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30144 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL 3014 BUILDING PROJECT IDF,NMFICATION DUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DA'II aly9U CAL 04 C+ OWNERS NAME: PHONE: CDNTRACTDR INAMG LIC NO: <H2 ¢ RN 9[ BZSL NIC CONTROLf �RCHITF:CTk1 fHE1 R: LIC NO: ADDRFS.: ❑ CONTACT: PHONE BUILDING PERMIT INFO ❑ Consultant Fete Paid by Applicant(Initial) BL PLumB MECO LICENSED CONTRACTORS DECLARATIONQTY ELECTRIC PERMIT FEE ❑ ❑ I hereby afrinn that I am licensed milru ama miler pvisiwof Chalker 9lcncing JOB DESCRIPTION wo, with Seed.7")of Divuim 3ofde Husireas and ProfnsioesCode.and any Hassesc is RESIDENTIAL: 1- in full face endeffect. PERMIT ISSUANCE Q CUU Liarue Clea Lic.l ❑SFDWL ❑KITCFiFN REMODEL QL Dan C..,., APPLIANCES-RFSTDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL Z O,'2 e, 5 I undMi casurd my,Ions all be."a,pth is reco o. MODIFICATION OZ'LZ UPTO 200AMP$ ❑INTERIOR ❑CHIMNEY REPAIR 1-4-1..y..II Lacerated nonseasonal 2U1-1001AMPS IMPROVEMENT Q I thereby efrirm Nat NTwn a new,afrml he Cd�ntruOa'a License Lew for the OVER 1000AMIS ❑BATH REMO F. DG ITION x36U fcZoaingrenwt.(Section 70315.Busitms sed Pfofaa4om Cade:Any city or comely SIGN'S ELECTRICAL 0OTHFA 41 u. which rryuires a permit to ronenti alter,impmve,dcmuli h.or o,s it any situation, E' Priamini.arat'alon"airesde,"icant fursuch,anir m file•signn ed Mocont SPECIAL CIRCUFUMISC. �} thin he is liceroacur dlsupo ant to the visimu ofthe Contrmr ecs Lis Low(Chapter9 {Yp0 (comrrcncing with Section 14100)of Diaision 3 of the BiunosW Rofcsions Code)or TEMP METER OR POLE INS?. COMMERCIAL Q. e that he it cwmlk thcrcfr.t ual tM haats for tM1c e11egN a¢mptiun.Any viuluti.nr ❑NEW BLDGJADDITION ❑DEMOLITION Smi.]UJIS by any applicemfmepemdt whjects Jr epplieeet tuedvil,emhy of POWER DEVICES ..y that mate than rive huMana dollars lg5rot. ❑TENANT ❑FOODSERVICE: �"Z'6 ❑ Le:owrcroflM prpmy,arm tm,lo an wish wogu utMir hale uxnIMPROVEMENT y y pnwtim, SWIMMING POLL ELECTRIC €� will othewort.Codec he Creniefors eMN.o,doesnor.'I''.nsoo nerds ❑OTHIIi W aril erry who Cao:The C.t torreor,U.Lew Jas not xIyly to an owner of OfII1PIi-SWRCHES-FIXTURES d 3- tm�y hand oye,i.aha impdvth thNich i and who don wan wart intended or nr Nrugh his own an,,o.she provided that.wch impavencnts ere not i cad s or ardml for NEW RP_SIDENI'IAI.FI,F,CTR SQ FT. auw,-loriler will otinathegmenof,rmcnti(hailwithindrcycuafmm,le for tate 'SQ.FT.FLOOR AREA SSQ.FT. amer-ballJer will hove the Meda of paving tint he did ma build aimprove fm,ur- rj i ❑I.as owns,ar Be ptwear,am aaldaivay axluxOng with Lianud aontreataa in caouact the prjcct(Sec.YIN],Bu a.and Professions Code:)The Consacmrs U. Q 02 19 cense law Jaen not apply no an owner of PoI who builds or im,mvo thermn.and TY. PLUMBING PERMIT FEE 4]96 whoa trm fareachprujecuwiNacmtmeor(s)lice ,awaittdO C.twa s Law. under Sac. ,B&1'C for this reason PERMIT ISSUANCE �I�Vr (.UF'tr 11 u Owa.. ALTER-DRAIN&VENT­WATVR/6�_C IfVALUATION WORKER:S COMPI..SATION DECLARATIONHACKFLOWPROTECf DF 1 r I hcrchy aRrt unor penalty nf,crjury an n[the following deelvntions: �]Ihavc read wJl mainuine Ccrtiftcatc afC.rent to self-iwve fm W'atcr:Canryrn- DRAINS-FLOOR,ROOF.AlkiZA.IXS STORIES TYPE CONSTRUCTION aati.,as noicles]for by Secti.3](10 of the Ichor Calc,for Be,crf.e of the hawk fac which this,cono is lamed. FIXTURES-PER'IRAP ❑ 1 hive and will mwntein Workers Cvmpenwtidn Immwce,a,rt90iml by Section 3700ofdc labor Cude.fordreptfamvmeoflhewark fmwhich Baia permit isiaii GAS-G.SYSTEM OCC GROUP APN My Workcr'a Com,cmati.Iruurucc cannerrind onumahem: Cerra,.Cerra,. Policyy NNn:: GAS-FA.SYSTIJN�OV ER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASPANDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES 'Bi,salon ceN not he aorpktN ifthe pnnit is ran mehirwad dllaa(5100) GREASETRAP hal ss) IcmifY she in Be perfomumz of Oe caret fawhich this pnmit isiuuN,lilWl PLANCHECK FEE aR cmpiny any pcson in anymermcr w m to hcOoc sub*l to the Watcri Com SEWER-SANITARY-STORM W.2(u FT. Z it.ls..fCu1lfarom Date ,ctr ENERGY PI:B O WATER HEATER WIVEM/FLECTR Z O ICnn GRADING FEE NOT rte-. NOTICE'.APPLICANT. e,reit.making Dia wmon, f,h F tntlkion,yna alcold WATER SYSTFJr1/IRFATING hecomc wompm it Woch Msisi.or crain,oati of the WNv Cods,you mu4 SOILS FEF, � r forthwith comply wNattch,mvtsionarcdtis Taman stall he Jeennl revoked. WATER SERVICE CONSTRUCTION LENDING AGENCY cai,y NEW RESIDENTIAL PfA1B. SOFT. PAID UQ IhertbyefBrmthc dertisases]( ce.30ending s.egaeyfa meper(ortwx of Dare Recciq♦ � F Be wmt rm which mire,remit is[a,eee(Sac.309].civ-.c.) 0U Lmdcrs Namc 'TOTAL herder'M AdJresa - T(ITAL: pW, 1 amity that I love reed IM1u aPfRiaetim hal Minta that dre¢hoax itJ«Teti.is BUILDING FEE (A concea I agree to connEy wilh all city and aunty aninemee and vee laws relating to QTY. MECHANICAL PERMIT FEE U Z M1uilJing cunurction,wJlmrcny au0lonzc rtµ.nntivcs ofWis citymrncr u,an the SEISMIC REE r above-rtlent:aocd pRe*tY fa impecti.ptryoua. PERMIT ISSUANCE (We)elate to save,incemnify and keep Mrmks ft City of Cdpeni.oleins, ELECTRIC FEE Iiabihtio,pd,—u,costs had exper,ca wh ch moy'm any wxy accrue egzhw wid City - n curryuenc,or me groom,of thio permit. ALTER OR ADD TO MECH. PLUMBING FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT QO IU,000 CFM) SOURCE REGULATIONS. I MFCHANICALFEE AIR HANDLING UNIT(OVER 10.001 CFM) CONSTRUCTION TAX Sigrouvc MApplinnVC.tranm Ih¢ EXHAUST FOOD(WMUC) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the epplieent or future building oca{ud uac or haeme hazudonta nwevial HEATING UNIT(M I PO.UoO BN) as defird by the Culertim Municipal Code.Clasper 9112 and the Ilaldl aril Safny Cock,Section 25532(u)'f HEATING UNIT(OVER 100,010 BTU) ❑Yea No PAID VENTILATION FAN(SINGLE RESID) Ihtc ftcccipe Will IR`rl ,licnnt fulurt huilding.cu,mt dm tyuipmcnt ox Jeviccs which tlOILER-COMP(JILT OR 100,000 HTO) t hiscai ur urnmmns itam defrnl by the Bay Ara Air Quality Monagemcm Dina, 0 BOILER-COME(OVER 1004 BTU) TOTAL: ❑1'a No I have read die hizwdotu mveriala AIR CONDTTIONER ISSUANCE DATE re'25533 n tick Caulker rsta of to Cali- fornia Health&Safcty try have Sections thus i,ix cy had 255]4.T to resuM Ow if the NFIV RESIDENTIAL MECH. sQ.FT writhing dca nor r a which hsi lie rnant,that n ie my reynmibilily to ntlify dre rccuptlm olthe«quirrncma which owsromn pia m-....vac oro Cmtiflaa of Orcupemy. Owner or eullKKlzcd agent Dale TOTAL: ISSUED BY: OFFICE 01- Ch 10300 Torre Avenue t 1, Cupertino,CA 95014 Cupertino Building Division (408)777-3228 (408)777-3333 (fax) March 24, 1997 i Homeowner 21890 Dos Palos Court Cupertino, CA 95014 SUBJECT Permit#30144 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 been finaled. Many times an inspector will sign the permit in the field, but neglect to report all of the information to the clerical staff for input into the computer. If your records show the subject permit as finaled, would you please contact us so we may complete our records? If the permit is not signed off your permit can be reactivated and an inspection could be scheduled for final closure of the permit 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 l� Printed an Recycled Paper