29951 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 29951
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: ^� SANITARY NO. APPLIC TI ON SUBMITTAL DATE
OW ND 'S AMBI'll NE: CO. CfDR'S NAMI_ LIC NO' _
Q S �` el`! L j\ N/C CONTROi
ARCHITECT/PNGINEER: LICNO: AD R S: YYY l ❑
CONTACT: PHONE BUILDING PER INFO
❑ Consultant Fees Paid by Applicant Hnithi BLDG ELECT PLUMB MECH
❑ ❑ ❑ ❑
LICENSED CONTRACIOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 thereby.firm four l am lthei alder pro nim..Of Chapter 9(ammcvcmg JOB DESCRIPTION
ow pz with Sschw7000)ofnlismin3OfN,Bum.art ProfeaaimrCaae,ardmyliccoeia L
' full f"oe erd m PERMIT ISSUANCE RESIDENTIA
U- m_cci _ 2 - C' C ❑SFDWL - 1:KITCHEN REMODEL
aul ye �ona.,ur APPLIANCES-RFSIDEM'IN. ❑ADDITION 11 PLUMBING RE-PIPE
V) ARCHITECTS UEChARATION 'MULTI-UNIT [I STRUCTURAL
F=Z al�l he uudu tic rands PANELS
ZO'-O I /4 `y RPvs J� _ AfODIFlCATION '
OZ- 1G IC UP TO AMP5 ❑INTERIOR �CHIMNEYREPAIR
F��,ul Lcs l 201.100VAMPS IMPROVEMENT
9p•.1 OWNER-HUILDHR )ECLARVrMN
" ❑1 bcrehy.!firm m that i aexcon m frothe Coan
raorLicense cense Lew [Ifor the OVER 1000AMPS BATH REMODpv�j AIR C]DEMOLITION
K 3 iM V "lowing rasion.(Schon 7031_i, c
,Busins and Professions Coda s:Any city cwmy SIGNS ELECTRICAL - OTHER -•1 T~�
t11 LL which requioi a pemut to c,ronxt,alta,improve.&hodiah,or repair any urucmre
prhsm u.iu aa,c,ulv)oryulrestM:appliront fir such Pcorrino file a signed srrmmum SPECIALCIRCULN1,11SC.
�Y than he isliverhil'msueat to the provisions of the Conuvoors Lcemc Lhw(Chapter 9 &. 01
RCIAIc
pLpO (wmrterxi...with Scuov]Ogl)of DiNssiorJ of Je Budneu vrW Pafcssiwa Cadc)« TEMP.METHR ORPOLEINS-L
6 a o¢ thm he is sterol therefrom and Nc basis for de alleged exemption.Any.idation of
"y Sectiw]OJI Shy any epplicnm tmepcmit wbjma the vppliaemmacivil pcmlry of IY)WFR DEVICES LDG/ADDITION ODEMOLRION
Unwc Nan five hundmishdlo.63(10). T ❑FOODSERVICE
I.uowm of de propertynr my<tnpl.Ycv with w.geuthcv sok VEMENT
mntpen%ineogWIMMINCPWLELECIRICwill Jo Oewak.odds he Con4rtorl Lie cd rroffemlfur sok(gc.o ant ai Of aW Pmfwsions Cole:TM Cwsanh License Ido Jm nm apply to o owner of OVREIS-SWITCHES-I'1%TIIRES -
d 3 hammy who Wilds o impmvcn, vh std why nisdoes,
are such wok hinnelf or through
his awn owevereet thad,u ed that wan imProvemenLa are hm inmrdal or ofi'sted for NIiW RESIDENTIAL ELECIR SG f'r.
sale llhoweva,the WlWingmse.of pcnem lowed wiid non older m'complc For the PT.FLOOR AREA S/NQ.FT
rwrcr W ilhr will have tlhe buNcn of Wooing that he did not hold a improve fm pur-
pro of ole.).
L v owner of ted cr
pmpeny..mrvdy, untmdirg with liced ensx �
mmea i- TOTAL_
.hi the Wrjat l.Sca.90,14.Basic.vrd Pa[eviwh QdcO The Conuvcmr's Li-
cerueLaw d(a mm oPPly m an owner Of property who buika mimproves theraon and QTY. PLUMB PE FEE
who corsh.forsucla poj Lawith a cmtrachd.)licensed Pushcart to the Cuhwnora a
Licenu Law. -rte . .
1 sin exempt umlcr Sw. ,H&P C for this mann PHRMR IS)SUANPIL
Owner Dee
ALTER-DRAINAV ATTR( ) VALUATION
WORKERS CUMPFNSATION DECLARATION BACK FLOW PRO D 1
IhuehY eRrm uvdcrp alny of perjury rote n(Ihc following deckivninne
havc.nJ will m.imuin aCenlfrwe of Conaenuoadl-insure far Wmtrr'n Compcm DRAINS-FLOOR.ROOE REA,CONU. STORIES s TYPE CONSTRUCTION
.anion,u proviJM for by Section 37W of the Ichor Cade,for de W rf«narc of the
cloruk ffgg" which fou permit is asuN. FIXTURES-PER TRAP
�-Zc and will mainnsn Worker's Comfemaniw I.,as rryuined by Stinson
37(Y)of the Libor Code,fo'he peK.cofnhe work for which Nis pctmit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS DEC.GROUP APN
My Work plan Xaa W Policy
Cartier Policy No.:� „��oS GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXE. PHON FROM WORKERS' -
COMPENSATION INSURANCE GREASMNDUSTRL WASTE INTERCEPTOR BUILDING DIVISION PEPS
(Thin acelion needno W conhpltSed it rh.petmir iv!mune hmdnvl rkdime(Sllpl GRLASETRAI'
1N 1f-hh) PLANCHECK FEE
IccnifytWtiv the pafmmercc ofde loci forwhich Nup<rmit is..,.,.h,lduH SEWER-SANITARY-STORM EA.200 FT.
that employ troy peraon in any man s 1 bjeo to the Woken'Cvmper, ENERGY ME
z rot Lawn��rhh(((Celh Dam
z /J a_ orf 2 WATER HEATER WNENT/I:I,ECfR -
z � NOTICEApplictunjI GRADIN('.PBL
UJ NONCE TO APPLICANT':If,after making this Cenif ac of EaemWkn,you should WATER SYS"TEMTREATING
1" ^ become subjeet to the Worker's Cotnyonoiot prov iscres d'Ns lalwr Cade.you mw SOILS Hit
Wforthwith comply with ach Woviaions Or this panun"I he dcerhed revoked. WATER SERVICE
Q
5z CONSTRUCTION LFNUINCAGENCV - NEW RFSIDENI'IALPLFIB. SQ,FL PAID
V C) I arebytrnmthanNveixaconstmaion knNngagaxyfmtheperfmmocenf Dae Basch,9
4k. F-".. de won far hich this perout u (Sec,309'7.Cil..C)
D I<N.Ya Name TOTAL '
0.W 1<nJcr'x AdthaN TOTAL: ,��,s
1 anify ileo I have read Nis.,Il,htiva od.sore But the ii inbrrmnim is BUILDING FEE 7f T. orb
(A Co LlagrctocooplywlthallcltyardcwntyoNN ttsetdoaekwa Rluingto QTY. MECHANICAL PERMIT FEE
V z WJding corssuctiw,tad Wrseby audhorize opoesemarvice M this city to cru Upon the SEISMIC FEE <
IS 0
ehrve mentioned papery for inhpcchon Par"" r PERMITISSUANCE,
(We)agra wsave,mdcmnit'y and keep hemde..the City of Cupcom.agnina ELECTRIC ME
Iisbilitiee,juJg.hems,costs od expenses wMch any iv any way acne.gain,said City
awagxrcc of de grmdvg of Oda pesmiL AI TER OR ADD TO MECIi. PLUMBING FEE '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT AIR HANDLING UNIT CLO 10.000 CFM)
SOURCE REGULATIONS. MECHANICAL ME
' - AIR HANDLING UNIT(OVER I0.000 CFM) CONSTRUCTIOi
Signatoeof ApplinwConrenm Doe EXHAUST HOOD(W/DUCD HOUSING MITIGATION ME
HAZARDOUS MATERIALS DISCLOSURE
Will the apl4icot Or fuwre building ocupem snarHEATING UNIT(TO 100,05016-U) -
ar dcEned by the Cupertino Municipto Co4%Chapter 9,12,od the Health and Sefay
CNe,Sech.2553$x)? HEATING UNIT
(OVER I00.000 BTU)
[-]Yes ❑No C•,
VENTILATION FAN(SINGLE RFSID) PAID
Use Reccip e
Williii
or icorm(marc Wilding weaponaveir emit devices which BOILER-COMP OR 1(q.gK)BTU)
t haranlotu air oomuminerhn u defircJ hY the Bay Ave.y air tJualiy Memgerrcm �•
t Dianin'1 MAy 21
❑Yes ❑No BOILER-COMP(OVER 100.000BN7
AIRCONDITIONEp r'^ - .•-'��r ut l
!neve ,Sooty,
mms 15505yaitencnta umkv CWlacr 6.95 of at CaII- ISSUANCE DATE
(milia fleahbdoca k Safery Cade,e."iws 25505,is toy erd 25534.I odmmrd Nor if the NEW RESIDENTIAL MECII. SQ.FT
building hrod.a vat n wit have a termnl that it is mY reaa.Celiny w rout,the ampere
M de mqubamns wfiich must be mu prim m i.vuarc of a CeniTicae M(kavpocy. A '_
Owrcro.uNmizcJ egcm Dae TOTAL: l (!/NL
OFFICE
ac
ii10300 Torte Avenue
Cupertino, CA 95014
c of
cupcl tv10 Building Division
(408)777--3-2-2T--
(408)
8 7 -322(408)777-3333 (fax)
January 15, 1996
Homeowner
10736 Farallone Drive
Cupertino, California 95014
SUBJECT Permit: #29951
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 CUPUPERRTNO
V
Christy Akatiff, Administrative Clerk