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S 2145 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-E,LEC'I'RICN, PESIT"° 2145 BUILDING DIVISION APPLICATION/PERMIT PLUNIBING-MECIANICAL `v BUILDING I-ROJECI IDEN'UIFICAI'ION BUILDING ADDRESS: SANITARY NO APPLICIM ION SUIT1,11PIAL UAII D 1 D ,T�� 4 2 -- OWNIi13'S AMI? � 111f 1tN}3/�� C)N'I' CI' R'S AMI:: ,1 /� Y/Y/JJ'' / NIC CUN'fHOhK I IT ECUENGINI:ER: I.IC NU: �yL)Itl.� , /1 119 � We ❑ f Gf PITONNI?: /�r� 55 J\ /•V!' BUILDING PERMIT INFO ��y ❑ Consuhait Fees Paid by Applicant(Initial) BLDG CI'/PLUMB NIPCH `l v 1 ❑ ❑ IJ" LICENSE])CONTRACTOWS DECLARATION Q'I'Y. ELECTRIC PERMIT FF15 I hereby alum me I en firrtned tinder pcoo,rm."f Chapter 9 ammnemliny JOB Df3SCR1Ia'1'ION OaZ id,Swir.7dnlnf UiG,m.3bflhc llminesrmd l'loessions Ct dnpl license i. R'' )F TI WOO �' C`1� q PERMIT'ISSUANCE10 CWF mfullnttnoand ryrf C� - `j .FOWL FIKITCHENRENIODEL aUU I.mcnscC s '-Y Lich APPLIANCES-RESIDENTIAL ❑ADDITION 0 PLUMBING RH.PIPI' Cummmnr_ ARCH f:CI"S UECLARAI'ION^ PANELS ❑MIIhIT-UNIT ❑STIiUC'I'URAI. ~vOi Z I unJrmmaA my plain shall be meed as uM1lic as bM UIFICAITON Z O m- UP TO 210 AMPS ❑ OZ-� IN'I I:RIOR ❑CHIMNEY REPAIRI•EL),F',,W Limeawd Pndessimml 201-1000AMPS 04PROVIiMEM' E]SWIMMING TOOLS a OWNER BUII.DEk DECLARATION C��� OVER UNV ANIPS ❑BAI'lI RF.MOOEIJREPAIR DFMOL11'ION C 6 I hemM1y nllirm Incl 1 mu exempt lium the Cnntrucmr'n Licen.lc Law Ibr the ❑UI'lllik billowing re (Section IID I.S. avine.s,Tied Profession.Code:Ani rip,ur county SIGNS Id.EC[RICAL -R bimain W Win which requires a permit to construct.alter.improve demolish,or repair any saucmre I��OQ prirarto its issuance,also requires the applicant for such eermil rat Eleasigtied vencrrcm SPECIAL CIRCUI TIMISC. ci�E tinN' the he is licenced parsons'I,'he provision of the Cummemb's License Law(Chapter 9 COMMERCIAL: W pO (mm tncncing wllhSccll...T700)ol Diviean 3 of the Busman Teal Pral—ions Cn Jet 'I1:M11 ME 11:k OR TOUT NST a a e IY that he is cacmm et drisfraand The naris for the alleged exemption.Any violmion of ❑NIT 131.DGIADDI'f1pN ❑UIiM01.1'I'IUN �y Section 7031.5 by any applicant for a Permit sobjecsthe vpplicanu0 a civil penalty or POWER DI:VICI- ❑l'IiNAN"I' ❑PWDSERVICIi FZY mnnm than fie Imbibed delta.($5(ft 1MI'ROVIMENT rat S % wi I,nsownerireem of the tirapertRu,tny... miaeax with wagcats late((Sec 70,mpcmwtinn. SWIMMING INDOh ELICCfHIC will An We worA.and the strudnre is not inlendvA unod'crul hx sale(Sec]M4.Ifn.ine.s ❑UTIIIiR W ado and Prolccnianr Code:'I he Contractor's License Law docs nil apply m;in owner of OU'fI.CrIS WITCI11:9-h1X'I'U RES 0. p.,,a,who build.,or improve,Ihemon,and who docs such work himself ser through his into employees,provided Inas such improvements am int intended or offered for NEW RI!SIDENTIAL ELECT SQ F1'. ade.If.however,the building or ntproverrem is slid within one year ofconpleaur,the SQ.PT.FLOOR AREA LSQ FL raw ocrvbnilrur will nave the Nolen"I proving Inst he did nal build nr Improve Ibr pur- po c ol'w1e.). s1.as owner of the n y contracting with licenced comments m IAL: pntpc y,.B sine s an g ao construct theprotect(Sec.t)an Businessandnywhobuicede)The Cnmrmaon.anti Li- wLsee Law li noeell 11 man ithacd'pmperty w1ecwdJar improvIhLTCt crn.and QTY. LU Bi MI" FEE e r"mwetc❑tratm1l,retmu wins It rnmmmerLv)bimnscn nrnmatnmme Cnnlrm0r. Uccoe law. PERMIT'NS AN I am exempt under Sec. ,B&1'C for this rcnson ALTER-Ilk. &Vii .R(EA) VALUATION Owner hate WUI3KEWSCOMPENSAITONDECLARAI'ION BACK ELUW PR(y1'IiC'I',IDFVICI: hcrcM1y slur,under anally of perlufy ene"f the lolb wing Workers iu I have and will maintain uCcnifcum of C"meno s uelf-ihwrtlin WBr[era Comilla- DRAINS-FLOOR.HOOT°,AREA,CON $'1'ORIILq 'TYPE CQN$THH(T1DP fin rvided Ibr M1y Section 3]1X1 of the IaMn CoNe,for the pednmmnce nr the ( which ods permit is i...cd, FIXTURES-1'F IW 1 Itavc Ind will nnnotate Worked,Compem:nion Inxumnm,a,resimmJ by Section 37(X00 the labor Code,for the pedormmce of lira wank fur which hiapenult in LcuW. OAS-IiA.SYS Em-I INC.40U'I'hEI:S OCC.GROUP APN My Wer t4�w1 C�0!XtFn on-hnsJ{[Im }�er and l'alicy n t •f' oH. Carrier: MIL I_ `f�A/UI-fir-Pel my Na: .7 GAS-I:A.SYSII VER4(I:nl CER'GIICATL'OP I:%E IT MN FR.M WORKERS' GREASIJINDUS A. IT 2,1'lY)R COMPENSATION INSURANCEBUILDING DIVISION FEES (Miu.eellan ncedmelieeutnpleted it thepennitiufor unchundreddull:"(5100) GREASE'I'RAP PLANCRECK FEE ran less.) Toy my,that in the anyclatanceof the work far which This thePermitWisismconmenl S[WEk-SANIT -S'IOR IA.1-00 .� nut employ any person in any mmnncr so u m became subject m the Warkcrs Canlecm INIiRGY FEC Z c:nion latw.af California.Date WAFER IIEATEN (TRADING ITER z0 APplicum N NOfICE'IT)APPLICANT IL mmnnrking this Ccnihcemil lieempnnn,you.should WAI'EK SYSTEMfl RFvTING SOILS FIRE h-' beemtnc 5utjat m the Workeh Gtmpcnsation Pmviaians ran the labor Cevde,you matt Wforthwith comply with such pace sions",this Ecrood,bml he deemed revoked WATER SERVICE Q PAID 5Z CONhe,,I,C'TIUNuni UINGAGENOY NEW It I!SIUEN'f1Al.PLMR, SQ.FL Dale Receipl4 U O l for which this there i.a..ed(motion lending agency lix the ryrlitmmnce of the work far which tris permit is:.reed(Star-3097.Ci,CJ 10'ITL: 0 F' Lender's Name TOl'A h: U Lender's Address Address CU I wnify air,I have feud Ibis upplicatimt and some dint the above infnmmtion is BUILDING EEIi F' Val correct.lalnece to comply with all city and county ordinances and state laws relating to QTY. MECHAN[CAL PERMIT I FEE SEISMIC 17VE G Z baildingeanstiuclion,std merhyaathodm mpmsanmtives orthindly menerupom the ((�� [[�� Tax"enandiu ed pntpeny for inspection purgrscs. PERMIT'ISSUANCE: 0 ELECTRIC PER lJ (WC)agree m.am,iodctnedy and keep harmless the City of Cupertino against ^ Iiuhilitiec.iudgmenls.costs amt expenses which trey in any waY:acmc against said City ACIIBURADD'IOMI:CH. PLUMBING FEE in consequence of the pointing of this permit. AI'PL1 INT O[.f 'I'ANDS AND WILL COMPLY WSO ITH ALL NON-POINT AIR HANDLING UNII'('1U 10.000CF14) MF,CIIANICALITI ©(� O 6 9-9�� AIR HANDLING UNIT(OVER 101Np CFM) CONS'Bl1Cf(ON'I'AX Signntuaf AEElicunJCnntmctnr / Date EXHAUST'IIOODIWIUUCI) HOUSING MITIOA1 ION FEE ILVZARDOUS MAUiRIA1 S DISCLOSURE Will the applicant or future building occupant store or handle hmardous material THEATING UNIT(TO 110,3 us defined by the Ceti Mcnicipul Corte,Chapter 9,12,and the Health and Safety HEATING UNIT'(OVER 100,000 It'1'U) Cure.Scctium 2553200" ❑Yes ❑No VE'N'D LA'CION IAN(SINGLE RE SI Of PAID Dae Rmzi tx AWL Will the nEElicam nr future building excretal use equipment or devices which BOILER-COMP Calf OR 100,000 BTU) nit Mtmrdom xir ttmtam Taus as defined by the Bay Area Air Quality Management 'IOTA . wrist! ........ flaaar U) ❑Yes ❑Nn '( AIH CONDITIONER CA-) — ISSUANCF D TH mind Kauravas,Kauravas,mat 1 have e hNous erims mquiremenu under Chapter 6.95 m the Cut, � Yy %7 Btmin ITana&Side,Cala Sections 25505,25533 and 25534.1 understand Irmo i f the NEW RESIDENTIAL MUCH, SQ,PP. hudding nae.n"I canal ly have a Icnunl.Ihal it Is my resrymdnility to noldy the mvnpant III the mgmmavers thidl mtsst be to poor m...cause cl a CenlOcem uroc,ta:mc,. Owner or authorind agent Dam YI'nl. ISSUED B\ OFFICE 5M '® 10300 Torre Avenue Cupertino, CA 95014 C let,V ottf Cupertino Building Division (408)777-3333 (fax) March 5, 1999 Homeowner 10110 United Place Cupertino, CA 95014 SUBJECT: Permit# 52145 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 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 CUPcEERRT�INO� Christy Akatiff, Administrative Clerk Printed on Recycled Paper