S 0518 (2)'R-- APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUILDING-ELECTRICAL. 1'I? I'I'NO.
CIT 'OF CtVF.RT1NO APPLICATION/PERMIT plkl Hj ING-MECHANICAL J 0518
BUILDING DIVISION Irt111,U1Nf.I'R0Jl,CT[DEN'0 MUNDON
I
ADD E:':
11lJILD1 SANITARY NO. AP LC'A'I[ON SCHMI I'1T
'At.DA]
OWNERS ME:
!!IN I?ONE: L ME: L /- l W I
NIC CONTROI.x
RCHIIECIyENGINEER: LIC NO: AD _ /I ❑
.lONTAce {- PHorson: `7 BUILDING PERMIT INFO
6/ �� ���(�N Y� ❑ Consultant Fces Paid by Applicant(Initial) BLDG aiCf PLUME EC
❑ ❑ ❑
-, LICENSED CONTRACTORS DECLARATION QTY.=REMDEW11I
ELECTRIC PERMIT - FEE JOB DESCRIPTION
I hereby oRrn thin 1 am licensed under provisions of Chapter 9(commencing
HOZ with Section 7000lofDivision lofthe fltolemoaodPofessinns Coe. my license isRESIDENTIAL:
UANCE.
Fes,Ly� a nfullfl7taidell ❑SFDWI. LI KITCHEN REMODEL
VgU License Cl Lim.N E REREMDEN'1'IAL [)ADDITION [I PLUMBING RE-PIPE
k", Dme TSDCmarElm -- 0MULTI-UNfT ❑STRUCTURAL
RCHITECI'$DECLARATION yZ I understand my plans shall he used as publ is recordsMODIFICATION
O,ZZ-O AMI'S ❑INTERIOR ❑CHIMNEY REPAIR
F�tYI I,iccnxeJ l'nsfes,innal - MPg IMPROVEMIiNT �SWIMMINCi POOLS
OWNIiR-❑UIhDEB DCCLARA'f10N )AMPS' ❑BATH REMODEIJREPAIR ODEMOLITION
I by II that ex pt tl C ntract license Luse rnr the ❑GIBER
fall wing t. IS cl' 7031 S [1 c d P f C d A y city or c may CI RICA(.
WµO
which regti res a S roil m construes,ober,Improve demolish r p' any nmemre
I: prior a its issuance,also requires the applicant for such permit to file u signedsmtement SPECIALCIRCUI'DMISC
that he is licensed pursuon0o the prnvi.iomof the Contractor's License Law(Chapter9 COMMERCIAL:
x..09 (commencing with Section 900)of Division 3 ofthe Business and Professions Code)or 'IEMP.MHTHROR POLHINST.
(hat he is treats Therefrom and the nasi,far the alleged exemption.Any violation of ❑NEW RLDG/ADDITION ❑DI?MOLITION
ttXl 4•
Section 7031.5 by any applicant for npermil subjects the applicemmacivil penuhy of POWER DE []TENANT C3 FOOD SERVICE
rn nut mom than live hundred dollars($500). -
Las owner ofthe n,mm In ecs with wa mtheir solecam tion SWIMMING MNII,ELECTRIC
IMPROVEMENT
0 trope y ,tint y ger penin [I OTHER
S• will Is thework,andthe nmmaure rldres rendnse Laancw
doend not applyc(See 70,14.Business
mal Pndesninns Code;The Cnmmnorx License law Jces not apply to on owner of OI1TLIi I:S—SWITCHGS—Il%TUBGS
property who builds or improves themm,and who does such work himselfor through NEW RESIDENTIAL 1?LL'CI'R SQ FT.
his own employees provided that such Improwm rms arc not intended or offered for $/SQ Ff
sale,if however,the huilding m improvement is mad within one yearof complal an,she
owneramllder will have she burden of proving that he did not build or improve for put.
P,mofsie.). TOTAL: SEP 3 01997
F1 1.as owner of the protea,,am exclusively contracting with licensed commerce,to
Omand she project(Sec.]f W,Business and Professions Coda)The Comm tar's Li- -
c sc law does nm apply a an owner of property who builds or improves thereon,and QTY. — PLUMB PI: FEE :
who contracts for such projects with a commands)licensed pumuam to the Commmors
License Law. PERMIT ISSUANCE
I am exempt under Sec. .B&P C for this reason
ACfER—DRAIN&VENT—WATER(EAI VALUADON
Owner Date n/�
WORKER'S COMPHNSA'rION DECLARATION BACK PLOW I'R(HIiC'I'.DEVICE /I✓�
1 hereby affirm under penalty of perjury one of the following decimations:
I have and will Maintain o Cerrormoa or Consent mself-insure for Workers Celli DRAINS—FLOOR,BOOP,ARE A,COND. STORIES 'I YPH CONSTRUCTIM
0 lion,as trnvided for by Section 3701 of the Labor Code,for she permoncoce of the
n k lin which this perntil is issued. I'IX' URILS—1'1?B'I'RAP
I have and will antinmin Worse,',Compensation Iteumnee'as required by Section -
3700mlheLubmCod fur the dnnnon of the woukfim which thl,anasi,i.,socd GAS—I?A.SYS'I'I?M'I INCA fsllTLE is OCC.GROUP AI'N
My Worse- C 'nalI i rcrand Polic MWJ .,./,// GAS—HA.SYS'I'EXI.OVER 4IPA)
Cartalit,Ne�nr+^/•�" '
CERTIFICATE 017 EXEMPTION FROM WORKERS' GNI?ASIIINLII15TRl.WASTE INTI?NCP.fTOR
COMPENSATION INSURANCE BUILDING DIVISION PI?HS
(This section neW am be completed if the permit is foranc hundrrdrichaml$1001 GNI?ASIi'I'RAI' -
or lens) PLANCIIECK FEE
I certify that in the performance of she work for which this permit is issued Ishall SEWHR—SANITARY—S'JORM P.A.A101T.
not employ any poem in any manner so as m subject Income subjeco the Workeri Coapcn- EN17RGY PER
Z action laws of Califenam.Date WApHRlll!AIERW/VFN'f/ELECIR
ZApplicant s GRADING FEE
to NOTICE TO APPLICANT:IL elite making his Cenificme of Exetnpsmn,yam should WATER SYS'I'EMITREATING SOILS FEE:
EE ^ become subject to the Worker's Compcmmum provisions of she Labor Code,you must
.�. fodhwk,comply with such pervisiann or this permit shall 4 deemed revoked. WATER SERVICE
aQ
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL YI.ME. SQ.PT. PAID
U 0 (hereby affirm that there is a construction lending agency for the performance of Dam Recap
f" the wart for which this permits issued(See 1097.Co.C.)
0 '1 OTAL:
U Lenders Name T AI-.
Wlender's Addles,
y 1 certify that I have read this application and state that the above information is BUILDING ITE
y carets.l agree to comply with all city and county ordinances and state laws relating a' QTY, MSCI IANICAL PERMIT FEE
building construction,and hereby authorize representatives of this city to enter upon the SEISMIC I'ILIi
above-mentioned progeny fill Inspection purposes. I'I?RMI'1'ISSUANCE f O
(We)agree m save,indemnify and keep harmless the City of Cupertino against ELECTRIC[:[it.
Iis
iuhllities,judgments,cassmal expenses which may in anyway wrote against suit)City ACIER ORAOD'to MF.CH ' PLUMBING FEE
in consequence of the granting of this terms.
APPLICANT UNDERSTANDS AND WILT.COMPLY WITH ALL NON-POINT AIN HANDLING UNI'I'(TO IBJNxa CFM) MECHANICAL FEE 7s
SOURCE?REGULATH9,16
AIR HANDLING I INIT,(OVCR IIJNIIICFM) CONST RUCI'ION'I'AN
Stgnme o-Appr llcowCa, Dale E
mXIIADS'IHOOD(WIDIICI) HOUSIN)MITIGA'DON ER
HAZARDOUS MATERIALS DISCLOSURE.
Will theapplicom or from,hrldingcecmry'm score or handle hamdom material II BATT NO ONE I'('1'0 LIN r0r)it I'U) x
as definrl by the Cupenimn M. pal Code.Chapter 9.12,and the Health and Safety
20
Code,Section 25532(a)! �l/�� HEA)'ING UNI]'(OVER(OVER IINUN 1 BTU)
VOP ! ' ff VRNTIL.ATIUN PAN ISINGLI?RISIDI PAID Date Receipl4
Will the uppiicanl nr from building occupant use equipment or devices which
init harardous air mmmminams as define)by the Bay Area Air Quality Managettunt 11(TILER—COA11'I3111'ONdlNl,ll(111 RTU) 'r(YfAL. o
9^alt MILES—COMP(OVER 100.0I0 BTU) _
❑Y
I have rear she hmuduusnte¢riaL a maker Chope,&95 of the Cali- AIR CONDITIONER ISSUANCE DATE
rtquire nn ^
bunia Hulth&Safety Code,Sections 25505,25511 and 2551).I undersand the if she NEW RESIDENTIAL MECH. SQ.RE �N ill 7
huilding) narmnty hast a ms.thmils my responsihiliD so ifyt occupant 1 l
of them trcn ms whit an Fa s n ssumcc afa Ce eof au y.
war,n ,homed Ogen Date TOTAL: r/ (/ ISSUED BY: (� `' 'J t
OFFICE
wlcitv
10300 Torre Avenue
Cupertino,CA 95014
ul'
--Clipei'tii o Building Division
(408)777-3333 (fax)
February 4, 1999
Owner
21467 Krzich PI
Cupertino, CA 95014
SUBJECT: Permit# 50518
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, this permit has not been signed off by the Building
Department. Many times an inspector will sign the permit in the field, but overlook
reporting all of the information to the clerical staff for input into the computer. If this is
the situation and your permit card shows the final sign-off, would you please contact us
so we may complete our computer records? If the permit is not signed off, please call to
schedule an inspection for final closure of the permit.
Because of the large volume of paperwork within the building department, we cannot
separately monitor the progress of each permit. We ask that you give this notification
your immediate attention. If we do not hear from you within ten (10) working days we
will remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Piinrn c sn�l�.Tyner