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S 1657 (2) APPUCANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL, PE IT NO. BUILDING DIVISION APPIACATION/PERMIT PING R OJECT'IDE TIFIC 1657 BUILDING PROJECT IDENTIFICATION BILL©G )RE3S; vi- _ c� SANITARY NO. APPhICAl10N Sl11iMITTAL UA9E 'S N1 'SS PHONE: COIATRACTOR'GNAME. LIC NO: ^ NEC CONTROLM +.R 1� GI E7 LIC NO: ADDRESS: 1:16A ONTACT k PHONE BUILDING PERMIT INFO ' SI' I��/fi�^/I ❑ Consultant Fees Paid by Applicant(Initial) IG etc PLUMB mTLH LICENSED CONTR(A/C(I OR SS DECLARATION QTY. ELECTRIC PERMIT PEE IL�pkl'W 1CJ 1 hereby aairin mm 1 am licensed tinder provisions of Chapin 9 warrmancing _ , .JOB DESCRIPTION wllhsemlon]a1o)nf Divkmn3 Bebe Btl,lnea,and Profession, d, mmylieenve i, RESIDENTIAL: W O p / PERMIT ISSUANCE Fp+���. In hal force and effect. �/I(�O O ❑SFDWL ❑KITCHEN REMODEL 6V0 License Class L", APPLIANCES-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE i-ZWDare Conlrvcmr ARCHITECT'S DECLARATION [_J MULTI-UNIT ❑STRUCTURAL z O in Z I mulded lid my plans slndl be used as public rmord, PANELS MODIFICA'T'ION CZ4- UP TC 200 AMPS ❑INTERIOR ❑CHIMNEYREPAIR Licensed Professional 201-100OAMPS IMPROVEMENT E]SWIMMING POOLS OWNER-BUILDER DECLARATION g C¢ I henhy affrrin that I am exempt from the Commcua' License law for the OVER IOOOAMPS ❑PATH REMO 1./REPAI DEMOLITION 3 W fnllowin ❑OTHER 0.a. g reason.(Section 9031.5,Business and Profusions Cade:Any Clly or weeny SIGNS ELECTRICAL WO which q permit t construct, II p ti I' P y structure f�n1 Is immo,issuance, 1 y thaamiturnalI ,,uchp a file ti,i,nad,aaenen, SPPCIA1.CIRCUIT/MISC. py�t�,yi theth tip c, the.......- o . ffl ( I L Le (Cltpter9 W no COMMERCIAL: ba g.,in Section Wand rD ass 3 a Bos nes IP f nuatimor TEMP MRTFiR OR POLE INST d e Sect he sex em pt tanya n and hfor a er Lima 11 gad p e m Any viPenfon d El NEW Ii LDCIADDITION ❑DEMOLITION an,a e than by hundred doll rs D500onit subjects the nppliwnl In a dvE Penalty of POWER DEVICES ❑TENANT ❑I°0011 SERVICE m mora Ibmt nava hundred dalbtw(8500). FzD+ Of HER IMPROVEMENT Q ❑Lav owner nHthe pmpeny,onny employees with wages as tbuirealo compensation, SWIMMING POOL ELECTRIC will,m mdwork,i dlhrOmcture is bol Lmmndedor otfcrenl for sule(Sec.9044,Business Of HER a m and Pool'essiona Code The Connecmr'a Lieensa Law does not apply la nn owner of OUTLETS-SWITCHES-FIXTURP.S 46 p d,wr,who bonds or Improves Oerenn,slid who dery such weak himself or Ibormh his own employees,provided that.such improvements am nm intended or offered for NEW RESIDENTIAL ELEC I R SQ FT. sale,If.however the budding or improvement isaoldwiNin oneyenrrnfwmpininn the SQ.FT.FLOOR AREA VSQ.FT. per-h.dder will haw(he burden cf proving fhm he did not build or improve Forpaa- xc ofsale.). ❑ Ta,Owner Of the p...Par,via nxalnsively contracting with licensed contractors In rndmcl the project(Sar.914q Business and Prelusion,Codsl'Me Commerce,Li- cause Law tires not apply w on Owner of PmParly who hailds or improves lhuennand QTY" EI FEE who contracts for such projwts with it conaaclor(s)licensed pursuant to the Contractor's License Low. PERMI"f ISSUANCh ❑ I am exempt under Sec. .B&P Cfnr Nis reason ALICE AIN VEN A]IIR(I. �7 VALUATION Owner Date WORKERS COMPENSA'1'IOE DECLARATION BACKP Iheehy affirm underpenalty Orp jury one of following Acdarnlinn,r. _ I hnve and willmnint.in nCenifotteof Consenttoself-insiiref(,r Worker's Com pen- DRAIN -PI" RIR O; R O D. Ij: STORIES TYPECONSTRUCTION don,as provided for by Section 3700 of the Labor Code,for the performmce of the - work In,wbich Ihls pwmll n,issued. FIXTURE.- TRAP1 I 1� ❑ I have and will maintain Workers Compensation Insurance,as required by Section t 3700 cftho Labor Code,far the perfortwnwei the work for which this permio,N,uml. GAS-EA.SYS'HM-llNC.40UTLETS .. ,, OCA.GROUP APN • My Worlr C npraycti nlnsul w comserlmd PoliryyyWW99��+ r ��F}'^� ) CAS-1>A.SYS'fBM-OVER 4(EA) CayrraieIL3z JY4 Policy NO.:IUC �I• ryr CERTIFICATE Of EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEANDUSTRLWASTP,INTERCEPTOR Obis.uetianneed not bemrnmewd Che pe nn it is fironehundreddollasspa) t p } { > xBU1L�INC 91V1310,J5',P liS y a J GREASE TRAP lir less) PLANCfIGCK PEE 2 +� Iec,loy mut anile performunceefthe wart retrained,dr,Uarmit isis,ued,I-shall SHWE NI R ?A.20 1'. mol employ any person in eery manner se as m be ecomsubject to No Workers'Conniver- ENERGY PEE z ,vtion Laws Of Utilitarian.Data A: RHEA R I. L R 7 O Applicant \ GRADING FEE G NOTICE TO APPLICANT:If.after making lhic Cert5qcy lion. Id 'T TING a bacon subject to the Worker's Canpens non pmvisib sod , ra" 1 t SOILS FEE W fnrlhwiN comply with such provisions or permit sadr VIE E SERVI Q CONSTRUCTION LF,NDINON R NEN'1 LPLMB, SQ.IrI'. PAID z Dole Receipt# I hataby 30 lendir(heperfomVIhaderk for whkh NisPemtit iv issued(Sac.3(199,C�' E"t 4ndcr's Namc TOTAL: C)V Landers AClass TOTAL , 1T Par BUILDING PEE 2 I eenee thin have reel all vty and coup yeti slam that the shove laws totaling is Z) correct lagreamaemply with un city and county ordinances and,tate lawn relating t0 QTY, MECHANICAL PERMIT FEE rt C.) Z building construction,and hereby amhonm ca,00 ntativesof lhiscily n entemupon Na P_ISAICrHq) abow-menliened properly far inspaatlon purposes. PERMIT ISSUANCE (We)agree to save,'ntdemnify and keep hurries,the Cu,of C.,rum0 against ELP.[TRIC FEE liabili0es,judgment.costs and expanses which may in any way aceauc against said City ACT ER OR ADD TO MECH. IU G in nsoquanee of the gmndng of this Perri 1, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,0100 CPM) MECHANICAL FEE SOURCE REGULA ONS C,I I I _ 9 AIR HANDLING UNIT(OVER 11,000CFKU CON 1TRI)6IiI61vfAR Sign.Intent Apphemll/GOn r em' ate EXHAUST HOOD(W/DUCT) HOUSING MITIGATION HE, HAZARDOUS MATE DISCLOSURG Will the upplinmt or Howe building, upantmorcakindlohamrl 1,,mineral HEATING UNI'1'1'1'0101 BTU) as defined by the Cuperlho Mmuir,vl Coda,Chapter 9.12,and the Health and Safety Code,Section 25532(a)'t HEATING UNIT(OVER 100,000 ROD ❑Yu ❑Na PAID f2'�-4b� C/�2� - VENTILATION VAN($1NGLERESID) Dae Recciptk Will the eppliumter fume building occupumuse cquipmtile, levlces which ry0I1.HR-COMP(3HPOR IW,OfM)B'fU) mit har Nous air euthanasias as defined by the Bay Area Air Quality Management L, inrimP❑Yc, ❑No BOILER-COMP(OVER 1001)00 RTU) I hexa real the hmmrinus materials mquimnmms unbar Chapter 6.95 of tireAIR CONDI GONER QD Coli- ISSUANCE DATE rami.Health&Safe,,Curd,Sections 25505,25533L ad 25534.1 undersand that if the NEW RP.SIDEN UAL MECH. SQ.FT building does not cruelly have toome.that It is my renpnmihillly In nrnify the occupant of the requirements which must be met prior to issuance of a Certificate of Occoponey. Owner Or truth odnul agent Dam TOTAL: ISSUED BY: OFFICE 10300 Torre Avenue Cupertino, CA 95014 City of Cupertino Building Division (408)777-3333 (fax) March 5, 1999 Tandem 10555 Ridgeview Court Cupertino, CA 95014 SUBJECT: Permit # 51657 - Entry Dear Owner/Manager: 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 Printed on Recycled Paper