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30762 (4) APPL)GANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY �-- CITYOF CUPERTINO BUILIIING-F.LF.CTRICAL PERMITN030762 . /� O L n BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL J BUILDING PROJECT IDENTIFICATION IIUILDING ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE d 014.4 OW Eli',NAMlV_ L - PHONE: R'SNAh CONIR LIC NO: NIC CONTROLx CHUTI.TM14GINEHR: LIC NO, ADDR17SS: ❑ NTACT: PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH ;K_ LICftNSEDCOcensed e,ProR 5 DECLARATION QTY ELECTRIC PERMIT FEE I hereby affirm that 1 am licensed ower Provisions of Chapter (rommencmg LOB DESCRIPTION O00 wim Sermon T(XIO)nf Divisinn3nf the Business and Professions Codc,and my littnae is RESIDENTIAL, b4Op PERMIT ISSUANCE - �� in full force and effete. ❑SFDWL ❑KITCHEN REMODEL 6U License Class Lic.x RESIDENTIAL ❑ADDITION C3 PLUMBING RE-PIPE {{. Dale Va66 TSDE ARCHITECTS DECLAcrete, RATION APPLIANCFS— ARATION ❑MULTI-UNIT ❑STRUCTURAL Z p N Z 1 understand my plans shall h used as public mends PANELS MODIFICATION 0Z4O UPTO 20)AMPS [I INTERIOR [I CHIMNEY REPAIR P,4�41 Licensed Professional 201-IIILYIAMPS IMPROVEMENT �Y .•�]] OWNER-BUILDER DECLARATION OVER IIg0AMP5 ATH REMODEVREPAIR DEMOLITION $Y 6 I hemby affirm m that 1 am exempt from she Commor's License Low far the !l Cy following reason.(Section 7031.5,Business and Professions Cattle:Any city or countySIGNS ELECTRICAL i]OTHER 444444777777 3,�zf which requires a Permit to construct,alcor,improve,demolish,or repair any structure F OS prior to its issuance.also requires the applicantfor such permit to file a signed statement SPECIAL CIRCUIT/MISC. y" that he is licensed Panaml to the provisions refine Contractor's License Law(Chamn9 GC (commencing with Section 7000)of Divisinm3 ofthe Businessand Professions Cade)or TEMP.METER OR POLE INS COMMERCIAL• a`6 p C that he is exempt merefrnm and the basis for me alleged emmption.Any violation of ❑NEW BLDG/ADDITION []DEMOLITION 4, Section 7031.5 by any applicant for a pvoind subjects the applicant too civil penally of POWER DEVICES ..y not more than rive hundred dollars []TENANT [I FOOD SERVICE IMPROVEMENT Q ❑I,ssowner of the property,or my employees with wages as their ante compensation, SWIMMING POOL ELECTRIC 0 will do the work,and the.grucone is not intended oroffered for sale(See.7044,Business ❑OTHER d 3$ and Pmfessions Code:I'he Conhncun's License Law does not apply to an owner of OUTLETS—SWITCHES;—RXI'u property who builds or improves thereon,and who does such work himself or through his own employees,provided that such Imp mearam s are not intended or offered fof NEW RESIDENTIAL ELECTR SQ FV sale IL however,the building or en of proving is sold within one year of completion,the SQ.PC FLO 12SISQ.FF. owner-builder will have the burden of proving Jut he did net build or improve for par- pose of sale.). k/ ❑ I,as ormof she property,am exclusively cemmning.,all licensed contract...to TOTAL: [a� construct Ne project(Sec.7044,Business and Pmfessions Code:l The Conoactoes Li- cense Law does not apply to an owner of property who builds or improves thereon,and QTY, f PLUMBING PERMIT FEE who contracts for such pmjeets with a commetogs)licensed pursuant to the Contractors License Law. PERMIT ISSUANCE C]lam exem tunderS e. .B&P C fort V Owner4111--aDa ALTEN—DRAIN&VENT—WATER(EA) VALUATION WOBKI 'SCOMPENSATIONDFCLARATION BACK FLOW PROTECT DEVICE 1 hereby unit.under penalty nT perjury ane of the fdlowing declarations: I have and will maintain a Certificate of Conger to self-insure for Worker's Cnmpcn- DRAINS—FLOOR,ROOTy AREA.COND. STORIES TYPE CONSTRUCTION lion,as provided for by Section 37M of the Labor Code,for the Performance of the 137M ork for which hthis permit is issued. FIXTURES—PER TRAP 1 have and will maintain Worker's Compensation histamine,as acquired by Section of me Lehr Code,for the performance of the work for which this permit is ismal. GAS—EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN y We ker's Compensation Inaunmce currierand Policy au n isn are: arrier: Policy No.: GAS—EA.SYSTEMAVER 4(M) CERTIFICATE OP EXEMPTION MOM WORKERS' GREASFANDUSTRL WASTE IMI'F.RCEITOR COMPENSATION INSURANCE BUILDING DIVISION FEES (Thissection need harbor completedHihe pemnitis fee,,.hundred delta.1$100) GREASETRAP or less.) PLANCHECK FEE lernify that in the performonceofine work Torwhich this permit isisseed,l shall SEWER—SANITARY—STORM F.A.200 IT. not employ any person in any manner an re to hcome subject to me Workers'Compen- ENERGY FEE ,Z action Laws of California.Date WATER HEATER WNENT/ELECTR Applicant GRADING ME vy NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should WATER SYSTEMPEREATING (" become subject to me Worker's Compensaiun provisions of the labor Cade,you must SOILS FEE forthwith comply with such provisions or ilia permit shall he deemed r.v.ktd, WATER SERVICE D Z CONSTRUCTION LENDING AGENCY NEW RISIDENTIAL PLMB. SQ.PI'. PAID Dam Receipt# V p 1forhereby which this that iaarnn(See.amendinagency for per(Onnvnce of w-t the work for which this permit is issued(See.309T,Co..C.) �''I-•' Lendefa Name TOTAL: O W Lender's Address TOTAL: I certify that I have read this application and state that the above micrmminm is BUILDING PER correct.l agree to comply with all city and county ordinances and nate laws mming to QTY, MECHANICAL PERMIT FEE V building construction,and hereby authorize representatives of this city to enter upon to SEISMIC FEE L above mentioned property for inspection puryoses. PERMIT ISSUANCE lave)agree to save,indemnify and keep harmless the City of Colosimo again" ELECBIC I•T:F. liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH. in consequence of the granting of this permit. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,0110 CFM) SOURCE REGULATIONS. MECHANICAL.FFP. AIR HANDLING UNIT(OVER 10.000CPM) CONSTRUCTIONTAX Signature of Applicard Conuacter Data EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant of form,building occupatn store or handle hazvdous material HEATING UNIT(TO 100.001g)BTU) as deduced by the Cupertino Municipal Code,Chapter 9.12,and me Health and Safety Code.Station 25532m)? HEAPING UNIT(OVER I DE"BTU) ❑Yes ❑No VENTILATION FAN(SINGLE RESID) PAID Date Receipltl Will dre applicmd or future building oeaapunt use equipment or devices which it hazardous air comemihants as definW by the Bay Area Air Quality Management BOILER—COMP(3HP OR 100,"BTU) TOTAL.: ,met? BOILER—COMP(OVER 100,000 BTU) ❑Yes F7 No 1 hive.cad ate me Internal materials reqrem uients under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE fOmiv fiealm&Safety Code,Senions 25505,255.13 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.FT. building does not carnally have a tenant,that it is my responsibility o notify me occupant of the requirements which must be met prior m issuance of a Cenifienc of Occupmmy. Owner, marmaircdagcm Dam OT L: LoiISSUED BY: OFFICE 4P�ei 10300 Torre Avenue ifCupertino,CA 95014 oBuildineDivision (408)777-3228 (408)777-3333 (fax) June 18, 1997 � Homeowner 10161 Bilich Place Cupertino, CA, 95014 SUBJECT Permit#30762 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, the subject permit has not had a final inspection. 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 Recycled Paper