S 1298 (2)�....._ APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY Qh CUPERTINO BUILDING-ELECTRICAL PEgl,HTNO.CHANICAL 1298
I BUILDING DIVISION APPLICATION/PERMIT 1'I.IG PRO JEC IIDENTHFUC
BUILDING 1'N(1JEC'I'IDENTIFICATION
ILD—7(P t � �5 �� uric ka l l �o 55 725 SANITARY NO. API'LICA'I'IDN SfII{MITTAL HATE
Ek:S NAME J'�,1•y`'/���, PHONE �p CONTRAC'F01CS NAME LIC NO:
L.0 rel Lx*bnq, 7,5'2-81 N/C CONTROL#
ARCHITECT/EN<JNEER: I LICNO: ADDRESS: ❑
)N'TACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH
LICENSED CONTRACTOR'S DECLARATIONQTY. ELECTRIC PERMIT FEE
I Imrehy rmrm that I am licensed under Isinininne tr Christer 9 formanencing JOB DESCRIPTION
agZ with Sectinn7fgl(BofDlvision3ofthe Rusinessand ProfessionsCode,andmy liceme ix RF,SIDENTIAL•
�ly 00 PHRMITISSUANCE y
Fs W n bill fo¢u and effect. ❑SFDWLTCHI REMODEL
QUU Licence Clan LI0.M APPLIANCES-RESIDENTIAL ❑ADDITION PLUMBN ING RE-PIPIT
�<� Dam Comment,
,;Dir, ARCIIII'IiC'I'S DF.CLARA'1lON PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z O r.Z I understand my plans shall be used as public recordsMODIFICATION
OZ�Q UPT02MAMPS El INTERIOR El CHIMNEY REPAIR
F-y,.F71Y Licensed Professional 201.1000AMPS IMPROVEMENT []SWIMMING POOLS
<PL�,� OWNER-HUILDER DECLARA'f10N OVER IWMAMPS [:I PATH REMODEUREPAIR El DEMOLITION
yC I hereby anion that I am exemPl limed the anutaemr'x License Law rnr Ile,
U following reason.(Section 78315,Business anal Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHI7R
u13 LJ- anywhich mutant a permit ul construct,alcor,improve,demolish,or repair mmema
0 prior lit it issuance,also requires the applicant for.mch lona In life v signed statement SPECIAL CIRC ISC �—
P0.a nitroheislicrnsedpursuantmile,pmvisinnsof the Contactors Licenue Law(Chapter a (conancowngwith Section Thai)of'Division 3 of he Rusinessand Probosionx Cale)nr TQM P.MI?'fl?R COMMF.RCIAI:
d 6 p y0y that he is exempt therefrom and the basis for the alleged examplian.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
W Semmn]o31.5 by any applicant for a Permit subjects the applicant to a civil penalty of POWER OEV :S TENANT ❑FOOD SE VICE
F=Qnot moa then live hundreA dollars(851(1), IMPROVEMENT
I] h usownerofthepmpeny,ormyemplayees with wages as lheirwhic compensation, SWIMMING POe .F.
PPPAGGG r"'q willdomework,and the structure is not intended or offcarl for sale(Set.7f}14,Ituxiness El OTHER
W and Professions Cale:The Contractors License Law does not apply to an owner of U OUTLETS-SWI'fCHfS- %T S
property who builds or improves thereon,and who does such work himself car though
his own employees,provided that such improvements arc not intended lir offered for NI?W RESIDENTIAL EI.FCTR SQ IT.
sale.if.however,the building or improvement is sold within one year ofeompletion,me SQ.FT.FLOOR AREA USQ.FT,
e,-builder will have the huNcn of proving mat he Jia nm huild or inlpnrve[It,In,
of salc.l. G1
r n(Ibe pmpcny,em exclusively contracting with license]contractors i- " /1 p
vs owns �'1 I
onssruct site pmjccl(Sec.]814, iminms and Professions Gide:)Theerstheuma§ nd
law Alex not npplyman owner of pmlrenY who brads trimpmvex lhercon.and QTY. PLUMBING PERMIT PEF, ll�p
Wnttl Pnnt cIr rnr Mm1pari„1,will semttmcmds)I irear d pmacon ladle Cmnmdnra P
license Law. PERMIT ISSUANCE n A
❑lam exempt under Sm. .a&PCfor thin reason C�� 25A
ALTER-DRAIN&VENT—WATER(?A) SW&TION
owner Q—11 tWORKEliSTOMPENSATION DECLARA'I']ON RACK FLOW PROI£CT.DEVICH A V�`rw�nfa�e
as
Iherchy affirm mdcr pcnahy of perjury one of the following Jedatatinns: LES W� eV
Stock
1haveaodwal ammuinrCeall,of of Conten oche inwafng Workers Compen- pRAINS-ILOOR,EDGE,ARRA. OND STORIES TYPECONSTRUCTION
lion,as iso vid,d Gar by Section 3700 of the Labor Cndc,fnnhu pn,h m.n,u of me
for which this permit is issued. ' t FIX'I'ORES-PER TRAP dI�
❑1 have and will samalmn Worker's Compensation Insurance,as reflation]by Section
3710.1 of the Luber Cale,for the pc,fbrmrnce of the work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUI LETS OCC.GROUP APN
Aly Worker's Compensation Insurance carrier and Policy number lire.
Came, Polley No.: GAS-EA.SYSTHM-OVHR 4(EA)
CERTIFICATE OF EXEMPTION PROM WORKERS' GRIiASFJINDUSTNi.WASTP.IMTL•RCIiPI'ON
COM PENSA'I'[ON INSURANCE BUILDING DIVISION FEES
(Thisecation need not becontpletM if thepenmit fn(monchmaredddla st(KO) GRPASETRAP
nr less.) PLANCIIISCK Flili
Iccni1'y11ad lnthc purfommnconftmw...Hl'orwhichmis tormis is issued,lshall SEWER-SANITARY-S'IORM EA.2110 PL
not employ any person in any manner so as m became subject to the Workers'Camper- ENERGY FEE
O Z scion haws of California.Dose WATER 111?AI'IR WN1?N'1'/F.LIiCTR GRADING FEE
Z Q Applicant
y NOTICE TO APPLICANT.If,atter making this Certificate of Exemption,you should WAD!k SYS'IEM/IRF.A'1'ING
a7hocome sahjoa to l he Worker's Crnnpennabion pnry it a,of the Labor Code,you meas SOILS FEE
forthwith comply with such pmvisinns or this Mmtit shall Its deemed revoked. WATER SERVICE
Q
Uz CONSTRUCTION LENDING agerAGENCY NEW ktSIDENTIAL PhMI{. SQ PT, PAID
I hereby affirm cont there is a constmctitn lending
ng agency for the perGlmuncc of Date R enpl p
L) the work for which this pmnfu is issued(Sec,3897,Civ.C)
L evder's Name AL:
W Lender's Adams,
1 sentry fail I hove read this appliutlion and nate Ihd the above information is BUILDING FEE
f;I1 emors'.I iamcmeomply with all city and county tmlmorces and xlme laws relating to QTY, MECHANICALPERMIT FEE
L1 ,2', building construction,and hereby aumome representatives ofthis city m enter upon the SEISMIC PEE i
above-mentioned property our inspection pugases. PERMIT ISSUANCE
(We)agree it)save,indemnify and keep harmless the City,,(Cupeninn against ELECTRIC
habiEliea,judgmcros,costs and cxlamcs which may in any way ucctm against suld City ALIER OR ADD 10 MECH.
in PLUMBING FEEnscquence of the graining of this pmmif.
APPLICANT UNDERS'T'ANDS AND WILL COMPLY WITH At.[,NON-POINT AIR IIAN OLING I IN IT(10 10.09)(1 CFM)
MECHANICAL If!
SOUR REGULAI10O S.
�� A�II AIR 14ANDLING UNIT(OVER I fl"CFM) CONSTRUC'T'ION TA
•
:ignate,of ApplicanUConlanor Date_�Q EXHAUST GOOD MMUCf7 HOUSING MITIGATION 'EE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building aaeuprm store or handle Outriders material HP.AI'ING UNITI'I'O IWJANI B'IU)
as definW by the Cupertino Municipal Code,Chapter 9.12,and the Heath and Safe,,
Coda,Section 25532(x)2 1 HEATING UNIT(OVER I II0,ux)13ru)
❑Ycx ❑No VENTILATION FAN(SINGLE RPSIDI PAID
Date keceips p
Will the applicant or future building occupant use equipment or devices which
t hassdous air couraminutns aAefined h me pay Arca Air Quality Management BOR.IiR-COMPDHPOR IB(I,WBBTU)
Y Y Y TOTA h:
,) 'isuictp
BOILER-COMP 100,0011TU)
❑Ycx [I No
I have read the me..too,mntentils requirements under Chapter 6.95 of the Cali- AIR CONI)i HONER ISSUANCE DATE
Interim Health&Safety Cale,Scctimns 255(13,25533 end 25534.1 umdermand mut if the NEW RESIDI?NTIAL MECIL SQ.FT.
huilling lues nal curantly hate a tenant,ohm it is rosy respmnsihility In notify the tedspmu
tithe requirements which must be met poor to issuanec of v Certificate of f ecupancy.
Owner or rathndzeJ agent Dale TOTAL ISSUED BY:
OFFICE
&. Citv
of 10300 Torre Avenue
Cupertino,CA 95014
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
February 9, 1999
Homeowner
7609 Prospect Rd
Cupertino, CA 95014
SUBJECT: Permit 4S 1298
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
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