28183 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO B n.D G- ,L4. 1 A. PERMIT NO.
APPLICATION/PERMIT I'LUMHIN'G-MECHANICAL 28183
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. 7AIIII�TION SUBMITTAL DATE
/OJ3 A.I� 1 UNIT# LOTH l� G qWNi� NAME IXIONIi; CONI W. OR'S NAMELIC NO: -\` L
�� r 293 NrC COMROL#
\�11�6 t�UK, LICNO: ADDRESS: Elu M. Drs
COMPACT: PIIONE� Qom. ELECTRIC PERMIT FEE BUILDING PERMIT 1 FO
B.DG E k,LT N.UMy I;CIi
PERMIT ISSUANCE; 171T1�L
LICENSED CONTRACTOR:S DECLARATION APPLIANCES-RESIDENUAL
mwz IhercM1y ellimidctlem liansed under prrwui«n MCTnper9(c«mlernng wiN JOB DESCRIPTION
VOO Salim 1000)af Dimino 3 M the Busies.erW Prefe.iam Coda,and my licrnu iv in PANELS ///����F j'y 11V
y� Licemse Class ffaL
ont Dam Clea Coem UPT03IXIAMfS 1 ` 1
tray Dam Cmm tm 201-LAMPS
, K AROUIT,CT'S DECIARATION
OVER I(Mp AMPS SQ.FT.I1,00RRSA SQ 17.
6z0 l undcmmmd my,4am slwll he used ere public mcn.mE.
[=vc C W SIGNS ELECTRICAL
y$ Li<en.cd Pmrcuio of
y�� OWNER-BUILDER DECLARATION `aL SPECIAL CIRCUIT/MISC.
°XX'DaUF. I h<rehY affimr ohm 1 son esmnp fmm pre Cnnlmcror's Lic.Lew for the
ulLLOln fWowingleesan.(Sccrim703].5,Bushrmsa fe Codc:Anycitymeomly TEMP.METIER OR POLE,INST.
F- rue 5 which«cones a isamul In cmomel,aper,improve,dm bli ,nr micuit y,.,am
�T$ Pilar m iu luuatce,.Lrr lryuim ncaappliclum for suchpcmil to fk.sip llmmmmm POWER DIi aS
O thathe is lic<nad pumam to the provisions of the Cnnlmclm's Liccnsc Low(Chagcr
6a yC 9(mnmrereing with Sarian 1000)caDivieim 3 ofrhe Buunaac and euioe Code) SWIMMING PORI.ELECTRIC ^ VALUATION
Scemon 7is1.5 It, lh«crromand the bmint vlMneOlsedcn<mleinn.Anyviolwimof OUTLET$ SWITCHES FI%TlIRFS MHr•
tZa Saban 7031.5dby hundred
coll. $501)) mbjcro lhc.pplimlt lo.civil pclmltYM
$ t mnrt dwn Evehondrtddy.orryearnp, NEW RESIDINTIAL ELECTR SQ.FT.
dFO �I,mowrlcofthe properly,ormyemploym wlthw.gbulhcirwkcmlpewtlm, STORIES TYPE CO SIR ON
a3� I tamomerWOre stmnuaiamrintcmtlednrnfrered fm saklSa.]M4,Baiaae
end Pmfi—ium Code:The Cmmearm s licrnx Law loas not epply to an owner of
pmpcny who builch or improves thernxh end wlbo o vvch work limslf«thneu6h his
cmPbym.pmvWedtlutsuch lmpmrcrlvlume mtimylulW«oRcld(souk if OCC GROUP RES.UNIT
howevo,the building or impovement is sold within me year Mmmpl Linn,the owner L
builder will hove the burden of proving buto Ie did not build m impovy fm parpmc.n
saJ ).
❑ I,mawreraf iFc pmpcny,um csclmivcly cvnuvcring wilt licerval anlr.[bA ro QI Y. P BI PERMIT FEE FLOG ZONE APN
«xucun to Project(See,7f ,Bmmas W Pmfaono,Code:)The Cmuanor'. pFIyMIT ISSUAN
IJanu I�wdocs nn npply Inanou'arof pmpmy who bui W�a impmvadmna4 end
wilclorncmeLaw. msuch pmjecm wiN.ttmmclor(.)Iiarucd pulwmlt la ole Cmueacv'n ALTER- & ENT-
❑ ) FEESUMMARY
lmexmpunda. B&PCforhuroismnumO
BACK ILO O T.DEVICE SANITARY Y N
Owrer Dem DRAINS-ILOOR,R( H ND, RECEIPI'M
WORKMAN COMPIliSAT10N DECLARATION SOi00L TA% YN
❑ Ibveby.f!WUlluve.mtifatc ofromery to selhinsurt.m•<mifcare of RECEIP It
Wudeer C—Por tion hen.or. copy lhcrmf(Sec.38M,Lab C.)which IlX'R1RFS�PEH TRAP �` PARK FEE Y N
rover.VI creployee'.tvrdcr Au parol. GAS- RECEIPT'N
Pat,N IA.SYSTEM-I INCA OU'ILLTS BUR.DING DIVISION FEES
Calvp.tly
❑ ih
GAS-ETE
A.SYSTEM OVER 4(EA) PLANCIIECK FEE
Cedcopyishmehyfum cs ty 2
❑ CeertNified copy le filed wish de city inspation diMslon. GREASEANDUSTRL WASTE INTECEFFOR GRADING FFJ:
' CERTIFICATE,OF EXEMPTION FROM WORKERS GREASETRAP SOILS FEE
COMPFASATION INSURANCE
�I (Tldssaticm nadnot be mmplelM if the permit of«orc hun4ed dolWa(1100) SEWER-SANITARY-STORM FA.200F1'. ENERGY FEE
I «leer)
I arrify that in the perfmwnce of the work(«which this permit oisaad.I dealt WATER HEATER W/VEN1DFTE
not camPley any Person in any manner w m to beams subjat to the Workeoi PAID
Z Crnrpenwim laws of Cnlif«nie. Dale WATERSYSTEM/IRFAa
TING DIa Receipt If
OO10EZ2 NTO APPLICAM':If,alta locking Our Cetificue of Escmptian,ym should NEW RESIDENTIAL PCMB. SQ.Ff. TOTAL
CI) ba.subjenlo the Workers C«nm
pc .Iim mso
imesisifthe 1,,o,C,,,,,you..at
forthwith comply with such rovisims of this pemdl shall 1s donned revoked. BUILDING FELE
_ r'
IL Q CONSTRUCTION LENDINO AGENCY SEISMIC PER
Z) Z Ihertby arr that drum is arnwmnim kMing.6uey f«the perf«nwlce of lJ
U O Nc wok for whrh Ilia person i.msm,!(Se,.3191.Civ.C.) L: E =)CFES
Ltnada'.Nude
I,
F Under',AMM,,, QTY. MECHANICAL PERMIT FEE PLUMIMNG EE �
I antry Hw I have read this applicamMsn old uata then the slave inf«matim is IraMECIiANICAL FFR
t. Fagraur oanply wilhell cil,andcnunlyoudivrra and able laws ml.tingm PERMIT ISSUANCE �.
_ building carr ran,uW hereby aulhoriu replcsnutoves offrescity to mtcr upon the CONSTRUCTION TAX
UZ ahova-memimtl'n y f«msptttim"oana. ALTERORADDTOMECL Z-
(Wc)agree Io save,hade encify usd kap hurtllns the Cur,,of C 'eirlo.g.lat
liahilitics,judgnents,cone and caPcnscs which rosy in any way cenucegeiw svJ City AIR HANDLING UNIT(T010,000CFM)
n<aeegallce of de gremin8 of this p«Nir.
AIR HANDLING UNIT(OVER IO,WO CFM)
Signmumnf Alrpli.VCmtmmm Marc EXHAUSTIIOOD(WA)UCT) . PAID
IIA]ARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,O)o BTU) Dam Raclµ#
will the applicant or(more mor in(¢euPam.or Luulle harordoru nutviJ
as defined by the Cupenim Municipal C«k,Cheptm 9.12,and toe health sued Safely MATING UNIT(OVER W,(XXI BTU) 1.:
Coma.Section 0 N VFXIILATION FAN(SINGLE RESIU) .
BOILER-COMP(JHPOR 10(1,000 BTU) ISSU NCE(LY'ATE
Will tair coi®limfummlvildiny bytbatltsaw AntoAent Quality
Mantic ne crait /1T�t 'f
urrYws air cnntmninante u deB�by de Bey Arm Air Qunliry Muugemcnt BOILER-COMP(OVER 100,000BTU) - Ju • 1 9 /99,5
DisuinP
❑Yes ❑No NEW RFSIDV2tML MECH. SQ.LT.
/ I have mad the horvdous nom LL,"alternates under OuVoer 6.95 of rhe 11 Ur �urtk��lVG
Obs Wie ipg d h& of cur Cody,avea n 2nt.de t a is sad 33534. 1 undmuend that
tithe huildinIJ«ry not currently hrvcatrnent.Nat ilhmy re manse ilirywmrify Ne \ _
«vvfant of rhe rtyui h u.I be I In isawnec M e C ifica of
Owner«umhunaal.,,at T ISSUED BY:
OFFICE
®' 10300 Torre Avenue
Cupertino, CA 95014
capertmi, 0 Building Division
(408)777-3228
(408)777-3333 (fax)
September 25, 1996
Ken Foot
10539 Farallone Drive
Cupertino, California 95014
SUBJECT Kitchen Rmdl, Permit 428183
To Whom it may Concern:
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
PdWl on Re lded PaOer