S 2132 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.R'I'INO BUB,DINC..ELECII RICAL Pel irNO. I
BUILDING DIVISION AI'PWCAT•IONIPERMIT I'INGPRLUM OJECII IDEM ICICI. 1
If1111.DIN1:I'RUJ]!C'1'(III?N"I'IPICAI'I(IN �_
32
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI'rrAI,
"Lo 32 Lf TowN a2 LA +k iea ( ol �(
OWNER'S NAME: pillINIi: CONI RACI U 'S NAME LIC NO:
vS IR inn -174,507Nfc CONI--r
LIC NO: AZR)DRESS: ��-� �/ S I ❑
AAJ
CONTACT( PHONE 7 BUILDING PERMIT INFO
Zo ❑ Consultant Fccs Paid by Applicant(Initial) BLDG ELECT PLUMB MIiCH
FV
LICENSED CONTRACT ORS DECLARATION `/P Q'I'Y. ELECTRIC THEM IT FEE JOB DESCRIPTION
1 hereby affirm that 1 an,licensed under prookions of Chapter 9l111nm¢ncing
CaZ tb S,,roa700 u Division 3oflhc ltosineo,end l'mtu.ai,umCxR,pod my license is RESIDENTIAL,
Y100 wl VERMl l'ISSUANCE
Fwfull force pct Ifec ❑SFDWL C1 KITCHEN REMODEL
U F i"lecmeca_ '• 036 ie.X
Q APPLIANCES-RESIDI3NTIAI. El ADDITION ❑PLDMBING BE PIPIT
'r.Z(y pptc Cnnlmdnr
t�Qy ❑A1ULT1-UNIT ❑STRUCILRN.
ARCIII'TIiCTt OIiCI. ATION
I'ANlilt MODIFICATION
OZ=Z lunderswnd ntl plans vM1a11tensed mpuM1lic rev 1, UPTO PXIAMPS
El INTERIOR ❑CIfIMN1iY REPAIR
C
t:ad Lir)s•nscd Pmfnsiowl 20i-100DAMPS IMPROVEMENT E]SWIMMING POOLS
Q�,yEj OWNER-BULLDLR DFCLARAI'ION OVIiR RN0AM1'S ElRATH REMOUEUREPAIR EJ DEMOLITION
m•O� ffi
I hereby arm,bat I ren exempt form the Colla ou',Licensor Low for the ❑OTHER
X 3IL U ballasting reason.(Section 9031.5.Business and Pmfcsslons Calc:Any city or county SIGNS ELECTRICAL
a: 4y which requites a pem,it to construct,alter,improve,demolish,or repair any structure
F'u•OQ prior to its issuance.also Inquires the applicant for such pernsilto file a signedslarcirmot SPECIAL CIRCUTr/MISC.
ELLy- that he is Beloved pursuant to the pmvi%mrsest the Contractors License,l:tw(Chap 11) COMMERCIAL:
WC,C) (commencing will,Section 900)id Division Jofthe Huslnessand Pmmr%ion%Co&)or TI:MR Mlfl'GR OR FOLE INST.
d d c z that he is exempt therefrom add the basis for the alleged exemption.Any violation of ❑NEN'BLDG/ADDITION ❑DEMOLITION
-m Sechon]m 1.5 by ary.pplicem fill. .if subjects the applicant n a civil punahyof PO
WERVIC' ❑TINANT ❑rOODSERVICE
not rc than five hundred dollars($5(0} IMPROVEMENT
01.as owner of the properly,or my employees with wages as their sole compenution. P( RIC
P. willdothcwork,and the.grvclure isnot imendsolmolleredfnr sale(Sec.](W.Businena [I OTHER
i3= and 1'rufession,Cwle:The Contractors License Law dtc,not apply man owner of Cl -FIAT
property who builds m impure,Ihcoam,and who docs such work him,elf or through
his own employees,provided that such impmvemenn am not intended or offered for .N' 'R FT
,sale.If,hasever.the building or Improvement is wtld within one year ofeamplction.the SQ.17.FLUOR AREA FI'.
S/SQ.
to
own
er-hulldcr will have the bunks of proving that he did not build or infinite for pur-
've of ales). TOTAL:
n L as owner of the progeny,um exclusively contracting with licensed cardamom,to
mslm[t the project(See.90,14.Business and Profession,Color)The Contmctur's I.i-
.w Law does at,,apply it)an owner of properlY who hddi or improves thereon,and QTY. PLUMBING PERMIT FEE
so ho contracts for such prajecn with a...... ¢rz(sl licensed pursuant to the Conaannr's
License Law. PERMIT ISSUANCE
❑ I am exempt under Sm. 13&1'C for this reason
ALI ER-DRAIN&VENT'-WATER(EA) VALUATION
Owner Dam
AW
W ORKI?R'S COMI'IiNSNI'ION DECLARAHON BACK FLOW PRUTEC1'.DEVICE
I hereby IdBnn under penalty of Ierju,one N the following declarations:
roc and x'ill maintain aCerlificamofConssentto self-insom for Worker's Cnlnp.m HRAINS-FLOOR,ROOF,AREA.COND. 199 O II TYPE CONSTRUCTION
p aJ IfuhyS t' I911nold Labor Code,For thepl or the 1
or which his pcm I issued. TIXI'URES 1'1'R[RAI'
wu I h d aII ,aim Worker's Con p f In,"mac required by Sic
3]Wollhe Lahor Cude.forohe performance oltbe work k)rwhieh disp anll ,issued. CAS HA.SYSThM-I INC.4 OLD Liz'IS Or GRO ' AYN
My W'nrk•rix 'nm msnuon In,nnvm.carrier and I'ulicy nn nbr arc
Pnfic Nn..
cordon,/ UYUAL y .IdfL' 1Lt03?`I LY- Gn5-Iin.svSTBM-uvea J(an) Fly
CI?R'IFICA'I'li OI B%1?MPIION FROM WORK(?R$'07$ ORI?ASIIINUUS'IRh WASTr:INfIiRCE1TOR
C'OMPENSAT'ION INSIIRANC17 BUILDING DIVISION FEES
(Thiµsediu onexA nuihecnmplacd lftM1C l%soil is firronu htmdmd Anllurs(b IIXB GREASE IRAI'
PLANCHECK FEE
uvJ
Loy daylor In perotI,,au,
r ..Wehelool subject ,,pfr W ixl C..ed.apa- SIiWER-SANI'1'AI(Y-S'FORM I?A.21X1ITT.
i not employ any loons in any lnunncr,aorto hu'nmu xuhjcmmthc WnAurd Campo,.
µanon Lowe nl'Culilbrva,Uwe WAFER HEATER WIVIiN'I'dd,FC'TR
zO
Applicant GRADI ( FEE
NIYIICC rUN)IIILANI II n 'A' IIis Ic[ II 't 11 bllamh. I ,IIII
aI �ATINSYS'L'I!M(TNEAI'LNG SOILS FEE
(~ ^ Ecu I M1j II tl W A C I a'I I ,. fn I I C I You
� L.I lust ''Il entnpl w'Ih Ipnvit uo'II ' tab Jl bel 'I'IRMRVICI! SEP
1998
Q AID
CONS'1'RUCI'ION LENDING AGENCY NEW RIiSIUIiN'1'IAI.I'LMIi, SQ pale Rcec'grlp
I hereby tiffnn Jim t hem is u mon,amcllon lendinga"re,for Ibc,orhor aucol
U 0 Thu work for which this pc'noil is is, (Sec.JID9,Civ.C.1
Q F' Lender's Nome
M
fIYPn IJU lenders Addm,s 'I ceaily that I have real this applaatlnn and aamThalthenMwe Inlonnalimn isTn c nuct.I agree el n,reply with:dl city and conmy nNin:times and else law,,rchningm QTY. MECHANICAL PERMIT FEE U Z builJingeonorturo ll,tint hmcbynutbnrizu aplemmmlre.Of Ibis city m ent"upn i duaMrvonmmionW pnrperlY Iia inapcainn puq,ums I'IiRI'I'ISSl1nNC11 t(We)agree to sure,indemnify and keep harmle"the CITY of Culrcninn agninaIntudilin,Idgmcnts,cast,rud,,,coms whlcbmay in any way momeag.imlmid City AM I?R OR ADD'TO MSCI I.in consequence of the granting of this permit.APPLICA- I1NDE S 'DS- 1)WILL.COMPLY WIf11 ALL NON-POINT' AIH IIANOLINO UN IT(TO IU.Wn CFM) 3E OSOAIR HANDLING UNI'1'(UVER IU.Ixx)CFMI 'rA%
S' n um(ofA 4icarwComommr Ume T EXI IAUST 11001)(W/DUCI I HOUSING MITIGATION R?I:
14AZARMUS MATERIALS DISCLOSURE
a Will lheapplicam tabulate building orcupanl name ter lnmJle lumnitmn,:mcrial IIHA'TING UNI'1'('1011010x)BTU)
a,defined by the Cupemao Municipal Code.Chapter 9.12,and the Health and Safety
Calc,Semon 11532bd! -1 HMI INC,UNIT(OVER 100.0x0 B'DD
❑Yc, Lt"o VENTILATION FAN(SINGLE RESID) PAID
Date ReceiptN
Will the applicant or future M,ildog occupant use equipow•nt or devices which BUI1.13R-COhll'1311P OR IIXLI0X1 It TU)
mil brardous air comamiwnb a,defined by not, m
[try Arc.Air Quality Manageent IY
TOTAL T
i,lria? I{OILER-COMP(OVER 11x1,(00 N'TUI
❑Yes r
I have wait the bzmdoulnmena)s uundm Ch (x95ol the Cali. AIR CONDI'I'IONER ISSUANCE DATE
nxlB533 alncr
fomia lloralth&Safay Cole Sections 255115.23531 and 255W.I ua{emund that if the NEW RESIUPNI'IAI.MECH. SQ 17.
IwilJing docs nm mrrendy harc a tenant,lha it in my responsibility to notify the occupant
oflhe requirements which muss be ma prior to ismalecafe Ccuificure Of OcralancY.
Owner ur authorized agent Date 4—,(, ISSUED BY:
OFFICE
10300 Torre Avenue
Cupertino, CA 95014
oot,
Cupertino Building Division
(408)777-3333 (fax)
March 5, 1999
Manager/occupant of
20394 Town Center Lane, 9168
Cupertino, CA 95014
SUBJECT: Permit# 52132
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 tharyou 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 CUPERT'IN]O
Christy Akatiff, Administrative Clerk
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