31289 (2) APPLICA,NTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITY OF CUPERTINO ' ' BUILDING-ELECTRICAL PERMITNO. w
BUILDING DIVISION APPLICATION/PERMIT• PLUMBING-MECHANICAL "37 C89
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
to L i a r
OWNER'S NAME O�I CONT�.CTOR'S NAME: - LIC N �
O: NIC CONTROLN
RCHITECT/ENGINBER: ., LIC NO: ADDRESS: Q
51Q I
b w
CONTACT. , PHONE: - BUILDING PERMIT INFO
0 Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSEDCONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affirm that ham licensed under provisions of Chapter 9(commencing ' JOB DESCRIPTION
Woo with Section 70(10)of Division 3 of the Business and Professions Code,and my license is „RESIDENTIAL'
F i r art ull forc01T off PERMIT ISSUANCE. ❑SFDWL ❑KITCHEN REMODEL
U��]] Licwse Llc.#
�Z DamI 9 ON APPLIANCES—RESIDENTIAL tE]ADDITION El PLUMBING RE-PIPE'
ARCHITECT'SDECLARATION PANELS p..p>m> �MULTI-UNIT ❑STRUCTURAL
Z O G - I understand my plans shall he used as public recordh � MODIFICATION
OZ-, UPT0200AMPS ❑INTERIOR El CHIMNEY REPAIR
W Licensed Professional•� 201-10(IBAMPS IMPROVEMENT] 'OWNER-BUILDER DECLARATION
yy 1 hereby affirm that 1 oexempt from the Contractors License Law for the OVER I(NIO AMPS El BATH REMODEIJREPAIR (]DEMOLITION
p(a WW U follo g eas n (Sect 7031.5.Business d Pr f ns Code Any city or county SIGNS ELECTRICAL ❑OTHER
YY77 W which eq permit t c n Wct alter, p dem Ilsh,or repair any structure
prior priori its,.wuance,als.no,moc.he applicant far such Pemit to file a,gned statement SPECIAL CIRCUIT/MISC -
y, Nat he is licensed pursuant o the provisions of the Contractor's License Law Chapter
<� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
TEMP.METER OR POLE II�ST. COMMERCIAL:
F q o K that he is exempt therefrom and the basis for he alleged exemption.Any violation of El BLDG/ADDITION ❑DEMOLITION
LiRC Y,
Station 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of POWER DEVICES
F,Z'Y not more than five hundred dollars($500) ❑TENANT ❑FOOD SERVICE
�pC]1,as owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
will clubs work,and the structure is not intended m offered fortune(Sec.7M4,Business ❑OTHER
sad Professions Cade:The Contmeme,License Law does oat apply m an-owner of OUTLETS—SWITCHES—FIXTU 5
SSS property who builds or improves thereon,and whodoes such work himself or through -
his own employees,provided that such improvements nee not intended or offered for NEW RESIDENTIAL ELECTR S
sale.If,however,the building.,improvement is sold withiaoneyear,of completion,the SQ.FT.FLOORAREA $/SQ.PT.
owner-builder will have the burden of Moving that he did not build or improve for pur- � '
pose of sale.). ' s
❑1,as owner of the prrponY'arn exclusively contracting with licensed conlrusbas to s „
'construct the p jeer(Sec.7040.Business and Professions Code:)The Contractor's Li- 14 cense Law does not apply to an owner of property who builds or improves thereon,and QTYm . PLUMBING PERMIT FEE ®�as
11
who contracts for such projects with a ntmcmr(s)licensed pursuantto the Contractor's 11
15
License Law. PERMITISSUANCE CITY❑I am exempt under Sec.. ,B&P C for this reason V - s
Owner Date' - ALTER—DRAIN&VENT—WATER(EA) U
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
m
1 hereM1y affirunder penalty of perjury one of Ne following declarations:
I have and will main[ainnCertificate of Cdnummself-insure for Workers Compen- DRAINS—FLOOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTION
sadmn,as provided for by Section 3700 of the Labor Code,for the performance of the ,
work for which this permit is issued. FIXTURES—PERTRAP
7 1 have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Code,for the performance of the work for which this permit is issued. GAS—EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
My Work�j'3�Co}np do Insurance can randpolicy b,
Camier:,[,I�FOsa yrvU� - 1e Palic,Nn:)i�n5M3—aV GAS—EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASWINDUSTRL WASTE INTERCEPTOR
(This seelinnneedmt be completed if the permit icforene hundred dollars(SIM) BUILDN DIVISIONM 5
or less.) GREASE TRAP PLANCHECKFEE
Icenify Natio Ne perfnrman eofxhe work for which this Permit isissued,Ishan SEWER—SANITARY—STORM EA.2W FT.'
not,,,ploy any arson in any mann c s to becom bjec1tot Workers'Camper- ENERGY FEE
z sation Laws of liforeia. tu' pun. (ysu /1�1)e
7�'O Appticaot 4 t� WATER HEATER WNENT/ELECT# GRADING FEE
q to NOTICE TO P CAN :1, along This Cenofnca[e of Exemption,you should WATER SYSTEM/IREATING
F+ ^+ sr
became sobj c Ne W ker's on cnsation provisions of the Labor Code,you must SOILS FEE
W.� forNwiNco y with such provisions or this permit shall be deemed revoked. WATER SERVICE
Q .
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.PT. PAID
U O 1bc.hyaff,.that hero iso construction lending agency for theperformnnce of Dam 'Recciplp
"s be work for which this permit is issued(Sec.3097,Co.C.) a
0 U Lender',Name TOTAL:
W ,Lendefs Address - O
1 certify that 1 have read this application and statethat the above information is BUILDING FE
0(4 correct.I agree to comply with all city and wormy ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE
7
U G building construction,and hereby authorize representatives of this city o enter upon the SEISMIC FEE
above-mentioned property for inspection purposes. .,
' (We)agree to save,indemnify it keep harmlessme City of Capital..against PERMITISSUANCE '.ELECTRIC
liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADO TO MECH.
in consequence of the granting of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,00)(TM7
SOURCE# MECHANICAL FEE '
1\41(
ULATIO 5.
Alli HANDLING HANDLING UNIT(OVER Iff”CFM) CONSTRUCTION TAX
gnaS Lure if ¢ant c r ' r. Date EXHAUST FOOD OYMUCT) HOU SING MITIGATION FEE
rHA nRDOUS MA .RIALS DISCLOSURE ,
tea Fiesta rfuture buildin occupant store or handle hazardous material HEATING UNIT(TO 100.000 BTU)
as defined by a upenino Municipal C Chapter 9.12,and the Health and Safety '
Code,Section 2 2(a)7 HEATING UNIT(OVER 100,000 BTU)
❑Yes ❑Nn VENTILATION FAN(SINGLE RES ID) - PAID
_ Date Receipt#
Willlhe air echiannicicant or mre building by upant theB.y Aomuipmeualityn or Management
BOILER—COMP(3HP OR 10y M0 BTU)
Slit haxazdous air contaminants as Jefinel by the Buy Area Air Quality Management 'TOTAL.
'
tomtit^
❑Yes 7 N BOILER-COMP(OVER IW,MOBTLD
1 I have mad
the hazardous materials requirements under Chapter 6.95 of to Cali-' AIR CONDITIONER Is DATE
fomia Health&Safety Code,Sections 25505,25533 and 25534.I understand but if the NEW RESIDENTIAL MECH. 5Q.FT.
building does not currently have a tenant,that it is my responsibility to notify the occupant
+II of the requirement which must be mer prior m kateraceefa Certificate of Occupanc,
1 Owner or authorized.,at Dates L u ISSUED BY:
OFFICE r
10300 Torre Avenue
® '_City of Cupertino,CA 95014
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
June 18, 1997
Homeowner
10986 Linda Vista Dr.
Cupertino, CA 95014
SUBJECT Permit#31289
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 had a final inspection.
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 dispose of the file and remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
Pnnled on Recycled Pape,