30690 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
,CITY OF CAFE'RTINO BUILDING•F.LHCTRICAI. PERMIT NO, /N 0 /+/�0
BUILDING DIVISION APPLICATION/FERMIT PLUMBING•MIXIIANICAL 3 MV�J•1
OUILDING PROJECT IDENTIFICATION
BIIILDINGADDRESS: SANITARY NO. APPLICA'HONSUIIMITTALDATI
03s's' j/I$ l/6LA-NSE ,
BBTtft04 �+
NCR'S NAME: PIi(]NE: CON RACTOI2;S NAMEr LIC NO: NIC CONTROLa
C SD G R6Non�z/6 s 4 / us
RCIEmCT/ENGINEER: LIC NO. ADDRESS,
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG EhCCT PLUMB MUCH
tLaF1Y` 1�-y
L.that IDCONTRACnderp DECLARATION04 Z QTY ELECTRIC PERMIT FEB !V_ES
1 herehy affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
A00 wird Sectinn"/II110)of DivisionJof the Business and Professions CoJq onJ mylicense is
O O PERMIT ISSUANCE RESIDENTIAL:
fall force and ellen. D
aVr�j License Classes B Lia# 74DV - ❑SFDWL ❑KITCHEN REMODEL
F W Mete —/j 8 Co.".cmr APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPIT
(N-py ARCHITECT'S DECLARATION - ❑MULTI-UNIT 0S'IRUCTURAL
Z p h I understand my plans shall be used as public records PANIi1S
MODIFICATION
OZ^ UPIU200AMP5 ❑INTERIOR El CHIMNEY REPAIR
Licensed Processional - 2U1-11ro AMPS PROVIiMI?NT
�X .J Oat I am exempt
from
m the xrdowN OVER I(NIOAMPS TH REMODEUREPAIR [I DEMOLITION
C W Q I hereby affirm that 1 am exempt from the Conaacmrs License W'o fur the O OTHER
3 O0.U following reason(Semina 9W s Business and Professions Cade:Any city err county SIGNS ELECTRICAL
0. which requires a permit m conswct,alter,improve,demolish,or repair any structure
prior m its issuance,also requires the applicant forsuch Permit no filen si,ruslUmenam SPECIAL CIRCUITIMISC.
Q� Nat he is licensed purmad,to the provisions of the Commnors License Law(Chapter 9
00 (commencing with Section]000)ofDivision 3.f the Businessand Professions CedGm TEMP,ME HBZ OR POLE INST. COMMERCIAL:
that he is exempt therefrom and the basis bribe alleged exemption.Any violation of ❑NEW BLDG/ADDITION []DEMOLITION
^y Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES
} tmare than five hundred dollars 5500). ❑TENANT ❑FOODSERVICE
^ 6n
01,as owner of the property,or my employees with wages in their sole compensation. SWIMMING POOL ELECTRIC IMPROVEMENT
will do the work,and the suremre N not intended m offered forsa]e(Sec.7W.Business []OTHER
and Professions Code:The Cmumcbm''s License Law it.not apply to an owner of OWLETS-SWITCHES-FIXTURES
properly who builds or improves thereon,and who does such work himself or through
his awn employees,provided that such improvements arc not intended or offered for NEW RESIDENTIAL ELECI'R SQ FT.
ince.If,however,the building or improvement is sold within one yearof completion,the SQ.FT.FLOOR AREA VSQ,FT.
caner-builder will have the burden of proving that he did not build or improve fm pup
pose of sale.).
O 1,as owner of the pmpcny,am exclusively convecting with licensed comracmrs to TOTAL: tri p M 1
conswct the project(Sec.9044,Business and Professions Code:)The Contractors P ctors Li.
ase Law does not apply man...in ofptoperty who builds or improves thereon.and QTY. PLUMBING PERMIT 17EE
who contracts(or such projects with a cantmclocs)licensed pursuant to the Comrannrs -PCRMIT ISSUANCE DEC 19 6
se v^0 pp
License Law.
❑eaaempt underSec. ,B&PCfnr Nis reason
Owner Date ALTER-DRAIN&VENT-WATER(EA) AT ON
CITY � IVV
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE `q/Q
1 herebyaffirm under penalty of e Perjury oneofthefollowing orkersCa
I have and will maintains Certificate of Consent ods.sure for WorkersCamper-
of the
DRAINS-FLOOR,ROOIi AREA,COND, STORIES TYPE CONSTRUCTION
cation,as provided for by is i Tun 3]00 of the Inbar Code,for the perfnmmnce of the
work for which this permit is issued. FIXTURES-PER TRAP
❑I have and will maintain Workers Compensation Insurance,as required by Section
39W of the Ldbor Code,for the performance of the work far which this permit is issued. GAS-PA.SYSTEM-I INC.40WLETS DEC.GROUP APN
My=
Co pcnsation�lnsuImnc� artier end Policy nup�bor ale: OVM4 )
Cartier: ST T_�ryAYd policy No: O�f6^ Q� GAS-EA.SYSTEM- (P.A
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE - GREASFJINDUSTRL WASTE INTERCEPTOR
(This section need not X completed if the permit is for one hundred dollars(SI W) BUILDING DIVISION Fgili.S
or less) GREA$E'I'RAP
PLANCHECK FEE
I employ
any,m more performance aide t work for which this themaranW is issued.]shall
notemploy eny.petson in any manner so as to become sub'ectrothe Workers'Com _ SEWER-SANITARY-STORM PA.2q)FT.
Z submit laws of California.Data ) an ENERGY FEE
WATER HEATHS WNCNTELEENzOApplicant
GRADING FEC
r rn NOTICE TOAPPLICANT.are Work If,after making this Cisions o of Exemption,you should WpT'CN SYSTEM?RCATINO
1^ ; become subject y it Workers Compensation provisions of the tabor Code,you must SOILS FF.P.
r foMwith comply wird such provisions mHis permit shall be deemed revoked. WATER SERVICE
UJ
Q
� � CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL I'LMB. SQ.FT. PAID
V O Iherebyaftinvid..there isaconswmian lendingagency forth,perfortnance.f D. ip
`+ the work for which this permit is issued(Sec.3099,Civ.C.)
I••' lenders None /TOTAL:
{VTa Lenders Address TOTAL:
I minify that I have read this application and sant that Ne above information is BUILDING IT
r, raA careen.l agree to comply withal]city and county ordinances and state laws mating to QTY, MECHANICAL PERMIT
U Z building convection.and hereby amhoriu representatives of this city to enter upon the FEE SEISMICMF
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep harmless are City of Cup,nino against ELECTRIC PE'
liabilities,judgments,costs and expenses which may in any way secruengainst said City ALTER OR ADD TO MECH..
in mnsegmmor,of the grafi ng of this pemul. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNIT Cin IR"CFM)
SOURCE REGULATIONS. - MECHANICAL FEE
AIR HANDLING UNIT(OVER If"CFM) CONSTRUC ION X i
Signature of ApplicaMCantractir Data EXHAUST HOOD OVIDUCT) HOUSING MITIG TION PEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building accused store mhaMle haurdous material HEATING UNIT CFO 100,000 BTU)
as defined by the Ciampi..Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532hol HEAPING UNIT(OVER 100,01 BTU)
❑Yes ON. VENTILATION PAN(SINGLE RESID) PAID
Will the applicant or future building occupant use equipmenl Of deviRa which Date Ru t x
mit harainkus air commitments as defined by the Bay Area Air Quality Management BOILER-COMP QHP OR 100,011 BTU)
Duron^ BOILER-COMP(OVER 100,000BTU) T( AI.
L�w�
ON.
ad the Notorious materials AIR CONDITIONER
requirements under Chapter 6.93 of the Cali- ISSUANCE DATE.
Safety Code,Scctiom 25305,25533 and 25534.1 understand that if the NEW RESIDENTIAL MUCH. SQ.FT.
ot currently have a tenant,that it is my responsibility to notify the occupant
ems which st he met prior m issuance of a Certificate of Occupancy.
iud age Dae TOTAL ISSUED BY:
OFFICE
10300 Torre Avenue
• Cupertino,CA 95014
Cite ul'
CUpertll10 Building Division
(408)777-3228
(408) 777-3333 (fax)
March 20, 1998
Homeowner
20355 Via Volante
Cupertino, CA 95014
SUBJECT: Permit#30690 bath repair/rmdl
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, this permit has not been finaled 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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Printed on Recyolod Pace,
i