S 1127 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUILDING-ELIIA:1'RICA L PERMIT NO.
CITYI)F CUP$:RTINO PLUNBBNC.MECHANICA L O
BUILDING DIVISION APPLICATIONIPERMIT O
I4U11.UING PRIIJRCT IUENTIEICATION
1127
SANITARY NO. APPLICATION SUIIM1IITTAI.UAfI
Jim NZi]NO DORM s'YrLC*_,_o oX!_ -Jr- Cap e r�csu� g5oi y -3/
UWNF:R'S NAW.: PN NE: CO A(70R'S 'AM. - - CN)' NIC LONG ROL
RCHI'rEC(ENGINEER: V LIC NO: ADDRESS: 8 ,/oq q a ,P/ j I ❑
CONTnc'1: PHONE: �G�.[. B UILUING P'RMIT INFO
' ,^a,..,_ Z�Gi�`�� ❑ Consultant Fees Paid by Applicant(Initial) NLOG IiuiCr p 1:1 MSCI
(i(j(J /' J ❑ ❑
LICENSED CON I RAC four S otcCLARAI'ION QTY ELECTRIC PERM ITFEF. JOB DESCRHYPION
I hereby aflim+that I am licensed under provisions of Chapter 9(commencing
��Z with Section7WOl ofDivision3n(lbe Business and l'r desmons fide andmylicenmiv PERMIT ISSUANCE RESIDENTIAL'
��� In lull force unJ ettcc. PhUMI11NC RGI'll'li
2 U ll ❑SFVWL O KITCHEN REMODEL
U Liaeme Lic.N APPLIANCE'{-RESIDENTIAL ❑ADDI'T'ION C
gzw pate Comr cto ❑MULTI-UNIT OSTRUCI ORA[
ARCHITECTS DECLARATION PANELS MODIFICATION
OZhyZ Iundcraand my plans shall he mcdas puhlic records UP TO 2m)AMPS 0INTERIOR [I CHIMNEY REPAIR
—aEMENT
F-�t:W Licensed Pnde.somill 2014000AMPS .IMPROVIiMF.NT [D SWIMMING POOLS
OWNHR-HUILDER DECLARATION OVER IIXXIAM1IPS C BATH REMODFIJ tEPAIR ODEMOLITION
C a d I hcrchY uffinn That 1'tit ucaun from the C,amm,mr's License Law far the ❑MHIiR
O a U following reason.(Section 0031.5.Business and Prolessiuns Cade:Any city or tautly SIGNS IiLIiC'FRICAh
34'N which routines Parrott t t It p demolish. p my structure
1.'�od1 prior to itsa Iso requires the pplc t for suchpermn file a signed.'temet SPECIAL CIRCUINMISC.
(Chapter
math licensedp s u 'h p ' hetC t t r I COM MP RC I AI.'
au bosmmencingwth Section 7000)of Dotson 3 off Brainard Profesio+'Coll0or IFpMED: OR[ 11(NST [I NEW NLUG/AUDITION ❑UFMOhITION
a a c C that he is commit therefrom and the basis for the alleged exemption,Any violation of
W m_� Scctinn7031.5 byany applicant fur a pemtit subjects the aPPlicam ma civil penalty of POWER DEVICES ❑TENANT 0FOOD SERVICE
nm more than f ve hundred dollars(SSW 1. IMPROV EMEN'I'
hos owner omhe pvpcny.or my employees with wages us their sole compensation, SWIMMING POOL ELECTRIC COTTER
will do the work.and the suucture is not intended oroRered for sale(SeeTinto.Business Of1TLE1'S-SwITCHF'_S
W 3 and Prolcexians Code:The Cn onncuds Licence Law does hat apply to an owner of
d property who builds or improves thereon,and who docs such work himselt or through
his own employees.provided that such Empravemems ore not intended m oNerW It,, NHW RESIDENT h 'CTR 'Q FL /SO Fr.FLOOR AREA 5/SQ.ITT
side.If,haricot,the building or improvemcm kind within one year afcomPlctioa the,woy�
aosnilder,will havoahe burdma of porving thin he did not build or improve for Pat
-
0
YCAL:
0 I,es owner of the property,am exclusively contracting with licensed umtracmrs to ( o
c roam,the project Sec,]nano ware(if and ray whonm Code)The Contractor's n
c tea Law dce'nm apply la rot nwxr of property who builds or improves mcram,trod GING M1 IT FEF,
who convects lot such projects with a contractor(')licensed pursuannn'll.Comrxmr'
Licence Law. PER. UA,
0 I am exempt under Sec. .H&P C f..'his
ALTh DR &VI?NT-WATER IEA) VALUATION
Owner Date
WORKER'S COMPENSATION DECLARATION BeW PROcIECr.DEVICE
I hereby affirm under tonally of perjury one of the following declarations:
I hnveand ni
willmain' nu Cer'ilicmenf Consent Conseno self-iro for Worker's Compen. AINS-FLOOR,ROOII AREA.CON 1). S'IORIEti TY[I[;CONSTRUCTIO
ration,as provided for by Section 3700(If'he Labor Cale.far the prf ninance of the FIXTURPS-PER TRAP
Vfor which this permit is issued.
have and will maintain Worker's Contpcnwtion Insurance,as required by Secoon
war
)of'he Labor Code.I the pad ounce ofthe work for which ibis pvonla,issued. GAS-EA.SYSTIIM.I INC.n OUTLETS (ICC GROUT' AIN
rim, pub,
Carotic-7/IC'Fgl�rn-_-_---._-A-- =.e+em�OOM W( KF.R.4l'I�� GAs-FA.SYSTI:MOVERn(I:A)
CER S12 CAI 11 OF-C0MPIiNSA'1'ION INSURANCE GREASIVINDUS'I'RL WASTIi INTERCEPTOR NUI(-DING DIVISION FEES
(his scroon need not becompleted ifthe permit is fnfone,hundred dollars(110(b GREASE TRAP PIANCHIECK FEE
or less.l
Iremy n,sm,th,,,a in pertiamwce til me work bar which this permitisil"Conthall SEWIiR-SANITARY-STORM F.A.PX)ITT, IiNERGY FIiIi
not at I.,any person in any manner so as m bcnnne suhlem'o me Wndcn'Compen-
i z, 'alien latae of California.Dae WATER HEATER WNENT/IiLECTR GRADING FEE
Applicant
z
NOTICE APPLICANT:11,adcs naking mis Cunllinvc of Exemption,you should WATER SYSTEM/IREATING 1011.5 PIiE
F `N" bme.mbjat to the Worker's Compensators Prov stem of the Labor Gdc you must
bouillon comply wimsuch plikoh on dr,permit shall be deemed revoked. WATER SERVICE
Iz AID
1t
CONS'I'RUCI'[ON LENDING AGENCY N EW RES I DENT I AL PLMIL SQ.IT, D., vv'R.'t
U 0 l hereby anion that hem is a construction lending agency for the performance of
W F" the work for which this permit is issued(Sec.3097,Civ.C.) AL:
Lenders Name TOTAL:
,r U Lender's Address RUB.DINO PEE
C 1 ccnify that 1 have read this application and state ma the above information is
F conca.l agree tit comply with a 11 city and county ntdinxnces and state laws totaling to QTY. MECHANICAL PERMIT FEE SEISMIC PER
h
U z builAing umstmction,and het"by anthonic rapresemmovesol this city to enter upon the
above-marambed similarly to,iaspecunn purysnue PERMIT ISSUANCE IiLEC'I RIC FEF:
(We)agree no save,indemnify and keep harmless the City of Conran.against
liabilities,judgments,costs and expenses which may in any way same against slid City ALTERORADDTOMECH. PLUMBING FEE
in nmseiplowe IT the grand ng of this pcnlo.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITCr010,4a)Cl.kp MECHANICAL I'HE,
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER IO.(Xq CFM) CONS1'RUCITON'rAX
Si,mmmof Ap,liumi/Comecom Dara EXHAUST NOOD(WIDUCO I SOUSING MITIGNIION FHH
HA7ARDOUS MATERIALS DISCLOSURE
Will the applicant m lumre building occupant store or handle h.nadous mammal HF.A'1'ING UNIT(TO IW.IXIII ETU)
as defined by the Cupertino Municipal Codes Chasten 9.12,loathe[],;can and Safety HEAPING UNIT(OVER IIXl,000 I I'U)
Code,Section 25532m)^ PAID
O Yes 1 No VENTILATION FANS INGLE RESI D) Dae Receipt#
Will the applicant or future building occupant use equipment or devices which BOILER-COMP I3HP OR III)(XW ifIE)
/ 'nn,mom air umbou rants as defined byte,Bay Arca Air Quality Management
",lett BOILER-COMP(OVER 100.000 RTU)
l ❑Ye. E]No
AIR CONDITIONER ISSUANCE DAT'Ii
1 have real the haaaNnus materials rryuitumenu umlcr Chapter 695 of the Cali- ^ 9
tarots Ileal'h&safety Csde.Sections 25545.2353)and 25.SSJ.11 1 ly,he ak,if the NEW RESIDCNI'IAL MECII. SO 17. —
builAingdms nm cusmntly hrveatenanh aha'n is my respmsihiliryt nasty mcoccupam ✓ '_
nim u' tem' hic et pd rata's' -aj:egir agarPA
O
Owner or out +ri>ed agcn'
Dae TAL: Issum PtY:
OFFICE
o. cliv
10300 Torre Avenue
Cupertino, CA 95014
01*
Cupertino Building Division
(408) 777-3333 (fax)
February 4, 1999
Homeowner
21438 Meteor Drive
Cupertino, CA 95014
SUBJECT: Permit#S 1127
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
•
p.ir.l�N nn q-11"."0,,