29873 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-F,LECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.-MECHANICAL. 29873
BUILDING PROJECTIDENTiFICAT'ION
ILDING ADURCSS: s SANITARY NO. APPLICATION SUBMITTAL DATE
NER'S NAME: '/ ..M.a�1w PHONE/: — COMkAC/tt)R'S,Nq/Mli L'IC NF,O'
�THu� owl O A•/�(. - WNIC ON TROLL
sHCHI'TECT/ENGINEER: LIC NO: ADD ESS A ' a+� ❑
//S ���/a•, KYL
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BI E PLUMB MECH
<PKLICENSE])CONTRACTORS DECLARATION ' QTY ELECTRIC PERMIT FEE
I hereby amffirLha I am licensed under Provisions of Chm
epmr 9(commencing QTY
DESCRIPTION
°OZ with Seenion]000d.f Division 3oRhe Busimssand Pmfcssimu Carc.and na,hone,is
Fly._ ' all foretold effect. -3,5-3076
QQ PERMIT ISSUANCE RESIDENTIAL'
License Class Licp -6 3O 7V r - ❑SFDWL �g\KITCHEN REMODEL
y<L Date Contractor APPLIANCES-RESIDENTIAL [-]ADDITIONLJPLUMB ING RE-PIPE
ARCHITI3LT5 DECLARATION PANELS ❑MULTI-UNIT EJ STRUCTURAL
Z O ti z 1 understand my plans shall be used as public records MODIFICATION
OZ40- UPT0201AMP$
F a,f"aiLrccnsed I'mfcsvonul 201-Iqp AMPS ❑INTERIOR ❑CHIMNEY REPAIR
OWNER-BUILDER DECLARATION
IMPROVEMENT
1 hereby affirm that I am exempt from
the Contractor's License Law for the OVER 1000AMPS ❑PATH REMODF.IJREPAIR ❑DEMOLITION
3aF fallowingreason.Section 7031.5,Businessland Pmfeseions Code:Any city or county. SIGNS ELECTRICAL ❑OTHER
OyQ which"moos a permit to consumer,alter,improve,demolish,or repair any straaurc
an Involaits issuance.also requires Ne applicam for tach permiuo file aligned ztaemzm SPECIAL CIRCUIT/Misis.
Y•a, that he is licensed puruanno thopmvminns of the Contractor's License Law(Chapter 9
W 00 (Commencing with Section 7")of Division 3 ofthe Business and Professions Ogle)or TEMP.METER OR POLE INST. OMM R IA
t1 xa C C that be ie exempt thcmfrom and the basis for Nc alleged exemption.Any violation of ❑NEW BLDG/ADDRION [3 DEMOLITION
W
:2m Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES
F Z} not more Nan Be.hundred dollars 13500). []TENANT ❑FOOD SERVICE
�=Q []1,as owner ofthe property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
d.y will do the work,and the structure is not intended(scattered for sale(Sec.]Bkl.Business ❑OTHF,R
63$ and Professions Cade:The Combat License Law does not.,ply to m owner of O OUTLETS-SWITCHES-FIXTURES
Property who builds or improves noticed,and who does such work himself or through
his own employees,prnvidcd Nut such improvements an not intended or ofiired for NEW RESIDENTIAL ELECTR SQ ET.
sale.If.however,the Wilding or improvement isard within one ycnofcompletim,the SQ.FT.FLOOR AREA VSQ.FT.
caner-builder will have the burden of proving Npu
at he did nut build or improve for n- ps I sy
pose of sola). m 'r/qy
❑1.as owner of the ppcny,am exclusively contracting with licensed contractors m T( 1
consumer the project ISec.70cL Business and Professions Col The Contractors Li- /fir U �np
nsc Low does nm amply to an owner ofpmpmty who build:or improves-thereon.and QTY, PLUMBING PERMIT FEE Ly.` s7
whocontmcts for such projects with o camranod%)licensed pursuant to the Contractors `~G
License Law, PERMIT ISSUANCE' gT/..•
❑Iamercmptunder Stec. m
,B&PCforthisrean O
OwnerALTER-DRAIN&VENT-WATER(EA)
Dare ..•/"J_
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
• Ihemby affirm under penally of perjuryone of the following declaationx:
❑halve provide for
Sent
i37amof Co LimorClf-Insurc for Worker'sst of dr- DRAINS-FLOOR,ROOF,AREA GOND.
scion,as provided Bxc by Semon 3]Ip of the lahuc Cole,far the peHumwnee or Ne STORIES TYPE CONSTIt UCTION
work for which l marmit is ismer. FIFIXTURES-PER TRAP
❑1 have and will maintain Workels Compensation Insurance,as IaryirM by Section
)af the Labor Code,fill the perfrndunce of the work for which this Permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS
C Work 3'��Co yyeen ofd�Ipp ��yc c and Policy nnbwry•:� � OCC.GROUP APN
Caricr.d9Lt/.��s/"//ggcanie Policy No.: 'f�/l � GAS-EA.SYSTEM-OVER E(EA)
CERFIFICA TE OP EXEMPTION MOM WORKERS' '
COMPENSATION INSURANCE. GREASE(INDUSTRL WASTE INTERCEPTOR
less.)
(This section need not he completed ifthc peorm is for one hundred dollars GREASE TRAP
lSled) BUILDIN ISION 'EES
nr
Icenify that in the perfommnee nfthe work for which this
PLACHECK FE
the
Workers. - SEWER-SANITARY-STORM EA.200 IR.
of employ any phrases in any manner so as m become subject the Workcn'Catalan- ENERGY FEE
2. Linn Laws a California.Date
�•a
WATER HEATER WNENT/ELF,CI'R
N \pp ICE GRADING F
in
es re subject
APPLICANT:IL army making Nis Cenifcam of F.aemption,you should Wgl'ER SYS'I EM/I'RIi TING
a(, ? ha jme suhjcct br Nc Worker's Compensation Provisions of the Lahr Cede,you must SOILS FET
W� QfnMwith comply with such provisions or this permit shall he deemed revoked.
I WATER SERVICE
Z) Z CONS'IRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.EI'. PAID
U O I hatAm
erehyrthat a there is construction lending agency for the perform...cut Dam ReceiptX
Fthe work for which this perm9],it is issued(Sec.30Civ.C.)
U Lender's Name
Leader.Address - TOTAL:
ped, 1 cenil'y that 1 have read this triplication and state that Ne above information is O BUILDING
lZf correct.1 agree to comply with all city and county ordinances add state laws relining to QTY. MECHANICAL PERMIT '
U Z buildingcnnsuuatim.and himadmrizcrcprescntmivcs of this city nnmmrri mthe FEE SEISMIC FE
al,ova-mentioned property for inspection opposes. PERMIT ISSUANCE
(We)agree to,save,indemnity and keep homeless the City of Cupertino against ELECTRIC 'EE
inconven encs of me lmsind of
Permit.
nmy in any way accrue against vid Ciry ALTERORADDTOMECH.
APPLICAN�TC UNDERSTANDS
Sthis permit. PLUMBIN FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH Ali.NON DINT AIR HANDLING UNIt'(TO I(I,IN)OCFM)
SOURCER GULATI S, MECHA CALFEE
Alk HANDLING UNIT(OVER I1,000 CFM)
CONSTRI NTA%
ignawre ofA„li,mE/Cmlrl Date EXHAUST HOOD(W/DUC)
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGA NfEE
Will the applicant orfumm building arabans store orleandle harardous material HEATING UNIT(TO 103,000 RTU) -
aa refund by the Copcnion Municipal Cnde.Chapter 9.12,and the Health and Safely
Coda,Section 25532(al” tIP.ATING UNIT(OVER 100,000 BTU)
p Ye. I]No
VENTILATION FAN(SINGLE RESIDE PAID
P
Will she applicant or future building accopam use equipment or devices which Dom Ree t X
emit hueardous all mhaminants as defined by the Bay Area Air Quality Management BOILER-COME GHP OR 100,0110 BTU)
District? lAL'
❑Yes ON. BOILER-COMP(OVER 100,owaru)
I have read the boeurrous materials requirements under Chapter 6.95of the Cali- AIRCONDI'1'IONER
forma Health&Safety Code,Sections 25505,25533 and 25534.1 nndemand that if the ISSUANCE DAT
builmagmes nolcunenllyhrveammmt,the it is mymsExmibRibmnmifym,aVxdpmn NEW RESIDENTIAL MECH, SQ.ET.
of the mquinmen¢which must be met Final la issuance of a Cirmlicae ol'Oscupancy.
Owner(1r amhoracd agent Gam TOTAL
ISSUED BY
OFFICE
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10300 Torre Avenue
Cupertino, CA 95014
of
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
March 18, 1997
Homeowner
8099 Hyannisport Drive
Cupertino, CA 95014
SUBJECT Permit#29873
Dear Homeowner:
We have been going through 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 frnaled, 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
•
Prnn�r.nI R-ococlen Pnoe,