S 0982 (4) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO IHHLDING-EI.ECFRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMB NG-MECHANICAL S' 0982
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SAN]I'ARY NO. APPLICATION SU13MI'TIAI.DATE
ka - -Dr• e r "ton (qSO4 t
WNER'SNAMF,: G PHONE: C A "NAME: C LIC NO: NIC CON kOLX
s __11A L 1
HITECT/ENGINEER: LICNO: SS I
1 ❑
Q.
ppNTpCp; PHONE: 4v'a' a `S0
'h C r'5 BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MF.CH
❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION QTY, ELECTRIC P17RMIT FEEJOg DESCRIPTION
1 hereby affirm Thal I am licensed under provisions of Chapter 9(commencing
'Z ZZ wish Secsion](M01 nfDivisionJof rhe Businesr and Pndessionx Cowl'monlylicenseis PERMIT ISSUANCE RESIDENTIAL;
�U= in full force and t. LO ❑SFDWI. El KITCHEN REMODEL
QU�j Lscnse Cla<x ec .to APPLIANCES-RESIDENTIAL. ❑ADDITION [I PLUMBING RE-PIPE
H Z W Dme Contractor
ris66 El MULTI-UNIT [I STRUCTURAL
Dom ARCHITECTS DECLARATION PANELS
Fv� lunderswnd my plans shall he uudmpuhlic records MODIFICATION
UP T021NIAMPS
El INTERIOR El CHIMNEY REPAIR
F,=�w Licensed Professional 201-IINq AMPS IMPROVEMENT []SWIMMING I'OOIS
-� OWNER-BUILDER DECLARATION
nt Q I hereby infirm shat 1 nm excmpt form the Commcsor's License Law for the OVER I(XI(IAMPS ❑BATH REM�j/RF.P N •MOCK
iq5 6 U following reason,(Section 7031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL �OTHER ([//''}v}
M
a 0.F' which requires a pemi
rt in m
conslm ,alter,improve,demolish,or repair any someone
00 primmilsisnuance,alro mquires the applicant for such Permit rile u signedwerement SPECIALCIRCUDUMISC.
;!IQs that he is licensed pursuant o the provisions ofthe Contractor's License Law(Chapter 9
W�CO (commencing with Section70(fid of Division 3 ofthe Business and Professions Code)or TEMP.METER OR POLE INST. COMMERCIAL'
Q.Iy o Y that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDGIADDITION ❑DEMOLITION
YX7 4.
Section 11111,1 by any applicant la a permit subjects the applicant m a civil penalty of POWER 11WICES 0TENANT ❑FOOD SERVICE
not morethan five hundred dollars C$50%
ey o IMPROVEMENT
)Lasownernf the pmpcny,or my employees with wages as tscirsole compensation, SWIMMING I'fl(]L ELECTRIC
will do the work,and the structure is not intended or uttered for sale(See.7044,Business ❑oUirR
and Professions Code:The Contractor's License Law does not apply m an owner of OUTLETS-SWITCHES-FIXT
L property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such impmvcmrna are not intended or offered for NEW RFSIDF.NTIAL ELCCfR SQ BE
sale.IL however,the building or impmvement issnld within one yearofcnmplic'mr,the SQ.FT.FI.00RI :AT
Q.IT.
caner-bui)deo will have the home.of proving than he did not build nr improve for par.you of salcJ,El I,ns owner of the pmpcny,um exclusively cnmructing wink IiccnsW emomcmrs to 'T(l'I'AI.ommanthe project(Sec.7(114.Business and Professions Cade:)The Conuactors Li-
censeLawdoesnmapplytoanrwnerof property who builds or improves thereon.and QTY. PLUMBING PERMIT FEC• Cjly Ur VUr
who counters for such concert,with a con raclads)licensed pursuant to the Contractor's
License Law. PERMIT ISSUANCE
❑ I am exempt under Sec. .B&1'C for Ibis reason
ALTER-DRAIN&VENT-WR'I'ER(EAI VAL.UA'I[ON
caner Dam
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTE(7T.DEVICE
1 hand w affirm m under penally of perjury one of she following Worker ion:
�-I�Iheve and will maintains Certificate of Conserv to self fm Worker's Compcn- pRAINS-PLWR.ROOF,ARBA.COND. STORIES It TYPE C(INSI'RUCT]ON
emian,nx provided for by Secninn 371X1 rf the].ubnr Cnde,for IM1e perfnnnanee of the
K1k far which this pemiil is issued. FIXTURES-E'ER TRAP
have and will maintain Worker's Compensation Insurance,as required by Section
of the Pal%Ir Code,for the performance to work for which this permit is issued. GAS-EA.SYSTEMA INC.JOUTLETS (ICC GROUP APN
My Workc'sCn ensation lee nee carrier and Pnlic r
Contactk 'C itP I �1SH7O GAS-EA.SYSTEM-OVER 4 WA)
CERT]FIC OF EXEMPTION FROM WORKERS' GREASt%INDl1STRL WASTE INTERCEPTORCOMPENSATION INSURANCE BUILDING DIVISION FEES
(This section need not he completed if the pemth is for one hundred dollmrs($100) GREASE'TRAP
I or less) PLANCHECK PER
I tinily lam imam performance.fthe work fill which this Nonoil is issued,l shall SEWER-SANITARY-STORM EA.200 IT.
nm nn
employ any peon in any moaner so as to become subject to the Workers'Campen- ENERGY PER
Q'z sation laws of California.Date WATER HEATER WNENIMLECTR GRADING FEEz Q Applicant
NOTICE DO APPLICANT IL,Mier making this Cenlficate of Exengninn,you should WATER SVS'I IiM?kfiATIN(1 SOILS PEE
a L�'I become.object to the Worker's Compensation provisions of the Labor Code,you mull
forthwith comply with such provisions or Permit shall be deemeJ revrkW. WATER SERVICE
Q
ID z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FE PAID
V 0 Iherchy affimtthauhcrc isaconsrmnion lending agency En the performance of
Done 'OO&CCIPI
{loth the work for whlchthis permit is issued(Ser.3197,Civ.C.)
O V Lenders Name )TAL.
y Lender's Address 'UYI'AE:
yI certify that I have mot this application and state that she abuse information is BUILDIN tli
rV) correct.Ia,.to comply with all city and coumy ominance-and slam laws relating to QTY, MECHANICAL PERMIT FEE
V .zi building construction.ad hereby authodm representatives cul city menterupon the SEISMIC R:
above-mentioned property for inspection purposes. PF,RMD'ISSUANCE
(We)n,me to save•indmn.ily and keep harmless the City of Cupertino against ELECTRIC FEE:
Iiahilities,judgmenta,costs and expenses which miry in any way insane against said City ALTER OR ADD TO MECH.
PLUMBING 11'.
in conugncnce of the gra Ia of am permit.
APPLICANT :POErt AI DS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO II1.000CFM)
MEEHANI LFEE
SOURCE .GU '(
AIR HANDLING UNIT(OVER 10,0011 CFM) CONSTRI HONTAX
Sign .- Commmor (lura EXHAUSTHOOD(W/DUCT') HOUSING MI'TIG ON ITH
c HAZARDQGS MATERIALS DISCLOSURE:
Will eapplicam or future building twcupant slam or handle haeardnux material HEATING UNIT(To 1110.001 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health twit Safey HEATING UNIT(OVER IIXL(M](1 BTU)
Cada Section 255J2(a)? //
❑Yes ❑No VENTILATION FAN(SINGLE RESID) PAID
Date Ecce p
Will the applicant ar future building occupant use equipment or devices which BOILER-COMP(3HP OR IIN1,lNN)BTU)
nit hamodom air contaminants as defined by the Bay Area Air Quality Management TO •L:
tsmes? BOILER-COMP(OVER 100.0(]0 BTU)
❑ye, .
I have read the havanyomsmamrials requirenams under Chapter 4.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
fomia Health Cale,Sections 25505,25533 and 25574.1 undumand lhel'dihe NEW RILSIUENTIAL MECIL SQ.1'T.
huildin my have.senanL a but it is my responsibility to notify she occueam
of Ih ire which must he met prior m issuance of a Comificme of cu cy.
d agent D Ie TOTAL: ISSUED UY:
OFFICE
WC
10300 Torre Avenue
Cupertino,CA 95014
of
Cupertilio Building Division
l,4013)7 1 8 —
(408)777-3333 (fax)
February 4, 1999
Homeowner
10300 Pharlap Dri
Cupertino, CA 95014
SUBJECT: Permit# 50982
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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