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30213 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATIONJPERMITPLUMBING-MECHANICAL 30213 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: I , u �� SANITARY NO. APPLICATION SUBMITTAL DAT fp/.1'i./t`. 1 WNF. :S NAM..^�� PIION17 `^ CONTRACTOR'S NAME: LIC N : 3 N/CF] �CONTROLe CI{ITIiC1lIiNGINELR: LI O: ADDRESS, 1 CONTACT: PHONE: //11 BUILDING PE li'll INFO • ,xf—Ivtd�� �-+ , r._(1.\��i�l`^�D ❑ Consultant Fees Paid by Applicant(Initial) I}LfKi ELECT PLUM1IB MECH Isc LICLNSI?DCONTRACTO . UECLA1RNI'I✓\ON ! U QTY. ELECTRIC PERMIT FEE Irl—Il�� 1 heathy torr,n mat I am ranxw ander prn,ixion.of chapter 9 anmmem'ing JOB DESCRIP'T'ION X with Sarion](KXO ofDivisinn3nfthe Business toed Pmfessi...Code.andrn,hcemeis RF_SII N'flAl: FI_- in full hrce and effect. PERMIT ISSUANCE: I ❑SFDWL ❑KITCHEN REMODEL CULL License Class Lic.M Q U APPLIANCES-RESIDIiNT1ALf)ITION ❑PLUh1BING RE-PIPE: yul Date Gtmrocmr rY1tf 0. ARCHI'UCT'S DECLARATION MULTI-UNIT' ❑STItUCfUkAI. Zp nn Iundentund myplansxhall be usedmpublic records IANLLS MODIFICATION OZ—� UPT0200AMPS ❑INTERIOR ❑CHIMNEY REPAIR F-HF"ad Licensed Professional 201-1000AMPS IMPROVEMEry•rJ']1 p e �1 ���; OWNER-BUILDER DECLARATION OVER IIXp AMPS ❑BATH REMODBIlREP7sIR I�IDIiMOLITION C)1yaQ I hereby rm w m (ion exemloc pt fhe Contractor's I.icense Law lin me iq5 D affy Q following reason.(Section 9031 5,Business and l'mfmsiom Code.Any city or coupy SIGNS ELECTRICAL. ❑OTHER W 3 LL N which requires is permit at cnnsuun, It,,improve,demolish or repair any saueaaa F.O¢ prior to its issuance also requires the applictm for,mh permit fileasignedste¢ment SPECIAL CIRCUIT/M ISC. MAR 10 REED E } that he is licensed pursuan.to the provisions of the Conuactors License law(Chapter 9 �{Yp0 (commencing with Section of Division 3 of the Business and Pmfmsions Code) TEMP METER OR POLE INST. a that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW Jf. /AFJ)IIIONrC©DEMOLITION �� Scotian]III L$L 1 Iforu permit sib ul rhev 1' int astute penult POWER DEVICES m y anY oPP icon j.,s pp icon Y n' �'I'ENANT ❑FOOD SERVICE of mom man Tive Lattice dollars($5001 IMI'ROVEMCNI' Fs ❑ Lo the work.the property,onnyemntended withwegesm ms,(Sec.cssmpensanes., SWIMMIN CBIC W p.,O will domewnrk.and the he emu isnot imm�ense La does of apply to an.Business ❑OTHER I�il— toed Pmrmsiom Code:The Contractor's License Law does not opP1Y m anoxvou of U - 'ITCHE. 'IXTURES property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for RIiAI 11171- R SQ PT sale.If,buildeT will h building(itimprovement la at hedidwithin one build or i uoupiprovetio P SQ ) A $J I'. er-builder will have the burden of sprovingenorm that he did not build or improve fur p pose of sale.). h as owner of the property,am exclusively contracting with license In construct the project(Sec.](1W,Business and Profes%ions Cale:)' e se Law does not apply at an owner of property who builds: in mhe PLUMBING PERh1I'f FEE whormilo tstinwcltProject,with rearlochtr(s)licensed per nu cCo wr'. License Law. ERMIT ISSUANCE ❑1 am exemp it Sec. PC is reason AI.TIiR-DRAIN&VPM-WATER(EA) VALUATION ) 1 WORKHR'S COMPENSA D At BACK PLOW PROTECT.DEVICE �— Ihcrchyafin,andI vcmhy of perjury ctollow dela uses: L I have and will maintain a Certilicamol Cunsci self-rote I orkcr's Cnmpen- DRAINS-FLOOR,ROOF.AREA,COND. STORIES 'TYPE CONS]RUCTION station,as provided for by Seniors 3700 of the La M 'ed perfrrmmce of the wed for which this permit is issued. FIXTURES-PER TRAP I have and will maintain Workers Compensation 1 . must,as required by Section 3700 of the Labor Code.far the performance of the work for which this permit is issued. GAS-EA.SYSTEM.I INC.4 OUTLETS OCC.GROUP APN My Worker's Coin,rreuion In,monve carrier and Policy mummers: Carrier: Policy No.: GAS-EA.SYSTEM"OVER 4(EA) CERTIFICATE OF EXEMPTION MOM WORKERS' GREASP/INDUSTRI.WASTE INTERCEPTOR COMPENSATION INSURANCE.- BLIJ."DINJ DI ISION FEES (This.section need not he completed if Permit is for one hundred dollars($I(p) GREASETRAP t or less.) PLANCH[CKFVI/ I�Q moil,that in the perfamwnccof the work for which his perma is issued,i shall SEWER-SANITARY-STORM EA.Nat FT. not employ any eterom in any manner m as to himorm subject to the Workers Cnmpmr. ZPAID Oz salon laws of California.Date WATER HEATER W/VI?NT/ELECTR GRADING 7 0 Applicant J.. N NOTICE TO APPLICANT.If,cher making this Certificate of Exemption,you should WATER SYSTEMNRRATING a ^ become subject to the Worker's Compensation provisions of the Labor Code,you amt GLIG forthwithcomply whh such pr�visionsonhis permnshallbe dccnmA rooked, WATER SERVICE � z CONS]SUCTION LENDING AGENCY NEW RESIDENTIAL PI,MB. SQ.FT cU 0 l hereby affrm hat hem i.s aconstrucbon lending agency for the perfomtance of(•-' he work for whichthis Permit is issued(Sec.3(19],Civ.CJOULender's NameIAL: Lender's Adthos LI carteyhm 1 have rwdcis application and ram thus the above information is V) correct.l agree to Comply win all city and county ordinances and state laws minting I, QTY. MECHANICAL PERMIT EEEZ building con.vwction,and hereby numeric representatives of this city to enter upon the k ISO above-mentioned property for inspection paryoses. PERMIT ISSUANCE 710(We)agreem save,indemnify and keep harmless the City of Cupertino against liabilities.judgments.cosrs:mdexpenses which may in any wayaccrveagaiml said City ALTERORADDTO MECH. 0 in sreminceolthe gmming otmis Permit. 1'Ll1MN1 FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNH(TO 10.001 CFM) MECHAIC ':E SOD r�E RE^GUVLA/Tj_DNN�S. AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION Sig TIX nature ofApplicart/Conaanor oc EXHAUSTHOODDV,`DUC*f) HOUSINGMITIGA IONFEE EAZARDOUS MATERIALS DISCLOSURE Will the uppl caul or stare looddingoccupantemus nr handle lm,amom material HEATING USE'(('1'O Wim()BTU) fned as deby the CupcIt Municipal Cale.Chapter 9.12,and the Health and Safety Coda Section 25532(a)^ HEATING UNIT(OVER IR."BTU) ❑Yes ON. VEN'TILA'TION FAN(SINGLE RF_S ID) PAID Will thea applicant or future building cu r use equipment or devices which Date Bac M pp gtc pen Area Qu BOU.ER-COMP(3HPOR IR,IgN111N) tit ha<urdnus air conmminnnrs m Jcfnal by the Ii1y.Area Air Quality Manugcnum DiSlricL'❑Ycs ON. BOILER-COMP(OVER 100,000 BTU) ` I have read the hisadous mamnals requiremerm under Chapter 6.95 of the Cali AIRCONDITIONER ISSUANCE DATE fomia Health&Safety Code.Sections 25505,25533 and 25534.I understand that if the NEW RESIDENTIAL MECH. SQ.FT. building docs out earivently have atennt,that it is tryms1m,hi liry to ami fy the occupant of the re .w ht the our pools is'I nee nraamE toes Oeeals toy. �wfS $ 7 C in , Owner or tmhonred agcm —�� Da 7 � ISSUED BY: OFFICE • '� 10300 Torre Avenue Cupertino,CA 95014 City of Cupertino Building Division (408)777-3333 (fax) 3� ' March 5, 1999 Property Owner 19894 Wheaton Drive Cupertino, CA 95014 SUBJECT: Permit 9 3 02 1 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 1 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 CUPERTINO ` Christy Akatiff, Administrative Clerk Printed on Recycled Paper