S 0502(� APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY.OF..CUPERTINO BUILDING•ELECTRICAL I AlNO Oa.O
BUILDING DIVISION APPLICATIONAPERMIT PLUMBING.MECHANICAL `V 1V, L
BUILDING PROJECT IIIENTWICAT'IUN
BUILDING ADDRESS: • SANITARY NO. APPLICATION SUBMITTAL DATE
/0933 WIC NSoN AV5, /fir 3
OWNER'S NAME /k" 'y�' �Pli( r C RS(4,5��f;/r LO4� I , NIC CONGROL#
CHITEC IENGIINNF.ER: l 1Y1 LIC NO, A7 6 C1490MU� J— ❑
CONTACT: PHONE: BUILDING PERMIT(NPO
❑ Consultant Fees Paid by Applicant(Initial) BLIIG EI.Iim PLUMB MECH
❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. - ELECTRIC PERMIT FEE
Z 1 hereby(norm ma-1 am reamed under provisions enamor 9 mmy i'me I, JOB DESCRIPTION
IL Section](AHO en Ilivi,ion 3 of oho Business and professions CnJc,and my liwnso Ix
a O� Wt I^ O ak PERMIT ISSUANCE ❑KITCHEN REMODEL
W In IUII I'nrce mA d7nc I+ r,
aUZU Licenser Cl.s� Y Lic.K APPLIANCES—RESIOCNTIAI, ❑AUDITION [I PLUMBING RE-PIPE
F Q all Dmc' Contsacmr
FOy A C ITF.CTS DECLXIfWI0V PANELS ❑MULTI-UNI'T El STRUCTURAL
Z O�'Z 1 understand my plans shall be usedas public maads MODIFICATION
OZ=� UP TO 200 AMPS El INTERIOR ❑CHIMNEYREPAIR
W Licensed Prom,xiuml 201.1000AMPS IMPROVEMENT 0SWIMMING POOLS
OWNER-BUILDER DECLARATION
c,44 � OVER 1000AMN ❑BATH k1iMODEI/RITA [I DEMOLITION
C Q I herthy alarm mm I em exempt from she Cnnwntor's License Low for the
W0 W F fallowing moved (Section]071.5,Business and Professions Cade:Any city or county SIGNS ELECTRICAL ❑GTHP
tall
which requires a permit to construct,alter.improve,demolish,or repair any structure
0� prior to its issuance.also requires the applicant for such Pmniun file a signed statement SPECIAL CIRCUITIM ISC.
} that he is licensed pursuant to she provisions of One Contractor's,License Law(Chapter 9
(commencing with Section]110()afDivision 3 of the Business and Professions Code)or TEMP.METIER OR POLE INST. COMMERCIAL:
a q M C that he is exempt therefrom and the hats for the ullegd exemption.Any violation of ❑NEW BLDGIADDIT1ON ❑DEMOLITION
Section 7031,5 by any upplicant far ape.i,subjectsthe applicants civil pcnultyof POWER DEVICES ❑TENANT 0FOOD SERVICE
F ah ret ream than rive hundred dollarsGSW).
' O I,an nwneral the properly.or myempinyees with wages as their enlecompensation, SWIMMING POOL ELECTRIC IMPROVEMENT
will do the work,and the structure is not intended or allocated for sale(Sec.7044,Business ❑OTHER
Fm and Prmfexsione Code:Via Contmemea License law does not apply to an owner of OUTLETS—SWITCHES—VESTURES
.. Properly Who huilds or Improves thereon,and who does such work himself or thrnugM1
his own emplulma.provided that such improvements are not intended or offered for NEW RESIDEN'I'IAI.HLECTR SQ FT.
sale.If,however.the building or improvement is sold within one year ofcompletimn,the El
SQ.CO.
waervhuilder will have she burden of proving that he did not build or improve Iia por-
Pse mope.).
1,as owner of the property,am exclusively contracting with licensed contmcmm 1. IO AI 131997
construct the project(Sec.70,14,Business and Profession,Csde:)Tat Caarmoon',U. NOV
nsc law does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBINGPERMIT
who contracts for such projects with a contractions)licensed pursuant in the Cantrunors
License Use PERMIT ISSUANCE.
❑1 am exempt under Sec. ,B&1'C for this reason
ALTER—DRAIN&VENT—WATER IEA) VALUATION
caner (late
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT'.DEVICE
1 hereby affirm under penalty of perjury one of the following declarations:
Ihave and will maintain a Certificate of Consent to self-insure for Worker's Comport DRAINS—FLOOR,RODE,AREA.CONDI S'1'ORIfS TYPE CONSTRUCTION
satin(,a provided for by Section J]W of the labor Code,for the ryrfnmsma of ober
r Our which this permit is issued. FIXTURES—PER'1'RAP
W
have and will andulain Worker's Compensmmn Imumnce,as roan al by Section
3] of the Labor Code,for the perfor ,mr,ofthe work for which this permit is issued. GAS—EA.SYSTEM-I INC.4 OUTLI I:S OCC.GROUT' APN
My Wnrk s Coni nsution Ina�s LL^;�f�Y�w�,,00l Policy n ora
Cartier �ry/q{�ff�sllcy Nn.: CTAS—F.A.SVSTIiM-GVHR 4111A1
L: C Illi OP SAT(I INN FROM ( ER.' �Y�
COMPENSATION INSURANCE OItEASFIINDUSTRI.WAS'T'E IN'll?NCEI'iOR
131111.DIN6 DIVISION FEES
(This section need nmhoompleteJ if me pennh is fonmehundrcJ Jollun($110) GREASE TRAP
se.IesaJ PLANCHF.CK PER
I eerily that in the performmeamNe work far which this Fu ii is issued,l said SEWER—SANITARY—STORM IIA.200 FI'.
not employ any perin y manner ra as m become subject m the Workers'Cmmpen- ENERGY FEE
son an
scion Law,of CuW
liful Date WATER HEATER /VENTiELECTR
z Applicant I GRADING PER
fn NOfFICH TO APPLICANT.If,after raking this Certificate of Hotraption,you shnnld WATER SYSTF.MCFEATING
a become subject to the Wei Compensation provisions of the LMsr Cale,you ntust SOILS PER
forthwith comply with such provision,or this permit shall he decided mvnked. WATER SERVICE
a �
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMN. SQ.FT. PAID
.7 Z Data Receipt Of
UO L for which thi nhanhemisaco (See,on[ending agency far the performance of
the work for which this permit is issued(Sec.3097,Cih,CJ
0 F' Lcndera Name TOTAL:
O'W Lenders Address 'T(YTAL:
I certify that 1 have read this application and state that the above information is BUILDING PEE
faq cortices.I agneas comply withal)city and anunty ordinmcc,and slam luwsrclutingm QTY, MECHANICAL.PERMIT FEE
U . building conntmction.and hereby numarize repre,cnmsives of this city tat cmentpon the SEISMIC FOP
atoo'.b ....ed property far im,sec0on amposse. PERMIT ISSUANCE(Wil agree to save,indemnify and keep harmless the City of Capatlnn against ELECTRIC PER
liabilities,judgments,cosssandexpenses which may,.any wayuc...casuist mid City ALTER OR ADD TO MECI I.
consequencein of oho granting of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI TOO 10,000 CPM)
SOURCE REGULATIONS,
MECHANICAL PI31i
AIR HANDLING UNIT DOVER 10,000 CPM) CONSTRUCTION'IAK
Signature of ApplicmtlConnactor Done EXHAUST HOOD OVADUC) I14OUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the ot,dimnt to future hudding occupant same or handle ha...I..,material HEATING ON]F(TO I W.WO RTU)as defined by the Cuperino Municipal Coder.Chapter 9.12,and the Health and Safety
Crile,Sectimn 25532pepl IIEAT'ING UNIT(OVER I00.110(111TU)
❑Yes 0 N PAID
VENTILATION FAN(SINGLE RESID) � (late Receipt p
Will the applicant or future building occupant use equipment or devices which d
mil hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER—COMP OHP OR 110,0(X1 BTU)- 'TOTAL:
Dintricd7 BOILER—COMP(OVER IIA(000 NTLI)
❑Yes ❑No
have rand the humrdnus materials requirement under ChapterM195mf the Cali AIR CONDITIONER ISSUANCE DATE
hrrnial Ilcnhh&Safety Gdc,Scannas 25505.25577 and 25534.1 rmdmataid that il'the NEW RESIDENTIAL.MECI I. SQ.I'T �f
buildln,doe,not currently huveu tenant,that it is my rexpoinsihillty to notify tote remount //�/� i9 /
mama nL uemx which rnystl�t::i Wzucerirlcp'�"r"-t Pllnc
Own omeZ ugenl P / S' k� ISSUED BY: O
OFFICE
�i 10300 Torre Avenue
Cupertino,CA 95014
Cil:v of
Cupertino Building Division
(408)777-3333 (fax)
February 4, 1999
Homeowner
10933 Wilkinson Ave
Cupertino, CA 95014
SUBJECT: Permit# 50502
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 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 CUPERTINO
Christy Akatiff, Administrative Clerk
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