29085 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING.MECUANICAL O
BUILDING PROJECT'IDENTIFICATION
BUILDING ADDRESS:iiI/Il SANITARY NO. APPLICATION SUBMITTAL DATE
OWNERS; }1U^^//1 PHONE: / /Vl CONT S —/ /� •v✓
�''2/ A5W � 40,
/^ NIC CONTROL is
•�MtCHITECT/ENGINEER: EEC NO: I ADDRESS.
CONTAbA
,/j�� PHONE: BUILDING PERMIT INFO
bt (ll/LJC_ 7,39 Consultant Fees Paid by Applicant(Initial) BLDG ELECT PmecH
LICENI,UMy SED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1:11 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
FOCZ with Section of Division 3 ofthe Business and fissions Code.and my license is v
OO iafullforceandcffcc�y1n/I �q PERMINSSUANCE RESIDENTIAL
a CZ) hiccnse Cla�ss�}��`�/.-.!��N -LIC.N DSR)WL D KITCHEN REMODEL
PQwA. Date .J Is ARCHITECT Gmvacror APPLIANCES-RESIDENTIAL [I ADDITION C1 PLUMBING RE-PIPE
•••••• '��I��• ARCHITECT'S DECLARA ON PANELS
F,zitzi ❑MULTI-UNIT ❑STRUCfUkAL
Z O n Z I understand my plans shall he used as public records MODIFICATION
O Z-O UP3O 200 AMPS
F:Ent:
m LicensM Professional [J INTERIOR (:I CHIMNEY REPAIR
al�itd S' OWNER BUILDER DECLARATION IDI-1(110AMPS IMPROVEMENT
C W Q I hereby affirm that I am exempt from the Contractnr's License Law for the OVER 1000 AMPS D BATH REMODEUREPAIR D DEMOLITION
p(3 L F following reason.(Seen..7031.5,Buxine-rs and Vrofessiem'Code:Any city orco.ny SIGNS 1?I.ECI'RICAL D OTHER
LLLL1l O y which requires a permit m ex,m rust,alter,improve,denmlish,or repair any structure
prior to its issuance,also requires the applicant for such permit it)file a argued smtcmenr
m SPECIAL CIRCUIT/MISC.
} Naheered witsedh
pursuantto3thewntracmrs License Loon,Coumr9
Wee: (commencing with Seetinn]000)of Division3 of Ne Business and Professions Code)or TEMP.METER OR POLE INST. COMMERCIAL
a 6 cy shat he is exempt therefrom and rhe basis for the alleged exemption.Any violation of
^N Swum 7031.5 by any applicant for a Fermirsubjects the applicant to a civil penalty of POWER DEVICES DNEWBLDG/ADDITION El DEMOLITION
ZD, nm more than five hundred ddlem($5IX).se
❑TIiNANT ❑FOODSERVICE,
�Xm Dl,asownantflhepntpengonnyantpl.ywswiNwoges uslhcinnlc aompcnsation, SWIMMING POOL ELECTRIC IMPROVEMENT
oeto will d.Ne work,.,,nine mmnme isnot intended in offered Ibrwle(Sec.7094.Business D OTHER
L'3 and Professions Code:The Contractors License Law does not apply roan owner of OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements arc not intended or offered for NEW RESIDENTIAL ELEM SQ FT.
sale.If.however the building or improvement is sold within one year ofcompletlon,the SQ.FT.FLOOR AREA $/SQ,FT.
owner-builder will have the harden of proving that he did not build or improve for pur. It
pose of sale.). w.
D 1,as owner of the Property,um exclusively contracting with licensed contractors to a 4 5�' EliTOTAL, /
unsnarl the Project(Sec.7014,Business unit Professions C dco The Contractor's Li-
useLawdoes]lot apply Loan owner ufpropony who builds or improves thereon,and QIY. PLUMBING PERMIT FEE
whocontracrs for such projects with a contraetor(s)licensed pursuant to Ne Commcmr's
License law. PERMIT 'SU CE ,5
D lamesanptunder See ,B&PCfor Nisreuun
4DRAINS-
ENT-WATT2R(EA)
Owner Dam VA�.U//TION
WORKER'S COMY17NSNI'[ON DECLARATION O DEVICE
• I hereby affirm under penanyor pedisyone of the fnnu ndgdebodions
D I have and will cammain a Cenifi<atc of Concentra self-insure for Worker's Compcn- R,ROO. ,COND.
sarion,as proudest for by Section 3]00 of rhe labor Code,for the performance of the STORIESwork for which this permit is issued. TI have and will nminmin Worker's Compensation Insurance,as required by Section
AUOof Ne L. G c,fur Ne perlbrmance of the warkfur which chispcnnil is ixsuMENC.40U1'hF. OCC.GROUP AI'N
Car Fahey
's r t ee. t W'�I a f➢f°rd'''Fahey No.y1661�V1�a GAS-EA. 'NS'.M. .A)
C1iRtttttTIFICAT//E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE OR UL DU, WAST. ,RCEPTOR
CREASE AP
(This section need nee be completed if the pemdt is for one hundred dollars(Slip) BUILDING DIVISION FEES
or leu.) - PLANCHECK FEE
I,any that in no perforanyinmaneeofthe work for which ttothepermit
okes'Cremer- SEWER-SAN R -S F.A.200 FT
nm empine any Person in any manner w a.m become subject to the Worker:Compen-
,� .Aril Lines of RJlfamia.Date� ENERGY ME Applicant
WA'I'LR BEAT W/ /E N I V0,n GRADING FEE
h NOTICE 1p APPLICANT mine,Work IL after making this Certificate of Exemption,you should WATER SYSTEM?REATIN
.�" become subject m rhe Worker's Compensm is provisions of the Labor Cale,you must
fuMwiN comply with such provisions m this petrous shall M deemed rcroked. WATER SERVICE SOILS FEF.
a �
.�1. z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.Ff. PAID
V 0 I for which this.
eeti0lending agency forthe perfosmunccof Dare RaciprN
4.0 the work for which ibis pennil is issued(Sec.1(19].Cl,,CJ
.Lenders Hunte
Lender's Address t TOTAL: 5,5D TOTAL:
1 certify o comply 1 have read chis ty and ours and aura char rhe above ws.sharing to BUILDING FEE
y concis lagreemium.mrherd all dtyair roprescrty dina.sewn,state laare,agingrre QTY. MECHANICAL PERMIT FEE
L) z building conumninn.and hereby authnnm represcnmtivez of Nis city r.enter upon the SEISMIC FEE
above-mentioned property for inspection purposes. PERMIT ISSUANCE O
(We)agree to%use,indemnify unit keep harmless Ne City of Cupertino against ELECTRIC FEE 6
liabildies,judgnmms,costs and expenses which nmy in any way uccmc against said City ALTER OR ADD TO MECH.
in consequence of Ne gmndng of this perils PLUMBING FEE
APPLICANJ4UNDERSTANDS AN WILL COMPLY WITH ALLNON-PpIN� AIR HANDLING UNIT(TO 10.01X1 CFM)
SOURRg,e'( LATIONS. ,per, IO/sf/`�,(/(/. MECHANICAL FEE
•��/y�� (/O� AIR HANDLING UNIT(OVER IO.IXq CFM)
SrgamugLfAApplicud/Com ucmr Dam EXHAUST HOOD(WMULT) CONSTRUCTION TAX
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEIi
Will the applicant or future huildin,,seupas Entre or hnndlc hv.Mo.,nalen al HEATING UNI'1'(10100.000 BTU) '2
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(ayf HEATING UNIT'(OVER 100.01X1 BTU)
❑Yes ❑No
VENTILATION FAN ISINGLE R'E'Lo PAID
Will the applicant or furore building occupant use eyuipmcm or Devices which Date Receipt N
mit hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP'L` OR 111.)BTU)
District
FI yes DNo BOILER-COM
"OVER 100.00 BTU) TO AL
I have mad the hazardous materials acquirements under Chapter 6.95 of the Cali- AIR CONDITIONER
forma Health&Safety Code,Sectiorn 23505.25533 and 25534.1 undcrsmnd that if the ISSUANCE DATE
building does..eminently have a tenant Nm it is my respamilaili.y..notify Ne oecupanr, NEW RESIDENTIAL-MECH. SQ.PT.
of the"Wermenes which must be met prior to issuance of a Ccom,are of Occupancy
owner m authonaed agent Uma TOTAL
ISSUED NY:
OFFICE
ecit�
10300 Torre Avenue
Cupertino, CA 95014
of
Cupe th10 Building Division
408)777-3228
(408)777-3333 (fax)
January 15, 1996
Homeowner
10778 E. Estates Drive
Cupertino, California 95014
SUBJECT Permit: #29085
Dear Homeowner:
We have been cleaning out our files in the Building Department, and contacting those
people with permits which have remained"open".
• According to our inspection records, the subject permit has never 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
•