S 1699 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITYOFCUPERTINO BUILDING-ELECTRICAL. PH IT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 1699
BUILDING PROJECT IDENTIFICATION
BIIILDINGADDRESS: - SANTFARY NO. APPLICA'T'ION SUBMITTALDA'fE
8 y- 6 /rl�l/E,e vE . S-'2Ce-
ra to
8NER'SNAME: IfONE: Coast RACfOR'S NAME: LIC NO:
/E- eXOA SA.✓c NEZ. NG81Z5'o62 we coNTpoLx
CHITECT/F.NGINF.ER: LIC NO: ADDRESS: ❑
CONTACT. PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENS17D CONTRACTOR'S DECLARATIONQwz QTY. ELECTRIC PERMIT PEE
I hereby aff..n Nal I um licensed under provisions el Chapter 9(emtmnncing JOB DESCRIPTION
WOO with Section TBBt)of Division 3ofthe Businessand professions Code,and my license is RESIDENTIAL:
WOO O PERMITISSUANCE
Fw in full force and effect. ❑SFDWL C1 KITCHEN REMODEL
aVZU License
Class
ss Lic.x
DoleGinmunm APPLIANCES-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE
hd1
ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL.
z O n z 1 understand my plans shall be used as public records MODIFICATION
Oz_O UP FO 200 AMPS A []INTERIOR ❑CHIMNEY REPAIR
F.h.5M Licensed Professional
'J 201.1000AMPS IMPROVEMENT []SWIMMING POOLS
SYOWNER-BUILDER DECLARATION OVER IIKNIAMPS C3BATH REMODELMEPAIR 0DEMOLITIO
R�C 'I hairair,,.,Nm m em
ereby air,,., I aexempt from the Contractor's Liven.Law for he
tY
following rcasmi (Section 7031 5,I odm,ss and Professions Code:Any city ortnumy SIGNS ELF ❑OTfIF�A � �N -
LL O
F.
which rnryims a permit construct,consmt,alley,improve,demolish,or repair any saturnine 1`
f" prinrmits izsmnce.also«quiresIle applicant for such permit m Bleu signed maternal SP1?C L CULT/
F, ,,i that he is licensed moment o the provisions ofthe Contractor's license Low(Chapter 9
(commeia,mg with Section 7000)of Division 3 oftbe Businessand Professions Gtde)or p, "0 OLE COMMERCIAL:
6 6III c C that be is exempt intention and the breis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DINOLI'RON
X ,y Section T(131.5 by any applicant fora permit subjects the applicant m a civil penalty of OW Ii 'i5 - [II'F.NANT ❑FDGD SERVICE
rat more than live hundred dollars($500).
F-.z.1. IMPROVEMENT'
=6 0 I,as owner of the progeny,or my employees with wages as their sole compensation, NOM) LEC'TRIC
F,O will do the work,and theamcwm is not intended cropland!for sale(See70,W,Bit ❑OTHER
mand Professions Code:The Contractor's License Law does not apply to an s OU 'S-SWITCHES-FIXTURES
a' property who builds or improves thereon,and who does such work himsel i it
his own employees,provided Nat such improvements art not intended Bred for 1, lE Q 1'Il
tale lLhcwer will l but the burden
of moving
is at he did n one ywete lesion, _SQ,FI' EA $/SQ.IT.
rvhuilder will have Om burden ol'prcving that he did not build or imp f �I`,Y-G
rynctof
Los owner of the property,am exclusively contracting with licensed comm 10 Ah:
roman the pmjcct(Sec.7014,Business and Pone,oions Cale:)The Contactor J ER 2j /(j
se Law docs not apply to an owner of property who builds or improves thereon.a QTY. PLUMBING PERMIT FEE �V�^
who contracts for such projects with a contmctor(s)Iicansnd pormanl In the ContractorLs
License low. PERMIT ISSUANCE i VC/Ux
Fj I in.exempt under Sec. .B k P C for this onium
ALTER-DRAIN&VENT-WATER(EA) VALUATION
Owner Dam
ION DECLARATION BACK FLOW PROI'EC'F.DEVICE
I hereby affirm under penalty of perjury one of the following deciaretlons:
Ihavennd wil Intuition a Caddicale of C.mi,nnn sethin...a lin Workers Camper. DRAINS-FLOOR.ROOF,AREA,GOND. ST,3Rff��faik I kjTYPE CONS]RUCTION
smion,as provided for by Section 37M of the Labor Code,for the perfomance of the
work for which his permit is issued. FIXTURIS-PER TRAP
1 have and will maintain Worker's Compensation Insurance.as required by Section
3700ofahe Labor Calc,for performance ofthe work for which this wrmit is issued GAS-HA.SYS'I'EM-I INC.4OUTLETS ,R U APN
My Workers Compenution Insurance carrier and Policy number are:
Carrier: Policy Nn: GAS-EA.SYSTEM OVER 4(EA)
CERTIFICATE OF EXEMMION FROM WORKERS' CITY
Ur I+UI'C
COMPENSATION INSURANCE: GREASFJINUUSTRI.WASIF.INTERCEPTOR If
NUIIAING DIVISION FEES
(This section need not be completed ifbepermil is forme hundrecidollars($100) GREASETRAP -- -_--
nr less] PIANCHIiCK FRE
le,mifythat Nnheperfofmaoceofthew... fur which this permia is ixsueJ,Ishall SEWER-SANITARY-STORM EA.200 IT.
not employ any person in any manner so as m become subject to the Worked Compen- ENERGY EEE
,Z sraim laws of California.Dane WATER HEATER W/VENTdzl_FCFIt
7�O Apglicunt - GRADING FEE
G y NOTICE TO APPLICANT.If,afar making this Ccr ificec of lisnnpnion,you should WATIiR SYSTEM11'BEATING
a ~ become subject to the Workers Compensation provisions of she Labor Code,you nmst SOILS FEE
L[I Iti forthwith comply with such provisions or this permit shall he deemed invoked. WATER SERVICE
0
CONSTRUCTION
constriction
iENDINGAGENCY NEW R251DIiNy'IAL PLMIs. SQ,IT. PAID
z Ihertby affirm that isaconswninn lending agency for the peHormun<e of Date Raei x
LJ � the work for which this permit is issued(See.3097.Ci,C.)
U Lenders Name TOTAL:
O V Lclaer's Add.. TOTAL:
1 certify ohm I have read this application and sme that the dso'a inmost..is BUILDING FEE
FiN correct.l agree it)comply with all city and county ordinances and surae laws mitiongm QTY - MECHANICAL PERMIT FEE
V z building construction.and hereby authorize representatives of Nis airy meaner upon the SEISMIC FEE
above-mentioned property for inspection mr,mes. PERMIT ISSUANCL>
(We)agree to save,indemnify and keep harmless the City of Commit-against IiLEc TlUC FEE
Iiahilitics,judgmems,costs and expenses which may in any way arca,against said City AI:FER OR ADD TO MECH.
in nscc uence of she granting of this permit. PLUMBING PEE
APPLICANT UNDERSTANDS 'D WILL COMPLY WITH ALL NON-POINT Alit HANDLING UNIT(1010,000 CFM1
SOURCE REGULATIONS. f / MIiCHANICAI.FF.
AIR HANDLING GNir(OVER I(I.oks,CFM) CONSTRUCTION TA
Signature of A,pIicma/C.snrrx Dae Q EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FF.E
I IALREFTMY Iii UAL.S DISCLOSURE
WIINeapplicana or future huilJing okcupant score nr handle hazaolousmmeriod BEATING UNIT(10100.000 BTU)
as defined by the Lineman Municipal Code,Chapter 9.12,and the Health and Safety
Cale,Section 255320)? HEATING UNIT(OVER 100,0110 BTU)
❑Yrs ❑No VENTILATION FAN(SINGLE REISID) PAID
Date Haciplx
Wel the applicant of future building occupant use eAir
or devices which •^ -
aithamrdeminun
ousnirconlsasokfinedbylheBayAre.Air Quality Management BOILER-COMP(3II1'OB I01,010 BTU)
TOTAL.:
tsoinP BOILER-COMP(OVER 10(1,00(1 B'1'll)
❑Yes ❑No
1 have read no huzmdous materialsrcuimde
ynemx under Chapter 6.95 0l the Cali AIR CONDITIONER ISSUANCEE DD/AATTSE—/E
fomia Health gdol&r cues Calc,Sections 25505,2553]and 5531.1 understand That if the NEW RESIDENTIAL MF.C.H. SQ.ET V
building Aces nm currently have a tions,that it is my rand 25 TL 1 to notify the hccupnm
of the requirements which must he tan prior v)issuance of a Certificate of Occt panty.
Owner or mthori'zed agent Data TOULAL: ISSUED BY:
OFFICE
10300 Torre Avenue
Rk
I rte oCupertino, CA 95014
, C� f
Cup El{_l 1 1 o Building Division
(408)777-3228
(408)777-3333 (fax)
February 9, 1999
Homeowner
885-886 Miller Avenue
Cupertino, CA 95014
SUBJECT: Permit#S 1699
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
i
Christy Akatiff, Administrative C erk
Pnntetl on Recvcled Paper