, - - rn prior to its issuance,ulou requires the applicant for such permit to file a signed statement SPECIAL CIRCUIT/MISC. 4' p+ thutheislicenaed,ursouatm the provisions of the Cmumserods License Law(Chapter 9 uI 0(D (commencing with Section 90W)of Division 3 of the Boslnexs and Pmfessians Code)or TEMP.METER OR POLE INST. COMMER IA 4{y m eG that he is exempt therefrom and the basis for the alleged exemption.Any violation of - ❑NEW BLDG/ADDITION ❑DEMOLITION it kms- Section]031.5 by any applicant for.permit subjects Ne applicant too civil penalty of POWER DEVICES not more Nan Eve hundred dollars(S50h). j ❑TENANT - ❑FOOD SERVICE qOEl 1.as owner of the property.or my employees with wages as their sole compensation, SWIMMINGPOOL YCTRIC -IMPROVEMENT 2a will do the work.and the structure is nor intended or offered for sale(Sec.7044,Business []OTHER, - Gand Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS-S I HES-FIXTURES propery who builds or improves thereon,and who does such work himself or through his own employees,provided that such impravempnts are act intended car offered for NEW RESIDE&fA SQ FT sale.If.however.the building or improvement is sold within one yearofcompletioa the M. ' 8/SQ. owner-builder will have the burden ofproving that he did not build or improve for pub- SQ.F7 PAID ARBAFT. , poae of sale].• A t' ❑ 1,as owner of the property,am exclusively contracting with licensedcamranors m ' construct the project(Sen.]044,Business and Professions Code,Tha C contractor Li- - A0.�q �1 REP Law does not apply to an owner of properly who builds or improves thereon,and QTY. PLUMBING PER T who contracts forsuch projects with a eonlmetor(s)licensed paraumno the Contractors uN1� FEE License Law. .. ❑.I am exempt under Sec. ,B&P C for Nis reason - PERMIT ISSUANCE CITY ur wrcirliivU Owner ;,, ALTER-DNAIN&VP.NT-WATER(EA) Dare ^YALLUATIO�N 1 WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICEffi '/ Ihereby arm under penalty of perjury one of the following declarations: - CCC�� l/ I have and will maintain n Certificate of Consent to self4mare for Worker's Conran - DRAINS-FLOOR,ROOF,ARFq,COND. sation,as provided for by Section 37W of the Labor Crile,for the performance of the STORIES TYPE CONSTRUCTION work for which this permit is issued FIXTURES-PER TRAP " - ❑I have and will mainmin Workers Compensation Insurance,as required by Section 39(0 afthe Luhor Code,hfrthe performance ofthe work for which this permit is issued GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN Mywerr, ac mpenaar µnab ee earidruna PN.,ZZVa 0/ni;I GAS-F - Carier. Policy No.: A.SYSTEM-OVER 4(EA) ' C RTIFICCOMPEN ATIONI NFROM WORKERS ' ' COMPENSATION INSURANCE GREASFJINUUSTRL WASTE INTERCEPTOR , unless.) (This smlion need not be completed ifthGREASE TRAP e permit is for one hundred dollars(Sl BUILDING DIVISION PEES _- - I certify that in the performaneeoflhe work forwhich thist is issued,l shall' .1 ANCHECK FEE not employ any person in an perms SEWER-SANITARY-STORM EA.loopm . p y y manner so as m become subject na the Workers Compen- ENERGY FEE O Z sation Laws of C mia.Dare WATER HEATER WNENTMLECTR z 0 Applicant al%A GRADING FEE #w y NOTICE TO AP�L]CANT:If,after ma sing Nis Certificate of Exemption,you should WATER'SYSTEMIIREATING E~ , become subject to the Worker's Compensation provisions of the labor Code,you most SOILS FEE _ , fonbwith comply with such provisions or this permit shall be deemed revoked WATER SERVICE Z CONSTRUCTION LENDING AGENCY NEWRESIDENTIALPLMB. SQ.FT. - PAID U O for which ThN wthiH tha0here isacorawetion len ding agency fonheperformunce of Date Receipt W F the work ch permitIs issued(Sec.3099,Civ.CJ O Lenders Name - Lenders Address TOTAL: y I certify that I have read this application and state that the above information is - BUILDING FEE h correct I agree to comply with all city and county oNinanfees and slate Iaws.platm,m QTY. MECHANICAL PERMIT FEE U Z7. building construction,and hereby authorize representatives of this city to enter upon the SEISMIC PEE above-mentioned bo -mentioned propemnsp y for iection purposes. PERMIT ISSUANCE (We)agree m save,indemnify and keep harmless the City of Caperton against .1 ELECTRIC FEE Iiabililiesjudgmenls,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH. n consequence of the granting of this pea. PLUMBING FEE APPLICANT DER ANDS A ILL C IMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO I(I,L00 CFM) SOU NS. q MECHANICAL FEE AIR HANDLING UNIT(OVER 10,001)CFM) CONSTRUCTION TAX Signature of ApplicamsConractnr Dam - EXHAUST H000(W/DUCT) HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE Will the applicant or future building occupant store or handle hazardous material HEATING UNIT TO 100,000 BTU) se defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety Cade,Section 25532ho? HEATING UNIT(OVER IMO#BTU) ❑Yes ❑No VENTILATION FAN(SINGLE RFSID) PAID Will the applicant or future building ocenpabt use equipment of devices which Date Receipt# mit havr lme, it tinmminenls as defined by the Bay Area Air Quality Management BOILER-COME QHP OR 100,00 BTU) District? TOTAL: ❑Yes Onto BOILER-COMP(OVER 100,030 BTU) 1 have reed the hazardous matenals regairemente under Chapter 6.95 of Ne Cali- AIR CONDITIONER , forma Health&Safety Code,Sections 25505,25533 and 25534.1 understand Nat if the ISSUANCE DATE building does not currently have alemmb that it is my responsibility m notify the occupml NEW RESIDENTIAL MECH. - SQ.PT of Ne requirement,which most In met pain.to issuance of a Certificate of Occupancy. Owner or authorized agentDate - TOTAL: ISSUED BY: OFFICE 10300 Torre Avenue • Cupertino, CA 95034 0citv of cupel'tll10 Buildine Division (408)777-3228 (408)777-3333 (fax) November 3, 1997 Homeowner 10369 Tonita Way Cupertino, CA 95014 ,1 SUBJECT Permit#30836 To Whom It May Concern: We have been going through our files in the Building Department, and contacting those people with permits remaining"open. �f 7 • 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 CUUPEERTINO ' Christy Akatiff, Administrative berk Printed on Pecvcled Paper