S 0690 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY /N�Q
•CITY OF CUPERTINO BUILDINI;-n:1ECTRICAL I I91I r NO. O V V O
BUILDING DIVISION APPLICATIONIPERMIT PLUMB mG-MECHANICAL `J
WILDING PROs IDENI1FTCA31ON
BUIhDINGADDHILSS'. SANITARY NO. APPLICATION SURMITTAL OA'Ili
q o e I�n1E- o
OWNER'SNAME: N/C CONTROL#
PHONE: CO RACTO 'S NAME: LIC NO.
LIC NO ADDRESS: ❑
3 9�bLk000
%'ONTACP vHON1i: BUILDING PERMIT INTO
Consultant Fees Paid by Applicant(Initial) BLDG [LIiCf PLUMB nnsCH
�kL_ Q 4'WM 271k-loo - ❑ ❑ ❑
LICENSED CONTRACTORS DECLAKATION QTY. ELECTRIC PERMIT FEE JOB DESCRIPTION
I benby affirm tom I an,lice-rd under provisions dChapmr 9[commencing
U0Z with Seen .7000).f Division 3 ofthe Business and professions Gba.mad my license is RESIDENTIAL;
Ffull force and eRcm. I'ERMI'1'ISSUANCE 0SPDWL ❑KITCIIEN REMODEL
ZU Lice1 Uurense Class Lica
QCnmmnar APPLIANCES-RLSIDENI'IAL ❑ADDITION
,-7W Dan—
Rr PIPES
QU
ARCHITECTS DECLARATION PANEIS ❑MULTbUNIT ❑S'I'ItUCTURN,
F y Z I understand my plans mall he used as public mcmds h10D111CAT1UN
ZOm- UPT0200AMPS ❑INTERIOR E3 CHIMNEY REPAIR
OZ-�
FaH�D) Licensed professional 201-1(x)(1AMPS IMPROVEMENT SWIMMING POOLS
ay a OWNER-BUILDER DECLARATION OVER U100 AMPS ❑BATH REMODELIRF.PAIR El DEMOLITION
(y C Q I hereby anion that I am exempt from the Contractors License Law for the ❑OTHER
x 6 U following mson.(Section]B3L5,Bminess and Poole,cros Cuda:Any city ar county SIGNS ELECTRICAL
W 3 LL 1Q'
which req pe t t t et It p demolish, p y snucmre
OJ priori t. u I terminal theapplicantf r. M1permiti flsigned.tatement SPECIAL CIRCUIT'/MISC.
N
'may that( Iron dp amt th pn fid C t t 1 lu (Chnpmr9 COMMPRCIM,
�Q0 commareng with Section Uividom 3 ufthe Business and prnfcsi CWe)ar TEMP.ME TER ORPOLEINSI' ''
d a o ya that he is exempt tnertfman and the hasis for the alleged exemption.Any violation of \ , ❑NEW BLDG/ADDITION ❑DEMOLITION
CMN Section 7031.5 by any applicaut for. a rmh xrd mt,the applicant o a civil penalty of POWER DEVICES [I TENANT ❑FOOD SERVICE
a,zY not more than five hundred dollars(S500). IMPROVEMENT'
E=a0 ❑I.as mune,of the pmpeny.tar myemployms witb wvgcz as their sole compcnuunn, SWIMMING M)0 C [1 OTHER
F will do the work,and thesloneture is not imtendedmroReted for mle(Sm.]UtA.Business Ot1T1,1515-. CUES HES
1 and Professions 6Nc:'Ihe Conlin.mh License Law docs sol tgeply m un owner of
property who builds or improves thereon,and who does such work himxlf or through NE R Q I.T.
his own employees,provided that such improvements am not amended or uReted for :SQJT�:ff)RARE�AhUSQ.FT.,.la IL hoeve,the boldingtarimprovement Ix sold within oneyeer"completion.Ne rerbuilder will nave the huNcn of proving that he did not mild or impmscIcerpun /
uI.ns ownerof the progeny,am exclusively cnmraaing with licensed contmcm eonxlram IM1e project(Sea]I W.1lusincsv anJ Prdesslons C:deJTheConnuc soan T UMBING PERMIT FEE woo mm�azuforsucM1 prnjems withacmntracnngs)licensed punuam to oat tar's License Law. Cfnrtr. PERMI'1 .SUANCE .
❑1 am exempt under Sm. '
LTER-DRAIN&VENT-WATER(EA) VALU I O
Owner
WORKI!R'S COM YENSATION DECLARA e BACK FLOW PR(YI'ECT.DEVICE (�
I hemby officer under penalty of perjary one of the follow thimanonr.
1 have and will maintainaCertificnm of Cnnanuasdf-insure far xr pen- DRAINS-FLOOR.ROOK.AREA.GOND. GTQµ1pG TYPIi CONSDiUCT10N
wino,ns pmvideJ for by Section 791x1 of the Ladv r Code,for the R lot the
worA for which 0is
permit is issued. FIXTURES-PER TRAP
I have an
d will illmainmin Workers Compensation lrumarm.as rcquhnd by Section
3]txl of theLabor Code,for the parturriarmuflhc w,,rk for which this permit is issued. GAS-EA.SYSTEM-1 INC.JOVI'LFTS (KC.GROUT' nl'N
MY Wsnknj's Compensation lnsumnyy'e carrier anJ Policy KSlsln TS.2Z•S
Cartier:
GAS-EA.SYSTEM-OV1eRdIFA1
CERTIFICCOMPE SATIO INN FROM WORKERS' GREASE/INDUSTRL WASTE INTECEPfOR
COMI'I!NSATION INSURANCE BUILDING DIVISION PHE.S
(Thivsmtion need notMnsmplmMif thcletmil is fomit,handraddallar,($100) GRFASETRAP PLANCHECK FEE
or less.)
Iccnifythalinthe anrfortn.., of the,become which this lremtitixlssuN.Ishall SEW1!H-SANITARY-S'TORAI F.A.21x1 PL ENERGY I�IiE
i nm employ any person m any manner so as es herome suhjecna the worked Cotnpem
Z satin.Laws of C.Iiferma.Date WATER HEATER WNEW"ELECTR GRADING FEE
NOTICE TO APPLICANT':1f,after snaking this Cenilicwc of 1?rccmpdnn,you sbunld WNITIt SYSI HM?REA'I'ING SOILS PI!I!
F "N" become subject or the Workers Cnmpenmtion provisions of the L1.n Coda you"last
a forthwith comply with such provisions or this Permit shall he deeroed revoked. wA'1'I!R SERVICE!
k1 Q
CONSTRUCTION LENDING AGENCY NEW BESIDIIN'1'IAL PLMIL SQ.E'. PAID
7 Z Ume Rttelpt a
L) p thereby eRmt that is lending agency for the Performance of
fLthe work for which this Permit is i...ad(Sm.NAR,Civ.C.) TOTAL:
l- Le dm's Name 'IOIAL:
D.1 I-amk,'s Address MBUR.DINGF. E:71 cerity that I have mad this application and state that the aove information is
tcrrcct.l.,me torom,ly whh all city and coomy onina"cesandslam laws relming to QTY. MECHANICAL PERMIT FEE U Z building conswetion.and hereby numerics,representative.s of this city to enter upm theabwomentioned rogeny for inspection purpeas. piiµMIT ISSUANCE E(We)agreem.rive,indemnify and keep ha"alf,"the Cityof Cupeninm againstIiabilllies.judgmem6co..1,and expenses which anal in ay way acerae against orad City A LTI!R OR ADD'TO MECH. Ein consequence or the granting of this Permit.APPLICANT UNDF.RST DS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.1x10 CFM) LITIESOUK( :REGUIATIO . AIR HANDLING ONI'I'(OVER 10,110 CFM) OON'I'AX
SlgnummdAPPbrear/ o ramor Dam EXIIAUSTHODD(W/DUCD HOUSING MITIGATION FEE
HAlARDOUS MADBOAI S DISCLOSURE
Will the applicant or future budding wer.pant.norm,handle harvdous material HEATING UNIT(TO Ihiffi,BIG)
as dcfnW by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEAPING UNIT(OVER 100.000 BTU)
Code.Section 2553210"
Cl Yes ❑No VIiNH ILATION FAN(SINGLE BUSED) PAID
Data Receipt a
Will the upplicum ar fm.m huilding oacupam use egnipmmm or devices which BOILER-COME'CHIP OR Iup.000 BTU(
it hamrdnus air contnminan,,as defined by tM Bay Area Air Quality Man,cocat 'I OPAL:
lon
ipricl] BOILER-COMP(OVER 100.0X0BTU)
Yes p No
AIH C'ONDIT'IONER ISSUANCE DKI'I3
I have toed the h ode.S materials 5.25533 ntsan under Chapter 6.95 l that
if the �\��,9mr--cyam
bsmia Health A'.Safety tlyha Fmtians tins, 3,ay x,p 2553J.1 i nobly, that if the NEN'RESNCNTLAL MECH. SQ.FT. V -
hullding deet nm enrz<ndy M1uve n tenunL Bnn it'm my rcspoasibllity m notify the oscntpam
of the ,uncomes which must Is, at poor m iou."ce of a C.nificale of Oc aloney.
Owner or tmthnrved agent
Dane TOTAL: ISSUED BY:
OFFICE
10300 Torre Avenue
Cupertino, CA 95014
(;iCv of
upeltillo Building Division
l� �J 1, -'--
(408) 777-3333 (fax)
February 4, 1999
Homeowner
19990 Pear Tree Lane
Cupertino, CA 95014
SUBJECT: Permit# 50690
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
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