29087 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITYOFCUPERTINO - BUILDING-ELECTRICAL. PERMITNO. O
•BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: t VY' - •SANITARY NO. (CATION SUBMITTAL DATE
9
0 NBq'S NAME' /J ; P ON '•�� - CONT A. '. NAM 1 LIC
U IYWl1 , P NIC CON'[ROL N-
ARCHITEC'UENGINEER: LICNO: ADDRESS: V ❑
CONT - PHONE: BUILDING PERMIT INFO
t - '
I'M
`O •� ❑ CBnsiiltan/Fees Paid by Applicant(Itiltial) BLDG - ELE PLUME C
a ❑l ❑'..
LICE SED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affl cel lam licensed notice provisions of Chapter 9(commencing JOB,DESCRIPTION
„fir Q O with 5ection'/000)ufDvixmm of UC Business end Pr fssins den my license is ' PERMIT ISSUANCE s� RESIDENTIAL:
Ian nfull fore and eifec�,� '�9FOWL ❑KITCHEN REMODEL
O Llemss I Lls.a
QZ w APPLIANCES—RESIDENTIAL DDITION ❑PLUMBING
URALRE-PIPE
6 w Dam Gmuacmr
F+CH ARCHITECT'S DECLAR PANELS MULTI-UNIT ❑STRUCTURAL
Oy Zz, I understand my plans shall be uud us public recods MODIFICATION
C< UP TO 200 AMPS
W❑ Licensed Professional ❑INTERIOR [_1 CHIMNEY REPAIR
CCgC4Q ' 201-1000AMP5 - IMPROVEMENT
g77 +Cy4� that I a -BUILDER DECe Coma ON OVER 1000AMPS ❑BATH REMODEUREPAIR El DEMOLITIONfollow -
I hereby.(Sero that 1 nm exempt from the Contractor's e:AnyLicense city
o Ibr the
ip5, d V
which
reason(Sermon 9031$Rosiness and Professions Cade:Any tiny m emmY SIGNS ELECTRICAL ❑OTHER
IN O I" which requires n permit to construct,almq improve,demolish,or repair any.wmme -
gC. pat heor isacensecgmuantx.requires thovisio sor forthe such Contractor's Licenfile ase
Use
SPECIAL CIRCUT/MISC. �a
y Q that(commencing
it pursuant m she of Division 3 the the
License Law(Chepter9 -
CW OO (commencing wink Section 9030)of OivieionJof Ne Brsinss and Pmfessimo Cdde)m TEMP. RPOLE INST. .COMMERCIAL:
F y m p{ ,that he is exempt therefrom and me basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Section 7031.5 by any applicant for a permit subjects the applicant no a civil penalty of POWER ❑TENANT ❑FOOD SERVICE
not more thmi five hundred dollars($500).
F 7„qP IMPROVEMENT
xQ ❑Lnsownerd the properly,or my employees with wages as their sole compensation,' SWIM POOLE
will da thework,and the swcture is not intended oraHered for sale(Sec.9044,Business ❑OTHER
and Professions code:The Contractor's License Law does not apply to an owner of OUTLETS— CS—FI
ft, property who builds an impasses thereon,and who does such work himself m thmugh s ?
his own employees,provided that such improvements are not intended or oRdred for NEW RESIDENT11(f,ik& SQ IT.
sale.If.however,the building or improvement issold within one year ofcompleton,the SQ.IT.FLOOR AREA $/SQ.FT.
ter-builder will have the burden of proving that he did not build or improve for put,
pose of sale.). ' ., - fly
❑h as owner of the properly,am exclusively contracting with licensed contractors In _ - TOTAL: 114 t
G"' 0
construct the project(Sec 9044.Business and Professions Cade:)The Contractor's Li-
terse Law does not apply to an owner of property who builds or improves themon,and QTT. PLUMBING PERMIT FEE q h y�
whoeomems for such projects with a amuaemr(s)licensed pursuant m the Contractors /-1!'/•(' 1 IY 19g(�
License Law. PERMIT ISSUANCE /
I an exemun
ptder Sea .B&P C for this mason' •ri�fV, V
,Owner Duro ALTER—DRAIN&VENT—WATER(EA) /..VALUATION -/•��/T�
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hereby affirm under Penalty of perjury mount,the following declmmions:
tl have and will maintain a Cenificate of Constrain self-insure for Worker's Compen- DRAINS—FLOOR,ROOF,AREA,COND. - STORIES 'TY PE CONSTRUCTION
ion,as provided for by Section 37W of the labor Code,for the Performance of the
_ work for which this permit is issued. - FIXTURES—PER TRAP
1 have will maintain Worker's Compensation Insurance,as required by Section
3900ofth ah de'foa Ne erforrance of the work for is P''�'y� GAS—EA.SYSTEM71 INCA OUTLETS OCC.GROUP APN
MyWar r' a neat dPolic lU /
Carries, Panic No.: ttD GAS—EA.SYSTEM-OVER
. CEIICH AT OF EXEMPTIONFROMWORKERS' - -
COMPENSATION INSURANCE GREASPIINOUSTRL WASTE INTERCEPTOR
_ BUILDING DIVISION FEES
(This section treed not becompletW if the permit is formic hundred dollars($IW) OREASB TRAP
or less] � PLANCHECK FEE �
I certify than in the perfomnmmeofthe work far which thispemot is issued,l shall SEWER—SANITARY—STORM EA.203 FT
net employ any person in any manner so as to become subjeca m the Wmkerat Compen- ENERGY FEE
�Z sort"Lans"fCelifomia Dme r WATER HEATER WNENT/ELECTR
O Applicant' - - - GRADING FEE
q (/j NOTICE TO APPLICANT:If,after making this Cenificate of Exemption,you should WATER SYSTEMOT EATING
a'h become subject o the Workers Compensation provisions of the Labor Cade,you must SOILS FEE
{>a ry forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE.
UO . CONSTRUCTION LENDING AGENCY - NEW RESIDENTIAL PLMB. SQ.FL PAID - Uam. Receipt#
1 hereby efftrm that there is a conswetion lending agency for the performance of
the work for which this pmmit is issued(Sea.3099,Cls.C.)
[L H Lender's Name . . TOTAL'
O.W Lender's Address ' TOTAL: .. -
certify that I have read this application and slate that the above information is BUILDING FEE
..i V7) correct.l agree is comply with all city and county mdire noes and state laws relining to QTY. MECHANICAL PERMIT FEE
' ,V A building construction,and hereby auhmize representatives of this city to enter upon the SEISMIC FEE
above-mentioned properly,for inspection puywses. ' PERMIT ISSUANCE eW�I5,
71 o(T
(We)agree to save,indemnify and keep harmless the City of Cupertino against ELECTRIC FEE
liabilities.judg ms,cre"mad expenses which may in any way seems,animalism City ALTERORADDTOMECH.
in nsequen it ming of this permit. PLUMBING FEE'
-APPLICAN IN E STANDS AND WILL COMPLY WITH At.NO/p-PO T AIR HANDLING UNIT(TO I0pDra M) MECHANICAL FEE 'L Q
SOURCE JL 1 16 -
-/�(]• AIR HANDLING UNIT(OVER110,00)CFM) CONSTRUCTION TAX
Signatam Iicant/Contmemir - •, Dane LX14AUST HOOD(W/DUCT) HOUSING MITIGATION PEE
HAZARDOUS MATERIALS DISCLOSURE '(Y
Will theaplithout or future building occupant store or handle hazardous material HEATING Uisi100,000, 0 BTU) t 2r L(J
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety '
'i Code,Section 25532nd? - HEATING UNIT(OVER 103,000 BTU) ,
E-]Yen L]No VENTILATION FAN(SINGLE RESID) PAID -
Will the a licam or future building t use t or devices which Date Receipt#
pp d by the B cqui it Qu BOILER—COMP(JHP OR I W,00D BTU) -
mit hazadous air comaminants as defined by the Bay Area Air Quaiity,Manage. 1^
)islrid? _ IOTA f.
❑Yes t QNa i' BOILER—COMP(OVER I00,003 BTU) r
AIR CONDITIONER
'
I have ressid tiazad umaterials req' t d Chapter 6,95 be cin ' "
ISSU/A/NU
.-BE
forma Health&Safery Cod S n 25505.25533d255]41 understand tdtheNEWRESIDENTIALMLCH SQ.FT
build est actual,tis myresponsibility t ovary the pant
of the rtxfourremmtn whichmust be met pnorto'ssuance of
Certificate of Occupancy. ,
' Owner or authorised agentDate TOTAL: ISSUED BY:
OFFICE
ky.
• 10300 Torre Avenue
Cupertino,CA 95014
CiLv of,
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
April 3, 1997
Homeowner
10966 Linda Vista
Cupertino, CA 95014
SUBJECT Permit#29087
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, the subject permit has not been finaled. Many times
an inspector will sign the permit in the Feld, but neglect to report all of the information to
the clerical staff for input into the computer. If your permit card shows the final sign-off,
would you please contact us so we may complete our records?If the permit is not signed
off, 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 C k
Pooled on Recycled River