S 1294 (2) i.APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL I'li IT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL t 12-9 4�
BUILDING PROJELT IDENTIFICATION
UILDINGAI]DRCSS,. - SAN]IAHY NO. APPLICATION SUBMI'ITA(L�DATE
ir \Q.tZ V
WNIM"t R"�.'Z3�` CONTRACTOR'S NAME: LIC NO:
11 SIC CONTROL p
CI IITLCI/1!NGINELR LIC NO: ADDRESS. ❑
OONIACT: PHONE: DUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BL G ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECIARAT'IONQTY ELECTRIC PERMIT FEE
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
OCZ with Seclion]INXq of Uivisirn3nl the Businns:ud Professions Ctde.andmylicenseis RESIDENTIAL'
FK W WOO F it full force and effect. ISSUANCE. ❑SFDWL ❑KITCHEN REMODEL
aUU Licenm Class Lic.B APPLIANCES-µ1i51 DLNTIAL ❑ADDITION ❑PLUMBING RE-PIPE:
v 6 a Dam Contractor
ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
ZOhz I cameraman., hardball h uwdns puhucommals PANELS MODIFICATION
OZtr'-� UPTO20XIAMPS [I INTERIOR ❑CHIMNEY REPAIR
HHadLicensed Pr,fessioml 201-Itx)BAMPS IMPROVEMENT ° 1❑-I SWIM MING POOLS
ei OWNEat BUILDER DECLARATION OVER 1111N)AMI'S El BATH REh1(11)E_UREl'BI�-yI� .ITION
R'= 1 hereby affirm thatOW 1 R-exempt from the Comr"cmr's License Law for the �r(];C R fC's /
aU following reason.(Section]831.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER
3 W which requires a permit to cn r,loul,roller.improve,demolish,or repair any s memre
� prior,,,its issuance.also requires themStnml mrmch permit m file.stricaldmment SPECIAL CIRCUI UMISC. l
F. �. Inst he is Teemed pursuant 10 the provisions at no contactors License Law(Chapter 9
CO (commencing with Section](XR)uf Division Sof the Buxinessnmd ProfirWous Code)or I EMP.ME I HR OR POLE INST. COMMERCIAL' t
a 6 o eC 'bar he is e.....I bendran and the basis India alleged exemption Anyttvpenretail's of ❑NEW BLDG/ADDITION El DEMOLITION
X^ Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of POWER DEVICES [:1 TENANT ❑FOOD SERVICE.
not marc than live hundred dollars(S51Xp.
Y IMPROVEMENT
�6Nd.she work.the popery,or myemployees ed antlerga as lole(S .compensiness SWIMMING POOL ELECTRIC
F will the work.anal:he Camara ot rri License Law doesed not
apply to
air Business ❑OTHER
a and property
who Curie:The C es then r'.s License Law docs Dol apply s if owner of OUTLETS-SWITCHES-FIXTURES
propeny who milds or improves thereon,and who docs such work himself or through
his own employeesprovided the such impmvcmems arc nm amended nr ooffered for NEW RESIDENTIAL ELECfR 5 FT.
aide.If,however,'he thee Mullding nr lnal nvenmmis xnld whhin arc year of unnplednn,the FI IB,OOR AREA S/SQ.PE
ncrbuilder will have the burden of proving that he did not build or improve for pur-
pose of rale.).
❑ I,as owner of the I TOTAL:
peepery.amexcessively, eofessins with licensed A
connmatto des not (Sec.]Dw,Business and ProfessionsCWea The theron.Li-
nsel.awdoesnolapply,oan ilha conincomy who
sed F....mprovcs Contract
and QTY. PLUMBING PERMIT FEEite 'b
License aw.l'nrsuch projects with.annmdngs)liwmw puaunmmlhe Comntemr's Ph
L1B4"A4�'" PERMIT ISSUANCE I'
❑1 am exempt under Sec. ,B&P C for this reason
wnc
ACTFR-DRAIN&VENT-WATER(EA) ql,
Warr Date
I hereby oOWORrina nderpeno lynfperjury�net the billowing declarations: BACK FLOW PHOTF.CT.DEVICE (/y..`
I
I hrmand will maintain a Cenificemof Consent tosclf-insure for Worker's Camper- DRAINS-FLOOR.ROOR AREA,COND. STORIES TYPE CONST RUCTION
ion,as provided for by Section 3]W of me Labor Code,for the performanceof the
rk Icor which this pian it is is,mT FMORIS-PFR TRAP
I have and will maintain Workers Grnpenmtion Inommuce,as required by lection
W of the Lidnr Gdc,for the performance of the work for which ibis fiction isrwed. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APNy Workers Compensation Insurance carrier and Policy number arerrier: Policy No.: GAS-CA.SYSTEM-OVER 4(CA)
CERTIFICATE OF EXEMPTION FROM WORKERSGNF:ASI%INDUS'1'RL WASTE INI'IiµClilvfOR
COMPENSATION INSURANCE. BDILDING DIVISION FEES
(7111issecameneednotlecomplacd ifthe permit isfuronchundreddrines(SIOD GRFASETRAP
or less.) PLANCHECK PER
I certify that in the performance of the work for which this permit is ixwed.I shall SEWER-SANITARY-STORM EA.200 FT.
nm employ any person in any manner so as to become subject Rs the Workers'Compen- ENERGY HE
O z satin"Laws of California.Data WATER HHATER W/VENIT/ELECTR GRADING FEE
z 0 Applicant
rA NOTICE TO APPLICANT.If.afar making this Cenifcate of Exemption,you should WATER SYSTEMOREATING SOILS FT:C
Irl nwornes compct ly
the Workarro Coons or ttionprovision ns,deemed resolved. muss
� forthwith comply with wch provision or this TSrmil shall be deemed rcvnkeJ. WATER SERVICE
az dCONS I o,themis.RUCTION LENDING AG'a., NEW RESIDENTIAL PLMB. SQ,FI', PAID Uac Re Ip
U ❑ k for
rwhich ra tha them isacontructinnleading agency for the performancanf p
H Lenders for which Ibis permit is issued(Sec.307,Civ.CJ
f& Leaders Address
TOTAL
❑ C7U.1 Lender's Address TOTAL:
1 certify that 1 have read this applicatimr and sat¢that the above information is BUILDING FEE
fin corns.I agree m comply with all clly and cmmy m linmms and a,are lawn mialing m QTY. MECHANICAL PERMIT' FEE
C„) Z building convection.and hereby aulhurize repreuntatives of this city to enter upon the SEISMIC P[F
above-mentioned propeny for inspection purpnas. PERMIT ISSUANCE
(We)agree to save,indemnify and ml
keep haress no City rf Cupertino again, ELECTRIC F
li,didiiiespalipaents.unu andexpenws which mayinanywayaccme dminmsuid CitygLTER OR ADD'tt)MECH. PLUMBING EE
to nsequcnce of the granting of,bi,pem,it.
APPLICANT UNDHRSTANDS AND WILL COMPLY WITH AL1.NUN-POINT' AIR HANDLING UNI'I'('1'010,NX)CFMI
SOURCE REGULATIONS. MECHANICAL ':C
�Ys.. Cr-V ^1L-s �{ AIR HANDLING ON]'1'(OVER III,"CPM) CONSTRUCTIONT
SignamreufAPPlicanUCon O� L—S- Uam V EXHAUSTHOOD(W/DUCD HOUSING MITIGATIO 'B
HAZARI US MATERIALS LOSURE
Will lheapplicaut or futurcbuilJing recupnm store nr bundle h....In.,material HEATING UNIT('TO 100,000 BTU)
as defined by the Cupertino Municipal Gale.Chapter 9.12.and,he Health and Safety
Code.Section 25532(.)'( HEATING UNIT(OVER 100,01)BTU)
E3 To, F7 No VENTILATION PAN(SINGLE RESID) PAID
Dam Receipt Is
Will the applicant iafurore building by the nt Bay
mea AirQument ordeviceswhich
ement µOILER-COMP(3HP Olt I ORSH)BTU)mil hazurdnus air conmminanls as defined by the Buy Arca Air Quality Management TOTAL:
-/ District?:1 Via, El No BOILER-COMP00VER I M000 BTU)
(have read Nc haraedous materials rxluirtments under Chapter 6.95 of the Cali- AIRCONDITIONER ISSUANCE DATE
fomiu Health&Safety Code,Sections 25505,25.933 and 25534 1 understand that if the NEW RESIDENTIAL MECIL SQ.FI'.
building does n d currently have a tenant.Nal it is my responsibility to unity the comprom
of I:requirements which must he met prior to issucam of a Certificate of Occupancy.
Owner or authorized agent Dam TornL: ISSUED BY:
OFFICE
t
10300 Torre Avenue
Cite of Cupertino,CA 95014
Cupertino Building Division
(408)777-3333 (fax)
February 4, 1999
Homeowner
10520 Castine Av
Cupertino, CA 95014
SUBJECT: Permit# 51294
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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