S 1136 (2) APPLICANTT,O FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY °
CITY OF CUPERTINO BUILDING..ELECI'RICA]. rr ITN° •]
BUILDING DIVISION APPIACATION/PERMIT
PLUMBING A1F.CIIANICAI. 3
BUILDING FKOJKCT ID19N'1'IF'ICATIIN
BUILDING ADDRE$.S: tiANITAKY NO. APPLICATION SUBMITTAL UA'1'll
`//Y//�__ LCJMON
V
OWNER' ME:� Q PCONTRACTOR'S NAME: LIC NO: NICCON'T'ROL#
CHITEC'OI!NGINEEIF LIADDRESS', ❑
CONTACT': PHONE: •/// 7a�/ BUILDING PERMIT INFO
L �Qc'NZ v6 5'O it /�• T ❑ Consultant Pres Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
-------------------
❑ ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FFE
I herehy affirm the,I.am licensed under pmvi%ions of Chapter 9(commencing JOB DESCRIPTION
IO1a��zO with Section 71X10)of Divisian3of Ne Bminesx unA Pndeesinnx Cale,wul mylicens°is I'I!RMIT ISSUANCE RES ����
FBF is full force and affect. Wh L•}AITCHEN REMODIiI.
Nk] License Class Lich 'PLIANCItS-RGSIUENTIAL 11 ADDITION 9}MLUMBING REPIPE
F z LLl Dna Grmrachnr
m<L ❑MUUFFUNf1' ❑STRUCTURAL
ARCHI FECI"S DECLARATION
z FO lAz I undersand my plans shall be used as public records PANELS MODIFICATION
UPI 0200 AMPS [I INTERIOR El CHIMNEY REPAIR
oz-o
Licensed Professional - 201-1000AMI'S IMPROVEMENT SWIMMING POOLS
OWNER-BUILDER DECLARATION OVIiR ANTE AMPS 11!1 HATH KPMODEIIREPAIR DEMOLITION
I herehy affirm had I am exanpt from the Contmetor's Lal Luw for Ne
fixx'C a V following maven.(Section 7031.5.Business and Professions Code:Any city Or county SIGNS ELECTRICAL OTHIiK
W 3 LL ye which require a permit ,,crnsmua,alter,improve,demolish,or repair any atrunum
BOJ prior In its Issuance,also requires the applicant for such permit to rile o signed statement SPECIALCIRCUIT/MISC.
that he lx licensed pm,mmulo hep.....voto.of the Commmm'x Uconac Law(Chrpmr9
y'OD (wmmendng wnh Section]000)afI]iviainn3nf the Busincax unJ Profe.+siana Cndc)rr TEMP.MUTER OR POLI!1
6 y M C that he is exempt therefrom end the basis fur the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLI9lON
uXl WN Section 7031.5 by anpe
yapplicant far rmit subjec¢theapplicunuo a civil penalty of POWER DEVICES lk ❑TENANT ❑FOODSERVICE
I„tnoht than fivehinimddollio,($501-0. IMPROVEMFNT
,�=Q �jha owner of Ne prnpeny,or my employees with wages vs theirsnleenmpensminn, SWIMMING III LI:Q IC
p., will do the work,and the mrvcwrt isnm imm�deJ nn,Reredfnr sale(Sec.]I/W,Business ❑OTHEk
Wm and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS W P XTUK
A' property who build or improves Thereon,and tube doessueh work himself or lhrnugl:
his own employees,powidal had such impmvcmcros are not intended nr offered for NI! U 'I'IA R SQ IT.
ode.If.however.the building.,impmvemem i,,old within one yearaf.n,li,tirnnhe SQ.PF.11.0011 AREA $ISQ.FI'.
ear-builder will have the burden of proving that he did not build or improve for par. �f
ry,,a of sole.). t"
❑i,a ownw of the properly, at exclusively am0oding with Ilcensal snnvnnorn m /� 1'r-^f�IA#/
construct the project(See.70,14.Business and Professions Gde:)The Cunbuom's U- 1
cense Law does not apply to an owner of property who builds or improves thereon.mal QTY, lox BIN PERMI�� / FEE
who contracts for such pnr,jents with it contmctons)licensed pursuant)the Contractor's
License Law.
I'I!RMI IIANCF.
❑Iron exert arder5ec. ,n&,arta,Nia rea,nn
O
l=ns—_� ALTER-GRAIN&VFW-WATER(EA) � VALUATID
WOR KK HR'S CUM DECLARATION HACK FLOW PROTECl'.DEVICE S, DOD
1 hand will maintain
ai under penalty Certificate perjuryoneof Nef ours,ingdorker'Co
JThaw and will mainbyetio7M of the Fier Code,forte performance
scempen- DRAINS-PLOOR,RO(]F.AREA,GOND. STORIES TYPE CONSTRUCTION
smirk,as provided for by Section 3]fNl of the LkMn Code,tit,the perfnmmnce of the
work for ad Nis permit is orke, I'IXTHRBS-PF.R TRAP
❑1 have end will ode.for Worker's Ca ce of rte w rk for
or which
u.+required by Section
3700 of the lnh,r Code for Ne performance of the work forwhich this permit is issued. GAS-EA.5YSTEM-I INCL YOUTLETS (>CC.GROUP AI'N
My Worker's Compensation Insurance carrier and Policy number are:
Cance Policy Na: GAS-EA,SYSTEM-OV ER 4(EA)
CERTI FICATE OIs EXEMPTION FROM WORKERSGRE WASTE IN'T'ER CEPTOR
COMPENSATION INSURANCE - BUI INTIlOpIP11rNMES
(TIiissectinnneed not be annpleted if the permit is fnnmeM1undmiJnllan(41(p) GREASETRAP
or less.) PLANC"I!CK FEE s
l certify that in the perfnrm:mec of the work far which this pcnnil is issued, .boll SEWER-SANITARY-S'I ORM ITA.21N1 F'I'.
not employ any person in any manner so as it)become subject o the Workers'Compen, ENI!BUY lith
z AN
xatirn lnws.f Califrmia.Dale WATER HEATER W/VENT/F.LECFR
Z Applicant GRADING F'. UU
r CIl t t1V
ti fA NOFICE'rO APPLICANT:IL after making this Certificate o1'Excmplion,you should WATER SYSTF.MnEI!AI'ING
abecome subject to the Worker's Compensation provisions of the Labor Code,you must SOILS FEE
{A forthwith comply with such pmvisi.ns orthi.s permit shall he deemed rtv.ke J. WATER SERVICE
Q
CONSTRUC'T'ION LENDING AGENCY NEW RESIDENTIAL I'hMH. SQ IT. PAID
U0 I hereby union that there is a construction lending agency for the performance nl. Dam Receipt#
U, the work for which this pemril is issued(Sec.3097,Civ.C.) TOTAL:
LF.1 Lenders Name
L11 Lander'.,Address - TOTAL:1 certify Nut 1 hove reed this application and one that the above in1'mmminn Is BUILDING I'EF. sic—
J l,t correct.I agree to comply with all city and county ordinances and sham law%Mining to QTY. MECHANICAL PERMIT FEE �y
SIeISMTC hili
Zbuilding construction,and hereby authorim mpresematives.fthis city in enter upon the b
shove-mentioned property for inspection purposes. iO
(Wt,)agrw hr save,indannlfy and keep harmless tau City of Cupertino against PERMIT ISSUANCE ELECTRIC IEE
liabilities,judgments.cosis and expenses which may m ory wuyaccmc against said City ALTER OR ADD TO MECIL
PLUMBING FEE
inconsequencethegranting thispeL
APPLICANT UNDF STANDSSWILL
AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING ONE'I'(TO IOJXNI CFM)
MECHANICAL FF.Ii
SOURCE JYNS
AIR HANDLING ON]'1'(OVER 10,000 CFM) CONSTRUCTION TAX
Signature of ApplicanUConOemor Dam EXHAUST HOOD(WMUCT) HOUSING MITIGATION FEE
HAZARD(] IIATERIAIS DISCLOSURE
WiITNeapplicanterfmun ddi........I start,or handle haeunloos material HEATING UNIT(TO IIN),BINI BTU]
ax defined by the Cupertino Municipal Calc,Chapter 9.12,and the Ilcalth and Safety
Code.Semon 25532(,)] HEATING UNIT(OVER Pat BTU)
❑Yes n N. PAID
VP,NTILA'DON FAN(SINGLE RHSIU) Dwc Rcaipt#
Will the appli...I or future building,.., ,use cyuipment or devices which
neaardous air contaminants as defined b the Ba Arca Air Quality Maser emcm BOILER-COMP(311,OR IIXLINNI BTU)
Y Y Y 6 TOTAL: y
ismict? Yea ❑Nn BOILER-COMP(OVER 100,00(1 BTI)
I have mad the luzammus materials requirements under Chapter 6.95 of the Cali- ATR CONDITIONER ISSUANCE DATE
form.Heath&Safe Cal Seninnx 25505,25533 unit 29534.1 undersand that if the NEW RESIDENTIAL.MIKE. SQ.EF.
huildingduu huvcumnunt.thin It way 1Xmomility m anti l ydmaaPand
of the m^ h mIt,senprionois+uanceofa Ccnific -of ,poor,
Owner nr ambndmd. ant Dam TGrn1,60 ISSUED BY:
OFFICE �
4® 10300 Torre Avenue
I� i
Cupertino, CA 95014
�.I tl' til�
Cupertino Building Division
(408) 777-3333 (fax)
February 9, 1999
Homeowner
7666 Rainbow Dr
Cupertino, CA 95014
SUBJECT: Permit#130 15 5 +.
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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