30744 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. 3 0 7 p(�,(,�
JI
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 3
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATI
/ D3--? o Nn. � lC-( -
OWNER'SNAME PI ONE: CONTRACTOR'S NAME: LIC NQQ
ch J''I S u / 5- -941. I)1 D,-v 3- V" G SoaS i �q D S r"e% N/C CONTROL#.
RCHITECT/E-NOINEER: LIC NO: ApDRESS: ❑
- PU j°L:, ID( Co- \/t .
CONTACT. PHONE:
BUILDING PERMIT INFO
1 \ I' I •� -7 �- 7 )-/Z- ❑ Consultant Fees Paid by Applicant(Initial) ELECT PLUMB MECH
Jw ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
G C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
with Sudan 7")dDivision 3 oftbe Business and Professions Code.and my license is PERMIT ISSUANCE
O in full force and effect n RESIDENTIAL•
ywE� C 2^•� } � V��1 OSFDWL ❑KITCHEN REMODEL
<UU LicanxF Lick wS APPLIANCES.ZWcosiotI, Dated! �� Commerce O "`z ❑ADDITION ❑PLUMBING R&PIPE
ARCHITECTS DRCLARATION - ❑MULTI-UNIT ElSTRUCUR
Z O E2 2 1 understand my plans shall be used as Public records PANELS MODI N
OZ- UPTO 2M AMPS
544 WA Licensed Professional
-g ❑INTERIOR NEY REPAIR
0,, OWNER-BUILDER DECLARATION 201-1000AMPS IMPROVEMENT
U 1 hereby affirm that I am exempt from the Commemr's License Law for the OVER I"AMPS El BATH REMQDELfREPAIR 0 DEMOLITION
O 6 U following reason.(Section 0031.5,Business and Professions Calc:Any city or countyOTHER #-Io b U 11 d C Ls s rss
SIGNS ELECTRICAL
0 Fy' which its issuance,
s a permit re cores m 4 when impmvc,demolish, file
repair any structure re) $I•Y p V„Q e y _
that heor its iensedp.alurt to the tbeapp asofant for such pmnivaicense aw statement SPECIAL CIRCUIT/MISC.
Y that he is licensed pursuant m the provisions of the Contractor's License Law(Chapter 9 I"4 A u G4.4
pJ'p0 (commencing with Section 7")of Division 3 of Ne Business and Professions Code)or TEMP.METER OR POLE ST. COMMERCIAL:
d q,e1 that he is exempt therefrom and the basis for the alleged exemption.Any violution of 0 NEW BLDG/ADDITION 0 DEMOLITION
fzXl 1i•
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of POWER DEVICES []TENANT []FOODSERVICE
} not mare Non to.hundred dollars(S50% IMPROVEMENT
G O hat owner ofthe property,or my employees with wages as their sole compensation, SWIMMING PO ELECTRIC
R• o wdldothework,and Nestrucmxisnat intended mothered hassle(See.]044,Business0OTHER
sod Professions Code:The Commences License Luw does not apply to an owner of OUTLETS- ITCHES-RXTU
prapeny who builds or improves thereon,and who does such week himself or through
his awn employees,provided that such improvements arc not intended or offered for NEW R IDENTIAL ELECTR
We.IL however the building or improvement is sold within one yearidemanletion,the SQ.FT. OOORRAHLAe $/SQ.PLro
owner-builder will have the burden of proving that he did not build or harpoons,for put, E GGee''
pommieue.).
0 1,as owner of the property,am exclusively contracting with licensed conwenut m AL:
construct the project(Sec.7044,Business and Prnfessions Cade:)The Contractor's Li- ❑O WAR
u 5 RECe®
cense Law docs not apply m an owner M property who builds or improves thereon.and QTY. PLUMBING PERMIT FEE y��/1R
who contracts for such pmice s with a contmctood liwreed pursuant in the Contractors
License law.
C Iamexempt under Set. ,B&P C fm this reason PERMIT ISSUANCE CfCY Ur GurtNIINU
Owner
ALTER-DRAIN&VENT-WATER(EA) VALUATION
Dane r ,,'�S5
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE / S`S V u
I hertby affirm under Penalty of perjury one of the following declarations:
I have and will maintain a CeniOcate ofConsento self-insure for Workers Compcn- DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPECONSTRUCfION
region, a provided for by Section 3201 of the labor Code,for the performance of the I ��
work far which this permit is issued. FIXTURES-PER TRAP
0 1 have and will maintain Waskers Compensation Insurance,as required by Section
37W(if
MyWader Labor Code.ffotr thspeerrfformance ofthhePuoyfor wldcch Nix 'e/mi�t refs issuedd.. GAS-EA.SYSTEM-I INC.4 OUTOCCGROUP APN
Cartier: (g--Tc'ceme Policy No.: Y^" � �"COS GAS-EA.SYSTF.MOVER4(EA) �� r
CERTIFICAM OF EXEMPTION FROM WORKERS' GRE4SF/INUUSTRL WASTEI RCEPfOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(This section need not be completed ifthe permit is for one hundred dollars Slot)) GREASE TRAP
or less) PLANCHECK FEE
I certify that in the pcifanneace of the work fnrwhich thin permit is issued,l shill
not empty any perms in any marine,so as to stemae subject the Workers'Compen- SEWER-SANITARY STORM EA.2001T. ENERGY FRE
Z sation laws of California.Date
7�7 O Applicant WATER HGATE /VENT/ELfiCI'R GRADING FEF.
G7 NOTICE TO APPLICANT:If,after making Nis Ceniftcam of Exemption,you should WATER SY M/TREATING
f'!
become subject m the Workers Compensation provisions of the Labor Cade,you most SOILS FEE
T4LL], forthwith comply with such provisions m this permit shall be deemed revokW. WATTERVIC6 11
0
d
CONSTRUCTION LENDING AGENCY N RESIDENTIAL PLMB. SQ.FT PAID
LJQ Iherehy affirm that them is a construction lending agency for the performance of _ re Receipnp
P. f+ the work for which this permit is issued(Sec.3097,Civ.C.) TOTAL:
O ULender's Name
Lender's Address TOTAL:
ly 1 certify d at I have mail this application and state that the above Information is BUILDING FEE
as TA correct.I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE - 77
V building concoction,and hereby authorize representatives ofthis city to enter upon the x SEISMIC FEE a
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify end keep harmless the City of Cupertino against ELECTRIC FEE
liabilities,judgments,costs and expenses which may in any way accme against said City ALTER OR ADD TO MECH. PLUMBING FEE
in consequence of the gaining of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
SOURCE gCgiUlVON -/�
// (wAjl AIR HANDLING UNIT(OVER IO.gpC MECHANICAL FEECONSTRUCIONTAX
Signmu A continue Date EXHAUST HOOD(W/DUCT) - HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100,000 RX,
as defined by the Cupertino Municipal Code,Chapter 912,and the Health and Safety
Code,Section 25532(x)'! HEATING UNIT(OVER I ,100 BTU)BTU)COM 3HP OR Iq),000
D ���
Yea ONa
' VENTILATION PAN NGLE REBID) PAID a/—i_
Will theoinnm
applicant or future Data Receipt#
re building occupant use equipment or devices which g0
nit hazvticus air
r conmms as defined by the Bay Arca Air Quality Management BOILER- .TOTAL
❑Yee CNn BOILLft- MP(OVER 100,000 BTU)
I hove re:ulthe hatrdme,materials requirements under Chapter 6o5 M the Cut, AIR C DHIONM ISSUANCE DATE
hunts Health&Safety ode,Sections 25505.25533 and 8534.I u �fat if the N RESIDENTIAL MECH. SQ.FT.
building drcsnppµµ nl haveahound
Nmitismy respnnsibilitym xof theral ire ntiwc smut thip"poor to issuance ofa Ceadeye�
Owner or ant .cd gen Data 1 TOTAL: ISSUED BY:
OFFICE
Ocilix
10300 Torte Avenue
Cupertino, CA 95014
ol,
Cllperth10 Building Division
(408)777-3228
(408)777-3333 (fax)
September 30, 1997
Homeowner
10370 N. Blaney Avenue
Cupertino, CA 95014
SUBJECT Permit#30744
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
1
Christy Akatiff, Administrative Clerk
k(fes
Prinfon on Recvded Paper