S 0740 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
,.-CITY OW CUPERTINO BUILDING.-ELECTRICAL1-7-_
51 ENO
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL �J 0740
BUILDING PROJECT IDEN'1'IF'ICA'fil)N
gl'I'LICA'IION$UBM IIT'AI.DATE
BUILDING ADDRESS: // ..''
S /SCI lJ . �D PHONIi: ONT Cf R'S N E: LIC NOKY(thQ CONTROL#RE:IH I ECT/ENGINEER: LIC NU'. ADDRESS.CONTACC PHONE G PERMIT INFO
❑ Consultant Fecs Paid by Applicant(Initial) RL❑DG ELECT PlV MF:r�({,.y
LICENSED CONTRACTOR'SDECLARA'T'ION QTY ELECTRIC PERMIT FEE JOB DESCRIPTION
I heruhy afiirm that 1 am licensed under provisions of CMmicr 9(Cnrnncrem,
OCZ will, of DiAmor 3 mine Bnairessard PromssinnsCoac,mndrny0.nsa is RESIDENTIAL .
m 0 PERMIT ISSUANCE
�FwO fulllimce:mite t ❑ADDHI El KITCHEN
U�j License Cl Lic.N APPLIANCES-kF.$IDF,MTIAI. ❑SPO L ❑KITCHEN REMODEL
F Z W Dam ARCHITECTS
v�64 EJ MULTI-UNIT El STRUCTURAL
Om ARCHITECTS DECLAk T ds PANELS
Zzj v�� IundcrswnA my plans boll he used as public records UPT02MAMPS CHIMMODINEY
OZ�O ❑INTIiRIOR ❑CHIh1NEY REPAIR
F f..Y.1I Lwoned Profasiowl 2014DEXAMPS IMPROVEMENT [I SWIMMING POOLS
.a.atC Q 1 hereby affirm he I am
OWNER-BUILDER
EGomE he Contractor's License Law for he OVER["AMPS El RATE REMODEIIHEPAIR D OF.h101.ITION
dye, U following regain.(Section 7031.5,Business and Professions Gale:Any city orcnumy SIGNS ELECTRICAL. ❑OTHER
4]3 LL i¢n which requires a penton its construct,alter,improve,demolish,or repair any structure
~u-OJ prior to its issuance,Ilan requires he applicant for such pemtino file a signed statement SPECIAL CIRCUITIMISC
That he is licensed pursuant n the provisions make Contractors license LW(Chaplet 9
X00 (orrichungwith Sectinn7(g)nlof Uivision3nfhe Businessond Pndessiea(21.10or TEMP.METER OR POLE INS'il COMMERCIAL:
e
4 4 p{� that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDGIADOITION ❑DEMOLITION
�,^yN
Section 7031.5 byany apidwar,for or permit subj.m the eppliomm la.civil penalty of POWER DEVICES IL
m moIMP,
re than live hundred dollar, T ❑FOODSERVICE
~'3Q [:ILE,ownefnfhe properly,or my employ.,with wlignsos hcirmlecnmpen.aminn, SWIMMING POOL ELE h1PROV13A1F:NT
will do the work,Emit the structure is not intended moffcrcd for sale(See 70TI.Bminene - — — W N� DOTHER
W and Is fcssin I,Code:Thu Cartnev r',license Law does Ern apply to an ownu of OUTLETS-SW' W PIXTURUH
IL a.. property who hnilds or improves thereon.and who does such work mousell'in through ,
his own mntployacs,provided that such improvements are not intended or interest for NEW I IAL E E i S 'T.
sale.ILhowevcethohuildirgor Enprovement is sold within one yearnl''cnmplefao,thu SQ.FI'.FLOORARIIA $ISQ. in
on-builder will have the burden of proving that he did not build or improve for pur-
pose of sale.).
❑ I,m owner of the pmpeny,ren exclusively conhvding with IicenwA nmwemrs 'T01'AL:
onstme the prujem(Sec.]614,Boniness and Professions Galea The Contrunars I.
cense Law has not apply m ua owner of property who builds or improves Ihemon,and M11ING PERMIT FEE
who contracts for such projects with a cornrdchound licensed pursuant n he Contractors
License law. PF. UANCE
❑1 am exentp under See. .B M P C fol Ibis moron Ir`
R-DRAIN&VENT-WATERIER 1 VALUATION
Owner Dam
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DE.VIC ( 11
1 hereby affirm under penalty of,adder,one of the following declarations:
I haveandwill maintain a Cmificateof Consent to wlf-insurc for Workers Compost- DRAINS-FLOOR.ROUE AR1iq,C()ND, S'InRlldi TYPECONSTRUC-HON
Cation,Es provided for by Section 37(X1 of the Labor Code,for he performance of the
work for which this permit is issued FIXTURES-PER TRAP
±`I have and will maintain Worker's Compensation Insurance,as required by Section
3106 of he Eaton Code,for he performance of he work for which
this permit is issued GAS-EA.SYSTEM-I INC.4 OIUDJE'TS OCG GROUP APN
My Will o;I cnxur tlnx,nonce cam pal cy Nnno Y�U�e Yv� I-� GAS-EA.SYSTBM-OVHR407,AI
CE„T-CAEOFEXEMPTIONFROMWORKI?RSGREASMNDUSTRLWASTIi IN'I£RCIIPIOR
COMPENSATION INSURANCE BUILDING DIVISION PERS
(Thi,,ainnncel not ba complemdif he pemdtlslinanc hundreA dnlLm($11111) GREASETRAP
or IeasJ 4'LANCHECK PL'll
Ioyany peatinthe irnformancany...er oOhe wmkfin e hichobject
It.,he ul Walker,'
wed Labatt SEWER-SANITARY-STORM HA.201 PT.
no,employ any penton in any manner erasing m become subject m the Wnrkcrn'Cnmpen- ENERGY FEE
OZ .motion Toward California.Date I WATER HEATER W/VENTIF.LECTR fo
GRADING ISLE
Z O Applicant
NOTICE TO APPLICANT.If,after making this Ccrar” a of Exemption,yen should WATER SYSTEM?REATING SOILS FEE;
a ? become subject m the Worker's Compensation proviaionx of the UngarCodc,you most
6I forthwith comply with such provisions or this permit shall ban deemed rcvokel. WATER SERVICE
d A
Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PI.M11. SQ.PT. PAID Date Receipt If
H I wyutnis0lendingagencyfor theperfomanceoUthe mood for which this Peron is issued(See 3fN], f
Civ.C.)
lenders Name Name TOTAL:
{U Lenders Address TOTAL
4 1 Omify but I have recd this application and store hat he aMwc Informatlom Is BUILDING FEE
LO) Correct,l ngrecit)comply with all city and county ordinances and,arae mows rdoringm QTY, MECHANICAL PERMIT FEE.
U building construction,and hireby Eutlamwfepmsemmives of hiseity to emerupon the :. SEISMIC FEE
aho e-meminned popery Tot o"'u.,puryoses. PERMIT ISSUANCE
(WC)Egr.m save,nodenalify and keep hurmdcss the City of Cupurt inu against ELECTRIC 1:1717
Iiuhilidos,judgntents,rnsts and expense,which may In any way aecrre agminslxuid CityALT ER OR ADD TO MHCH.
in coavcquen.of the grunting of his permit PLUMBING pNl?
APPLICANT UNDERSTANDS AND WILL.COMPLY WITH ALL NON-POINT AIR HANDLING USEF(TO 161XX1 CIM)
MECHANICAL FEES 1RCF.REGuE_An 5.
AIR HANDLING UNIT LOVER 10.000 CIM) CONSI'HOC'T]ON'fAX
III 111��Fiii .n
Signatr canon
c mAppliaCtaltos' ole EXHAUST HOOD IW/DUCT) HOUSING MITIGATION Fill;
HAZARDOUS MATERIALS DISCLOS E
Will thCapplicant or future budding.cupamstoreor handle[common,mmcrial HEATING UNIT(TO RMJXM HTE)
donned as by terti
But Capital..Municipal Code,Chapter 9,L!,and the Hulth and Safety
Cale,Sermon 2553200? BEATING UNIT(OVER 100.1 BITI)
Ycs No
VENTILATION FAN(SINGLE R"ID) PAID pram RreciplN
Will the appontaorfuturents a building bythewropernBuse equipment ordevices which BOILER-COMP(3HP OR 1(0,01X)BTU)
it M1azeMnus air contaminants as defined by the Bey Area Air Quality Management 'TOTAL:
District? BOILER-COMP(OVEN 100.0BO B I O)
❑Ycs F-1 No
AIR CONDITIONER
1 hove rcnA he hasntdnus materials requirements under Chapter 6,95 of the Cali. ISSUANCE DATE
fornin I Icalh A Solely Code,Sections TE05,25533 and 25534.1 understand that I the NEW RESIDENTIAL.MUCH, SQ.PT. �^ 4-,_(� y�
building does not c'mrenlly have a taint that it is my responsibility to untily the ocruja nl - c
,flM1•lp ...nn id a tri--,pnormisluamo of a Cerlililanc'If 0,curyncy,
1 ri ��O'S��-a J
!!'���� ¢¢
Uwneror tharisJ ngcm Omc 'I'(y1'A L: ISSUED NY(J�fI P -701
OFFICE
V c1l.v
10300 Torre Avenue
Cupertino,CA 95014
Cupertiuio Building Division
(408)777-3333 (fax)
Febmary 9, 1999
Homeowner
10615 Santa Lucia Road
Cupertino, CA 95014
SUBJECT: Permit#50740
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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