S 1816 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO nml,lnar..ELncrkto\1, pit l8Trno. 1816
BUILDING DIVISION APPLICATIONIPERMIT rLUMRING-MECHAMCAL
BUILDING PROJEC I IDENTIFICATION
BUILDING ADDRESS: ., f ' SANITARY NO. A['i'IJGM'IONSIIIiM]]'1'AI.DA It:
�oa8 1 C't�� LeaIre-
'
e-
OWNER'S NAME: PHONIi; CON'I'kA-CCT�OR'S NAME: 1.1 NO:
0. Q u x57' A�lI 1 �/ ( NIC CON'IR(ll.a
RCI HTI!CT/ENGINEER: hIC NO'. ADDRESS
: �LlOIO ❑
R� �roSVeno rDr. S fir 957 3a
CON'I'ACI': NH BUILDING PERMIT INFO
'�1-es Low
A� '1 "'CS> ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELIiC'I' PLUMB MI CIL
1-� -a7/9 ❑ ❑ ❑
LICENSED CON'TRACTOR3 DECLARATION QTY. ELFCTRIC PERMIT FEE JOB DESCRIPTION
- w I hcrchy aftinn than I an,liecased under prnvi.viuns of Chnp4+9(nmunencing
7 'm SaY'I'1o119(00)TI Divioinn3al theltu,ine,sandl'rofbueioroC,uie,and my license ix RESIDENTIAL:
µµ11 PERMIT'ISSUANCE
Ful " full force and ❑SFDWI. ❑KITCHEN REMODEL.
QUU Liccn,c Cl Lica AYYLIANCGS-k131DENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
f-ZW Ume Comraclor_
Nae' ARCHffECI'S DECLARATION ❑MULTI"UNIT ❑STRUCTURAL.
~-Z Imdcnm.ulmy pnuuchall heti—I axpubllcmcoNs PANELS MODIFICATIONOZ�,, Oil FO2WAMPS C]INTERIOR (_1 CHIMNEY REPAIR
F vlhy; Licenced Num,,ional 201-1000AMPS IMPROVEMENT 0SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IUM1AMPS ❑BATH REMO�DkE '.PAIR 6;L.TION
C
_WW, I hereby.1Bnn that I nm exp npl Lou.the Cammemds[J,emo,Law for he (ITHIiR A '�-�-IIII+ e-
XOyU fullowingreusun.Ncctlnn 91DI5.Bu,mm—nd Dole,eim,Code An,,ayor,,unny SIGNS EI.I'C'I'RICAL T/
W 3 W ti which requires a permit to mrotmct,alcor,improves dcmnlisM1,or repair any sunaure
I":0.5 prior it.issuance.also requires the applicant for wen Learn lot file a signed Statement SPECIALCIHCtill T/MINC.
E w. that he licensedpursuant t t1, fof n Courtrai 1 < L IChoptcr9 COMMERCIAL;
xm neon n g hS 1 7cBj IU t f11 It eu, JI f:i nCnde),r 'I'LMP.ATI?fIiH OH POLEI .
c,4 p, that h,is ese.pl t,Jm n and the be,i,iou,la,a Il g l a, pf I.Any rola,.n f ❑NEW BLDG/ADDITION ❑UEMOIA PION
XImSenlan 9091,5 by any applicantfur a permit subjects the applicuntm a evil iwnahy of POWERDI?VIGITS ❑'I ENANT []FOODSERVICE
nm mom than Ovc hundred dollar.(S51X0. IhfPROVEMENT
SSC ❑ Los owner of she pmpcny,nr my enoployeel witM1 wages as their Hole compensation, SWIMMING I RI
(_.
will do,t1, k Ids t t tintendedofferedfor al (See.9(134) ehe., El OTHER
W and probe 'C &, IT C t I r l I' I x I Illy t c (if OUTLETS-S -IRES
pr,sny who builds p ,therenn.and wha thns uch wourkI' If Ihmugh
his town employee,p J d Unit h in p 1: nut'vended n,offcml far
NEW RES[ IAL SQ FT. SONIC C R AREA 4/S4st.IT.
sale.If,mA ever,the building or improvement is cold within one year of completion,the
,,builder will have the burden of proving that he did not build o p��
q�Lc nlsalcl. r ' IOfAL: JUL 0 jU'GTD
❑1.uw owner of lhu pmpeny,an,"o,l—osely amnmening wlth licen.Exp,
shorn the project(Sec.70,W,Rn inc..and Pmm,,sinns CtodoO The Comrac ars Li-
en -
sc law dors not apply to an owner of pmpeny who builds or improves thereon,and QT IAMBI 3PERMIT FEE Cin ut l;urcti I1NU
who conuacl,for such projects with a mmranor(})Iicem,ed pursuant to the Comra as.s
1"iem.r Law. 0 'Cers GTgc MTT It. CI!
I an escm I under Sec4'�• If AT,PC for 11,11 reason
At &VBM'-WATER(HA) VALUATION
Dam 7 0
WORKER'S C(.IYENSATION DECLARATION IMC _OW PROTECT.DEVICE
40, 1 hereby ullinn noodle,penalty of p,,jury unu of the fullowing dcalimankys:
I have and will nouinmin.Cctib,aeufConnun In,e Fin,une for Wnrke,SCnn.pc DI( -FLOOR,ROOF.AREA,GOND' ED
ItIIiS TYPE CONSTRUCT ION
talion,nc provided for by Section 371Xl of the I.ahnr Cede,for the performance of the
work for which this permil is wand. RLLS-I`IiR TRAP
❑I have and will maintain Worked Compensation Inmmnce,as required by Section
370M of the Lunor Coale,far the perlonnnnce uf(he stork for which this semen is issued GAS FA.SYSTEM-I INC.4 OUTLETS GROUY APN
My Wmkr,'xCoaopenwlion lnmrun,r canner and Polley it....I ram: GAS-EA"SYSTEM-OVER 4 fFA)
Carrier: Policy Nn,:
CERHFICATE OFIiXEMPION FROM WORKERS' GRCASEANUUSTRL WASTE INTERCEPTS
COMPENSATION INSURANCE BUILDING DIVISION Plil!S
('{'hi,sectinn need nnthecnmplmcdifth,Naait is fn,onchemdmddollam(SIIM) GREASETRAP
1'hANCIIECK FEE
ov.)
lay any laatroti,anynnumn to as
M1tto)the ii,Widssucdlxhnll SEWER-SANITARY-S'(ORM EA 2IM)PI'.
not employ any pclsnn in anY,nannvr so us to bcconm subject m Inc worker:Compos- ENERGY Plili
Z vtiun{awsnf Califumia.Date WATER HEATER WNFXUCLECTR GRADING FEE
Z Applicant
NOTICE'Bo APPLICAN'1111:admr makingdoir Cerificam of Ilxuanptim.yea ennuld WATER SYS'I'EM/fREX]'ING SOILS IIiE
been.. Wake,subject m the Woer's C...n.w Trion prnvisimu"of to,he LobCnde,Yon nnmt
W bnhwith comply with,ucn pmisiurl or this peril shall be deceived revoked WATER SERVICE
y
:Dz CONSTRUCTION LENDING AGENCY NEN'RIiSIDIiNf1ALI'LM11 B. SQ.fT, PAID pate Rnxiptp
herebyatIna that there ieacnnXlominn leadingagency for the perfnnnmme of
the work for which this permit i,luvuad Neer 3091,Civ.C") TOI'Al,
O F I<ndds Name TOTAL:
r U Lemlcr',Address _ BUILDING FEE
W 1 certify ghee 1 have mad this application and a,am than the aMrve inftomm ina
.F..i In c torn.lagme to comply withall city and many onllmnces and stale laws rela0ng to QTY. MECHANICAL PERMIT FE- SEISMIC P1i1i
U burdia,,anxtmmiun,and hereby unlhmirc reprrsuncetive"A l hi,city to enmrupon the
alwvc mentioned p,.,,By In,im,a tion lumpel". I'IiRMI'1'ISSUANCE ELECTRIC ITHE
(We)agmc to save.indemnify and keep harmless the City of Captain.,aiir,e
Imbililiel,judgments,costs and expenses which'nay many way uccamagainat said City ALTER OR ADDTO MECII, PLUMBING FITE
into aumeofthe grantingof This peril.
AI'I'I.ICANT UNTAIRS'T'ANDS AND WILL COMPLY WI'I It ALJ,NON-POINT' AIR HANDLING UNIT(I()In,(AMt CFM) MECHANICAL FEE
SOURCE REGUI.A'i'IONS.
AIR HANDLING UNITIOVER 141)(X1 CFM) CONSTRUCTION TAX
Signature of ApplicanVContmcmr Dec EXHAUST IIWD(WIDUCI') HOUSING MI'I IGATION FEE
IIA'ZARDOIIS Mr\'TERotep OtSCL(lSI1Rli
Will the applicant or Talar Fuildin6 ctcupunl xlnrc or bundle M1oiardom anulcriol IIEATING ONf(TD IIX)JXN)[it U)
us delined by the Cupertino Municipal Coco Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100.0110 BTU)
(sode.Semina 255321x)' ,,,�//�'�'
E]ye, 1(yvo VENTILATION FAN(SINGLE REMD) PAID
Owe Re-im to
Will the upplicnnt mit c bonding oceupm l use equipment or devices which BOILER-COMP CUNT OR IIX).q)0 R'DII
mit harardnul air conuminunu ns defined by the[lay Area Air Quality Management TOTAL
Camel BOILER-COMP(OVER 110.000 BTU) _ O
❑Yes �No r
I have read the hamrdou.e mmenals re ks under Chu ter 6 95 A the Cali- AIR CONUI'I'IONEN ISSUANCE,IJA'I'li
25533.
fomia Health
or,n Sonny Ctode,ertrep 125hen 12550.,oil 35341 unwr,med that it the NEW RESIDENTIAL MliClf. SQ.1-7.
,of, n6 docsmanowhilly haveamninptnae it i,myecofa Cert.y urnmif lehc ex out,
ft nems which mu rt poor iwuanee ofaCanificWe (Oc`�u@ency.
ey.1L11/llalmhch 7f/f Le�
Uwlfc or aulhunlld age al I D.u• TOTAL: ISSUED Ii Y:
OFFICE
,. A
l�
t®, 10300 Torre Avenue
p.,..
Cupertino, CA 95014
Citv of
Cupertino Building Division
(408) 777-3333 (Pax)
February 4, 1999
Homeowner
20284 North Glen Square
Cupertino, CA 95014
SUBJECT: Permit#S 1816
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
0
_prinrPd 011 Pzcvc,'ed Pnner