29541 (2) APPLICANTTO FILL IN INFORMATION WITHIN,RED LINES-USE BALL POINT PEN ONLY
CITY OF - BUILDING.'-ELECTRICAL. PERMIT NO
B ..
UILDING..DIVISION - APPLICATION/PERh11T PLUMBING-MECHANICAL. " 29541
BUILDING PROJECT IDENTIFICATION
BUILDINGADURFSS: dSANITARY NO. API'LICA BOOIIN^SUUBB/MI'FTALUATE
OWNER ME:- 11'iIONE: � CONT CI OR'S NAME;�r/) ' LIC NO: y�
a ��. \-]F`✓J,1L//. I N/C CONTROL If
RC I'I'I:CTd:NGI Id;R: LIC NO ` ADDRESS: V-L f C'n,
w
'CONTACE. PHONE: BUILDING PERMIT INFO
B1,f, Ir/ � O�•�7_�� ❑.ConsultanlFees Paid byApplicant(Initial) ' BLDG ELECT PLUMB MECH
/ � (((�N 35'7—It s'
LICENSED CONI RAC 'S DECLARATION' QTY. ELECTRIC PERMIT FEE
I hereby affirm that last,licensed under provi:inn.of Ch:Ipm,9(comtnenclug JOB DESCRIPTION
"Z with Swtion]qX)of Uivision3o(the Rosiness and l'nsfesninns Cole,anJm licenu is
kWco _ , Y PERMIT ISSUANCE. ' RESIDENTIAL:
t full fitrcc.nd uUu't. ,
CSF II - ❑SEDWL [D KITCHEN REMODEL
License Class Licp r
F�W Date Contrecmr APPLIANCIS-RISIUENTIAI.sDITION ❑PLUMBING RE-PIPE.py - ARCHITECT'S DECLARATION PANELS UI.TI-UNIT', ❑STRUCTURAL ' ,
z O�2 Z 1 understand my plans shell he used is public cords MODIFICATION
Oz-, - UPT02MAMPS .El INTERIOR ❑CHIMNEY REPAIR
I740 F J Liccmed Ponfic,sicamil 201.100IAMPS REMODEIYREPAIR 0 DEMOLITION
IMPROVEMENT, 1
�jd ❑B
� OWNERBUIIDER DECLARATION P M
11'' 1 he by off m Ili t 1 pt f th C t t 1 L u the OVIiR IIII111AMPF A'I H
se 3 6 V f91m n8 ea n (S m ]011 5 P .' es. d P f C I A y ty ..runty SIGNS ELECTRICAL ❑OTH�.jig
LLLLII LL which y p It t I he P J I:h p y uun \/V
poor to is issuance,also¢genres Rtc applicantfor such panadt file as gncdnmen,mn SPECIAL CIRGDIT/MISG. -
;!�D+ tM1m hmsllcenscd putsuam unhe pmvisiona of the Cnmmcwds license Luw(Chupmr9
apo (commencing with Sutinn]gMq of Division)oftM Business anJ l'rnfesri,ins Cnde)nr TEMP.MET'BE OR POLE INST. COMMERCIAL- x '
C.0.0�' that he is exempt therefrom:mJ the basis for the alleged exemption,Any violation of O NEW BLOG/AD YTION10i DEMOLITION
��y Scetina'ADI.S hyany applicant foorulh:mtit suhjecm l henppliennin uuivilpenulty of 4POWER DEVICEfi ❑TL'NANT' �,! OPOOD SERVICE t
[- 6ma ore than five hundred Dollars(5500). -
_ I,as ownerpf the property,ar my employcce with wages as their sole compensation, SWIMMING POOL ELECTRIC _ IMPROVEMENT
wt
the Weak,and thesWemreisnotintended.,offerW farsulc(Sea.]fW,l)usiness 00THE2
and Professions Code:The Contraemrm a
s License Law does not apply n owner of OUTLETS-SWIES
TCHES-FIXTUR
popery who hoilds or ruprnvcs thnnon,and who does such work M1tntealf or Through - it,
his own employees,provided that such improvements are not intended or offered for NEW RL'SIDEN'IIAL ELECTR SQ P.
nale.if,hnwevee the building nrimprovemcm is sol within one year ofrompinion,the •�' SQ.IT,FLOOR AREA E/SQ.Fr
owner-builder will have the hurden of proving that he did not build or nalmove for pun to%%
a salcJ.
0 1. -
1,m itwner of S opbny,.B exdusimal an profession,
with licensed ninOnnnrs w
• nnswct the project(Sao.]MJ.Business anJ Professions Cade:)The Cmm�cmfs Li- ,
come law Jtws mai apply to an uwncrofpmpeny who builds or improves thereon;and QTY, PLUMBING PI 1 FEE
who contracts for such projects with a contractors)licensed pursuant to the Contractors
t License Law. PERMIT ISSUANCE 01
❑ Iam exempt; tSce. ,BYe PC fitr thl> luso - r
Owner Dam :1 T:R-DRAIN&VENT- A �r VALUATION
�j
WORKER:S OMPENSA]'ION DECLARATION BACK PLOW PItpTELT.DEVICE ��'�OS
I hereby uffimt under Penalty of perjury one of the following declarations: I
11
lhnl;and will maintain.Certifieumot Coment to reit-Insote fnr Worker's Confer. DRAINS-FLOOR:ROOF,AREA,GOND. STORIES TYPE CONS'I'RUCIION
mien,as provided for by Section 3]13 of the Labor Cale,for the performance of the
work for which this permit is issued. FIXTURES-PER TRAP
O I have and will maintain W'orker's Compensation Insuranee,'us required by Section
37Mm me Labor Code,for the perfonommeauf the work for which this permit is issued. GAS-EA.S YSTENL-I INC.J OUTLETS DEC.GROUP APN
My Workers Compensation Insurance carrier and Policy number um: - ..
Coiner: Policy No: GAS-EA.SYSTC21-0VF,R q(EA)
' -CERI'I FICATI.OP IiXEMPTION PROM WORKERS'COMPENSATION INSURANCE GRFASFJINDUSTRL WASTE INTERCEPTOR
y (This section need not IN completed it permit is forces,hundred dollars($100) BUILDING DIVISION FEES
ord.s.) CREASE TRAP I'LANCHECK VEE . as
I ceniny thatinthe performance afthehecoor whichthis thetWorkes Compn- SEWER-SANITARY-STORM G,213 FI.
not mnLaw any parson i a any manner so as In becunre suhjul m the Workers Comport- .ENP.RGY FL'i;
,Z
Applicant
nt of Califomio.Dom -
WATER IILATER W/VI:NT/ELECIR
z O NOTICE - - - GRADING
rq NOTICE TO
APPLICANT If, fl making Z Certificate of F pi you should WATER SYSTEMEAI'ING
hiscomate
object to the W ke vi re .ps s of theLatin,Coleyou most SOILS LYE
Uj ndhwia comply with such provisions
orthisp l.h Il lie d ncl c k A.
-
WAI f;R SCRVICE s
CONS TRUC'I IONL.ENDING AGENCY NEW RESIDENTIAL PI.MB, SQ.FE PAID �n•1g�,,
UO 1mobyaffim,that there iso construction lendingagehcy fnr the pcfformanca of r Receipt - ,
Its h the work for whichthispem,it is stated(St 3097,Civ,C.) '
Q U Lender's Nanta - 'IOTA L:
Isrdefs Address I t
HCw 1 card fy that I have rend this t,l icmion vol state Ihot the above information is RU LI FEE
tq correct.I agree to comply with all city and county ordinances and slate laws calming as Tfy. MECIIANICAI^PERMIT FEE r
U building construction,and hereby andnriec representatives of Nis cityto enter upon the SEISMIC PER
above-mentioned property Gar inspection purposes. 4, PERMIT ISSUANCE
(We)agree m harm
save,indemnify and keep less the City of Cupertino against Ii1,ECTRIC PIi11 `
Iiabilines,jod,mems,costs:red expenses which may many way accrue,ZumI,Zud City ACICRORADDTOMECI, p
in consequence of the granting of this permit.' PLUMBING FLEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT. AIR HANDLING UNI"T(TO 10,(3)CFM) MECHANICAL FEB
SOURCE REGULA9'IONS. .-,
AIR HANDLING UNIT(OVER 10,0(3CFM) CONSTRUCTIONTAX '
Signature of Appliam/Cammoom Dom EXHAUSTHOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE.
Will iheappllcant in Intim bulldingtweapam ammo,handle hsomMisnun,dill H HNI'ING UNIT(TO 11111did,11TU) ,
us define)by the Cupertino hfunicipal Calc.Chapter 9.12,anJ Ne Heahh and Sa&iy
- Cade,Section 255321:01 ' HEA'L'ING UNI'1'(OVER IDI,(IDI BTU) -
❑Yes ON. - - PAID.
VI NTILATION MN(SINGLE RESID)
ys Duro Receipt N
Will the applicantinor future building occupancy A'ea Air em"urdevicessalient BOILER-COMP(3HP OR 100,000 BTU)
nn harardnus air contaminants as JefincJ by the[lay Arca Air QualityManogemem TOTAL.
istriaO Yes ON. BOILER-COM 11(OVER I(foldo IT IU)6 ,
d 1 have read the hanadaus materials reuirements under Chuter 6.95 of the Cali. A]It CONDITIONER - -
9 P ISSUANCE DAT'Ii
form.Health&Safety Cate Section,255115 25533 it 25534 1 understand that dthc NEW RESIDENTIAL NIECE. SQ.ET,
hildlgJ tanomalyh t ttl:odi y pnnsibil'tyt tlyth od,strt
[the refinements which mainhe armaenor tri' of.Certf m [Occupancy. - •�f��)/��-J(waN//�/1,laa�\/
Owinern,anhancediii - D to - 'I' ISSU[it)BY:
OFFICE
• 10300 Torre Avenue
Cupertino, CA 95014
PCnl
C p rt 10 Building Division
(408)777-3228
(408)777-3333 (fax)
September 30, 1997
Homeowner
22311 Regnart Road
Cupertino, CA 95014 .
SUBJECT Permit#29541
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, the subject permit has not had a final inspection.
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 dispose of the file and remove the records from our computer.
Thank you for your assistance. )
Sincerely, d,Q,
CITY OF CUPERTINO �'.`n_,8�,1"
Christy Akatiff, Administrative Clerk
P... on Facvr;ac P.^.ca,